Nigerian Journal of Paediatrics

Conference summary report of the 10th Annual General and Scientific Meeting of the Nigerian Society of Neonatal medicine NISONM held in Ibadan Nigeria on 4th 7th July 2017

Niger J Paediatr 2018; 45 (2):123 - 126

ORIGINAL

Ezenwa BN

CC – BY Conference summary report of

Ezeaka VC

the 10 Annual General and

Okonkwo IR

Audu LI

Scientific Meeting of the

Mukhtar-Yola M

Nigerian Society of Neonatal

Opara P

Oluwafemi B

medicine (NISONM) held in

Ibadan, Nigeria on 4 -7 July,

Amsa MB

Mokuolu OA

2017

Bello M

Tongo OO

Ayede AI

Olateju E

Ezeanosike O

Ibe BC

Okolo AA

Oruamabo RS

DOI:http://dx.doi.org/10.4314/njp.v45i2.9

Accepted: 3rd May 2018

Abstract : The 10th Annual Gen-

relevant to newborn health from

eral

and

Scientific

Meeting

eminent speakers from across the

Ezenwa BN

(

)

(AGSM) of the Nigerian Society

globe. The four-day conference

Ezeaka VC, Okonkwo IR

of Neonatal Medicine (NISONM)

included preconference workshops

Audu LI, Mukhtar-Yola M

took place in Ibadan, South -West

and

community

mobilization/

Opara P, Oluwafemi B, Amsa MB

Nigeria. The theme of the confer-

health outreach in Lagelu local

Mokuolu OA, Bello M, Tongo OO

ence was: Imperatives in neonatal

government area.

Ayede AI, Olateju E, Ezeanosike O

survival initiatives in Nigeria: The

Ibe BC, Okolo AA, Oruamabo RS

current state. The conference ad-

Nigerian Society of Neonatal

dressed a variety of topics

Medicine C/o Department of

Paediatrics, Lagos University

Teaching Hospital, Idi-Araba,

Lagos, Nigeria

Introduction

300,000 are stillborn. Neonatal deaths contribute 33% of

under -five mortality.

The 10

Annual General and Scientific Meeting

The Nigerian Society of Neonatal Medicine (NISONM)

(AGSM) of the Nigerian Society of Neonatal Medicine

encompasses a subspecialty group of

paediatricians

(NISONM) took place from 4 -7 July 2017 at the Carl-

working in the area of newborn health in Nigeria with

ton Gate Xclusive Hotel Ibadan, South -West Nigeria.

the strategic objectives of advocacy, capacity building,

The theme of the conference was: Imperatives in neona-

social mobilization, dissemination of best practices, de-

tal survival initiatives in Nigeria: The current state. The

velopment and strengthening of partnerships, and neona-

sub themes were: Optimal newborn nutrition - early ex-

tal operational research; all towards reducing neonatal

clusive breastfeeding a priority; as well as, Evidence

morbidity and mortality in Nigeria.

based practices in newborn respiratory support.

The newborn period which is the first 28 days of life is a

Preconference activities

very vulnerable and critical period in the life of a child.

The preconference activities of the 10

Newborn health is one of Nigeria’s major health chal-

NISONM

lenges. In Nigeria, while mortality rates are decreasing

AGSM included community enlightenment and mobili-

for mothers and children, progress is slow especially for

zation outreach programme at Lagelu local government

newborns. Of the 7 million babies born in Nigeria every

area (LGA) and preconference scientific workshops. On

July 4 2017 NISONM organized a community mobili-

year, about 260,000 die within the first month of life and

124

zation/health talk outreach to about 300 mothers of in-

Fig 3: NISONM President donating training manuals and bag

fants on how to stop newborn sepsis, emphasis on hand

and mask devices during the Health outreach at Lalupon/

hygiene, use of 4% chlorhexidine gel for cord care, ex-

Ejioku community town hall, Ibadan

clusive breast feeding, demonstration of kangaroo

mother care, neonatal jaundice and other common new-

born problems. There was also training on Helping Ba-

bies Breathe (HBB) and the Overview of modified Es-

sential Newborn Care Course (mENCC) for community

health workers at Lalupon/Ejioku community town hall,

Lagelu LGA, Ibadan (Fig 1 and Fig 2). During the work-

shop, breathing bags and masks (Ambubag) devices

crucial for newborn resuscitation, ENCC Action Plan

Charts, HBB provider manuals and packets of 4% chlor-

hexidine gel were donated by NISONM for use in all the

primary health care centres (PHCs) in the local govern-

The conference proceedings

ment area (Fig 3).

Participation

On 5 July 2017, a second preconference workshop was

With respect to registrations, about 400 delegates at-

also held on Newborn Respiratory Support (bubble

tended the conference. The opening ceremony of the

CPAP and mechanical ventilation), where paediatricians

conference was chaired by Professor Temitope Alonge,

and nurse/midwives and other health care providers

the Chief Medical Director University College Hospital,

from secondary and tertiary facilities were trained on

Ibadan. In attendance were representatives from the Fed-

this life saving intervention used especially for prema-

eral Ministry of Health (FMOH) Nigeria, UNICEF,

ture babies. Modules at the workshop included intuba-

USAID, Maternal and Child Survival Programme

tion techniques, bubble CPAP and basics of mechanical

(MCSP), JHPIEGO, Save the Children International,

ventilation respiratory support, didactic lectures and

Pathfinder International, Wellbeing Foundation, Paediat-

hands – on practical skills. Attendance was impressive

ric Association of Nigeria (PAN), West African College

with more than 120 participants.

of Physicians, Society of Obstetrics and Gynaecology

(SOGON), International speakers from USA, UK, Neth-

Fig 1: Cross section of NISONM members during the Health

erlands, Ghana and South Africa, Neonatologists/

outreach at Lalupon/Ejioku community town hall, Ibadan

paediatricians, Nurse Midwives, other health care practi-

tioners from public and private establishments, pharma-

ceutical companies, and the Media. The Head of Child

Health FMOH, Dr. Bose Adeniran, represented the

Honourable Minister for Health in Nigeria. At the open-

ing ceremony, HE Barr (Mrs) Toyin Saraki, President

and Founder of Wellbeing Foundation Africa, delivered

the keynote address and dwelt on critical neonatal sur-

vival initiatives in Nigeria; and the President of

NISONM, Prof Chinyere Ezeaka gave a welcome

speech on behalf of the Association.

The conference addressed a variety of topics relevant to

Fig 2: Cross section of mothers during the Health outreach at

newborn health, including specific questions about new-

Lalupon/Ejioku community town hall, Ibadan

born survival, essential newborn care, breastfeeding,

preterm nutrition, prematurity; kangaroo mother care,

congenital anomalies and a host of other topics includ-

ing indicators of positive outcomes (Fig 4 shows cross

section of speakers at the conference).

Fig 4: Cross section of speakers at the 10 NISONM AGSM

2017

125

At the 10 AGSM, NISONM showcased the pictorial

not to be routinely screened for in all facilities managing

"NISONM Newborn Discharge Information Guide" to

preterm births. Cases of ROP were reported from several

be used for giving crucial health messages to mothers

centers across the country and it was stressed to be the

after every birth in Nigeria, and help avert newborn

commonest cause of blindness in surviving very preterm

deaths from harmful practices and undue delays.

infants.

Furthermore, we formally presented the NISONM Help-

ing Babies Breath Action Plan training charts translated

The conference provided a forum to review the breast-

to Hausa, Igbo and Yoruba languages to the FMOH for

feeding mileage in Nigeria. It was noted that exclusive

adaptation prior to national dissemination. These were

breastfeeding rate was still poor at 25% as of 2014.

coordinated by the great efforts of the NISONM zonal

Breast-feeding is the strongest child survival strategy

program coordinators of the country’s six geopolitical

and early initiation is key to sustainable breast-feeding.

zones.

Challenges to feeding the premature infants were also

highlighted. Evidence abounds that early nutrition and

Conference highlights

improved neurodevelopmental outcomes are linked. The

benefits of breast milk fortifiers were also mentioned, as

Among the many issues raised at the NISONM 10

well as the need to have available low cost human milk

AGSM, the burden of neonatal deaths was still noted to

fortifiers to help boost the nutrition of our preterms.

be high and contributes to one-third of under-five mor-

The presentation by Professor Vinod Bhutani from Stan-

tality in Nigeria. Simple and cost effective strategies

ford University USA on Rhesus incompatibility and the

effective in reducing neonatal morbidity and mortality

CURhE (Consortium for Universal Rhesus Elimination)

were enumerated but found to be under-practiced. Nige-

study noted that the prevalence of Rhesus negative

ria currently has the highest number of newborn deaths

status in Nigeria was high and may contribute to the

in Africa and the second highest in the world, and this is

unacceptable high rate of exchange blood transfusions

unacceptable. Major causes of newborn deaths are pre-

noted in many centers. Mothers need to know their

maturity, asphyxia, infections, newborn jaundice and

blood groups and Rhesus status; and every newborn

congenital anomalies. Ninety percent of these deaths are

baby must be closely monitored for neonatal jaundice.

preventable by low cost interventions.

The CURhE study aims to investigate and address this

over the next five years pending institution of compre-

Availability of basic resuscitation materials (Bags and

hensive implementation strategies.

masks) and competencies in neonatal resuscitation was

still low in many primary health care centers, private

The conference also noted the paucity of comprehensive

and public health facilities. The community health work-

surveillance system for birth defects in Nigeria. Con-

ers who were trained at the preconference had not used a

genital abnormality was highlighted as a major cause of

bag and mask device prior to the NISONM preconfer-

infant morbidity and mortality accounting for 4.4% of

ence workshop. Incidentally this category of health

neonatal mortality globally. It may also cause long term

workers undertakes about 90% of deliveries at the

disability. The need to document the types of congenital

PHCs. This emphasizes the crucial need for training,

anomalies seen in Nigeria was highlighted. There should

provision of basic equipment, and ongoing mentorship

be a congenital anomaly register to follow the trend and

for healthcare workers involved in newborn care.

variability in order to aid policy decisions and counsel-

ling of affected families.

The FMOH in collaboration with NISONM and other

In all, the conference entertained two pre-conference

key stakeholders have made significant progress by de-

workshops, six plenary sessions and two scientific sym-

veloping newborn policy documents such as the Nige-

posia.

rian Every Newborn Action Plan (NIENAP), The Nige-

rian Newborn Situation Analysis, the Newborn Call to

Take home messages and recommendations from the

Action, the Integrated MNCH strategy, Chlorhexidine

conference

roll out guidelines, harmonized ENCC training docu-

ments, ICCM etc. It was further noted that progress was

Paediatricians and Neonatologists should be in-

made on the Saving 100k newborn initiative in collabo-

volved in advocacy, resource mobilization activities

ration with the American Academy of Pediatrics (AAP)

and engage in sustainable community activities

and the Global Development Alliance (GDA), inclusion

geared towards newborn survival.

of chlorhexidine and antenatal corticosteroids on the

Guidelines on KMC should be implemented fully.

essential medicine list, increasing level of respiratory

The international policy statement for universal use

support services, mama care initiative etc. However,

of KMC for preterm and low birth weight infants

bottlenecks such as low coverage for MNCH services,

was endorsed by NISONM for implementation

poor birth registration, and funding challenges still exist.

across the country.

It was also highlighted that the implementation of kan-

Urgent need to scale up ENCC trainings to commu-

garoo mother care (KMC) services remains low despite

nity level and the private sector. It is also crucial to

strong evidence for effectiveness. The urgent need for

scale up skills and availability of bag and mask ven-

incorporation of KMC in newborn care practices espe-

tilation devices to all public and private levels of

cially for very low birth weight neonates was empha-

care.

sized. Retinopathy of prematurity (ROP) was also noted

Establishment and strengthening of professional

126

linkages and partnerships with other relevant stake-

prevents intestinal atrophy, improves motility and

holders viz obstetricians, nurse/midwives, public

reduces loss of enzyme function as well as improve-

health physicians, private practitioners, community

ments in neurodevelopmental outcomes. FMOH

health workers as well as development partners, non

should identify ways of leveraging funds to resusci-

-governmental and private organizations is manda-

tate the Baby Friendly Initiative and ensure it oper-

tory.

ates at community, facility and workplace level. It

Government to establish "Neonatal Centres of Ex-

should also champion a study on the need for breast

cellence NICUs " in each of the six geopolitical

milk fortifiers in Nigeria.

zones of the country and the use of Public-Private

Urgent need to establish surveillance and screening

Partnerships strategy to ensure proper funding, in-

programs for congenital anomalies in the country in

frastructure, maintenance and sustainability.

order to update the types of congenital anomalies,

Need for collaboration between the ophthalmology

follow the trend and variability in order to aid pol-

society (NIPOSS) and NISONM and routine screen-

icy decisions and counselling of affected families.

ing to prevent blindness due to retinopathy of pre-

Finally, the NISONM 10 AGSM came to a close with a

maturity. Capacity for oxygen monitoring and respi-

dinner and gala night on the 7 of July 2017. It was a

ratory support should be strengthened through train-

ing, provision of pulse oximetry, bCPAP and sup-

great opportunity for social interaction and networking

among participants. The success of the 10 AGSM in

portive supervision at all secondary and tertiary

health care levels.

Ibadan was due in no small part to the engagement of

All health workers involved in the care of the new-

the Local Organizing Committee Ibadan, the NISONM

borns, including doctors and nurses should have

Executive Council members, the co-chairs, speakers,

training in lactation management, Essential new-

delegates, and the support by the many sponsors and

born care course (ENCC) and Kangaroo Mother

contributors from around the globe such as the FMOH,

Care (KMC) processes in view of the documented

UNICEF, USAID, Maternal and Child Survival Pro-

effectiveness of these interventions in the reduction

gramme (MCSP), JHPIEGO, Save the Children Interna-

of child mortality.

tional, American Academy of Paediatrics. Pathfinder

NISONM joins the global health community in ad-

International, General Electric, The Wellbeing Founda-

vocating and encouraging early nutrition of the

tion, Help My Pikin Healthcare Trends (HMP), and

newborn as studies have shown that enteral feeding

Pharmaceutical Companies.