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Supportive Care for Common Conditions in Small Vulnerable Newborns and Term Infants: The Evidence
Li Jiang1, Rachel Lee Him1, Davneet Sihota1
1Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Essential newborn care interventions significantly improve outcomes for small vulnerable newborns (SVNs) in low- and middle-income countries (LMICs). Kangaroo mother care and early erythropoiesis stimulating agents show particular promise, though more high-quality trials are needed.
Area of Science:
- Neonatal care
- Global health
- Evidence-based medicine
Background:
- Small vulnerable newborns (SVNs) face elevated risks of mortality and morbidity.
- Essential interventions are critical for improving outcomes in SVNs and other high-risk neonates.
- 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 the effectiveness and safety of essential care interventions for SVNs in LMICs.
- To synthesize current evidence from LMIC-specific studies.
Main Methods:
- A comprehensive literature search was conducted.
- LMIC-specific evidence for essential SVN care interventions was updated and reanalyzed.
- 113 individual LMIC studies were identified, with most assessed as high risk of bias.
Main Results:
- Kangaroo mother care significantly reduced SVN mortality by discharge.
- Early erythropoiesis stimulating agents decreased the need for blood transfusions.
- Prophylactic ibuprofen reduced patent ductus arteriosus but increased gastrointestinal bleeding risk.
- Reflective curtains with phototherapy enhanced bilirubin decline more effectively than standard phototherapy.
- Early child development interventions improved cognitive and motor scores in SVNs.
Conclusions:
- Updated evidence confirms the effectiveness and safety of key interventions for SVNs in LMICs.
- Kangaroo mother care, early erythropoiesis stimulating agents, and certain phototherapy methods show significant benefits.
- Further high-quality trials are necessary to strengthen the evidence base for SVN care in LMICs.
Introduction:
Small vulnerable newborns (SVNs) are at an increased risk of early death and other morbidities. Essential interventions provided to SVN, and other high-risk newborns have been proven critical in improving their outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Method:
Following a comprehensive literature scope, we updated or reanalyzed LMIC-specific evidence for essential SVN care interventions.
Results:
A total of 113 individual LMIC studies were identified. Most of them were of high risk of bias. Kangaroo mother care significantly reduced SVN's mortality by discharge. Early erythropoiesis stimulating agent lowered SVN's risk of receiving blood transfusion. Prophylactic oral or intravenous ibuprofen resulted in a decreased risk of patent ductus arteriosus in SVN. But it did not have a significant effect on mortality and led to a higher risk of gastrointestinal bleeding. No pooled LMIC data were available for universal screening of hyperbilirubinemia in high-risk newborns. Sunlight therapy had no effect in treating hyperbilirubinemia but increased the risk of hyperthermia. Reflective curtains with phototherapy resulted in a greater and faster decline in bilirubin than standard phototherapy in treating hyperbilirubinemia. Early child development interventions were shown to have a favorable effect on cognitive and motor scores in SVN. The evidence for family involvement and family support was limited and uncertain.
Conclusion:
We present the most updated LMIC evidence for interventions targeting SVN. Despite their effectiveness and safety in improving certain neonatal outcomes, further high-quality trials are required.
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