Global gains after <i>Helping Babies Breathe</i>

Niermeyer, Susan

doi:10.1111/apa.13999

Cited by 15 publications

(6 citation statements)

References 10 publications

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“…Improving quality of care and health center protocols for managing birth complications at small health facilities must be a priority. For example, being able to identify and assist a newborn suffering birth asphyxia can reduce mortality–asphyxia accounted for 23% of the deaths in our sample [20]. In addition, nearly half of deaths in this study were due to some form of neonatal sepsis, indicating infection prevention control at the level of the health centers may have been inadequate.…”

Section: Limitationsmentioning

confidence: 99%

Neonatal deaths in Cambodia: findings from a community-based mortality review

et al. 2019

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Objectives The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015–November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

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Section: Limitationsmentioning

confidence: 99%

Neonatal deaths in Cambodia: findings from a community-based mortality review

et al. 2019

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“…Meeting Sustainable Development Goal (SDG) targets by 2030 for ending preventable neonatal deaths requires universal coverage of high quality care around birth for women and their babies, including resuscitation for those who do not breathe at birth [8,9]. Globally~80% of births are now in facilities [10], with many LMICs scaling up neonatal resuscitation programs [11][12][13]. However, lack of measurement for coverage and quality of neonatal resuscitation impedes tracking of progress [14].…”

Section: Introductionmentioning

confidence: 99%

Neonatal resuscitation: EN-BIRTH multi-country validation study

Peven

Ameen

et al. 2021

BMC Pregnancy Childbirth

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Background Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. Methods The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017–2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. Results Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV accuracy was higher (sensitivity 12.4–48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. Conclusions Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.

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“…For example, being able to identify and assist a newborn suffering birth asphyxia can reduce mortality--asphyxia accounted for 23% of the deaths in our sample. [20] In addition, nearly half of deaths in this study were due to some form of neonatal sepsis, indicating infection prevention control at the level of the health centers may have been inadequate. Sub-optimal infection prevention and control (IPC) practices have been identified in other settings as important contributors to mortality and morbidity.…”

Section: Conclusion and Recommendationsmentioning

confidence: 81%

Neonatal Deaths in Cambodia: A Case Series

Bazzano¹,

Var²,

Wilkosz³

et al. 2019

Preprint

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Introduction: Neonatal mortality has declined in Cambodia but remains a key contributor to under-five deaths. The aim of this study was to further understanding of potential factors contributing to high neonatal mortality rates in Cambodia through assessment of verbal autopsies collected following newborn deaths. The study team analyzed verbal autopsies of perinatal deaths in order to describe timing and causes of neonatal deaths, demographic data, and factors potentially related to mortality. Methods: The case series data derive from 13 verbal autopsy reports collected in rural southern Cambodia. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial.  The study examined all neonatal deaths occurring to infants born at 16 health centers between in the study site of Takeo province. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results: Thirteen newborn deaths of infants born at a health facility were reported during the time period February 2015–November 2016. Ten out of the 13 deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life, indicating death was likely due to an intrapartum event. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of the deaths were attributed to asphyxia. Other causes of death included stillbirth and prematurity. Eight deaths (61.54%) occurred within the control group of the larger intervention study. Conclusion: The study highlights the continuing need to improve both intrapartum and postnatal quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

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Global gains after Helping Babies Breathe

Cited by 15 publications

References 10 publications

Neonatal deaths in Cambodia: findings from a community-based mortality review

Neonatal deaths in Cambodia: findings from a community-based mortality review

Neonatal resuscitation: EN-BIRTH multi-country validation study

Neonatal Deaths in Cambodia: A Case Series

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