My Takeaways from COINN 2024: A Neonatal Clinical Instructor’s Perspective 

I am a neonatal clinical instructor at Kenyatta National Hospital’s School of Nursing in Nairobi, Kenya. Each day I am privileged to train nursing students who wish to specialize in neonatal nursing from all 47 counties in Kenya and from across the East Africa region. Recently, I joined more than 250 attendees from 28 countries at the 11th Council of International Neonatal Nurses Conference (COINN 2024) in Denmark. The conference brings together experts in neonatal care every five years to learn and share experiences.  

As I left to return to Kenya, I wondered what would I want the people who couldn’t make it to the conference to know? In this post, I share three of my primary takeaways and describe key actions that I’m ready to advocate for in my own hospital.

Research funding for newborns and stillbirths exists, but there are glaring inequalities 

There were a magnitude of takeaways coming out of the conference. At the top of my list is that there is research funding for newborns and stillbirths globally, with a commitment of approximately $577 million per year. This is, however, hampered by some glaring inequalities. 

For example, presenter Joy Lawn and NEST360 noted that only 7% of this funding goes to low- and middle-income countries (LMICs) and yet they carry 98% of the burden of newborn mortality and stillbirth. Signifying even more imbalances, the presentation reported that more than 50% of funding in LMICs is allocated to high-income partners, and as such, what remains to support LMIC-led research is less than optimal due to a lack of absorption capacity and other factors.  

Neonatal nurses are a critical component of the health workforce

Secondly, as many speakers noted: we need neonatal nursing for every newborn, everywhere. That’s not happening yet.  

In a separate presentation, NEST360 shared multiyear health workforce data from a study of 63 hospitals in Kenya, Malawi, Nigeria and Tanzania. The findings show median daytime nurse-to-newborn staffing ratios as one nurse for every six or eight newborns. However, this increased to one nurse for every 85 newborns in some cases and worsened further at nighttime. Notably, up to three-quarters of hospitals had no doctor providing care at night. 

Presenters noted that these existing health workforce gaps can be closed by increasing the number of neonatal nurses who are practicing in settings with safe and optimal nurse-to-patient ratios. Further, we must also increase awareness of professional standards and improve our education curricula to channel quality neonatal nurses with the correct skill sets to where they are needed most. 

As many speakers noted: we need neonatal nursing for every newborn, everywhere. That’s not happening yet.

Managing neonatal pain is an essential component of optimal evidence-based care

In appreciating all that neonatal nurses and medical personnel do, we should all remember that managing neonatal pain is more than something nice to do. It is an essential component of optimal evidence-based neonatal palliative care. If effective interventions, including parent-led neonatal pain management, are implemented to reduce pain while newborns are in the NICU, other desirable outcomes can be realized, including improved neurodevelopment in the extreme and low-birthweight neonates.  

I want to highlight the parent-led neonatal pain management research from Ullsten, Campbell-Yeo and Erikkson featured at the conference. Findings show that parental involvement in care during pain management leads to better neonatal outcomes. 

The authors showed that even greater and more successful outcomes can be achieved when the parents are informed and present during procedures when their newborns undergo painful and uncomfortable procedures. It is equally important to inform medical personnel that the parents’ presence and active participation during these procedures is a globally accepted phenomenon and considered part of parenting.  

I also want to shine a spotlight on one of the COINN 2024 speakers that was most memorable to me. Alex Mancini is a senior neonatal nurse, who leads the National Neonatal Palliative Care Project in the UK. Her presentation on neonatal palliative care remains unforgettable.  

In her presentation, Ms. Mancini emphasized how vital it can be to raise awareness about neonatal palliative care, training opportunities and available improvements, as well as the importance of supporting neonatal teams. This resonated with me, for the reason that neonatal palliative care nursing is one specialty that has for the most part been elusive and neglected in the African context.   

It was quite encouraging to learn that neonatal palliative care guidelines are being reviewed, as this assures me that such care will be handled professionally so that patients can receive current and evidence-based care – leading to better outcomes. In all this, the biggest beneficiaries remain the newborns and their families, a win for humanity.

What I learned at COINN 2024 that I can implement in my hospital now 

Finally, I want to close by highlighting a key takeaway from COINN 2024 that I plan to immediately advocate for in my own work. In my community, there is a need to set the pace for Immediate Kangaroo Mother Care (iKMC) which involves starting iKMC as soon as the baby is born (sometimes even before they are stabilized). This combines skin-to-skin contact with exclusive breastfeeding or provision of breastmilk and has been associated with reducing the risk of sepsis among small and preterm babies.   

Data show that thanks to iKMC, suspected sepsis cases in newborns have been reduced by 18%, sepsis-related deaths by 36%, and overall deaths by 25%. Studies have also shown a mortality reduction of approximately 32% across newborns of less than 2,000 grams (about 4.41 lbs.) and who are clinically stable when compared to their counterparts in incubator care. The World Health Organization (WHO) therefore recommends starting iKMC as soon as possible after birth.   

The introduction of iKMC in my community can be beneficial not only for the reasons mentioned above but also to support cardiovascular and respiratory stabilization, prevent hypothermia, improve breastfeeding rates, and eventually reduce the length of stay in the hospital for newborns. To be successful, starting out on iKMC will involve educating other departments of the same, especially obstetric and gynecological departments (labor ward and maternity theaters) and the emergency department, as they are part of the patient’s entry points in most health facilities.  

I appreciate that such implementation is not without challenges that may require restructuring the maternity ward and adding more staff to care for the newborns (especially with the existing shortage of nurses worldwide) which adds on to existing resourcing challenges. However, I believe that where there is a will there is a way, and innovative ways could be explored to gradually go around these challenges so that we do not lose vision of having the ideal ecosystem for mothers and newborns – with the full knowledge that the next generation can depend on the actions we prioritize now.