Lata Medical Research Foundation, Nagpur, India.
Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra State, 442102, India.
BMC Pregnancy Childbirth. 2019 Sep 4;19(1):324. doi: 10.1186/s12884-019-2480-7.
The Helping Babies Breathe (HBB) educational program focuses on training of first-level birth attendants in neonatal resuscitation skills for the first minute of life (The Golden Minute). Pre-post studies of HBB implementation in sub-Saharan Africa and Asia have shown reductions in facility-based very early neonatal mortality and stillbirth rates. However, the Global Network pre-post HBB Implementation Study (GN-HBB-IS) found no difference in day 7 perinatal mortality rates (PMR-D7) among births to women participating in the Global Network's Maternal and Newborn Health Registry. To address potential differences in perinatal outcomes in births occurring in facilities that implemented HBB vs. all births occurring in the communities served by facilities that implemented HBB, we compared day-1 perinatal mortality rates (PMR-D1) among births occurring pre and post HBB implementation in facilities in Nagpur, India, one of the 3 sites participating in the GN-HBB-IS.
We hypothesized that there would be a 20% decrease in the Nagpur facility based PMR-D1 in the 12 months post GN HBB implementation from the pre-period. We explored pre-post differences in stillbirth rates (SBR) and day-1 neonatal mortality rates (NMR-D1).
Of the 15 facilities trained for the GN-HBB-IS, 13 participated in the Nagpur HBB Facility Study (Nagpur-HBB-FS). There were 38,078 facility births in the 12 months before the GN-HBB-IS and 40,870 facility births in the 12 months after the GN-HBB-IS. There was 11% overlap between the registry births analyzed in the GN-HBB-IS and the facility births analyzed in the Nagpur-HBB-FS. In the Nagpur-HBB-FS, there was a pre-post reduction of 16% in PMR-D1 (p = 0.0001), a 14% reduction in SBR (p = 0.002) and a 20% reduction NMR-D1 (p = 0.006).
In the Nagpur-HBB-FS, PMR-D1, stillbirths and NMR-D1 were significantly lower after HBB implementation. These benefits did not translate to improvements in PMR-D7 in communities served by these facilities, possibly because facilities in which HBB was implemented covered an insufficient proportion of community births or because additional interventions are needed after day 1 of life. Further studies are needed to determine how to translate facility-based improvements in PMR-D1 to improved neonatal survival in the community.
The Global Network HBB Implementation Study (GN-HBB-IS) was registered at ClinicalTrials.gov: NCT01681017 .
“帮助婴儿呼吸”（HBB）教育项目专注于培训一级分娩人员掌握新生儿复苏技能，以应对生命最初的一分钟（黄金一分钟）。在撒哈拉以南非洲和亚洲实施 HBB 的前后研究表明，机构内的极早期新生儿死亡率和死产率有所降低。然而，全球网络 HBB 实施前后研究（GN-HBB-IS）发现，参与全球网络母婴健康登记处的妇女分娩的第 7 天围产死亡率（PMR-D7）没有差异。为了解决在实施 HBB 的机构中分娩的围产结局与在实施 HBB 的机构服务的社区中所有分娩之间可能存在的差异，我们比较了印度那格浦尔设施中实施 HBB 前后第 1 天围产死亡率（PMR-D1），该设施是参与 GN-HBB-IS 的 3 个地点之一。
我们假设在 GN HBB 实施后的 12 个月内，那格浦尔设施的基于 PMR-D1 的基础上会降低 20%。我们探讨了死产率（SBR）和第 1 天新生儿死亡率（NMR-D1）的前后差异。
在为 GN-HBB-IS 接受培训的 15 个设施中，有 13 个参与了那格浦尔 HBB 设施研究（Nagpur-HBB-FS）。在 GN-HBB-IS 之前的 12 个月内，有 38078 例机构分娩，在 GN-HBB-IS 之后的 12 个月内，有 40870 例机构分娩。在 GN-HBB-IS 中分析的登记处分娩和在 Nagpur-HBB-FS 中分析的设施分娩之间有 11%的重叠。在 Nagpur-HBB-FS 中，PMR-D1 在前后期减少了 16%（p=0.0001），死产率减少了 14%（p=0.002），NMR-D1 减少了 20%（p=0.006）。
在那格浦尔-HBB-FS 中，实施 HBB 后，PMR-D1、死产和 NMR-D1 明显降低。这些好处并没有转化为这些设施服务社区的 PMR-D7 的改善，这可能是因为实施 HBB 的设施仅覆盖了社区分娩的一小部分，或者因为在生命的第 1 天后还需要额外的干预措施。需要进一步研究如何将机构内 PMR-D1 的改善转化为社区新生儿生存的改善。
全球网络 HBB 实施研究（GN-HBB-IS）在 ClinicalTrials.gov 注册：NCT01681017。
