Introduction to COIN

Most deaths in neonates and young infants can be prevented with low cost interventions. It has been estimated that we can reduce up to half of all preventable neonatal deaths, with optimal treatment of neonatal illness.

In addition to providing care to newborns at birth, a district health facility receives sick young infants with diverse clinical presentations, some of whom are extremely sick and need emergency treatments. This manual and the course associated with it will deal with care of newborns at birth, the first few days of life, and sick young infants who are likely to be encountered in a secondary level health facility.

There is a lot of overlap between the clinical presentation and the management of conditions in the neonate and the young infant (defined as an infant less than two months of age). In this manual, when referring to both age groups we will discuss as the Neonate/Newborn and Young Infant (NYI). The young infant who requires resuscitation may be a neonate who is only a few days old. The approach to initial resuscitation is slightly different between the neonate and young infant, but the skills required are the same and you will practice these during this course.

This manual is for the candidate participating in a training on the Care of the Young Infant and Newborn (COIN). Lectures, videos, drills, and scenarios are the main methods used to deliver the course. The training is targeted at nurses, midwives, clinical officers, medical officers and medical assistants. The course is evidence- based and we have tried to strike the right balance between the best and most pragmatic practice for our setting as well as incorporated current practices. In this course we have tried to give clear directions in a given situation. If unclear about the management of a NYI, the next step is to consult a colleague at your facility or to discuss with colleagues from your central hospital.

In the special newborn care unit, it is usual to have medical equipment not designed for use in hot, humid dusty environments with an unstable power supply. Clinicians are often untrained on the use of technologies and are unsure of how to clean them and who to contact should the equipment fail. In addition to clinical knowledge and skills, the course will equip participants on the management and use of technologies used in special newborn care units.

At the back of the manual there are wall charts or job aids that can be printed and placed in all clinical areas (clinic, ward, and special newborn care unit) where NYI are cared for.

On the last day of the COIN course, there is an examination which includes a Multiple Choice Questions (MCQ) to test knowledge and a competency-based assessment which tests skills. Attitude includes attendance and participation, and this is assessed throughout the course.

Learning Objectives of COIN

COIN provides information that would allow an individual to be able to do the following:

• Provide care at birth for all newborns including those of low birth weight.
• Provide neonatal resuscitation for those who need it.
• Provide resuscitation for young infants.
• Provide emergency assessment and treatment for sick young infants (e.g. breathing difficulties and birth asphyxia.
• Know how to use and maintain equipment necessary for the care of newborns.
• Understand which infants may benefit from referral and safe transport.
• Counsel families on common problems arising in this age group.
• Carry out an audit and introduce quality improvement in their own facility.

Note:
This manual should be used as a guide for care of the newborn and infant and is also a participant guide for an individual attending the COIN training course. It is divided into several chapters which correlate with the course schedule.

In order to get the most out of the manual, the theory must be complemented with practical sessions either during an actual course or in mentorship session. This would allow an individual to become competent in the practical skills that the manual describes. Consequently, in order to pass the COIN course a participant should pass both the MCQ paper (80% pass mark) and a practical scenario exam.

As you go through this manual, remember that there is considerable overlap between the neonate and the young infant.