1 / 15

Albert Manasyan, MD; Wally Carlo, MD and the FIRST BREATH Study Group

Global Network for Women’s and Children’s Health Research Resuscitation: How to Save One Million Lives Per Year. Albert Manasyan, MD; Wally Carlo, MD and the FIRST BREATH Study Group For the Global Network for Women’s and Children’s Health Research. Stillbirth and Neonatal Deaths Per Year.

peigi
Télécharger la présentation

Albert Manasyan, MD; Wally Carlo, MD and the FIRST BREATH Study Group

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Global Network for Women’s and Children’s Health ResearchResuscitation: How to Save One Million Lives Per Year Albert Manasyan, MD; Wally Carlo, MD and the FIRST BREATH Study Group For the Global Network for Women’s and Children’s Health Research

  2. Stillbirth and Neonatal Deaths Per Year • 98% of all stillbirths and neonatal deaths occur in developing countries • ~ 2.6 million stillbirths • ~ 3.5 million neonatal deaths • Preterm 1.0 mil • Birth asphyxia 0.8 mil • Sepsis 0.5 mil • Other 1.2 mil

  3. Background: Essential Newborn Care • The WHO developed Essential Newborn Care (ENC) course sets minimum standards for training birth attendants in neonatal care including: • Basic resuscitation • Universal precautions • Routine neonatal care • Thermoregulation • Breastfeeding • Kangaroo mother (skin-to-skin) care • Care of the small baby • Danger signs

  4. First Breath Protocols • The First Breath protocols were designed to address the impact of Essential Newborn Care (ENC) on perinatal mortality: • First Breath: Clinic Study • First Breath: Common Protocol

  5. Comparison of First Breath Protocols

  6. First Breath: Clinic Study Design: Pre-Post controlled study with active baseline data collection Setting: Level 1 health delivery centers in Zambia Interventions: WHO ENC (including resuscitation training) and NRP Patients: 71,689 low risk newborns Carlo W et al. Pediatrics 126:e1064-71, 2010.

  7. First Breath: Clinic Study Results Pre-ENC Post-ENC p value All cause 7-day mortality/1000 11.5 6.8 p<0.001 Perinatal mortality/1000 18.3 12.9 p=0.002 Mortality due to asphyxia/1000 3.4 1.9 p=0.02 Mortality due to infection/1000 2.2 0.8 p=0.02 Mortality < 1500/1000gr 576 407 p=0.049 SB rate/1000 4.9 4.9 NS Carlo W et al. Pediatrics 126:e1064-71, 2010.

  8. Delivery by Birth Attendant Birth Attendant Home 10% Family members 19% Physician 16% Clinic 9% TBA 37% Nurse/Midwife 28% Hospital 25% Home 56% Carlo et al. N Engl J Med. 362:614-23, 2010.

  9. First Breath: Common Protocol 1. Population-based prospective study 2. 96 communities in 6 countries (7 clinical sites) in South America, Africa, and Asia 3. 3,676 birth attendants trained in data collection and clinical measures (fetal heart rate monitoring, Apgar scoring etc.) 4. Active baseline data collection 5. Training in ENC 6. Post-ENC data collection

  10. Results Pre-ENC Rate/1000 Post-ENC Rate/1000 RR (CI) Stillbirth 23.0 15.9 0.69 (0.54 ,0.88) All cause 7-day mortality 23.4 23.2 0.99 (0.81, 1.22) Perinatal mortality 45.9 38.9 0.85 (0.70, 1.02) First Breath: Common Protocol Carlo et al. N Engl J Med. 362:614-23, 2010.

  11. Family/ Unattended Traditional Birth Attendant Nurse/Midwife Physician All Birth Attendants Pre-Post ENC Perinatal Mortality Rates by Birth Attendant Perinatal Mortality * * Carlo et al. N Engl J Med. 362:614-23, 2010.

  12. Methods: Cost Analysis • Cost-effectiveness was calculated as follows: Cost per life saved = Cost Reduction in death • Cost per disability-adjusted life years (DALY) was calculated as follows: Cost per DALY = Cost per life saved Life expectancy

  13. Results: DALY Cost per DALY = Cost per life saved Life expectancy Cost per DALY = $208 39.7 years Cost per DALY = $5.24

  14. Final Conclusions 1. WHO ENC training of midwives in first level centers reduced neonatal mortality by ~10/1000 2. This intervention was very cost-effective in first level facilities ($5 per DALY) 3. In communities, ENC reduced fresh stillbirths and perinatal mortality without increasing neonatal mortality 4. Survivors of birth asphyxia have low rates of impairment

  15. Acknowledgement Support for this project from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health within the U.S. Department of Health and Human Services, and the Bill and Melinda Gates Foundation

More Related