Saving our newborns by doing the basics right--and keeping it simple.

In view of the absence of significant reduction in SA's neonatal mortality rate over the past decade and the country failing dismally to reach this year's Millennium Development Goal (MDG) of reducing its 1990 child mortality rate by two-thirds, Izindaba quizzed Zar on the most vital interventions required. Antenatal steroids to mature a baby' s lungs when its mother is in preterm labour, the now world-famous kangaroo care, exclusive breastfeeding, optimal labour and delivery management, neonatal resuscitation and optimal postnatal care including appropriate treatment of neonatal sepsis would, taken together, send the neonatal death rate plummeting, she said. In preventing preterm delivery, better antenatal and obstetric care would also go a long way to ensure safer delivery and effective subsequent postnatal care, she added. When it came to reducing under-5 mortality (another MDG SA didn't achieve), several well-known effective preventive strategies such as immunisation, optimising nutrition, breastfeeding, provision of antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) of HIV were required. As neonatal deaths make up almost a third of under-5 deaths, strategies to reduce deaths in the first 28 days of life (and especially in the first 7 days) could have a big impact on the under-5 mortality rate. The above are all areas in which SA has improved by varying degrees, especially PMTCT, where major reductions in HIV infections have for the first time put almost zero transmission within reach, achieving world acclaim. Vaccines for children were a growing local success story, with rates of invasive pneumococcal disease – including cases caused by antibiotic-resistant bacteria – having fallen substantially following the introduction of a pneumococcal conjugate vaccine. The rate of infections resistant to two different antibiotics had declined nearly twice as much as that for infections that could be treated with antibiotics. This proportionately greater effect of vaccination on antibiotic-resistant strains pointed to a very valuable added benefit of immunisation. Zar said that a maternal influenza vaccine during pregnancy had also recently been shown to substantially reduce influenza in mothers and their babies, and was a strategy that should be strengthened as a matter of urgency. Despite official and scientifically backed recommendations for the influenza vaccine to be prioritised for pregnant women, uptake remained very low. Zar described as 'very exciting' current overseas work on the development of a vaccine for respiratory syncytial virus (RSV), which causes infections of the lungs and respiratory tract. RSV is so common …