Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up?


Wall, SN; Lee, AC; Niermeyer, S; English, M; Keenan, WJ; Carlo, W; Bhutta, ZA; Bang, A; Narayanan, I; Ariawan, I; Lawn, JE; (2009) Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? International journal of gynaecology and obstetrics, 107 Suppl 1. S47-62, S63-4. ISSN 0020-7292 DOI: https://doi.org/10.1016/j.ijgo.2009.07.013

[img]
Preview
Text - Accepted Version
License:

Download (2MB) | Preview

Abstract

BACKGROUND Each year approximately 10 million babies do not breathe immediately at birth, of which about 6 million require basic neonatal resuscitation. The major burden is in low-income settings, where health system capacity to provide neonatal resuscitation is inadequate. OBJECTIVE To systematically review the evidence for neonatal resuscitation content, training and competency, equipment and supplies, cost, and key program considerations, specifically for resource-constrained settings. RESULTS Evidence from several observational studies shows that facility-based basic neonatal resuscitation may avert 30% of intrapartum-related neonatal deaths. Very few babies require advanced resuscitation (endotracheal intubation and drugs) and these newborns may not survive without ongoing ventilation; hence, advanced neonatal resuscitation is not a priority in settings without neonatal intensive care. Of the 60 million nonfacility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum-related neonatal deaths, based on expert opinion. Case studies illustrate key considerations for scale up. CONCLUSION Basic resuscitation would substantially reduce intrapartum-related neonatal deaths. Where births occur in facilities, it is a priority to ensure that all birth attendants are competent in resuscitation. Strategies to address the gap for home births are urgently required. More data are required to determine the impact of neonatal resuscitation, particularly on long-term outcomes in low-income settings.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 19815203
Web of Science ID: 271178200004
URI: http://researchonline.lshtm.ac.uk/id/eprint/878787

Statistics


Download activity - last 12 months
Downloads since deposit
298Downloads
319Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item