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Immediate Care for Common Conditions in Term and Preterm Neonates: The Evidence
Li Jiang1, Georgia Dominguez1, Aoife Cummins2
1Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Immediate newborn care interventions like delayed cord clamping and kangaroo mother care improve survival and reduce risks in low- and middle-income countries. Thermal care also prevents hypothermia in preterm infants.
Area of Science:
- Neonatal Medicine
- Global Health
- Evidence-Based Practice
Background:
- Neonatal survival and birth outcomes are critically influenced by interventions at birth or within 24 hours.
- This study updates evidence on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Purpose of the Study:
- To provide an updated analysis of LMIC-specific evidence for immediate newborn care interventions.
- To assess the effectiveness and safety of interventions such as delayed cord clamping, thermal care, and kangaroo mother care.
Main Methods:
- A comprehensive scoping of existing literature was performed.
- LMIC-specific evidence for included topics was updated or re-analyzed.
- Ninety-four studies conducted in LMICs were identified and included in the analysis.
Main Results:
- Delayed cord clamping reduced transfusion risk in preterm infants and anemia in term infants, with no significant impact on mortality.
- Immediate thermal care (plastic wrap/bag) reduced hypothermia by 38% in preterm infants without increasing hyperthermia risk.
- Kangaroo mother care (immediate or early) significantly reduced neonatal mortality and hypothermia in preterm/low-birth-weight neonates.
Conclusions:
- Updated evidence confirms the effectiveness and safety of several immediate newborn care interventions in LMICs.
- While beneficial for specific outcomes, further high-quality trials are needed to optimize neonatal care.
- Delayed first bath evidence was inconclusive due to study heterogeneity; anti-D effectiveness noted in high-income countries.
Background:
Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Summary:
Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.
Key Messages:
We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.
Background:
Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Summary:
Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.
Key Messages:
We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.
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