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High mortality rates for very low birth weight infants in developing countries despite training
Waldemar A Carlo1, Shivaprasad S Goudar, Imtiaz Jehan
1University of Alabama at Birmingham, School of Medicine, Department of Pediatrics, 176F Suite 9380, 619 S. 19th St, Birmingham, AL 35249-7335, USA. wcarlo@peds.uab.edu
Pediatrics
|October 13, 2010
Summary
Essential Newborn Care (ENC) and Neonatal Resuscitation Program (NRP) training for birth attendants did not reduce early mortality in very low birth weight (VLBW) infants. Facility-based delivery is recommended for high-risk VLBW infants.
Area of Science:
- Neonatal Medicine
- Global Health
- Public Health Interventions
Background:
- Very low birth weight (VLBW) infants face high mortality risks, particularly in resource-limited settings.
- Training birth attendants in essential newborn care (ENC) and neonatal resuscitation (NRP) is a strategy to improve neonatal outcomes.
- The effectiveness of these training programs on early mortality for VLBW infants requires rigorous evaluation.
Purpose of the Study:
- To evaluate the impact of Essential Newborn Care (ENC) and Neonatal Resuscitation Program (NRP) training on 7-day neonatal mortality rates in very low birth weight (VLBW) infants.
- To test the hypothesis that ENC and NRP training would significantly reduce neonatal mortality for VLBW infants.
Main Methods:
- A train-the-trainer model was used to deliver ENC and NRP training to birth attendants in 96 communities across 6 developing countries.
- A before/after, active baseline, controlled study design was employed to assess ENC training impact.
- A cluster-randomized, controlled trial design was utilized to evaluate the impact of NRP training.
- Data were collected on 1096 VLBW infants (500-1499 g), with 98.5% of live-born infants monitored for 7 days.
Main Results:
- Training in Essential Newborn Care (ENC) and Neonatal Resuscitation Program (NRP) did not significantly affect all-cause 7-day neonatal mortality rates.
- Stillbirth and perinatal mortality rates remained unchanged following the implementation of ENC and NRP training.
- No reduction in early mortality was observed for very low birth weight infants born at home or in first-level facilities.
Conclusions:
- Essential Newborn Care (ENC) and Neonatal Resuscitation Program (NRP) training for birth attendants did not decrease 7-day neonatal, stillbirth, or perinatal mortality in VLBW infants.
- For expected deliveries of VLBW infants, encouraging facility-based delivery at a higher level of care may be a more effective strategy.
- Current training programs may not be sufficient to overcome the challenges associated with VLBW infant survival in low-resource settings.
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