Active management refers to a package of care that includes strict diagnosis of labor, routine amniotomy, oxytocin for slow progress, and one-to-one support Brown and others A Cochrane review of seven RCTs involving 5, women finds no significant difference in poor neonatal outcomes; however, CS rates were nonsignificantly reduced in the active management group Brown and others Antenatal corticosteroids.
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The administration of antenatal corticosteroids to women in preterm labor, or in whom preterm delivery is anticipated for example, in severe preeclampsia , for the prevention of neonatal respiratory distress syndrome RDS has been shown to be very effective in preventing poor neonatal outcomes in well-resourced settings. A Cochrane review of 21 RCTs involving 4, neonates finds that a single course of steroids administered between 26 weeks and 35 weeks gestation reduced the risk of neonatal death by 31 percent and reduced neonatal morbidity including cerebroventricular hemorrhage, necrotizing enterocolitis, RDS, and systemic infections Roberts and Dalziel However, a large cluster randomized trial Antenatal Corticosteroids Trial conducted in LMICs to test provision of antenatal corticosteroids at lower levels of the health system with mainly unskilled workers and limited assessment of gestational age finds no difference in neonatal mortality with the administration of antenatal corticosteroids Althabe and others Neonatal mortality in the intervention clusters overall was increased, which may have been due to overtreatment, as were maternal infections.
This trial has important implications for the setting, implementation, and scale up of this intervention, notably that antenatal corticosteroids should be used in the context of more accurate assessment of gestational age and assessment for maternal infection; ensuring that maternal and newborn care can be provided should also be a part of this intervention. In the Antenatal Corticosteroids Trial, half of the births were at home Althabe and others The evidence does not support the routine administration of antibiotics to women in preterm labor with intact membranes in the absence of overt signs of infection Flenady and others However, antibiotics for preterm premature rupture of membranes are effective in reducing the risk of a number of early morbidities, including RDS and postnatal infection, without having a significant impact on mortality Kenyon, Boulvain, and Neilson Magnesium sulphate.
A Cochrane review of five RCTs involving 6, babies found that MgSO 4 given to women considered to be at risk of preterm birth reduced the risk of cerebral palsy by 32 percent and improved long-term outcomes into childhood Doyle and others However, evidence is insufficient to determine the existence of neuroprotective benefits for infants of women with high-risk pregnancies at term Nguyen and others , and more research is needed.
Training of birth attendants. Newborn resuscitation is not available for the majority of newborns in LMICs. Limited evidence suggests that training of birth attendants improves initial resuscitation practices and reduces inappropriate and harmful practices Carlo and others ; Opiyo and English but may not have a significant impact on perinatal mortality. This finding may be because advanced resuscitation, including intubation and drugs, is appropriate only in institutions that provide ventilation.
A large cluster RCT of a combined community- and facility-based approach with a package of interventions including community birth attendant training, hospital transport, and facility staff training finds the intervention package to have no detectable impact on perinatal mortality Pasha and others This finding suggests that substantially more infrastructure may be necessary, in addition to provider training and community mobilization, to have a meaningful effect on neonatal outcomes.
The WHO defines essential newborn care as including cleaning, drying, and warming the infant; initiating exclusive breastfeeding; and cord care WHO a. Ideally, this care should be provided by a skilled attendant; however, most of these tasks can be carried out at home by alternative attendants. High-quality evidence shows that home visits by community health workers in the first week after birth significantly reduces neonatal mortality and are strongly recommended by the WHO WHO c.
Other important but less prevalent conditions include jaundice and hemorrhagic disease of the newborn. These conditions all have high fatality rates, particularly tetanus and encephalopathy Lawn and others Preventive measures needed to adequately reduce this burden of disease include much of what has already been discussed.
Other interventions include routine vitamin K administration in newborns for the prevention of vitamin K deficiency bleeding and early phototherapy for jaundice.
Early phototherapy reduces both mortality and chronic disability subsequent to kernicterus and is feasible in facilities Djik and Hulzebos ; Maisels and others Kangaroo mother care. Kangaroo mother care, which is part of the extra newborn care package for small and low-birthweight infants and includes continuous skin-to-skin contact between mothers and newborns, frequent and exclusive breastfeeding, and early discharge from hospital, has been evaluated in comparison with conventional care in a Cochrane review.
In low-birthweight infants, kangaroo mother care reduced neonatal mortality by 40 percent, hypothermia by 66 percent, and nosocomial infection by 55 percent. Exclusive breastfeeding. Infants who are exclusively breastfed for six months experience less gastrointestinal morbidity Kramer and Kakuma , less respiratory morbidity, and less infection-related neonatal mortality than partially breastfed neonates WHO c. A meta-analysis shows that breastfeeding education or support or a combination of education and support increased exclusive breastfeeding rates Haroon and others For small or preterm babies, extra feeding support is needed WHO a.
Cord cleansing. Pooled data from three community trials involving 54, newborns of cord care with chlorhexidine versus dry care show a reduction in omphalitis of 27 percent to 56 percent and in neonatal mortality of 23 percent Imdad and others Chlorhexidine cord cleansing did not have these effects when used in hospital settings Sinha and others The WHO recommends daily chlorhexidine application to the umbilical cord stump during the first week of life for newborns who are born at home in settings with high neonatal mortality WHO c.
Seizures are common following perinatal hypoxic ischemia. Induced hypothermia cooling in newborn infants who are encephalopathic because of intrapartum hypoxia reduces neonatal mortality, major neurodevelopmental disability, and cerebral palsy.prefunreisys.tk
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This evidence is derived from a Cochrane review of 11 RCTs involving 1, term and late preterm infants with moderate or severe hypoxic ischemic encephalopathy Jacobs and others Cooling reduced neonatal mortality by 25 percent and the authors conclude that induced hypothermia should be performed in term and late pre-term infants with moderate or severe hypoxic ischemic encephalopathy if identified before age six hours Jacobs and others However, most of these studies were conducted in HICs and more trials in LMICs are needed before implementing this intervention in these settings.
Routine anticonvulsant prophylaxis with barbiturates for the neuroprotection of term infants with perinatal asphyxia is not recommended Evans, Levene, and Tsakmakis RDS is the most important cause of mortality in pre-term infants. Institution of continuous positive airway pressure may bring down the requirement and cost of surfactant therapy Rojas-Reyes, Morley, and Soll Antibiotics for treatment.
Over 1 million neonatal deaths annually in LMICs are attributable to infectious causes, including neonatal sepsis, meningitis, and pneumonia Liu and others Feasible and low-cost interventions to prevent these deaths exist. Oral antibiotics administered in the community reduce all-cause mortality by 25 percent and pneumonia-specific mortality by 42 percent Zaida and others Presumptive antibiotics for group B streptococcus. The risk of serious infection in term newborn infants is increased if group B streptococcus GBS is present in the birth canal, if rupture of membranes is prolonged, and if maternal temperature is raised during labor.
In the absence of GBS screening and strong evidence to guide clinical practice regarding routine prescription of antibiotics Ungerer and others , the use of presumptive antibiotic therapy for newborns at risk of GBS and other bacterial infections is recommended WHO a. Household air pollution is recognized as a risk factor for several health outcomes, including stillbirth, preterm birth, and low birthweight, but rigorous evidence for the impact of reducing household air pollution on these birth outcomes is lacking Bruce and others Interventions to reduce household air pollution may reduce poor perinatal outcomes.
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A habitual supine sleeping position has been associated with an increase in stillbirth Owusu and others Whether sleeping position can be changed by advice or other interventions, and whether such a change would affect stillbirth rates, remains to be established. Increasing the coverage of interventions demonstrated to be effective and cost-effective is essential, but reliable data remain limited Mangham-Jefferies and others Chapter 17 of this volume Horton and Levin summarizes the findings of a systematic search of the cost-effectiveness literature of reproductive, maternal, newborn, and child health interventions and discusses the difficulties, including methodological gaps, multiple platforms, and outcome measures.
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Although evidence of effectiveness is not available for several vital interventions, these interventions save the lives of thousands of mothers and newborns every day. For other simple interventions, research has demonstrated convincingly that, if provided in the appropriate time and with the appropriate protocol, many more lives can be saved. However, effective interventions are not consistently used or available in LMICs, and accelerated investments are needed in health system infrastructure, intervention implementation, health worker training, and patient education to improve health outcomes for mothers and newborns.
Even in the poorest settings simple approaches at the family and community levels and through outreach services can save many lives now. Well-known interventions, such as neonatal resuscitation and case management of infections, can be added to existing programs, particularly Safe Motherhood and Integrated Management of Childhood Illness programs, at low marginal cost. Although community-based options are often most feasible, if the commitment to strengthen clinical care systems is lacking, the potential improvements in health outcomes from these options is limited.
However, as increasing numbers of women and babies reach first-level facilities and hospitals, the quality of care challenges in these facilities need to be addressed. A shift in focus to quality of care has the potential to unlock significant returns for every mother and every newborn beyond to end preventable maternal and newborn deaths and stillbirths by In those instances, an alternative data source is noted. This work is available under the Creative Commons Attribution 3. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions:.
Attribution—Please cite the work as follows: Black, R. Laxminarayan, M. Temmerman, and N. Walker, editors. Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities , third edition, volume 2. Washington, DC: World Bank. Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation.
The World Bank shall not be liable for any content or error in this translation. Adaptations—If you create an adaptation of this work, please add the following disclaimer along with the attribution: This is an adaptation of an original work by The World Bank. Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by The World Bank. Third-party content—The World Bank does not necessarily own each component of the content contained within the work.
Conservative music of the Roman school continued to be written in Palestrina's style which in the 17th century came to be known as the prima pratica by such students of his as Giovanni Maria Nanino , Ruggiero Giovanelli , Arcangelo Crivelli , Teofilo Gargari , Francesco Soriano , and Gregorio Allegri. Much research on Palestrina was done in the 19th century by Giuseppe Baini , who published a monograph in which made Palestrina famous again and reinforced the already existing legend that he was the "Saviour of Church Music" during the reforms of the Council of Trent.
These unique characteristics, together with effortless delivery and an indefinable "otherness", constitute to this day the attraction of Palestrina's work. From Wikipedia, the free encyclopedia. Italian Renaissance composer. Agnus Dei from Missa in Festis Apostolorum. Instrumental midi version. Madrigal Vestiva i colli - Prima parte. New Advent. Retrieved 13 September The Psalter Hymnal Handbook.
Retrieved 26 January New York: Dover, Cambridge University Press. The Life and Times of Felix Mendelssohn. Mitchell Lane Publishers, Inc. Stanley Sadie. London, Macmillan Publishers Ltd. Routledge, New York, An early entry in the Master Musicians series, and, like other books in that series, combines biographical data with musicological commentary. Verlag Dohr, L'Epos, Palermo, Alfred Mann.
Waveland Press, Inc. Harvard University Press, , pp.
An exhaustive study of his contrapuntal technique. New York, Available through Dover Publications, Grove Music Online, ed. Broude Brothers Limited, Oxford University Press, Motte, Diether de la, Kontrapunkt.