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Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up?
Stephen N Wall1, Anne C C Lee, Susan Niermeyer
1Saving Newborn Lives/Save the Children USA, Washington DC and Cape Town, South Africa.
Insights
Basic neonatal resuscitation can significantly reduce newborn deaths, especially in low-income countries. Ensuring birth attendants are trained is crucial for facility births, with urgent strategies needed for home births.
Area of Science:
- Neonatal Health
- Global Public Health
- Medical Education
Background:
- Approximately 10 million newborns annually require resuscitation at birth, with 6 million needing basic interventions.
- Low-income settings face significant challenges in providing adequate neonatal resuscitation capacity.
- The burden of birth asphyxia and the need for resuscitation are disproportionately high in resource-constrained environments.
Purpose of the Study:
- To systematically review evidence on neonatal resuscitation content, training, equipment, and program considerations.
- Focus on resource-constrained settings to identify effective strategies for improving neonatal survival.
- Evaluate the impact and feasibility of basic neonatal resuscitation in diverse low-income contexts.
Main Methods:
- Systematic review of observational studies and trials on neonatal resuscitation.
- Analysis of evidence related to training, competency, equipment, and cost-effectiveness.
- Inclusion of case studies to illustrate program scale-up considerations.
Main Results:
- Facility-based basic neonatal resuscitation can avert up to 30% of intrapartum-related neonatal deaths.
- Advanced resuscitation is not a priority in settings lacking neonatal intensive care.
- Community health workers can effectively perform basic resuscitation, potentially reducing intrapartum-related neonatal deaths by 20%.
Conclusions:
- Implementing basic neonatal resuscitation is a priority for reducing intrapartum-related neonatal mortality.
- Ensuring birth attendant competency in resuscitation is essential for facility births.
- Urgent strategies are needed to address resuscitation gaps for home births, and further research on long-term outcomes is required.
Background:
Each year approximately 10 million babies do not breathe immediately at birth, of which about 6 million require basic neonatal resuscitation. The major burden is in low-income settings, where health system capacity to provide neonatal resuscitation is inadequate.
Objective:
To systematically review the evidence for neonatal resuscitation content, training and competency, equipment and supplies, cost, and key program considerations, specifically for resource-constrained settings.
Results:
Evidence from several observational studies shows that facility-based basic neonatal resuscitation may avert 30% of intrapartum-related neonatal deaths. Very few babies require advanced resuscitation (endotracheal intubation and drugs) and these newborns may not survive without ongoing ventilation; hence, advanced neonatal resuscitation is not a priority in settings without neonatal intensive care. Of the 60 million nonfacility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum-related neonatal deaths, based on expert opinion. Case studies illustrate key considerations for scale up.
Conclusion:
Basic resuscitation would substantially reduce intrapartum-related neonatal deaths. Where births occur in facilities, it is a priority to ensure that all birth attendants are competent in resuscitation. Strategies to address the gap for home births are urgently required. More data are required to determine the impact of neonatal resuscitation, particularly on long-term outcomes in low-income settings.
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