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Impact of a nationwide training program for neonatal resuscitation in China
Tao Xu1, Hui-shan Wang, Hong-mao Ye
1National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100089, China.
Insights
The China Neonatal Resuscitation Program (NRP) successfully trained over 110,000 professionals, leading to significant reductions in newborn mortality and intrapartum-related injuries. This initiative improved policy and infrastructure, saving lives in China.
Area of Science:
- Public Health
- Neonatal Medicine
- Health Policy
Background:
- Neonatal mortality remains a critical issue in China, with intrapartum-related injuries contributing significantly to infant deaths and long-term disabilities.
- The Chinese Ministry of Health launched a nationwide initiative to enhance neonatal survival by ensuring trained resuscitation personnel at every birth.
Purpose of the Study:
- To evaluate the impact of the China Neonatal Resuscitation Program (NRP) on policy and infrastructure.
- To assess the effectiveness of the NRP in reducing neonatal mortality rates.
Main Methods:
- The China NRP involved policy reform, professional education, and sustainable health system development for resuscitation.
- A train-the-trainer cascade model was used, reaching professionals across 31 provinces, with a focus on 20 high-mortality regions.
- Evaluation data were collected from 322 representative hospitals in the targeted provinces.
Main Results:
- Policy changes enabled midwives to initiate resuscitation and mandated training for licensure.
- Over 110,659 professionals were trained between 2004-2009, achieving 94% facility and 99% county coverage in target provinces.
- Intrapartum-related delivery room deaths decreased from 7.5 to 3.4 per 10,000 births, and Apgar scores ≤ 7 at 1 minute dropped from 6.3% to 2.9%.
Conclusions:
- The China NRP successfully implemented policy changes, trained a large workforce, and reduced delivery room mortality.
- Further improvements can be achieved by enhancing algorithm adherence, extending training to township levels, and covering out-of-facility births.
Background:
Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.
Methods:
The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.
Results:
Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110,659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10,000 from 2003 to 2008, and the incidence of Apgar ≤ 7 at 1 minute decreased from 6.3% to 2.9%.
Conclusions:
The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.
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