Abstract
BackgroundOf the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.MethodsRetrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border.FindingsFrom 21,225 newbonrs delivered, 15,073 (71%) met the inclusion criteria (liveborn, singleton, ≥28 weeks’ gestation, delivered in SMRU). Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced) cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40–8.06). Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66–2.55; p = 0.442), and 6.32 (95%CI 3.01–13.26; p<0.001) respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001). Neurodevelopmental follow-up to one year was performed in 1,608 (10.5%) of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565) versus 63 (n = 41); p = 0.732), while advanced resuscitation scores were significantly lower (56 (n = 5); p = 0.017).InterpretationsNewborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery) associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.
Highlights
Birth is one of the most challenging biological events in the human life cycle
This was a retrospective analysis of hospital records with data spanning the antenatal period, birth, and admission to the special care baby unit of the Shoklo Malaria Research Unit (SMRU) located at the Thailand-Myanmar border
Records for 15,073 (71%) newborns were included in the analyses (Fig 2), of which 460 (3%) newborns received neonatal resuscitation at birth and, from those, 422 (2.7%, 95% CI (2.0–3.0)) underwent basic resuscitation and 38 (0.3%, 95% CI (0.1–0.3)) advanced resuscitation
Summary
Birth is one of the most challenging biological events in the human life cycle. According to a 2005 World Health Organization report, around 136 million newborns are born each year[1] of which 10 million (5–10%) need assistance to initiate effective breathing.[2]. 4 million neonatal deaths are registered annually, representing 40% of under-5 child mortality.[1] Seventy-three percent of neonatal deaths occur in the first week of life, especially during the first 24 hours after delivery.[4] Ninety-eight percent of all neonatal deaths occur in low- and middle-income countries, and 77% of those in Asia and Sub-Saharan Africa. Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable
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