Beyond survival: Improving long-term outcomes for survivors of serious newborn illness in Asia and the Pacific Dr Kate Milner Centre for International Child Health, Department of Paediatrics University of Melbourne

1. Beyond survival: Improving long-term outcomes for survivors of
serious newborn illness in Asia and the Pacific
Dr Kate Milner
Centre for International Child Health, Department of Paediatrics
University of Melbourne

2. Background
-Newborn morbidity in a survival context – the data gap
-Rationale for increased focus on outcomes beyond survival
Long-term outcomes in resource-limited settings
-Key considerations
-Available literature - disability and early child development
Research to inform models of care beyond survival
-Fiji Newborn Integrated Care Initiative
Outline

3. 134.6 million live births
~14 million preterm survivors
3.1 million newborn deaths
Survivors of intrapartum
related events (‘birth asphyxia’)?
Survivors of serious infections?
World Health Organisation. Born too soon: the global
action report on preterm birth. C.P Howson, Kinney M.V,
Lawn J.E, Editor 2012: Geneva
Newborn morbidity data gap

4. To improve:
- quality of maternal and newborn care
- follow-up care for newborns who survive serious illness
To advocate for issues beyond survival in regional newborn health policy
Importance of strengthened long-term outcomes data

5. • Post neonatal mortality
• Growth and nutrition
• Infectious and respiratory morbidity
• Disability and early child development
• Hospitalisation
• Outcomes in adolescence and adulthood
• Others - Impact on families, economic implications
Long-term morbidity in resource-limited settings – key considerations

6. Disability and early child development

7. 153 studies
22,161 survivors
39.4% survivors
neurodevelopmental ‘impairment’
Cognitive delay Cerebral
palsy
Hearing
impairment
Vision
impairment
Seizures
Neurodevelopmental outcomes
(Mwaniki et al, Lancet 2012)

8. Fiji Newborn Integrated Care Initiative

9. To assess the early childhood health and developmental outcomes for a
cohort of sick newborns in Fiji compared with compared with controls.
Aims

10. To assess:
• Prevalence of neurodevelopmental impairment at age 2-4 years.
• Prevalence of stunting, wasting, anaemia, immunisation rates, feeding
practices.
To explore:
• Nurse-administered developmental screening compared with a gold
standard developmental assessment.
Objectives

11. Sr Lanieta Koyamaibole and Dr Rakei Kaarira
Colonial War Memorial Hospital
Progress: team building and local linkages

12. Progress: logistics

13. Progress: developmental clinics

14. Progress: hearing clinics

15. • Fiji National Child Health Strategy for 2010-2015
• Developmental screening for revised maternal and child health card
• Health worker capacity building
• Strengthening inter-sectoral linkages
• Collaborative regional networks
Progress: strengthening the platform for change

16. • Long-term morbidity amongst newborns who survive serious illness is an
increasing public health issue in resource-limited settings.
• Improving outcomes requires improved maternal and newborn care and
early detection and intervention when complications arise.
• Formative research through international collaboration provides a platform
for change.
Conclusions

17. Knowledge Hubs for Health are a strategic partnership initiative funded by the
Australian Agency for International Development
Dr Joseph Kado & Paediatric Team
Colonial War Memorial Hospital Suva
Lanieta Koyamaibole
Dr Rakei Kaarira
Dr Raina Prasad
Mere Gunaivalu
Kathryn O’Heir
Dr Sue Woolfenden
University of Melbourne Audiology
Carabez Ear Clinic Suva
Prof Trevor Duke, Dr Gehan Roberts, Dr Andrew Steer, Centre for International Child Health
CureKids Fiji
Thank you