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Beyond Survival 2nd Edition 525 Twenty-third St. N.W., Washington, D.C. 20037 Tel: 202.974.3000 Fax: 202.974.3724 www.paho.org/alimentacioninfantil Beyond survival: Integrated delivery care practices for long-term maternal and infant nutrition, health and development Beyond survival: integrated delivery care practices for long-term maternal and infant nutrition, health and development 2nd Edition PAHO HQ Library Cataloguing-in-Publication Data ********************************************************************************************************* Pan American Health Organization. Beyond survival: integrated delivery care practices for long-term maternal and infant nutrition, health and development. 2. ed. Washington, DC : PAHO, 2013. 1. Infant, Newborn. 2. Infant Care. 3. Infant Nutrition. 4. Child Development. 5. Delivery, Obstetric. I. Title. ISBN 978-92-75-11783-5 (NLM classification: WS 420) The Pan American Health Organization welcomes requests for permission to reproduce or trans- late its publications, in part or in full. Applications and inquiries should be addressed to the Department of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C., U.S.A. ([email protected]). The Family Health, Gender, and Life Course will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. Please contact Dr. Chessa Lutter at [email protected] or go to www.paho.org/alimentacioninfantil. © Pan American Health Organization, 2013. All rights reserved. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Orga- nization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. Table of contents Acknowledgments ............................................................................................................................................................. v Introduction ....................................................................................................................................................................... 1 1. Optimal timing of umbilical cord clamping .......................................................................................................... 7 Recommendation for practice .................................................................................................................................... 7 1.1 History of the timing of umbilical cord clamping ............................................................................................ 9 1.2 Physiological effects of the timing of cord clamping and determinants of the “placental transfusion” .............................................................................................................................. 9 1.3 Short- and long-term effects of cord clamping time on pre-term and low birth weight infants ..............................................................................................................................14 1.4 Short- and long-term effects of cord clamping time on full-term infants ...................................................17 1.5 Effects of cord clamping time on maternal outcomes ....................................................................................23 1.6 Infant iron status and development: an emphasis on prevention .................................................................23 2. Mother and newborn skin-to-skin contact ...........................................................................................................25 Recommendation for practice ..................................................................................................................................25 2.1 Short- and long-term effects of skin-to-skin contact for mothers and late-pre-term and full-term infants ...........................................................................................................................................27 3. Early initiation of exclusive breastfeeding ............................................................................................................30 Recommendation for practice ..................................................................................................................................30 3.1 Immediate effects of early and exclusive breastfeeding .................................................................................31 3.2 Long-term effects of breastfeeding ...................................................................................................................33 4. Integration of essential delivery care practices within maternal and newborn health services .................................................................................................................................34 4.1 Contextual considerations: current health facility and domiciliary delivery care practices .....................35 4.2 Steps for achieving universal implementation of an integrated set of delivery care practices ..................42 4.2.1 Increasing access to guidelines and the scientific information supporting evidence-based practices ............................................................................................................................44 4.2.2 Addressing the skills needed to implement the recommended practices ..........................................45 4.2.3 Organization of delivery care services ....................................................................................................45 4.2.4. Establishment and communication of regional, national and local (hospital and community level) policies and guidelines for implementation of the recommended practices .......46 4.2.5 Advocacy and synchronization with other maternal and neonatal care efforts ................................47 4.2.6 Monitoring and evaluation .......................................................................................................................49 4.2.7 Scaling up implementation of delayed cord clamping, skin-to-skin contact and early initiation of breastfeeding...........................................................................................................................49 5. Conclusions .................................................................................................................................................................51 iii References ........................................................................................................................................................................61 Additional resources and websites .............................................................................................................................72 List of boxes, figures and tables Box 1: Active management of the third stage of labor for the prevention of postpartum hemorrhage ...... 3 Box 2: Neonatal resuscitation and delayed cord clamping ................................................................................ 8 Box 3: Amount of iron provided in the “placental transfusion” allowed by delayed clamping ..................20 Box 4: Promoting and supporting early skin-to-skin contact and early initiation of exclusive breastfeeding after cesarean delivery .................................................................................26 Box 5: Short- and long-term effects of skin-to-skin contact as part of Kangaroo Mother Care for mothers and pre-term infants ...........................................................................................................29 Box 6: Actions needed to ensure implementation of the essential delivery care practices .........................48 Figure 1: Demonstration of changes in umbilical cord appearance during the first 15 minutes of life .........10 Figure 2: Stepwise nature of the placental transfusion .........................................................................................11 Figure 3: Birth weight measurements during placental transfusion (through 5 minutes of age) ...................12 Figure 4: Comparison of clamping time and technique on placental residual blood volume (PRBV) with infants held on the mother’s abdomen skin-to-skin after delivery ............................................13 Figure 5: How long should birth iron stores last? An analysis by
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