Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia.
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia ; Liggins Institute, University of Auckland, New Zealand.
EBioMedicine. 2015 May 31;2(8):985-1000. doi: 10.1016/j.ebiom.2015.05.023. eCollection 2015 Aug.
Evidence-based interventions and strategies are needed to improve child survival in countries with a high burden of neonatal and child mortality. An overview of systematic reviews can focus implementation on the most effective ways to increase child survival.
In this overview we included published Cochrane and other systematic reviews of experimental and observational studies on antenatal, childbirth, postnatal and child health interventions aiming to prevent perinatal/neonatal and child mortality using the WHO list of essential interventions. We assessed the methodological quality of the reviews using the AMSTAR criteria and assessed the quality of the outcomes using the GRADE approach. Based on the findings from GRADE criteria, interventions were summarized as effective, promising or ineffective.
The overview identified 148 Cochrane and other systematic reviews on 61 reproductive, maternal, newborn and child health interventions. Of these, only 57 reviews reported mortality outcomes. Using the GRADE approach, antenatal corticosteroids for preventing neonatal respiratory distress syndrome in preterm infants; early initiation of breastfeeding; hygienic cord care; kangaroo care for preterm infants; provision and promotion of use of insecticide treated bed nets (ITNs) for children; and vitamin A supplementation for infants from six months of age, were identified as clearly effective interventions for reducing neonatal, infant or child mortality. Antenatal care, tetanus immunization in pregnancy, prophylactic antimalarials during pregnancy, induction of labour for prolonged pregnancy, case management of neonatal sepsis, meningitis and pneumonia, prophylactic and therapeutic use of surfactant, continuous positive airway pressure for neonatal resuscitation, case management of childhood malaria and pneumonia, vitamin A as part of treatment for measles associated pneumonia for children above 6 months, and home visits across the continuum of care, were identified as promising interventions for reducing neonatal, infant, child or perinatal mortality.
Comprehensive adoption of the above six effective and 11 promising interventions can improve neonatal and child survival around the world. Choice of intervention and degree of implementation currently depends on resources available and policies in individual countries and geographical settings.
This review was part of doctoral thesis which was funded by University of Adelaide, Australia.
需要循证干预措施和策略来提高新生儿和儿童死亡率高的国家的儿童生存率。系统评价概述可以将实施重点放在最有效的提高儿童生存率的方法上。
在本概述中，我们纳入了已发表的 Cochrane 及其他针对产前、分娩、产后和儿童健康干预措施的系统评价，这些干预措施旨在使用世界卫生组织基本干预措施清单预防围产期/新生儿和儿童死亡。我们使用 AMSTAR 标准评估了综述的方法学质量，并使用 GRADE 方法评估了结局的质量。根据 GRADE 标准的发现，干预措施被总结为有效、有前途或无效。
该概述确定了 148 项 Cochrane 及其他关于 61 项生殖、孕产妇、新生儿和儿童健康干预措施的系统评价。其中，只有 57 项综述报告了死亡率结局。使用 GRADE 方法，产前皮质激素预防早产儿呼吸窘迫综合征；早期开始母乳喂养；脐带卫生护理；袋鼠式护理早产儿；提供和促进儿童使用经杀虫剂处理的蚊帐（ITN）；以及 6 个月以上婴儿补充维生素 A，被确定为降低新生儿、婴儿或儿童死亡率的明确有效干预措施。产前保健、妊娠破伤风免疫、妊娠期间预防性抗疟疾、延长妊娠引产、新生儿败血症、脑膜炎和肺炎的病例管理、表面活性剂的预防性和治疗性使用、新生儿复苏的持续气道正压通气、儿童疟疾和肺炎的病例管理、维生素 A 作为治疗麻疹相关肺炎的一部分用于 6 个月以上的儿童，以及整个护理过程中的家访，被确定为降低新生儿、婴儿、儿童或围产期死亡率的有前途的干预措施。
全面采用这 6 项有效干预措施和 11 项有前途的干预措施可以提高全球新生儿和儿童的生存率。干预措施的选择和实施程度目前取决于各国和各地区的资源和政策。
本综述是阿德莱德大学博士论文的一部分，由澳大利亚阿德莱德大学资助。
