Journal Article

Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study

Say, Wah Wah, Thin, Nant War War, Janet, Sophie, Paw, Naw Ta Mlar, Carrara, Verena I., Chotivanich, Kesinee, Crawley, Jane, Simpson, Julie A., Turner, Claudia, McGready, Rose

2018

Overview

Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable. Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border. From 21,225 newbonrs delivered, 15,073 (71%) met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU). Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced) cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06). Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442), and 6.32 (95%CI 3.01-13.26; p<0.001) respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001). Neurodevelopmental follow-up to one year was performed in 1,608 (10.5%) of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565) versus 63 (n = 41); p = 0.732), while advanced resuscitation scores were significantly lower (56 (n = 5); p = 0.017). Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery) associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Biology and Life Sciences / Cardiopulmonary resuscitation / Cohort Studies / CPR / Fatalities / Fetuses / Gestation / Health Care Rationing / Hospitals / Humans / Hypoxia / Infant / Infant Mortality / Infant, Newborn / Intubation / Low income groups / Malaria / Marginalized groups / Meconium / Medicine / Medicine and Health Sciences / Morbidity / Mortality / Myanmar - epidemiology / Neonatal care / Neonates / Nervous System - physiopathology / Newborn babies / Pregnancy / Resuscitation / Retrospective Studies / Risk analysis / Risk factors / Thailand - epidemiology / Ultrasonic imaging / Vector-borne diseases / Ventilation / Ventilators