Cavicchiolo Maria Elena, Lanzoni Paolo, Wingi Mazungo Olivier, Pizzol Damiano, Daverio Marco, Da Dalt Liviana, Putoto Giovanni, Trevisanuto Daniele
Doctors with Africa CUAMM, Padova, Italy.
Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
BMC Pregnancy Childbirth. 2016 Nov 22;16(1):366. doi: 10.1186/s12884-016-1170-y.
Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of neonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of healthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a project with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the CBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality Improvement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH.
A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently, the intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement. A retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed.
Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation. Baseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33% vs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for asphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period. Mortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%, p < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01).
We found a reduction in mortality rate among newborns admitted to CBH's NICU after the first year of CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis and prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives was associated with a reduction of neonatal mortality rate in a low-resource NICU.
新生儿死亡率仍然是一个严重的健康问题，尤其是在资源匮乏的国家，99%的新生儿死亡发生在这些国家。“医生救助非洲”（Doctors with Africa CUAMM）是一家意大利医疗保健领域的非政府组织，自1955年以来一直在非洲开展工作。在莫桑比克的贝拉中心医院（CBH），该组织开展了一个项目，旨在通过多层次干预来支持CBH的新生儿重症监护病房（NICU）和产科。我们的目的是评估CUAMM持续质量改进干预措施在降低CBH新生儿重症监护病房总体新生儿死亡率方面的有效性。
进行基线分析以评估新生儿护理的实际标准。随后，干预重点集中在三个主要领域：基础设施、设备和临床方案的改进。对临床结果进行了回顾性的实施前（2013年）/实施后（2014年）分析。
总共有4276名新生儿，2013年出生2118名（50%），实施干预后出生2158名（50%）。两组的基线特征相似，但院外出生新生儿的发生率较高（33%对30%，p = 0.02），5分钟时阿氏评分<7的发生率较低（37%对43%，p < 0.01）。两个研究期间，窒息（22%对30%）、败血症（4%对7%）和早产（18%对28%）的入院率有所增加。这些原因导致的死亡率在实施前后均有所下降：窒息（34%对19%，p < 0.
