Prenatal interventions for preterm |
Antenatal corticosteroids | For women at risk of preterm birth (24–34 weeks gestation) under specific conditions | Strong | Moderate | 0/10/50 | 0/5/25 | RDS: 50 IVH: 42 NEC: 54 | 16–18,28 |
Antibiotics for preterm labor | For women with preterm prelabor rupture of membranes | Strong | Moderate | Not included in model | | | |
Postnatal care |
Cord care | Daily CHX application to the umbilicus for newborns born at home in settings with high neonatal mortality. Clean, dry cord care for newborns born in health facilities and at home in low neonatal mortality settings. | Strong | Moderate | 0/0/0 | 0/0/0 | 55 | 29–32 |
Care of the preterm/LBW neonate |
Thermal care for preterm newborns | KMC for the routine care of newborns weighing ≤2,000 g at birth, and should be initiated in health care facilities as soon as the newborns are clinically stable. | Strong | Moderate | 95/95/95 | 0/0/2 | 51 | 15,33 |
| Unstable newborns weighing ≤2,000 g or stable newborns weighing ≤2,000 g who cannot be given KMC should be cared for in a thermo-neutral environment either under radiant warmers or in incubators. | Strong | Very low | 0/0/50 | 0/0/30 | 60 | 34–36 |
Feeding | LBW infants, including those with very low birth weight, should be fed mother's own milk. | Strong | Moderate | 99/99/99 | 20/40/55 | Sepsis: 55 LBW: 18 | 37–39 |
Management: newborn resuscitation |
Immediate drying and additional stimulation | Newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before cord clamping and PPV initiation. | Weak | Not graded | 50/85/90 | 50/70/85 | 15 | 40–42 |
PPV | In newly born term or preterm (>32 weeks of gestation) babies requiring PPV, ventilation should be initiated with air. | Strong | Moderate | 5/50/95 | 20/40/60 | 40 | 42–45 |
Oxygen therapy for preterm newborns | Ventilation of preterm babies born at or before 32 weeks of gestation with oxygen therapy with 30% oxygen or air (if blended oxygen is not available). | Strong | Very low | 0/15/60 | 0/50/75 | RDS: 25 Asphyxia: 25 | 46,47 |
Management: RDS |
Continuous positive airway pressure for newborns with RDS | Continuous positive airway pressure therapy is recommended for the treatment of preterm newborns with RDS. | Strong | Low | 0/2/20 | 0/50/70 | RDS: 50 Asphyxia: 50 | 46,47 |
Surfactant administration for newborns with RDS | Surfactant replacement therapy is recommended for intubated and ventilated newborns with RDS. | Conditional (health care facilities only with intubation, ventilator care, blood gas analysis, newborn nursing care and monitoring) | Moderate | 0/1/5 | 0/50/75 | 35 | 46,48 |
Management: neonatal sepsis |
Prophylactic antibiotics for prevention of sepsis | A neonate with risk factors for infection (i.e., membranes ruptured > 18 hours before delivery, maternal fever > 38°C before delivery or during labor, or foul-smelling or purulent amniotic fluid) should be treated with the prophylactic antibiotics ampicillin and gentamicin for at least 2 days and reassessed if signs of sepsis or positive blood culture. | Weak | Very low | Not modeled | | | |
Empirical antibiotics for suspected neonatal sepsis | Neonates with signs of sepsis should be treated with antibiotic treatment for at least 10 days. | Strong | Low | 10/85/95 | 20/65/75 | 72 | 49,50 |
Management: NEC |
Antibiotics for treatment of NEC | Young neonates with suspected NEC should be treated with intravenous or intramuscular ampicillin (or penicillin) and gentamicin as first-line antibiotic treatment for 10 days. | Strong | Low | Not modeled | | | |