Caring for small or sick newborns – WHO guidelines and implementation toolkit on follow-up care under development

EFCNI and the Doris Mollel Foundation both contribute to efforts by the World Health Organization (WHO) to develop a guideline on discharge management and follow-up care of small or sick newborn as well as an implementation toolkit. Joining an international expert group, led by EFCNI Chairwoman Silke Mader and Doris Mollel from the Doris Mollel Foundation, we advocate for considering and incorporating crucial patient perspectives.

The survival, health, growth, and neurodevelopment of small and/or sick newborns (SSNs) remain concerning in many countries. The pace of improvement has been slow. The Every Newborn Action Plan (ENAP) has clearly summarised how high coverage of intrapartum and postnatal care would save nearly three million lives (women, newborns, and stillbirths) each year. The ENAP includes both essential SSN care in health facilities and follow-up primary healthcare after discharge. There is consensus about the need for investing in both hospital care and follow-up community care. However, there are no current WHO tools and guidelines for SSN follow-up. Tools and guidelines are available from high-income countries; however, most involve specialised care and do not address the barriers and facilitators to follow-up care in primary care settings in low- and middle-income countries (LMICs). Timing, schedules, content, and quality of follow-up care also varies widely across countries and regions.

The WHO is therefore planning to develop guidelines and implementation guidance for follow-up care for SSNs that can be used directly and easily in the respective communities, clinics, and district hospitals. This is a joint project between the departments of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA), Nutrition and Food Safety (NFS), and Mental Health and Substance Use (MSD).

The WHO has brought together four expert review teams and a technical consultative group to advise on and scope published and unpublished literature, guidelines, and tools currently available for follow-up care for SSNs from hospital discharge until five years of age in LMICs.

Over 50 international and interdisciplinary experts came to a face-to-face meeting at the WHO in Geneva on 10-12 June. EFCNI is honoured to participate in discussions with our Chairwoman Silke Mader who, together with Doris Mollel, represents the patient and parent voice.

The meeting aimed to bring together key stakeholders, including UN organisations, development partners, and academic institutions, clinical subject matter experts, implementers in high-burden settings, parent groups, and expert scoping review teams to discuss evidence on follow-up care of SSN, develop frameworks for priority actions, and to help plan the next steps for the WHO and UNICEF. The final and official guideline and implementation toolkit is expected for the end of 2024 or the beginning of 2025. EFCNI and all other partners plan to be actively involved in the dissemination process.