Introduction
- Government of India initiative launched in 2009 under National Rural Health Mission (NRHM, now NHM) by Ministry of Health & Family Welfare
- Aims to reduce early neonatal mortality & morbidity, especially due to birth asphyxia (major contributor to NMR in India)
- Focus: Train at least one health personnel (doctor/nurse/ANM) at every delivery point in basic newborn care & resuscitation
- Evidence-based, scalable training package aligned with WHO/ILCOR guidelines & Indian Neonatal Resuscitation guidelines
Objectives
- Ensure skilled attendance at every birth for essential newborn care
- Prevent & manage common neonatal problems: asphyxia, hypothermia, infection & breastfeeding difficulties
- Reduce perinatal asphyxia-related deaths & long-term neurodevelopmental sequelae
- Integrate with other RMNCH+A components (SBA, HBNC, NBSU/SNCU)
Key Components (The 4 Pillars of NSSK)
- Prevention of hypothermia: Warm chain (immediate drying, skin-to-skin contact, delayed bathing, Kangaroo Mother Care for LBW)
- Prevention of infection: 5 cleans, hand hygiene, aseptic cord care, exclusive breastfeeding, maternal immunization
- Early initiation of breastfeeding: Within 1 hour, exclusive till 6 months, techniques of positioning & attachment
- Basic newborn resuscitation: For non-breathing/asphyxiated babies
Newborn Resuscitation Algorithm (NSSK-Specific)
- Initial steps (30 seconds): Warm, dry, stimulate, position airway, clear secretions if needed
- Assess breathing & heart rate:
- Vigorous crying & HR >100 → Routine care
- Apnoea/gasping or HR <100 → Positive pressure ventilation (PPV) with bag & mask (40–60/min, 21% O2 initially)
- If no improvement after 30 sec effective PPV → MR SOPA corrective steps
- Advanced steps: Chest compressions (3:1 ratio), medications (adrenaline) only if HR <60 after ventilation
- End with post-resuscitation care & referral to NBSU/SNCU if required
Essential Newborn Care Practices Emphasized
- At birth:
- Delayed cord clamping (1–3 min)
- Vitamin K prophylaxis, eye prophylaxis
- Weighing, APGAR scoring, identification
- Kangaroo Mother Care (KMC): For all stable LBW babies (<2500g); continuous skin-to-skin, exclusive breastfeeding
- Monitoring: Danger signs recognition, timely referral
- Counseling: Mother & family on home-based newborn care (HBNC)
Monitoring & Integration
- Part of NHM key performance indicators
- Training cascade: National → State → District → Facility level
- Linkage with LaQshya, SUMAN, HBNC & Home-Based Newborn Care (ASHA kits)
- Recent updates (2024): Strengthened focus on quality of training, pre/post-test evaluation & refresher training every 2–3 years
Impact & Prognosis
- Significant contribution to decline in NMR from 29 (2014) to 18 (2022) per 1000 live births
- Cost-effective intervention; high return on investment in low-resource settings
- Long-term: Reduces cerebral palsy, developmental delays secondary to asphyxia