Perinatology,

1. INTACT SURVIVAL STARTED FROM BIRTH M.Sholeh Kosim Chairman of Perinatology Working Group Indonesian Society of Pediatrician (UKK Perinatologi IDAI) Presented in 13 rd National Congress of Child Health Bandung Indonesia July 6, 2005

3. LIFE CYCLE

9. Asphyxia-related sequellae ‘ Birth asphyxia’ Not breathing at birth Intrapartum Stillbirth Lawn J, et al 2005 Neurological Disability Severe Mild Other factors, e.g., preterm birth Intrapartum factors Pre-delivery factors Asphyxia-related neonatal death Not resuscitable Healthy development Neonatal Encephalopathy Severe Moderate Mild

10. www.thelancet.com March, 2005

11. Recent estimates... Lawn J,et al 2005 Cases/year not specified 7,565,000 years of life disabled Methods not yet published 691,000 Not assessed WHO GBOD I version 2 2001 (around 2000) Not assessed 1.6 million [40% of 3.9 Million stillbirths] WHO RHR 2001 Not assessed 1.16 million (Of 4.0 million neonatal deaths, 29% due to birth asphyxia) Not assessed WHO RHR 2001 (around 1999) Not assessed 1.6 million [32% of 5.0 million neonatal deaths] Not assessed WHO RHR c 1996 (1990 data) Cases/year not specified 3,525,000 years of life disabled 770,000 Not assessed WHO GBOD I 1996 (1990 data) ‘ at least an equal number’ to the 800,000 neonatal deaths 800,000 Not assessed WHO a 1991 Asphyxia-related neonatal disability Asphyxia-related neonatal deaths Intrapartum stillbirths Source Date

12. www.thelancet.com March, 2005 Indonesia 82 2% 18

42. Evidence of efficacy for interventions at different time periods www.thelancet.com March, 2005 33 .58% Incidence of neonatal tetanus:88 .100% Prevalence-dependent Prematurity:34%(-1 to 57%) Low birthweight:31%(-1 to 53%) 32%(-1 to 54%) PMR:27%(1-47%)(first/second births) Incidence of prematurity/low birthweight: 40%(20 .55%) V IV IV IV IV Tetanus toxoid immunisation Syphilis screening and treatment Pre-eclampsia and eclampsia:prevention (calcium supplementation) Intermittent presumptive treatment for malaria Detection and treatment of asymptomatic bacteriuria Antenatal Incidence of neural tube defects:72%(42 .87%) IV Folic acid supplementation Preconception Reduction (%)in all-cause neonatal mortality or morbidity/major risk factor if specified (effect range) Amount of evidence

43. Evidence of efficacy for interventions at different time periods www.thelancet.com March, 2005 Incidence of infections:32%(13 .47%) 40%(25 .52%) Perinatal/neonatal death:71%(14 .90%) (early neonatal deaths):40% 58 .78% Incidence of neonatal tetanus:55 .99% IV IV IV IV IV Antibiotics for preterm premature rupture of membranes Corticosteroids for preterm labour Detection and management of breech (caesarian section) Labour surveillance (including partograph) for early diagnosis of complications Clean delivery practices Intrapartum Preconception Reduction (%)in all-cause neonatal mortality or morbidity/major risk factor if specified (effect range) Amount of evidence

44. Evidence of efficacy for interventions at different time periods www.thelancet.com March, 2005 6 .42% 55 .87% 18 .42% 13 Incidence of infections:51%(7 .75%) 27%(18 .35%) IV V IV IV V Resuscitation of newborn baby Breastfeeding Prevention and management of hypothermia Kangaroo mother care (low birthweight infants in health facilities) Community-based pneumonia case management Postnatal Preconception Reduction (%)in all-cause neonatal mortality or morbidity/major risk factor if specified (effect range) Amount of evidence

46. Table 1: Cause of Neonates Mortality in Indonesia in 2001

47. Newborn baby Survive for a while Does not get optimum care Serious health problem & developmental delayed

59. Thank you