Impact of a Country-Wide Implementation of the Neonatal Resuscitation Program
Oswaldo Revelo-Castro, Carlos Ramos, Yanira Burgos, Claudia de Alas, Lorena Parada, Waldemar A. Carlo. Departamento Neonatologia, Hospital Nacional de Ninos, San Salvador, El Salvador; Gerencia del Nino, Ministerio de Salud Publica y Asistencia Social, San Salvador, El Salvador; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
BACKGROUND: Neonatal mortality due to birth asphyxia continues to account for a substantial proportion of neonatal mortality. Neonatal resuscitation programs may reduce neonatal mortality due to asphyxia but their impact on survival in developing countries needs to be determined.
OBJECTIVE: To determine if training in neonatal resuscitation decreases all cause neonatal mortality and neonatal morbidity due to birth asphyxia.
DESIGN/METHODS: The Ministry of Health in El Salvador in collaboration with non govermental organizations introduced the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) in a progressive fashion starting in 2000 in an effort to decrease neonatal mortality due to birth asphyxia (failure to initiate and sustain normal breathing at birth). NRP courses were provided to train hospital-based perinatal health care providers in all 28 delivery hospitals in El Salvador. Trends in rates and causes of institutional neonatal mortality were analyzed before and following NRP training.
RESULTS: From 2000 to 2004 3,415 hospital-based perinatal health care providers have been trained nationwide by 113 instructors. The proportion of trained personnel reached 12% by 2001, 38% by 2002, and 76% by 2003. All cause neonatal mortality decreased from 12.2 per 1,000 to 10.2 per 1,000 (P=0.02) and mortality due to birth asphyxia decreased from 1.22 per 1,000 to 0.70 per 1,000 (P=0.06) from 1999 to 2004 (Table).
CONCLUSIONS: Country-wide implementation of NRP in a developing country may reduce neonatal mortality. Because of possible cofounders, controlled trials are needed to confirm these findings.
|Year||All Cause Mortality||Mortality due to Ashphyia|
PAS 2005: 57: 2412
Tuesday, May 17, 2005 11:00 am, Washington Convention Center - Room 207 A
Platform Session: Global Perspectives on Birth Asphyxia, Part II (10:30 AM - 12:30 PM)
Course Number: 7350