Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training
Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training
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DOI：
10.1542/peds.2012-2112
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发表时间：
2013-02-01
期刊：
影响因子：
8
通讯作者：
Singhal, Nalini
中科院分区：
文献类型：
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作者：
Goudar, Shivaprasad S.;Somannavar, Manjunath S.;Singhal, Nalini
目的：本研究评估了帮助婴儿呼吸（HBB）新生儿护理和助产士复苏培训在减少死产（SB）、出院前和新生儿死亡率（NMR）方面的有效性。印度贡献了很大一部分的世界每年310万新生儿死亡和260万SBs.METHODS：这项前瞻性研究包括4187出生在>28周的妊娠前和5411出生后，在卡纳塔克邦的HBB培训。共有599名来自农村初级保健中心以及地区和城市医院的助产士接受了美国儿科学会开发的六溴代二苯培训，采用了培训员培训级联。分别使用卡方检验和t检验对分类变量和连续变量进行评估，以评估培训前和培训后的书面受训者知识、培训后提供者的表现和技能、SB、出院前死亡率和HBB培训前后的NMR。后向逐步logistic回归分析调整潜在的confounding.Results：供应商的知识和性能系统地提高与HBB培训。HBB训练减少复苏，但增加辅助袋和面罩通气的发生率。HBB训练后SB从3.0%下降到2.3%（比值比[OR] 0.76，95%置信区间[CI] 0.59-0.98），新鲜SB从1.7%下降到0.9%（OR 0.54，95% CI 0.37-0.78）。两个时期的出院前死亡率均为0.1%。在HBB训练之前和之后NMR分别为1.8%和1.9%（OR 1.09，95%CI 0.80-1.47，P = 0.59），但是在HBB训练之后28天的未知状态增加了2%（P = 0.007）。建议进行监测和社区评估。儿科2013;131：e344-e352
OBJECTIVE: This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs.METHODS: This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using chi(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding.RESULTS: Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007).CONCLUSIONS: HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended. Pediatrics 2013;131:e344-e352