Jiang Li, Dominguez Georgia, Cummins Aoife, Muralidharan Oviya, Harrison Leila, Vaivada Tyler, Bhutta Zulfiqar A
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Global Health Department, McMaster University, Hamilton, Ontario, Canada.
Neonatology. 2025;122(Suppl 1):106-128. doi: 10.1159/000541037. Epub 2024 Nov 12.
Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.
We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.
Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.
We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.
已证实，在出生时或出生后24小时内对新生儿采取的几种干预措施对改善新生儿存活率及其他出生结局至关重要。我们旨在更新这些干预措施在低收入和中等收入国家（LMICs）的有效性和安全性方面的情况。
在对文献进行全面的范围界定后，我们更新或重新分析了纳入主题的特定于LMICs的证据。共确定了94项LMICs研究。延迟脐带结扎并在结扎后立即进行新生儿护理，可降低孕周<32 - 34周新生儿输血风险，并降低足月儿贫血发生率，但对早产和足月新生儿的死亡率或其他常见疾病并无显著影响。使用塑料薄膜/袋子进行即时保暖护理可使早产新生儿体温过低风险降低38%，并使其腋窝温度升高，且不会增加体温过高的风险。立即（iKMC）或出生后早期（eKMC，24小时内）开始袋鼠式护理可显著降低早产或低体重新生儿的死亡率及体温过低的发生率。对于新生儿延迟首次洗澡，由于纳入研究的高度异质性，未得出汇总估计值。来自高收入国家的试验表明，如果在产后72小时内给予抗-D，可有效降低后续妊娠中恒河猴D同种免疫的发生率。
我们生成了关于几种即时新生儿护理干预措施的最新LMICs证据。尽管它们在改善某些新生儿结局方面具有有效性和安全性，但仍需要进一步的高质量试验。
已证实，在出生时或出生后24小时内对新生儿采取的几种干预措施对改善新生儿存活率及其他出生结局至关重要。我们旨在更新这些干预措施在低收入和中等收入国家（LMICs）的有效性和安全性方面的情况。
在对文献进行全面的范围界定后，我们更新或重新分析了纳入主题的特定于LMICs的证据。共确定了94项LMICs研究。延迟脐带结扎并在结扎后立即进行新生儿护理，可降低孕周<32 - 34周新生儿输血风险，并降低足月儿贫血发生率，但对早产和足月新生儿的死亡率或其他常见疾病并无显著影响。使用塑料薄膜/袋子进行即时保暖护理可使早产新生儿体温过低风险降低38%，并使其腋窝温度升高，且不会增加体温过高的风险。立即（iKMC）或出生后早期（eKMC，24小时内）开始袋鼠式护理可显著降低早产或低体重新生儿的死亡率及体温过低的发生率。对于新生儿延迟首次洗澡，由于纳入研究的高度异质性，未得出汇总估计值。来自高收入国家的试验表明，如果在产后72小时内给予抗-D（药物），可有效降低后续妊娠中恒河猴D同种免疫的发生率。
我们生成了关于几种即时新生儿护理干预措施的最新LMICs证据。尽管它们在改善某些新生儿结局方面具有有效性和安全性，但仍需要进一步的高质量试验。
