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Every Newborn: progress, priorities, and potential beyond survival
In this Series paper, we review trends since the 2005 Lancet Series on Neonatal Survival to inform acceleration of progress for newborn health post-2015. On the basis of multicountry analyses and multi-stakeholder consultations, we propose national targets for 2035 of no more than 10 stillbirths per 1000 total births, and no more than 10 neonatal deaths per 1000 livebirths, compatible with the under-5 mortality targets of no more than 20 per 1000 livebirths. We also give targets for 2030. Reduction of neonatal mortality has been slower than that for maternal and child (1–59 months) mortality, slowest in the highest burden countries, especially in Africa, and reduction is even slower for stillbirth rates. Birth is the time of highest risk, when more than 40% of maternal deaths (total about 290 000) and stillbirths or neonatal deaths (5·5 million) occur every year. These deaths happen rapidly, needing a rapid response by health-care workers. The 2·9 million annual neonatal deaths worldwide are attributable to three main causes: infections (0·6 million), intrapartum conditions (0·7 million), and preterm birth complications (1·0 million). Boys have a higher biological risk of neonatal death, but girls often have a higher social risk. Small size at birth—due to preterm birth or small-for-gestational-age (SGA), or both—is the biggest risk factor for more than 80% of neonatal deaths and increases risk of post-neonatal mortality, growth failure, and adult-onset non-communicable diseases. South Asia has the highest SGA rates and sub-Saharan Africa has the highest preterm birth rates. Babies who are term SGA low birthweight (10·4 million in these regions) are at risk of stunting and adult-onset metabolic conditions. 15 million preterm births, especially of those younger than 32 weeks' gestation, are at the highest risk of neonatal death, with ongoing post-neonatal mortality risk, and important risk of long-term neurodevelopmental impairment, stunting, and non-communicable conditions. 4 million neonates annually have other life-threatening or disabling conditions including intrapartum-related brain injury, severe bacterial infections, or pathological jaundice. Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change them. Failure to improve birth outcomes by 2035 will result in an estimated 116 million deaths, 99 million survivors with disability or lost development potential, and millions of adults at increased risk of non-communicable diseases after low birthweight. In the post-2015 era, improvements in child survival, development, and human capital depend on ensuring a healthy start for every newborn baby—the citizens and workforce of the future.
Journal Article
Financial Support to Medicaid-Eligible Mothers Increases Caregiving for Preterm Infants
ObjectivesTo assess the impact of financial support on maternal caregiving activities for preterm infants.MethodsWe conducted a small randomized controlled trial (RCT) in two Massachusetts Neonatal Intensive Care Units (NICUs). We enrolled 46 Medicaid-eligible mothers of preterm infants between January 2017 and June 2018 and randomly assigned them to a treatment group (up to 3 weekly financial transfers of $200 each while their infant was in the hospital) or a control group. We collected hospital-record data while the infant was admitted. The primary outcome was a binary variable indicating skin-to-skin care (STSC) was provided during a hospital day. Secondary outcomes included daily maternal visitation, daily provision of breastmilk, neonatal growth and length of stay (LOS). Multilevel generalized linear models with random effects were used to estimate treatment effects on daily maternal behaviors and ordinary least squares models were used to estimate impacts on neonatal growth and LOS.ResultsWe assigned 25 women to the intervention and 21 to the control and observed them over 703 days of their infants’ hospitalization. Mothers who received financial support were more likely to provide STSC (adjusted risk ratio: 1.85; 95% confidence interval [CI] 1.31–2.62) and breastmilk (adjusted risk ratio: 1.36; 95% CI 1.06–1.75) while their infant was in the NICU. We see no statistically significant impact on neonatal growth outcomes or LOS, though estimated confidence intervals are imprecise.ConclusionsOur evidence demonstrates the potential for financial support to increase mothers' engagement with caregiving behaviors for preterm infants during the NICU stay.
Journal Article
Appropriate complementary feeding practices and associated factors among mothers of children age 6–23 months in Southern Ethiopia, 2015
Background
Poor complementary feeding of children aged 6–23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Evidences have shown that promotion of appropriate complementary feeding practices reduces the incidence of stunting and leads to better health and growth outcome. This study was aimed at assessing practices of complementary feeding and associated factors among mothers of children aged 6–23 months.
Methods
A community-based cross sectional study design was conducted among 611 mothers who had children with 6–23 months of age in the ten randomly selected Kebeles (smallest administrative unit). A multistage sampling technique was used to identify study subjects. Data were collected using pre-tested structured questionnaire. Data were entered in to Epi info version 3.5.1. Data cleaning and analysis were done using SPSS version 16. Odds ratios (ORs) with 95 % confidence interval (CI) were computed to measure the strength of association.
Results
The response rate was 97.6 % (611/626). The practices of timely initiation of complementary feeding, minimum meal frequency and minimum dietary diversity were 72.5, 67.3 and 18.8 % among mothers of 6–23 months aged children, respectively. The practice of appropriate complementary feeding was 9.5 %. Child’s age (12–17 and 18–23 months) [Adjusted OR: 2.75 (95 % CI: 1.07 7.03), 2.64 (95 % CI: 1.06 6.74)], educational level of mother (primary and secondary and above schools) [AOR: 3.24 (1.28 8.20), 3.21 (1.1.07 9.70)], and smaller family size [AOR: 12.10 (95 % CI: 1.10 139.7)] were found to be independent predictors of appropriate complementary feeding practice of 6–23 months old children.
Conclusion
Low appropriate complementary feeding of children aged 6–23 months was observed. Mothers who are illiterate, children age 6–11 months and families with large size were associated factors for inappropriate feeding practices. Therefore, nutritional counseling on child feeding practices were recommended.
Journal Article
Caring for your baby and young child : birth to age 5
Based on the latest AAP recommendations, this evidence-based guide covers everything from preparing for childbirth to breastfeeding and from toilet training to starting school. The revised and updated eighth edition reflects current AAP policy statements and guidelines. Also included is a complete health encyclopedia addressing injuries, illnesses, congenital diseases, and other disabilities.
BOOK
Physiological stability in an indigenous sleep device: a randomised controlled trial
ObjectiveTo compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits.DesignRandomised controlled trial.SettingFamily homes in low socio-economic areas in New Zealand.Patients200 mainly Māori mothers and their infants.InterventionsParticipants received a wahakura or bassinet from birth.Main outcome measuresOvernight oximetry, heart rate and temperature at 1 month.ResultsIntention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures.ConclusionsThis indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing.Trial registration numberAustralian New Zealand Clinical Trials Registry: ACTRN12610000993099.
Journal Article
Impact of an integrated nutrition, health, water sanitation and hygiene, psychosocial care and support intervention package delivered during the pre- and peri-conception period and/or during pregnancy and early childhood on linear growth of infants in the first two years of life, birth outcomes and nutritional status of mothers: study protocol of a factorial, individually randomized controlled trial in India
Background
The period from conception to two years of life denotes a critical window of opportunity for promoting optimal growth and development of children. Poor nutrition and health in women of reproductive age and during pregnancy can negatively impact birth outcomes and subsequent infant survival, health and growth. Studies to improve birth outcomes and to achieve optimal growth and development in young children have usually tested the effect of standalone interventions in pregnancy and/or the postnatal period. It is not clearly known whether evidence-based interventions in the different domains such as health, nutrition, water sanitation and hygiene (WASH) and psychosocial care, when delivered together have a synergistic effect. Further, the effect of delivery of an intervention package in the pre and peri-conception period is not fully understood. This study was conceived with an aim to understand the impact of an integrated intervention package, delivered across the pre and peri-conception period, through pregnancy and till 24 months of child age on birth outcomes, growth and development in children.
Methods
An individually randomized controlled trial with factorial design is being conducted in urban and peri-urban low- to mid-socioeconomic neighbourhoods in South Delhi, India. 13,500 married women aged 18 to 30 years will be enrolled and randomized to receive either the pre and peri-conception intervention package or routine care (first randomization). Interventions will be delivered until women are confirmed to be pregnant or complete 18 months of follow up. Once pregnancy is confirmed, women are randomized again (second randomization) to receive either the intervention package for pregnancy and postnatal period or to routine care. Newborns will be followed up till 24 months of age. The interventions are delivered through different study teams. Outcome data are collected by an independent outcome ascertainment team.
Discussion
This study will demonstrate the improvement that can be achieved when key factors known to limit child growth and development are addressed together, throughout the continuum from pre and peri-conception until early childhood. The findings will increase our scientific understanding and provide guidance to nutrition programs in low- and middle-income settings.
Trial registration
Clinical Trial Registry – India
#CTRI/2017/06/008908
; Registered 23 June 2017,
http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies
Journal Article
Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study
BackgroundThe thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed.ObjectiveTo compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth.Study design and settingMulticentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals.ParticipantsInfants with estimated birth weight <1500 g and/or gestational age <30+6 weeks.InterventionThermal management with or without a thermal servo-controlled system during stabilisation in the delivery room.Primary outcomeProportion of normothermia at NICU admission (axillary temperature 36.5°C–37.5°C).ResultsAt NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C–36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01).ConclusionsIn very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge.Trial registration number NCT03844204
Journal Article