For many parents, the sound of their newborn’s first cry is a moment of pure joy, signaling the transition from life in the womb to independent existence. However, for healthcare professionals in labor wards, that first cry marks the beginning of a critical race against time—one that can determine the survival of a baby. The “Golden Minute,” a term used to describe the first 60 seconds after birth, is a precious window during which life-saving interventions can mean the difference between life and death for a newborn.
Despite advances in maternal and child health care, neonatal mortality remains a significant challenge in Kenya. According to the most recent Kenya Demographic and Health Survey (KDHS), neonatal mortality rates have decreased marginally, but the current rate of 21 deaths per 1,000 live births is still far from the Sustainable Development Goal target of 12.
According to newborn and maternal health specialists many of these deaths could be prevented with timely interventions during that critical first minute of life, especially for babies born prematurely, with respiratory issues, or in complicated deliveries.
A Race Against the Clock
Speaking at an event hosted by the Kenya Obstetrical and Gynecological Society (KOGS) and the inter religious caucus in Nairobi, Dr. Supa Tunje, Paediatric Neurologist and President of the Kenya Paediatrics Association, emphasized the importance of this first minute.
“The first cry of a baby is critical—it’s the first sign of a successful transition from fetal life to independent breathing. If the baby doesn’t cry, we have only 60 seconds to act,” Dr. Tunje explained.
This “Golden Minute” requires healthcare providers to be highly skilled and prepared to recognize danger signs in neonates. Newborns who are not breathing, or whose breathing is weak, need immediate resuscitation with a bag and mask ventilation to clear their airways and initiate proper breathing.
According to Dr. Tunje, resuscitation protocols must be standardized and practiced regularly.
She added that approximately 50 percent of babies born in Kenya are not crying at birth and need immediate intervention to begin breathing on their own. However, a worrying statistic reveals that 20 percent of trained providers fail to effectively ventilate due to skill decay or errors in technique such as air leaks or improper ventilation rates.
The Tools and Skills to Save Lives
“Every labor ward in Kenya must be equipped with effective resuscitation tools and the trained personnel to use them,” Dr. Tunje emphasized. “Ventilation equipment such as a bag-valve mask (BVM) device, along with oxygen, is crucial in stabilizing a newborn in the first minute.” This practice is not only lifesaving and not just about getting the baby to cry; it’s about ensuring that they can breathe on their own and avoid further complications like hypoxia or brain injury.
Dr. Tunje also stressed the importance of thermal protection, especially for preterm or low-birth-weight babies who are more vulnerable to hypothermia. “If we don’t regulate their body temperature, we risk losing them to conditions like hypothermia, which is a leading cause of neonatal death,” she said.
Newborn units and labor wards, she explained, must be prepared for all potential complications—from premature births and multiple pregnancies to maternal conditions like diabetes, hypertension, or infections.
“A team approach is key,” she noted. “There should always be a designated team leader and at least one person whose sole responsibility is managing the newborn immediately after birth and one managing the mother.”
To combat the high rates of neonatal mortality, Kenya has been making strides in equipping healthcare providers with the necessary skills and tools to handle high-risk deliveries.
Last year, Kenya’s Ministry of Health, in collaboration with the Clinton Health Access Initiative (CHAI), rolled out essential and comprehensive neonatal care training program. This training focuses on the critical skills required for resuscitating newborns, managing common neonatal complications such as prematurity, birth asphyxia and providing thermal care.
One notable success story is the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), where healthcare providers have embraced innovative approaches to resuscitation. After attending specialized neonatal care training, the hospital introduced a trolley system fitted with Continuous Positive Airway Pressure (CPAP) equipment to transport preterm babies from the labor ward to the newborn unit. This system helps stabilize the baby’s temperature and oxygen levels during transportation, reducing the risk of complications.
Roselyn Akinyi, a nurse at JOOTRH, shared the impact of the training and innovation: “Before, we used to receive cold babies, and hypothermia was a major issue. But now, after the MoH and CHAI led training, we’re receiving warm, breathing babies. It’s made a huge difference in how we care for them.”
The Importance of Thermal Care
Thermal care, Akinyi stressed, should be a continuous process. After birth, keeping the baby warm through skin-to-skin contact with the mother or using special warming devices such as radiant heaters or heated water-filled mattresses is crucial. The first hours after birth are a vulnerable time, and if newborns are not kept warm, they are at a greater risk of death or long-term health problems.
“Keeping the baby warm, particularly those born prematurely is one of the most effective ways to reduce neonatal mortality,” Akinyi explained. “We now know that up to 75 percent of neonatal deaths can be prevented simply by ensuring proper thermal protection.”
Despite the high neonatal mortality rates, the efforts to strengthen newborn care protocols, by enhancing resuscitation skills, introducing innovative solutions in the labor ward can make a difference. “With better training” Dr Tunje say, “improved equipment, and a commitment to acting swiftly during the Golden Minute the healthcare workers can help reduce neonatal deaths.”
Dr. Tunje concluded that, “If every healthcare facility, every labor ward, and every healthcare provider commits to the Golden Minute strategy and applies it consistently, we can significantly reduce neonatal deaths in Kenya. It’s about giving every baby the best possible start in life.”
As the country moves forward in its efforts to combat neonatal mortality, the Golden Minute will remain the touchstone of progress, offering a window of opportunity to save lives and ensure every newborn has a chance to survive and thrive.
