Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Neonatology, University at Buffalo, SUNY, Buffalo, New York.
Pediatr Res. 2017 Aug;82(2):194-200. doi: 10.1038/pr.2017.48. Epub 2017 May 24.
As rates of childhood mortality decline, neonatal deaths account for nearly half of under-5 deaths worldwide. Intrapartum-related events (birth asphyxia) contribute to approximately one-quarter of neonatal deaths, many of which can be prevented by simple resuscitation and newborn care interventions. This paper reviews various lines of research that have influenced the global neonatal resuscitation landscape. A brief situational analysis of asphyxia-related newborn mortality in low-resource settings is linked to renewed efforts to reduce neonatal mortality in the Every Newborn Action Plan. Possible solutions to gaps in care are identified. Building on international scientific evidence, tests of educational efficacy, and community-based trials established the feasibility and effectiveness of training in resource-limited settings and identified successful implementation strategies. Implementation of neonatal resuscitation programs has been shown to decrease intrapartum stillbirth rates and early neonatal mortality. Challenges remain with respect to provider competencies, coverage, and quality of interventions. The combination of resuscitation science, strategies to increase educational effectiveness, and implemention of interventions with high coverage and quality has resulted in reduced rates of asphyxia-related neonatal mortality. Further efforts to improve coverage and implementation of neonatal resuscitation will be necessary to meet the 2035 goal of eliminating preventable newborn deaths.
随着儿童死亡率的下降，全球每 5 名死亡儿童中就有近一半是新生儿。与分娩过程相关的事件（出生窒息）导致了大约四分之一的新生儿死亡，其中许多死亡是可以通过简单的复苏和新生儿护理干预来预防的。本文回顾了影响全球新生儿复苏领域的各种研究。与资源匮乏环境下与窒息相关的新生儿死亡的简要情况分析相关联的是，在《每个新生儿行动计划》中，再次努力减少新生儿死亡。确定了在护理方面存在差距的可能解决方案。在国际科学证据、教育效果测试和基于社区的试验的基础上，确定了在资源有限的环境中进行培训的可行性和有效性，并确定了成功的实施策略。新生儿复苏方案的实施已被证明可以降低分娩时的死产率和早期新生儿死亡率。在提供者的能力、覆盖率和干预措施的质量方面仍然存在挑战。复苏科学、提高教育效果的策略以及高覆盖率和高质量的干预措施的结合，已经降低了与窒息相关的新生儿死亡率。为了实现到 2035 年消除可预防的新生儿死亡的目标，还需要进一步努力提高新生儿复苏的覆盖率和实施。
