Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

Bhutta, Zulfiqar Ahmed; Das, Jai K; Bahl, Rajiv; Lawn, Joy E; Paul, Vinod K.; Sankar, Mari Jeeva; Blencowe, Hannah; Rizvi, Arjumand; Chou, Victoria B; Walker, Neff

doi:10.1016/s0140-6736(14)60792-3

Cited by 1,131 publications

(1,053 citation statements)

References 123 publications

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“…Therefore, the time of childbirth and the period immediately after birth are particularly critical for maternal, fetal and neonatal survival and well‐being. Effective care to prevent and manage complications during this critical period is likely to have a significant impact on reducing maternal deaths, stillbirths and early neonatal deaths—a triple return on investment 12. Within this critical period, quality of care improvement efforts would target essential maternal and newborn care and additional care for management of complications that could achieve the highest impact on maternal, fetal and newborn survival and well‐being.…”

mentioning

confidence: 99%

“…Within this critical period, quality of care improvement efforts would target essential maternal and newborn care and additional care for management of complications that could achieve the highest impact on maternal, fetal and newborn survival and well‐being. Based on the current evidence on burden and impact, the following specific thematic areas have been identified as high priority for this vision:10, 11, 12 …”

mentioning

confidence: 99%

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Quality of care for pregnant women and newborns—the WHO vision

Tunçalp

Were

Maclennan

et al. 2015

BJOG

837

798

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confidence: 99%

mentioning

confidence: 99%

Quality of care for pregnant women and newborns—the WHO vision

Tunçalp

Were

Maclennan

et al. 2015

BJOG

837

798

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“…In order to achieve the ambitious agenda of the Sustainable Development Goals, quality of care for mothers and infants around the time of birth must be strengthened [3]. An important intervention when the infant does not initiate and sustain breathing after birth is the practice of neonatal resuscitation, which can significantly reduce intrapartum-related stillbirth and neonatal mortality [4]. The Helping Babies Breathe (HBB) protocol was developed to respond to the need for increased coverage of clinical skills regarding neonatal resuscitation in low-income settings [5].…”

Section: Introductionmentioning

confidence: 99%

Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Wrammert

Zetterlund

et al. 2017

Global Health Action

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Background: The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored. Objective: To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting. Methods: Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression. Results: A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24–2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34–0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups. Conclusions: Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.

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“…Access to basic but high quality inpatient neonatal services for small and sick newborns will be key if progress is to be made in reducing neonatal mortality in low- and middle-income countries (LMICs) 1, 2 . Care should ideally be in a newborn unit (NBU) with specialised equipment and staff providing interventions such as feeding and respiratory support and phototherapy 2, 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Care should ideally be in a newborn unit (NBU) with specialised equipment and staff providing interventions such as feeding and respiratory support and phototherapy 2, 3 . However, evidence from single-site studies in Kenya and other resource-limited settings suggests that newborns are often admitted to general paediatric wards (PWs) due, among other reasons, to limited space and resources within the NBU 4, 5 .…”

Section: Introductionmentioning

confidence: 99%

A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

Murphy¹,

Nyakangi²,

Gathara³

et al. 2017

Wellcome Open Res

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Background: Small and sick newborns need high quality specialised care within health facilities to address persistently high neonatal mortality in low-income settings, including Kenya. Methods: We examined neonatal admissions in 12 public-sector County (formerly District) hospitals in Kenya between November 2014 and November 2016. Using data abstracted from newborn unit (NBU) admission registers and paediatric ward (PW) medical records, we explore the magnitude and distribution of admissions. In addition, interviews with senior staff were conducted to understand admission policies for newborns in these facilities. Results: Of the total 80,666 paediatric admissions, 28,884 (35.8%) were aged ≤28 days old. 24,212 (83.8%) of newborns were admitted to organisationally distinct NBU and 4,672 (16.2%) to general PW, though the proportion admitted to NBUs varied substantially (range 59.9-99.0%) across hospitals, reflecting widely varying infrastructure and policies. Neonatal mortality was high in NBU (12%) and PW (11%), though varied widely across facilities, with documentation of outcomes poor for the NBU. Conclusion: Improving quality of care on NBUs would affect almost a third of paediatric admissions in Kenya. However, comprehensive policies and strategies are needed to ensure sick newborns on general PWs also receive appropriate care.

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Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

Cited by 1,131 publications

References 123 publications

Quality of care for pregnant women and newborns—the WHO vision

Quality of care for pregnant women and newborns—the WHO vision

Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

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