Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training
TL;DR: HBB implementation was associated with a significant reduction in both early neonatal deaths within 24 hours and rates of FSB, a call to action for other resource-limited countries striving to meet Millennium Development Goal 4.
Abstract: BACKGROUND: Early neonatal mortality has remained high and unchanged for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic interventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.
METHODS: Master trainers from the 3 major referral hospitals, 4 associated regional hospitals, and 1 district hospital were trained in the HBB program to serve as trainers for national dissemination. A before ( n = 8124) and after ( n = 78 500) design was used for implementation. The primary outcomes were a reduction in early neonatal deaths within 24 hours and rates of fresh stillbirths (FSB).
RESULTS: Implementation was associated with a significant reduction in neonatal deaths (relative risk [RR] with training 0.53; 95% confidence interval [CI] 0.43–0.65; P ≤ .0001) and rates of FSB (RR with training 0.76; 95% CI 0.64–0.90; P = .001). The use of stimulation increased from 47% to 88% (RR 1.87; 95% CI 1.82–1.90; P ≤ .0001) and suctioning from 15% to 22% (RR 1.40; 95% CI 1.33–1.46; P ≤ .0001) whereas face mask ventilation decreased from 8.2% to 5.2% (RR 0.65; 95% CI 0.60–0.72; P ≤ .0001).
CONCLUSIONS: HBB implementation was associated with a significant reduction in both early neonatal deaths within 24 hours and rates of FSB. HBB uses a basic intervention approach readily applicable at all deliveries. These findings should serve as a call to action for other resource-limited countries striving to meet Millennium Development Goal 4.
* Abbreviations:
BA — : birth asphyxia
BW — : birth weight
CI — : confidence interval
ENM — : early neonatal mortality (within 24 hours)
FMV — : face mask ventilation
FSB — : fresh stillbirths
GA — : gestational age
HBB — : Helping Babies Breathe
MDG — : Millennium Development Goal
ND — : neonatal deaths
RR — : relative risk
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TL;DR: The analysis indicates that available interventions can reduce the three most common cause of neonatal mortality--preterm, intrapartum, and infection-related deaths--by 58, 79, and 84%, respectively.
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TL;DR: Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP, but countries and the global community must further improve the quality and comparability of data.
734 citations
Brigham and Women's Hospital1, Johns Hopkins University2, University of London3, Institute for Health Metrics and Evaluation4, The Global Fund to Fight AIDS, Tuberculosis and Malaria5, Bill & Melinda Gates Foundation6, University of Colorado Denver7, University of Bristol8, University College London9
TL;DR: In settings without neonatal intensive care, the impairment rate is low due to high mortality, which is relevant for the scale-up of basic neonatal resuscitation, but rates of impairment are highest in middle-income countries where neonatalintensive care was more recently introduced, but quality may be poor.
Abstract: Intrapartum hypoxic events (“birth asphyxia”) may result in stillbirth, neonatal or postneonatal mortality, and impairment. Systematic morbidity estimates for the burden of impairment outcomes are currently limited. Neonatal encephalopathy (NE) following an intrapartum hypoxic event is a strong predictor of long-term impairment. Linear regression modeling was conducted on data identified through systematic reviews to estimate NE incidence and time trends for 184 countries. Meta-analyses were undertaken to estimate the risk of NE by sex of the newborn, neonatal case fatality rate, and impairment risk. A compartmental model estimated postneonatal survivors of NE, depending on access to care, and then the proportion of survivors with impairment. Separate modeling for the Global Burden of Disease 2010 (GBD2010) study estimated disability adjusted life years (DALYs), years of life with disability (YLDs), and years of life lost (YLLs) attributed to intrapartum-related events. In 2010, 1.15 million babies (uncertainty range: 0.89–1.60 million; 8.5 cases per 1,000 live births) were estimated to have developed NE associated with intrapartum events, with 96% born in low- and middle-income countries, as compared with 1.60 million in 1990 (11.7 cases per 1,000 live births). An estimated 287,000 (181,000–440,000) neonates with NE died in 2010; 233,000 (163,000–342,000) survived with moderate or severe neurodevelopmental impairment; and 181,000 (82,000–319,000) had mild impairment. In GBD2010, intrapartum-related conditions comprised 50.2 million DALYs (2.4% of total) and 6.1 million YLDs. Intrapartum-related conditions are a large global burden, mostly due to high mortality in low-income countries. Universal coverage of obstetric care and neonatal resuscitation would prevent most of these deaths and disabilities. Rates of impairment are highest in middle-income countries where neonatal intensive care was more recently introduced, but quality may be poor. In settings without neonatal intensive care, the impairment rate is low due to high mortality, which is relevant for the scale-up of basic neonatal resuscitation.
420 citations
TL;DR: Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD.
Abstract: Objective This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism. Method A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample. Results Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes. Conclusion Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information—Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.
299 citations
Save the Children1, University of London2, UNICEF3, Bill & Melinda Gates Foundation4, United States Agency for International Development5, World Health Organization6, Jhpiego7, University College London8, Pontifical Xavierian University9, John Snow, Inc10, Makerere University11, All India Institute of Medical Sciences12, College of Health Sciences, Bahrain13, International Centre for Diarrhoeal Disease Research, Bangladesh14, Brigham and Women's Hospital15
TL;DR: A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care, and tools to be developed and actions to test, validate and institutionalise proposed coverage indicators are outlined.
Abstract: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout.
ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.
234 citations
Cites background from "Newborn Mortality and Fresh Stillbi..."
...Many newborns may respond to stimulation alone, and there is evidence demonstrating that the provision of resuscitation training is associated with a reduction in bag and mask use [47]....
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References
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TL;DR: The latest estimates of causes of child mortality in 2010 with time trends since 2000 show that only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4.
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TL;DR: This work states that Neonatal Resuscitation and Emergency Cardiovascular Care Science With Treatment Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary is the most likely cause of sudden death in newborns aged under six weeks.
Abstract: 2010;126;e1319-e1344; originally published online Oct 18, 2010; Pediatrics COLLABORATORS CHAPTER Sithembiso Velaphi and on behalf of the NEONATAL RESUSCITATION Sam Richmond, Wendy M Simon, Nalini Singhal, Edgardo Szyld, Masanori Tamura, Chameides, Jay P Goldsmith, Ruth Guinsburg, Mary Fran Hazinski, Colin Morley, Jeffrey M Perlman, Jonathan Wyllie, John Kattwinkel, Dianne L Atkins, Leon Recommendations Resuscitation and Emergency Cardiovascular Care Science With Treatment Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary http://wwwpediatricsorg/cgi/content/full/126/5/e1319 located on the World Wide Web at: The online version of this article, along with updated information and services, is rights reserved Print ISSN: 0031-4005 Online ISSN: 1098-4275 Grove Village, Illinois, 60007 Copyright © 2010 by the American Academy of Pediatrics All and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk publication, it has been published continuously since 1948 PEDIATRICS is owned, published, PEDIATRICS is the official journal of the American Academy of Pediatrics A monthly
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