Wrammert J, Kc A, Ewald U, Målqvist M
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
Children's University Hospital, Akademiska Sjukhuset, Uppsala, Sweden.
Acta Paediatr. 2017 Aug;106(8):1280-1285. doi: 10.1111/apa.13835. Epub 2017 Apr 19.
Helping Babies Breathe (HBB) is a neonatal resuscitation protocol proven to reduce intrapartum-related mortality in low-income settings. The aim of this study was to describe the timing and causes of neonatal in-hospital deaths before and after HBB training at a maternity health facility in Nepal.
A prospective cohort study was conducted at the facility between July 2012 and September 2013. All 137 staffs, including medical doctors and midwives, were trained in January 2013. The causes of 299 neonatal deaths and the day of death, up to 27 days, were collected before and after the training course.
Deaths caused by intrapartum-related complications were reduced from 51% to 33%. Preterm infants survived for more days (p < 0.01) during the neonatal period, but overall in-hospital neonatal mortality was unchanged (p = 0.46) after training. The survival rates linked to complications of infection, congenital anomalies and other causes were unaffected by the intervention.
The continuum of postnatal care for newborn infants needs to be strengthened after Helping Babies Breathe training, to maintain the gains in neonatal survival on the day of delivery. Additional interventions in the postnatal period are therefore required to increase neonatal survival at facilities in low-income settings.
“帮助婴儿呼吸”（HBB）是一项已被证实可降低低收入地区分娩期相关死亡率的新生儿复苏方案。本研究的目的是描述在尼泊尔一家产妇保健机构进行HBB培训前后新生儿院内死亡的时间和原因。
2012年7月至2013年9月在该机构开展了一项前瞻性队列研究。包括医生和助产士在内的所有137名工作人员于2013年1月接受了培训。在培训课程前后收集了299例新生儿死亡的原因及死亡日期（最长至出生后27天）。
分娩期相关并发症导致的死亡从51%降至33%。早产儿在新生儿期存活的天数更多（p<0.01），但培训后院内新生儿总体死亡率未变（p = 0.46）。与感染、先天性异常及其他原因相关的并发症的存活率未受该干预措施影响。
在进行“帮助婴儿呼吸”培训后，需要加强对新生儿的产后连续护理，以维持分娩当日新生儿存活率的提升。因此，在低收入地区的机构需要采取额外的产后干预措施来提高新生儿存活率。
