Navjaat Shishu Suraksha Karyakram (NSSK)

Summary

NSSK Overview: Launched in 2009 under the Ministry of Health & Family Welfare, this initiative aims to reduce early neonatal mortality and morbidity, particularly from birth asphyxia.
Primary Goal: Ensures that at least one trained health personnel is available at every delivery point to provide basic newborn care and resuscitation.
Four Key Pillars: Focuses on the prevention of hypothermia (via warm chain and KMC), prevention of infection, early initiation of exclusive breastfeeding, and basic newborn resuscitation.
Resuscitation Algorithm: Mandates initial steps (warm, dry, stimulate) within 30 seconds; if the newborn has apnoea or a heart rate <100, Positive Pressure Ventilation (PPV) is initiated, escalating to chest compressions or medication if necessary.
Essential Care Practices: Highlights practices such as delayed cord clamping, Vitamin K prophylaxis, Kangaroo Mother Care (KMC) for stable low-birth-weight babies, and counseling for home-based care.
Overall Impact: Serving as a cost-effective intervention and NHM key performance indicator, it has significantly contributed to lowering India's Neonatal Mortality Rate (NMR) and reducing long-term complications like cerebral palsy.

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

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)

Prevention of hypothermia: Warm chain (immediate drying, skin-to-skin contact, delayed bathing, Kangaroo Mother Care for LBW)
Prevention of infection: 6 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

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

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)

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

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