High Mortality Rates for Very Low Birth Weight Infants in Developing Countries Despite Training

Abstract

OBJECTIVE The goal was to determine the effect of training in newborn care and resuscitation on 7-day (early) neonatal mortality rates for very low birth weight (VLBW) infants. The study was designed to test the hypothesis that these training programs would reduce neonatal mortality rates for VLBW infants. METHODS Local instructors trained birth attendants from 96 rural communities in 6 developing countries in protocol and data collection, the World Health Organization Essential Newborn Care (ENC) course, and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP), by using a train-the-trainer model. To test the impact of ENC training, data on infants of 500 to 1499 g were collected by using a before/after, active baseline, controlled study design. A cluster-randomized, controlled trial design was used to test the impact of the NRP. RESULTS A total of 1096 VLBW (500–1499 g) infants were enrolled, and 98.5% of live-born infants were monitored to 7 days. All-cause, 7-day neonatal mortality, stillbirth, and perinatal mortality rates were not affected by ENC or NRP training. CONCLUSIONS Neither ENC nor NRP training of birth attendants decreased 7-day neonatal, stillbirth, or perinatal mortality rates for VLBW infants born at home or at first-level facilities. Encouragement of delivery in a facility where a higher level of care is available may be preferable when delivery of a VLBW infant is expected.

Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality

“…The quality of evidence was downgraded to low as the participants were not blinded to the intervention and due to the inconsistent effects across studies. A significant increase in the use of bag mask ventilation was reported by Carlo et al [20] in 2010 [RR 1.18 (95% CI 1.04-1.33)] and Gill et al [12] in 2011 [RR 29.50 (95% CI 9.39-92.65)], but was not significant in another study by Carlo et al [24] in 2010 [RR 0.85 (95% CI 0.63-1.15)].…”

“…We downgraded the quality of evidence from high to moderate quality as the participants were not blinded to the intervention and also due to inconsistency in the direction of the effects across studies (heterogeneity, I 2 = 71%). Studies by Carlo et al [20,24] did not report a decrease in neonatal mortality, whereas Gill et al [12], who included only traditional birth attendants, showed a significant decrease in early neonatal mortality in the intervention group. In subgroup analyses, training of traditional birth attendants in neonatal resuscitation decreased early neonatal mortality: RR 0.79 (95% CI 0.65-0.95; 3 CRTs, 27,673 participants, moderate-quality evidence; fig.…”

Stillbirths: what difference can we make and at what cost?

“…The quality of such care is highly important: training of community health workers without adequate triage and referral is unlikely to reduce the burden of stillbirths and early neonatal mortality. 28 The fact that no diff erences were noted for stillbirths and perinatal deaths between facility-based and community-based births in one urban setting in Pakistan 29 underscores the importance of staff training and high quality of care.…”

“…95,96 However, a high proportion of the eff ect of such community platforms, including women's support groups, 104 is through preventive care and improved care seeking rather than from direct domiciliary care for maternal and neonatal complications. Indeed, community-based trials of training community health workers and traditional birth attendants in neonatal resuscitation 93,105,106 and care of neonates with very low birthweight 28 have underscored the limitations of training for such care providers. Hence, wherever deployed and feasible, outreach workers should be linked to functional facilities.…”

Low birth weight profiles at H. Boejasin Hospital, South Borneo, Indonesia in 2010-2012

“…This problem should be addressed immediately to decrease neonatal mortality rates, and a systematic referral system should be made for high-risk neonates (birth weight less than 1,500 grams or gestational age less than 32 weeks), or even for pregnant mothers expected to give birth to high-risk neonates, who need to be admitted to the NICU. 29,30 At our hospital, sepsis was the third most frequent cause of death (16%). Sepsis may have been caused by LBW infants' higher susceptibility to infection.…”