Kamath-Rayne Beena D, Griffin Jennifer B, Moran Katelin, Jones Bonnie, Downs Allan, McClure Elizabeth M, Goldenberg Robert L, Rouse Doris, Jobe Alan H
Perinatal Institute, Cincinnati Children's Hospital, MLC 7009, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA,
Matern Child Health J. 2015 Aug;19(8):1853-63. doi: 10.1007/s10995-015-1699-9.
To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.
为评估新生儿复苏和基本产科护理对低收入和中等收入国家产时相关新生儿死亡率的影响，我们使用了数学模型“孕产妇和新生儿技术定向评估（MANDATE）”。利用MANDATE，我们评估了针对导致出生窒息的产时相关事件的干预措施（基本新生儿复苏、高级新生儿护理、增加机构分娩和急诊产科护理）在2008年撒哈拉以南非洲和印度的家庭、诊所和医院环境中实施时的影响。产时相关新生儿总死亡率（IRNM）是产时相关事件导致的急性新生儿死亡加上持续产时相关损伤导致的晚期新生儿死亡。在所有环境中引入基本新生儿复苏对降低IRNM有很大影响。增加机构分娩以及在诊所和医院扩大急诊产科护理规模对降低IRNM也有很大影响。在医院环境中提高高级新生儿护理的普及率和利用率对IRNM的影响有限。IRNM的最大改善见于广泛的高级新生儿护理和基本新生儿复苏、诊所和医院急诊产科护理的扩大以及机构分娩的增加，这使得印度每1000例活产的IRNM估计降至2.0，撒哈拉以南非洲降至每1000例活产2.5。随着更多分娩在诊所和医院进行，产科护理的扩大所产生的效果可能比单独建模时更大。使用MANDATE可使卫生领导人将资源导向可预防产时相关死亡的干预措施。基本新生儿复苏、增加机构分娩和急诊产科护理缺乏广泛实施是挽救新生儿生命的错失机会。
