TABLE 42.

Neonatal Care in Peripheral Health Facilities

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Arif et al736Pakistan; urban hospital setting; RCT362 babies were randomly assigned to either an incubator or heated cot by the mother's side (n = 151), or to the special care baby unit (n = 211). Mothers were trained by nurses.Weight gain from admission to discharge was significantly higher among newborn infants in the maternal care group (P < .001). Mortality in the fair and poor babies was significantly lower (44%) in the maternal care group (P < .001). Overall, mortality in the maternal care group was 57% lower than the special care unit, irrespective of condition at admission.
Bose et al666India; rural setting; RCSAt the Community Health and Development Hospital, a low-cost nursery for newborns (n = 175) was established with facilities for phototherapy, heat cradles and other basic nursing facilities.Of 175 newborns admitted, 6 died and 8 were transferred to nurseries in a tertiary care or government hospital.
Borulkar et al737India; rural setting; PCSStaff at a community hospital was taught special care for newborns (n = 2266), comprised of provision of optimal warmth, resuscitation of asphyxiated neonates, proper feeding and oxygen administration when indicated.For a 5-y period, survival was 61.5% in the 1000–1500 g birth weight category and 92.5% in the 1520–2000 g category of admissions. No comparable historical data was reported.
Dutt et al669India; rural setting; PCSJawaharlal Institute Rural Health Center served as a treatment as well as a referral center in the rural area for births (n = 356).94% of the deliveries were conducted by trained personnel, as compared to 16% in 1967. All mothers were immunized against tetanus.IMR decreased by 68% (comparative neonatal mortality rates were not specified). In the postnatal period, >98% of the children had received the full courses of DPT, oral polio, and BCG immunizations. There were no deaths due to neonatal tetanus.
van der Mei et al667Ghana; rural hospital setting; PCSCare of neonates (n = 567) was done under limited resources by training mothers and nurses in basic newborn careSurvival rates of infants weighing ≤1500 g and for those weighing 1500–2000 g were 52% and 90%, respectively.
Wilkinson668South Africa; rural hospital setting; QTThe pilot study was based on an analysis of consecutive hospital and clinic deliveries (n = 640). A subsequent study included 2193 consecutive hospital and clinic births. Basic interventions (including a community obstetrics guide for local midwives, a policy change to admit all pre-eclamptic women with high diastolic blood pressure to the hospital, a managed system for blood collection and result delivery, and training for midwives and skilled birth attendants in neonatal resuscitation and management of labor emergencies) were introduced in the hospital to tackle problems identified through a pilot study.A 32% decrease in NMR was seen during the intervention period.
Bhakoo et al738India; urban hospital setting; RCSChanges were made to the admission and discharge criteria in the neonatal special care unit (NSCU), to encourage keeping the baby with the mother and early hospital discharge for home care. Rather than be kept in the NSCU (where mothers were not allowed), more high-risk babies stayed with their mothers. Outcomes for infants kept in the NSCU (n = 165) were compared to infants who were cared for alongside their mothers (n = 127).After changes were made to the admission and discharge criteria, fewer newborn infants who were cared for outside the NSCU alongside their mothers died (7/127), as compared to those admitted to the NSCU (57/165). Neonatal mortality in babies weighing <2 kg declined significantly over a 13-y period (7.94% in 1986 vs 12.88% in 1973; P < .005), and over the same period, mortality fell among preterm babies from 26.88 to 11.5% (P < .001). This was achieved despite a two- to threefold increase in the high-risk babies and without any increase in the number of neonatal special care beds or nurses.
Daga et al494India; urban hospital setting; QTA conservative neonatal care unit was established in J J Hospital, Bombay, having 4 main features: 1) room warming, 2) exclusive breastfeeding, 3) maternal involvement in infant care, and 4) minimum handling and minimum intervention. Birth outcomes for a cohort of infants (n = 21) in 3 different weight groups (1000–1250 g, 1260–1500 g, and 1510–2000 g) were measured and compared to historical controls.3 neonates were admitted with birth weights of 1000–1250 g, and the survival was 33% in this group compared to a previous best of 50%. In the birth weight group of 1260–1500 g, 8 neonates were admitted and their survival was 75%, compared to 66% as a previous best in this weight group. For the weight group 1510–2000 g (n = 10 admitted), a 90% survival rate was found, compared to 92.5% as a previous best.
Cooper et al739South Africa; urban hospital setting; RCTA group of VLBW infants (n = 19) was fed a formula specifically developed for such infants, while another group (n = 20) was fed expressed breast milk (EBM).Time to reach a weight of 1800 g was 28 d for the formula-fed group, vs 40 d for those receiving EBM. The allocation groups were not strictly randomized for severity of illness.