Newborn-care training and perinatal mortality in developing countries.
Newborn-care training and perinatal mortality in developing countries.
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DOI：
10.1056/nejmsa0806033
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发表时间：
2010-02-18
期刊：
影响因子：
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通讯作者：
First Breath Study Group
中科院分区：
文献类型：
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作者：
Carlo WA;Goudar SS;Jehan I;Chomba E;Tshefu A;Garces A;Parida S;Althabe F;McClure EM;Derman RJ;Goldenberg RL;Bose C;Krebs NF;Panigrahi P;Buekens P;Chakraborty H;Hartwell TD;Wright LL;First Breath Study Group
每年370万新生儿死亡和330万死产中有98%发生在发展中国家，因此需要对基于社区的干预措施进行评估。当地教员采用培训教员模式，对六个国家（阿根廷、刚果民主共和国、危地马拉、印度、巴基斯坦和赞比亚）农村社区的助产士进行了世界卫生组织新生儿基本护理课程（新生儿常规护理、复苏、体温调节、母乳喂养、袋鼠式护理、小婴儿护理和常见疾病）的培训。在美国儿科学会新生儿复苏计划（深度基础复苏）的修改版本中，除了阿根廷。新生儿基本护理干预采用前后设计进行评估（N= 57,643）。新生儿复苏计划干预被评估为一项集群随机对照试验（N=62,366）。主要终点为7天新生儿死亡率。7 d随访率为99.2%。接受新生儿基本护理培训后，全因7天新生儿（RR 0.99; CI 0.81, 1.22）或围产期死亡率较基线无显著降低；死胎率显著降低（RR 0.69; CI 0.54, 0.88; p<0.01）。与对照组相比，随机分配到新生儿复苏计划训练组的7天新生儿死亡率、死产和围产期死亡率没有降低。在对社区接生员进行基本新生儿护理培训后，7天新生儿死亡率并没有下降，尽管这种干预措施降低了死产率。随后的新生儿复苏计划培训并没有显著降低死亡率。（clinicaltrials.gov编号：NCT00136708）。
Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths per year occur in developing countries, and evaluation of community-based interventions is needed. Using a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby, and common illnesses), and in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in depth basic resuscitation), except in Argentina. The Essential Newborn Care intervention was assessed with a before and after design (N=57, 643). The Neonatal Resuscitation Program intervention was assessed as a cluster randomized controlled trial (N=62,366). The primary outcome was 7-day neonatal mortality. The 7-day follow-up rate was 99.2%. Following Essential Newborn Care training, there was no significant reduction from baseline in all-cause 7-day neonatal (RR 0.99; CI 0.81, 1.22) or perinatal mortality; there was a significant reduction in the stillbirth rate (RR 0.69; CI 0.54, 0.88; p<0.01). Seven-day neonatal mortality, stillbirth, and perinatal mortality were not reduced in clusters randomized to Neonatal Resuscitation Program training as compared with control clusters. Seven-day neonatal mortality did not decrease following the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced following this intervention. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates. (clinicaltrials.gov number, NCT00136708).