Indian Pediatrics

, Volume 49, Issue 8, pp 651–658 | Cite as

Does facility-based newborn care improve neonatal outcomes? A review of evidence

  • Sutapa Bandyopadhyay Neogi
  • Sumit Malhotra
  • Sanjay Zodpey
  • Pavitra Mohan
Review Article

Abstract

Context

Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality.

Objective

To assess different factors that affect effectiveness of facility based newborn care on neonatal outcomes.

Evidence acquisition

Electronic search using key search engines along with search of grey literature manually. Observational and interventional studies published between 1966–Aug 2010 in English having a change in neonatal mortality as an outcome measure were considered.

Results

A total of 40 articles were fully reviewed for generating synthesized evidence. All were observational studies. The exposure variables that affected neonatal outcomes were grouped into three categories-regionalization of perinatal care (17 articles), strengthening of lower level neonatal facilities (12), and other miscellaneous factors (11). Regionalization played a key role in advancing newborn care practices. It increased in-utero transfer of high risk newborns and improved survival outcomes especially for very low birth weight neonates at level III facilities. It led to reduction in neonatal mortality owing primarily to enhanced survival of low birth weight infants. Strengthening of lower level units contributed significantly in reducing neonatal mortality. High patient volume (>2,000 deliveries/year), inborn status, availability of referral system and inter-facility transfers, and adequate nursing care staff in neonatal units also demonstrated protective effect in averting neonatal deaths.

Conclusions

Countries investing in facility based newborn care should give impetus to establishing regionalized systems of perinatal care. Strengthening of lower level units with high case loads, can yield optimal reduction in NMR.

Key words

Efficacy Evaluation Mortality rate Newborn Outcome Regionalization 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Supplementary material

13312_2012_135_MOESM1_ESM.pdf (265 kb)
Supplementary material, approximately 264 KB.

References

  1. 1.
    Knippenberg R, Lawn JE, Darmstadt GL, Begkoyian G, Fogstad H, Walelign N, et al. Systematic scaling up of neonatal care in countries. Lancet. 2005;365:1087–1098.PubMedGoogle Scholar
  2. 2.
    Bahl R, Martines J, Ali N, Bhan MK, Carlo W, Chan KY, et al. Resaerch priorities to reduce global mortality from newborn infections by 2015. Pediatr Infect Dis. 2009;28:S43–S48.CrossRefGoogle Scholar
  3. 3.
    Bowes WA. A review of perinatal mortality in Colorado, 1971 to 1978, and its relationship to the regionalization of perinatal services. Am J Obstet Gynecol. 1983; 141: 1045–1052.Google Scholar
  4. 4.
    Hein HA, Lathrop SS. The changing pattern of neonatal mortality in a regionalized system of perinatal care. Am J Dis Child. 1986;140:989–993.PubMedGoogle Scholar
  5. 5.
    Committee on Perinatal Health. Toward Improving the Outcome of Pregnancy: Recommendations for the Regional Development of Maternal and Perinatal Health Services. White Plains, NY: March of Dimes National Foundation; 1976.Google Scholar
  6. 6.
    Gould JB, Marks AR, Chavez G. Expansion of community based perinatal care in California. J Perinatol. 2002;22:630–640.PubMedCrossRefGoogle Scholar
  7. 7.
    Neto MT. Perinatal care in Portugal: effects of 15 years of a regionalized system. Acta Pediatrica. 2006;95:1349–1352.CrossRefGoogle Scholar
  8. 8.
    Mullem CV, Conway AE, Mounts K, Weber D, Browning CA. Regionalization of care in Winconsin: a changing health care environment. Wisconsin Medical Journal. 2004;103:35–38.PubMedGoogle Scholar
  9. 9.
    Howell EM, Richardson D, Ginsburg P, Foot B. Deregionalization of neonatal intensive care in urban areas. Am J Public Health. 2002;92:119–124.PubMedCrossRefGoogle Scholar
  10. 10.
    Peddle LJ, Brown H, Buckley J, Dixon W, Kaye JM, Muise M, et al. Voluntary regionalization and associated trends in perinatal care: The Nova Scotia Reproductive Care Program. Am J Obstet Gynecol. 1983;145:170–176.PubMedGoogle Scholar
  11. 11.
    Kirby RS. Perinatal mortality: the role of hospital at birth. J Perinatol. 1996;16:43–49.PubMedGoogle Scholar
  12. 12.
    Mayfield JA, Rosenblatt RA, Baldwin LM, Chu J, Logefro JP. The relation of obstetrical volume and nursery level to perinatal mortality. Am J Public Health. 1990;80:819–823.PubMedCrossRefGoogle Scholar
  13. 13.
    Chien LY, Whyte R, Aziz K, Thiessen P, Matthew D, Lee SK, et al. Improved outcome of pre term infants when delivered in tertiary care centres. Obstet Gynecol. 2001;98:247–252.PubMedCrossRefGoogle Scholar
  14. 14.
    Cust AE, Darlow BA, Donoghue DA, on behalf of the Australian and New Zealand Neonatal Network (ANZNN). Outcomes for high risk New Zealand newborn infants in 1998–1999: a population based, national study. Arch Dis Child Fetal Neonatal Ed. 2003;88:F15–F22.PubMedCrossRefGoogle Scholar
  15. 15.
    Manatgos S. International Perinatology/neonatology-a global perspective. Neonatal perinatal care in Greece. J Perinatol. 1997;17:156–160.Google Scholar
  16. 16.
    Cifuentes J, Bronstein J, Phibbs CS, Phibbs RH, Schmitt SK, Carlo WA. Mortality in low birth weight infants according to level of neonatal care at hospital of birth. Pediatrics. 2002;109:745–751.PubMedCrossRefGoogle Scholar
  17. 17.
    Bode MM, O’shea TM, Metzguer KR, Stiles AD. Perinatal regionalization and neonatal mortality in North Carolina 1968–1994. Am J Obstet Gynecol. 2001;184:1302–1307.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldenberg RL, Humphrey JL, Hale CB, Boyd BW, Wayne JB. Neonatal deaths in Alabama, 1970–80: an analysis of birth weight- and race specific neonatal mortality rates. Am J Obstet Gynecol. 1983;145:545–552.PubMedGoogle Scholar
  19. 19.
    Skelton MA, Perkett EA, Major CW, Vaughan RL, Stahlman MT. Transport of the neonate. Southern Medical Journal. 1979;72:144–148.PubMedCrossRefGoogle Scholar
  20. 20.
    Walker DB, Vohr BR, Oh W. Economic analysis of regionalized neonatal care for very low-birth-weight infants in the state of Rhode Island. Pediatrics. 1985;76:69–74.PubMedGoogle Scholar
  21. 21.
    Rosenblatt RA, Mayfield JA, Hart LG, Baldwin LM. Outcomes of regionalized perinatal care in Washington state. West J Med. 1988;149:98–102.PubMedGoogle Scholar
  22. 22.
    Campbell MK, Chance GW, Natale R, Dodman N, Halinda E, Turner L. Is perinatal care in south western Ontorio regionalized? Can Med Assoc J. 1991;144:305–312.Google Scholar
  23. 23.
    Hein HA, Lofgren MA. The changing pattern of neonatal mortality in a regionalized system of perinatal care: a current update. Pediatrics. 1999;104:1064–1069.PubMedCrossRefGoogle Scholar
  24. 24.
    Rosenblatt RA, Dawson AJ, Larson EH. The regionalization of perinatal care in Wales and Washington state. Am J Public Health. 1996;86:1011–1015.PubMedCrossRefGoogle Scholar
  25. 25.
    Gessner BD, Muth PT. Perinatal care regionalization and low birth weight infant mortality rates in Alaska. Am J Obstet Gynecol. 2001;185:623–628.PubMedCrossRefGoogle Scholar
  26. 26.
    Thompson RE, Souma ML, Cassdy G, Sumners J. Impact of intensive newborn acre on neonatal mortality in a community hospital. South Med J. 1976;69:688–690.PubMedCrossRefGoogle Scholar
  27. 27.
    Jivani SKM. Evolution of neonatal intensive care in a district general hospital. Arch Dis Child. 1986;61:148–152.PubMedCrossRefGoogle Scholar
  28. 28.
    Berge LN, Rasmussen S, Dahl LB. Evaluation of fetal and neonatal mortality at the University Hospital of Tromso, Norway, from 1976 to 1989. Acta Obstet Gynecol Scand. 1991;70:275–282.PubMedCrossRefGoogle Scholar
  29. 29.
    Hotrakitya S, Tejavej A, Siripoonya P. Early neonatal mortality and causes of death in Ramathibodi Hospital. J Med Assoc Thai. 1993 Oct;76 Suppl 2:119–129. 1981–90Google Scholar
  30. 30.
    Pollack LD. An effective model for reorganization of perinatal services in a metropolitan area: a descriptive analysis and historical perspective. J Perinatol. 1996;16:3–8.PubMedGoogle Scholar
  31. 31.
    Were FN, Mukhwana BO, Musoke RN. Neonatal survival of infants less than 2000 grams born at Kenyata National hospital. East African Med J. 2002;79:77–79.Google Scholar
  32. 32.
    Sen A, Mahalanabis D, Singh AK, Som TK, Bandyopadhyay S. Development and effects of a neonatal care unit in rural India. Lancet. 2005;366:27–28.PubMedCrossRefGoogle Scholar
  33. 33.
    Sen A, Mahalanabis D, Singh AK, Som TK, Bandyopadhyay S. Impact of a district level newborn care unit on neonatal neonatal mortality rate: 2 year follow up. J Perinatol. 2009;29:150–155.PubMedCrossRefGoogle Scholar
  34. 34.
    Nzinga J, Ntoburi S, Wagal J, Mbindyo P, Mbaabu L, Migiro S, et al. Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan District. Implementation Science. 2009;4:45.PubMedCrossRefGoogle Scholar
  35. 35.
    Laryea CCE, Nkyekyer K, Rodrigues OP. The impact of impoved neonatal intensive care facilities on referral patternand outcome at a teaching hospital in Ghana. J Perinatol. 2008;28:561–565.CrossRefGoogle Scholar
  36. 36.
    Mootabar H, Fox HE. Level 2 hospital delivery of low birth weight infants 1970–1979. Int J Gynaecol Obstet. 1983;21:27–32.PubMedCrossRefGoogle Scholar
  37. 37.
    Subramaniam C, Dadina ZK. Intensive care for high risk infants in Calcutta. Am J Dis Child. 1986;140:885–888.Google Scholar
  38. 38.
    Dooley SL, Freels SA, Turnock BJ. Quality assessment of perinatal regionalization by multivariate analysis: Illinois, 1991–1993. Obstet Gynecol. 1997;89:193–198.PubMedCrossRefGoogle Scholar
  39. 39.
    Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very low birth weight infants. N Engl J Med. 2007;356:2165–2175.PubMedCrossRefGoogle Scholar
  40. 40.
    Moster D, Lie RT, Markestad T. Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units. BJOG 2001;108: 904–909.PubMedCrossRefGoogle Scholar
  41. 41.
    Moster D, Lie RT, Markestad T. Relation between size of delivery unit and neonatal death in low risk deliveries: population based study. Arch Dis Child Fetal Neonatal Ed. 1999;80:F221–F225.PubMedCrossRefGoogle Scholar
  42. 42.
    Bartels DB, Wypij D, Wenzlaff P, Dammann O, Poets CF. Hospital volume and neonatal mortality among very low birth weight infants. Pediatrics. 2006;117:2206–2214.PubMedCrossRefGoogle Scholar
  43. 43.
    Sims DG, Wynn J, Chiswick ML. Outcome for newborn babies declined adsmission to a regional neonatal intensive care unit. Arch Dis Child. 1982;57:334–357.PubMedCrossRefGoogle Scholar
  44. 44.
    Sehgal A, Roy MS, Dubey NK, Jyothi MC. Factors contributing to outcome in newborns delivered out of hospital and referred to a teaching institution. Indian Pediatr. 2001;38:1289–1294.PubMedGoogle Scholar
  45. 45.
    Mori R, Fujimura M, Shiraishi J, Evans B, Corkett M, Negishi H, et al. Duration of inter facility transport and neonatal mortality: systematic review and cohort study. Pediatrics International. 2007;49:452–458.PubMedCrossRefGoogle Scholar
  46. 46.
    Callaghan LA, Cartwright DW, O’Rourke P, Davies MW. Infant to staff ratio and risk of mortality in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2003;88:F94–F97.PubMedCrossRefGoogle Scholar
  47. 47.
    Ferster G, Pethybridge RJ. A local maternity care system in South West England under review. International Journal of Health Services. 1975;5:663–678.PubMedCrossRefGoogle Scholar
  48. 48.
    Denny F, St John MA, Lewis DB, Daniel B. Nosocomial Klesiellapneuminiae colonization in a neonatal special care unit. Ann Trop Pediat. 1986;6:123–126.Google Scholar
  49. 49.
    Mugford M, Szczepura A, Lodwick A, Stilwell J. Factors affecting the outcome of maternity care II: neonatal outcomes and resources beyond the hospital of birth. J Epidem Comm Hlth. 1988;42;170–176.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2012

Authors and Affiliations

  • Sutapa Bandyopadhyay Neogi
    • 1
    • 2
    • 4
  • Sumit Malhotra
    • 1
    • 2
  • Sanjay Zodpey
    • 1
    • 2
  • Pavitra Mohan
    • 3
  1. 1.Indian Institute of Public HealthDelhiIndia
  2. 2.Public Health Foundation of IndiaHaryanaIndia
  3. 3.UNICEFIndia Country OfficeNew DelhiIndia
  4. 4.Indian Institute of Public Health (IIPH-Delhi)Public Health Foundation of India (PHFI)GurgaonIndia

Personalised recommendations