Neonatal period

Abstract

Delayed umbilical cord clamping, immediate skin-to-skin contact, and early initiation of breastfeeding have been shown to be simple, safe, and effective and should be implemented in all deliveries, with very few exceptions. Although these practices can also prevent death, their importance extends beyond survival and optimizes both short-and long-term neonatal and maternal health and nutrition. Their implementation requires that they be integrated with one another and included with other standard lifesaving care practices. Leveraging knowledge of efficacious interventions into high-quality programs with broad coverage is often the main obstacle to improving neonatal and maternal health in low-income countries. To achieve results at-scale, attention must be given to increasing access to scientific information supporting evidence-based practices and addressing the skills needed to implement the recommended practices; establishing and communicating global, national, and local policies and guidelines for implementation in conjunction with advocacy and synchronization with other maternal and neonatal care efforts; reorganizing delivery care services; and monitoring and evaluation. This will require international investments similar to those being made for other lifesaving neonatal interventions. Neonatal vitamin A supplementation, recommended for implementation in Asia, is controversial, and the evidence for and against this recommendation is reviewed.