Implementation status and effectiveness evaluation of early essential newborn care in 156 pilot hospitals
10.3760/cma.j.cn113903-20240223-00150
- VernacularTitle:全国156所试点医院新生儿早期基本保健技术实施现状及效果评价
- Author:
Xiaosong YANG
1
;
Yun LIN
;
Tao XU
Author Information
1. 中国疾病预防控制中心妇幼保健中心儿童保健部，北京 100081
- Keywords:
Early essential newborn care;
Implementation status;
Effectiveness evaluation
- From:
Chinese Journal of Perinatal Medicine
2024;27(7):582-587
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the current implementation status of early essential newborn care (EENC) core interventions in China.Methods:Based on the Safe Neonatal Project jointly launched by the National Health Commission and United Nations International Children's Emergency Fund (UNICEF), a questionnaire survey was conducted on the implementation of eight EENC core interventions in 161 pilot hospitals. The eight interventions were skin-to-skin contact immediately after birth for at least 90 min, delayed cord clamping (until 1 min after birth or after the cord stopped pulsating), initiation of breastfeeding within the first hour after birth, exclusive breastfeeding at discharge, delayed first bath (24 h after birth), kangaroo mother care, eye care (using erythromycin ointment or other eye drops), and intramuscular injection of vitamin K 1. The survey was completed by the pilot units based on actual conditions from January 1 to December 31, 2022. Neonatal disease information was obtained from medical records from birth to discharge, and neonatal mortality rates were obtained from outpatient and inpatient records in obstetric institutions. The main indicators were the implementation rates of EENC core interventions in the eastern, central, and western regions, as well as the neonatal mortality and the incidence of common neonatal diseases in hospitals that implemented EENC or not. Chi-square test was used for data comparison. Results:A total of 156 pilot hospitals completed the survey, with 66 (42.3%) in the eastern region, 45 (28.8%) in the central region, and 45 (28.8%) in the western region. The implementation rates of skin-to-skin contact immediately after birth for at least 90 min, initiation of breastfeeding within the first hour after birth, exclusive breastfeeding at discharge, kangaroo mother care, eye care, and intramuscular injection of vitamin K 1 were higher in the western region than in the eastern and central regions [60.1% (62 491/104 012) vs. 22.4% (104 991/467 982) and 29.4% (31 419/106 812), 76.5% (78 188/102 266) vs. 41.2% (188 740/458 627) and 62.9% (67 200/106 812), 74.0% (60 062/81 141) vs. 39.7% (181 921/458 627) and 70.2% (74 947/106 812), 27.9% (1 407/5 035) vs. 9.4% (1 670/17 807) and 22.9% (2 510/10 968), 46.9% (48 442/103 313) vs. 23.0% (105 917/461 176) and 31.4% (31 731/100 966), 96.2% (51 674/53 729) vs. 56.6% (263 273/465 433) and 92.1% (98 365/106 812), χ 2 values were 58 218.40, 50 113.04, 55 466.24, 1 456.92, 24 686.13, and 72 696.66, respectively, all P<0.001]. The implementation rates of delayed cord clamping and delayed first bath were higher in the central region than in the eastern and western regions [76.9% (82 161/106 812) vs. 37.0% (163 808/443 285) and 59.3% (60 596/102 266), 75.0% (80 159/106 812) vs. 46.6% (216 935/465 433) and 68.4% (71 161/104 012), χ 2 values were 62 516.10 and 37 987.11, respectively, both P<0.001]. Seventy-six hospitals (48.7%) implemented EENC, while 80 hospitals (51.3%) did not. The neonatal mortality and the incidence of neonatal asphyxia, sepsis, pneumonia, diarrhea, eye infection, and umbilical cord infection were higher in the hospitals that did not implement EENC than in those that did [1.3‰ (478/378 519) vs. 1.0‰ (645/679 795), 1.8% (6 849/378 519) vs. 0.9% (5 895/679 795), 1.0% (3 917/378 519) vs. 0.7% (5 029/679 795), 6.2% (23 481/377 890) vs. 3.8% (25 463/679 795), 0.2% (916/378 519) vs. 0.1% (950/656 781), 0.5% (1 837/370 540) vs. 0.2% (1 403/656 949), 1.1‰ (422/375 149) vs. 0.6‰ (405/672 291), χ 2 values were 22.62, 1 766.11, 184.86, 2 832.09, 100.89, 866.59, and 64.94, respectively, all P<0.001]. Conclusions:About half of the pilot hospitals did not carry out EENC and the implementation of specific measures in hospitals carrying out EENC still needs to be improved. The implementation rate of EENC core measures is high in some regions, but there are regional differences.Neonatal health outcomes were better in hospitals with EENC than in hospitals without EENC.
