Panel 1.
ENC practices: Overview of evidence on impact and mechanisms
| Concept | Indicator | Study | Impact on mortality and morbidity | Mechanisms and other benefits |
|---|---|---|---|---|
| Thermal care | Immediate drying | Lee 2011.14 Delphi panel on newborn assessment and stimulation (warming, drying, rubbing the back or flicking soles) | Reduction intrapartum NM: 10% Reduction NM preterm births: 10% |
Thermal regulation and prevention of hypothermia caused by heath loss through evaporation of amniotic fluid,15 stimulation and simple resuscitation of babies who do not breathe16 |
| Immediate skin-to-skin contact (SSC) | Moore 2017.17 Systematic review on RCTs comparing immediate (<10 min) or early SSC (10 min–24 h) vs usual hospital care, all settings. | Breastfeeding at 1–4 months: RR 1.24 (GRADE: moderate) Exclusive breastfeeding at 1 month: RR 1.30 (GRADE: moderate) |
Thermal regulation through conduction of mother’s body heat,15,18 regulation of cardiorespiratory parameters and stress levels (heart rate, cortisol, oxytocin),18,19 improvement of mother-infant interaction/ bonding18,19 | |
| Bathing delayed for at least 1 day | - | No evidence found | Maintaining vernix coating to avoid infection, prevention of hypothermia due to evaporation of water15 | |
| Hygienic cord care | Clean cord tying | Blencowe 2011.20 Delphi panel on clean birth practices (Handwashing, clean delivery surfaces, clean cord cutting/tying, hygienic cord care) and clean postnatal care practices (clean cord care) | Reduction NM sepsis: 5–60% Reduction NM tetanus: 5–80% |
Prevention of infections at the cord stump site due to increased hygiene21 |
| Clean cord cutting | ||||
| Clean cord care | Reduction NM sepsis: 10–60% Reduction NM tetanus: 5–70% |
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| Optimal breast-feeding | Colostrum feeding | - | No evidence found | Rich source of nutrients, anti-microbial and immune-stimulating agents, and muscular-skeletal repair and growth factors22 |
| Breastfeeding started ≤1 h after birth (EBF) | Smith 2017.23 Systematic review on breastfeeding initiation time and mortality and morbidity, all settings. | Late (2–23 h) vs early (≤1 h) breastfeeding: Increase all-cause NM: RR 1.33 (GRADE: moderate) | Exposure to colostrum and reduction of hypothermia through body contact with mother.23 | |
| Exclusive breastfeeding first 3 days | Sankar 2015.24 Systematic review on optimal breastfeeding practices, LMIC | Predominant, partial, no vs exclusive BF: Increase IM (0–5 months): RR 1.48, 2.84, 14.4 (GRADE: very low - low) | Reduction of risk of infection including for diarrhoea, pneumonia, neonatal sepsis, measles or malaria24 |
Overview based on a narrative review of key systematic and narrative reviews on impact and mechanisms of ENC practices.
Abbreviations: BF, breastfeeding; EBF, early breastfeeding; GRADE, Grading of Recommendations, Assessment, Development and Evaluations quality of evidence grading tool; IF, all-cause infant mortality 0–5 months; NM, all-cause neonatal mortality; RCT, Randomized controlled trial; RR, risk ratio; SSC, skin-to-skin contact.