Newborn survival: a multi-country analysis of a decade of change

Lawn, Joy E; Kinney, Mary; Black, Robert E.; Pitt, Catherine; Kerber, Kate; Corbett, Erica; Moran, Allisyn C.; Morrissey, Claudia S.; Oestergaard, Mikkel Z.

doi:10.1093/heapol/czt008

Cited by 41 publications

(57 citation statements)

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“…It is the main contributor to neonatal mortality and morbidity, moreover, this morbidity contributes to 40% of all deaths of children under 5 years of age. 18,19 A Swedish national population-based cohort study 2014-2016 showed an unprecedented high survival (77%) of extremely preterm infants born between 22 and 26 weeks of gestation. 20 One contributing factor to severe morbidity is the chronic lung disease, BPD, which is also a predictor of adverse long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

Neonatal clinical blood sampling led to major blood loss and was associated with bronchopulmonary dysplasia

et al. 2019

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Aim Studies indicate that reduced foetal haemoglobin levels are related to increased neonatal morbidity rates. This study investigated the relationships between sampling‐related blood loss and adult blood transfusions administered during postnatal days 1‐14 and the development of severe neonatal morbidities in extremely preterm infants born before 28 weeks of gestation. Methods The medical files of 149 extremely preterm infants born at two university hospitals in Sweden from 2013 to 2018 were investigated. Results Blood sampling resulted in a 58% depletion of the endogenous blood volume postnatal days 1‐14 (median 40.4 mL/kg, interquartile range 23.9‐53.3 mL/kg) and correlated with the adult erythrocyte transfusion volume (rS = 0.870, P < .001). Sampling‐related blood loss on postnatal days 1‐7, adjusted for gestational age at birth and birth weight standard deviation score, was associated with the development of bronchopulmonary dysplasia (BPD) (odds ratio by a 10‐unit increase 2.4, 95% confidence interval 1.1‐5.4) (P = .03). No associations were found between blood sampling and intraventricular haemorrhage or necrotising enterocolitis in the full statistical model. The largest proportion of sampling‐related blood was used for blood gas analyses (48.7%). Conclusion Diagnostic blood sampling led to major endogenous blood loss replaced with adult blood components and was associated with the development of BPD.

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Section: Discussionmentioning

confidence: 99%

Neonatal clinical blood sampling led to major blood loss and was associated with bronchopulmonary dysplasia

et al. 2019

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“…In Ghana, demographic data reveal a neonatal mortality rate of 28 deaths per 1000 live births, with an under-five mortality rate of 74 per 1000 live births (Rajaratnam et al 2010;You et al 2011. Despite Recent reports indicate that neonatal health initiatives have been drastically underfunded at the global scale, accounting for <6% of official development assistance earmarked for neonatal health interventions (Lawn et al 2012). Meanwhile, it is estimated that universal implementation of relatively low-cost interventions such as Kangaroo Mother Care, prevention of asphyxia and treatment of infection can reduce overall newborn mortality by 75% (Darmstadt et al 2005;Lee et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Evidence‐based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana

Brantuo

Cristofalo

Meheš

et al. 2014

Tropical Med Int Health

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Abstractobjective To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity.methods The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices.results In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre-and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence.conclusions Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance.keywords neonatal mortality, training, mentorship, evidence-based, district hospitals, Ghana

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“…Moreover, progress in reducing NMR has been slowest in the regions with the highest NMRs. Reductions of over 40% have been estimated for most regions, except in South Asia (32%) and sub-Saharan Africa (24%) ( Table 1) neonatal deaths must become a major public health priority in all regions if Millennium Development Goal 4 (MDG 4), to reduce under-5 mortality by two-thirds between 1990 and 2015, is to be achieved (Lawn et al 2012b).…”

Section: Progress In Reducing Neonatal Mortalitymentioning

confidence: 99%

“…Improved individual case management and supportive care outside of neonatal intensive care units historically led to large reductions in neonatal mortality (Figure 3). More recently, some countries have reduced their NMRs using this approach (Lawn et al 2012b). Facilities in middle to high-mortality settings are well placed to benefit from the low-tech solutions and lessons learnt over the last century.…”

Section: Improved Case Management Of Those With Conditions Associatedmentioning

confidence: 99%

“…Scale-up of evidence-based newborn care to achieve substantial reductions in neonatal mortality and morbidity will require a large increase in funding. While it is recognised that in the short-term interventions and packages used will need to be adapted according to context to maximise their effectiveness, ultimately, a strong primary care infrastructure linked with functioning referral facilities will be required (Lawn et al 2012b).…”

Section: Policy and Funding To Reduce Neonatal Deathsmentioning

confidence: 99%

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Review: Addressing the challenge of neonatal mortality

Blencowe

2013

Tropical Med Int Health

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Reducing neonatal mortality remains a challenge with an estimated 3.0 million neonatal deaths in 2011, three-quarters of these in sub-Saharan Africa and Southern Asia. The leading causes of neonatal death globally are complications of preterm birth, intrapartum-related causes and infections. While post-neonatal, under-5 deaths fell by 47% between 1990 and 2011, neonatal deaths only fell by 32% and they now account for 43% of all under-5 child deaths. This article reviews the progress in reducing neonatal deaths in high-burden countries and presents an overview of known effective interventions to reduce neonatal mortality and the challenges faced in implementing these in highburden settings. Effective action is possible to reduce neonatal mortality, but innovative approaches to implementation will be required if these preventable deaths are to be avoided.keywords infant, newborn neonatal mortality

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Newborn survival: a multi-country analysis of a decade of change

Cited by 41 publications

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Neonatal clinical blood sampling led to major blood loss and was associated with bronchopulmonary dysplasia

Neonatal clinical blood sampling led to major blood loss and was associated with bronchopulmonary dysplasia

Evidence‐based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana

Review: Addressing the challenge of neonatal mortality

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