Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

Wall, Stephen N.; Lee, Anne CC; Niermeyer, Susan; English, Mike; Keenan, William J.; Carlo, Wally; Bhutta, Zulfiqar A.; Bang, Abhay; Narayanan, Indira; Ariawan, Iwan; Lawn, Joy E.

doi:10.1016/j.ijgo.2009.07.013

« Previous Next »International Journal of Gynecology & Obstetrics
Volume 107, Supplement , Pages S47-S64, October 2009

Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

Stephen N. Wall
- Saving Newborn Lives/Save the Children USA, Washington DC and Cape Town, South Africa
Anne CC Lee
- Saving Newborn Lives/Save the Children USA, Washington DC and Cape Town, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Susan Niermeyer
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO, USA
Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
William J. Keenan
- St Louis University, St Louis, MI, USA
Wally Carlo
- University of Alabama at Birmingham, AL, USA
Zulfiqar A. Bhutta
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
Abhay Bang
- Society for Education, Action and Research in Community Health, Gadchiroli, Maharashtra, India
Indira Narayanan
- USAID/BASICS, Washington DC, USA
Iwan Ariawan
- PATH, Indonesia
Joy E. Lawn
- Saving Newborn Lives/Save the Children USA, Washington DC and Cape Town, South Africa
- Corresponding author. Saving Newborn Lives/Save the Children USA, 11 South Way, Cape Town 7405, South Africa. Tel.: +27 21 532 3494.

Abstract

Background

Each year approximately 10million babies do not breathe immediately at birth, of which about 6million require basic neonatal resuscitation. The major burden is in low-income settings, where health system capacity to provide neonatal resuscitation is inadequate.

Objective

To systematically review the evidence for neonatal resuscitation content, training and competency, equipment and supplies, cost, and key program considerations, specifically for resource-constrained settings.

Results

Evidence from several observational studies shows that facility-based basic neonatal resuscitation may avert 30% of intrapartum-related neonatal deaths. Very few babies require advanced resuscitation (endotracheal intubation and drugs) and these newborns may not survive without ongoing ventilation; hence, advanced neonatal resuscitation is not a priority in settings without neonatal intensive care. Of the 60million nonfacility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum-related neonatal deaths, based on expert opinion. Case studies illustrate key considerations for scale up.

Conclusion

Basic resuscitation would substantially reduce intrapartum-related neonatal deaths. Where births occur in facilities, it is a priority to ensure that all birth attendants are competent in resuscitation. Strategies to address the gap for home births are urgently required. More data are required to determine the impact of neonatal resuscitation, particularly on long-term outcomes in low-income settings.

Keywords: Asphyxia neonatorum, Birth asphyxia, Intrapartum-related neonatal deaths, Low-income countries, Neonatal, Neonatal encephalopathy, Neonatal resuscitation, Newborn resuscitation, Perinatal, Hypothermia