Early essential newborn care is associated with increased breastfeeding: a quasi-experimental study from Sichuan Province of Western China

Lin

et al. 2021

Preprint

Self Cite

Introduction: Neonatal survival remains a public health concern globally. Early Essential Newborn Care (EENC) recommended by World Health Organization is a package of cost-effective interventions to improve neonatal health and development outcomes. In this study we aimed to explore the effectiveness of EENC implementation in four provinces of western China.Methods: A pre- and post-intervention investigations were conducted in 4 selected EENC intervention counties and 4 control counties of four western provinces of China, during June to August 2017 and December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected through post-intervention face-to-face questionnaire interview with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health outcomes were obtained through mail surveys in both investigations. We also performed semi-structured interviews with stakeholders of policymakers, health staff, and postpartum mothers to learn their perceived usefulness of EENC implementation. Results: 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. With the confounding factor of province being controlled for, proportions of newborns receiving any skin to skin contact (99.50% vs. 49.07%), exclusive breastfeeding before discharge (92.57% vs. 63.80%), no applied medicine to the umbilical cord (98.50% vs. 9.73%), routine eye care (93.16% vs. 8.73%), and vitamin K1 administration (98.33% vs. 88.98%) were higher in the intervention group compared with the control group (P<0.05). Lower incidences of neonatal diarrhea (0.07% vs. 0.22%) and eye infection (0.04% vs. 0.29%) were reported in the intervention group than the control group (P<0.05). The enhanced satisfaction of stakeholders primarily manifests in belief acknowledgement, policy promotion, emotional support, health improvement, widely-acknowledged sustainability, and work support. Conclusion: EEEC-recommended core practices have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national rolling out.

Section: Discussionsupporting

confidence: 93%

Effectiveness of Early Essential Newborn Care Implementation In Four Provinces of Western China

Lin

et al. 2021

Preprint

Self Cite

“…Our study showed that mother-newborn SSC was associated with increased proportions of early initiation breastfeeding and a longer duration of first-breastfeeding -findings that are highly consistent with previous studies [27,28]. SSC may activate the oxytocinergic system, and the elevated concentration of oxytocin in postpartum mothers in turn promotes lactation and prolonged breastfeeding duration [29].…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of early essential newborn care implementation in four counties of western China

Lin

et al. 2022

BMC Health Serv Res

Self Cite

Background Neonatal survival is a public health concern globally. However, the regional disparity in neonatal mortality between rural counties of western China and urban areas of eastern provinces remains high. Early essential newborn care (EENC), recommended by World Health Organization, refers to a set of cost-effective interventions to improve neonatal health and development outcomes. In this study, we aimed to explore the effectiveness of EENC implementation in four counties of western China. Methods Pre- and post-intervention investigations were conducted in four selected EENC intervention counties and four control counties of four western provinces of China, from June to August 2017 and from December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected via a post-intervention face-to-face questionnaire survey with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health indicators were obtained through mail surveys in both investigations. We also performed semi-structured interviews with policymakers, health staff and postpartum mothers to understand their perceptions about the usefulness of EENC implementation. Results Overall, 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. Controlling for the confounding factor of province, the proportion of newborns receiving EENC interventions was higher in the intervention group than in the control group (P < 0.05). Intervention groups in four provinces had higher coverage of: any skin-to-skin contact (99.50% vs. 49.07%); early breastfeeding initiation (within 60 min of birth) (90.84% vs. 80.35%); no medicine applied to the umbilical cord (98.50% vs. 9.73%); routine eye care (93.16% vs. 8.73%); and vitamin K1 administration (98.33% vs. 88.98%). EENC implementation was associated with decreased risk of neonatal diarrhea (OR: 0.326, 95% CI: 0.123, 0.865) and eye infection (OR: 0.147, 95% CI: 0.045, 0.483). Policymakers, health staff and postpartum mothers expressed satisfaction with the EENC interventions, noting a willingness among staff and policymakers to implement and sustain these interventions; the promotion of these interventions within hospital policy; the positive emotions experienced by postpartum mothers; perceived improvements in health; and improvements in support for health workers. Conclusion EENC-recommended core practices (except kangaroo mother care) have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national roll out.

“…In China, EENC during vaginal deliveries has been performing since 2016 and contributed to increased rates of exclusive breastfeeding and improved maternal and neonatal health [4,6,15], while the evidence during cesarean deliveries remains lacking. The objective of this multicentered randomized controlled study is to evaluate the effectiveness of EENC for cesarean section newborns on exclusive breastfeeding rates and early initiation of breastfeeding rates in China.…”

Section: Discussionmentioning

confidence: 99%

“…EENC is a package of simple evidence-based and cost-effective interventions delivered around birth including thoroughly drying a newborn immediately after birth, delayed cord clamping, immediate and sustained skin-to-skin contact (SSC), initiating exclusive breastfeeding, and routine care (newborn eye care, vitamin K 1 , immunizations, weighting, and examinations) [3,4]. Implementation of EENC has been demonstrated to increase rates of exclusive breastfeeding at discharge, 3 months and 6 months of age, and reduce neonatal intensive care unit admissions, admissions with hypothermia and sepsis [5,6].…”

Section: Introductionmentioning

confidence: 99%

Early essential newborn care for cesarean section newborns in China: study protocol for a multi-centered randomized controlled trial

Sobel

et al. 2022

Trials

Background Early essential newborn care (EENC) is a package of evidence-based and cost-effective interventions delivered around birth mainly including delayed cord clamping, immediate and sustained skin-to-skin contact, and early initiation of exclusive breastfeeding. EENC is proven effective in promoting breastfeeding and improving women’s and newborns’ health. However, there is little evidence on implementation of EENC on newborns born by cesarean section in China. Therefore, the objective of this study is to assess the effectiveness of EENC intervention on rates of exclusive breastfeeding and early initiation of breastfeeding for cesarean section newborns in China. Methods This is a multi-centered, randomized controlled trial conducted in 4 tertiary hospitals in China. A total of 720 eligible women who will receive cesarean section are being randomized into four groups: control group (n=180), intervention group 1 (skin-to-skin contact for 30 min, n=180), intervention group 2 (skin-to-skin contact for 60 min, n=180), and intervention group 3 (skin-to-skin contact for 90 min, n=180). The control group will receive routine care, whereas the intervention groups will receive EENC with different duration of skin-to-skin contact. Demographic characteristics, clinical information, and breastfeeding outcomes will be collected. The primary outcome is rates of exclusive breastfeeding and early initiation of breastfeeding, and the secondary outcomes include maternal and neonatal morbidity and admissions. Discussion This study will provide evidence of the impact of EENC on improvement of breastfeeding outcomes and maternal and neonatal health for cesarean section newborns in China, and evidence-based recommendation to inform optimal duration of skin-to-skin contact for cesarean deliveries. The results of this study have potential to inform national-level guidelines and policy-making for optimizing EENC implementation for cesarean section newborns. Trial registration Chinese Clinical Trial Registry ChiCTR2100048997. Retrospectively registered on 19 July 2021