Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study
Background To improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with...
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| Format: | Article |
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BMJ Publishing Group
2021-07-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/10/3/e001089.full |
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| author | Zhao Li Howard Lawrence Sobel Priya Mannava John Charles Scott Murray Hoang Thi Tran Le Thi Huynh Phuong Thi Thu Nguyen Hoang Thi Nam Giang Tuyen Thi Mong Le Tuan Anh Hoang Vinh Duc Nguyen Nga Thi Quynh Pham |
| author_facet | Zhao Li Howard Lawrence Sobel Priya Mannava John Charles Scott Murray Hoang Thi Tran Le Thi Huynh Phuong Thi Thu Nguyen Hoang Thi Nam Giang Tuyen Thi Mong Le Tuan Anh Hoang Vinh Duc Nguyen Nga Thi Quynh Pham |
| author_sort | Zhao Li |
| collection | DOAJ |
| description | Background To improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.Methods Maternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.Findings A total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).Conclusion The EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU. |
| format | Article |
| id | doaj-art-271711b7ebe84773bade3512700fd68a |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2021-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Quality |
| spelling | doaj-art-271711b7ebe84773bade3512700fd68a2025-08-20T02:33:04ZengBMJ Publishing GroupBMJ Open Quality2399-66412021-07-0110310.1136/bmjoq-2020-001089Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention studyZhao Li0Howard Lawrence Sobel1Priya Mannava2John Charles Scott Murray3Hoang Thi Tran4Le Thi Huynh5Phuong Thi Thu Nguyen6Hoang Thi Nam Giang7Tuyen Thi Mong Le8Tuan Anh Hoang9Vinh Duc Nguyen10Nga Thi Quynh Pham11Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, PhilippinesMaternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, PhilippinesMaternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, PhilippinesMaternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, PhilippinesNeonatal Unit, Da Nang Hospital for Women and Children, Da Nang, VietnamNeonatal Unit, Da Nang Hospital for Women and Children, Da Nang, VietnamNeonatal Unit, Da Nang Hospital for Women and Children, Da Nang, VietnamSchool of Medicine and Pharmacy, The University of Da Nang, Da Nang, VietnamGeneral Obstetrics and Gynaecology, Da Nang Hospital for Women and Children, Da Nang, VietnamMaternal and Child Health Department, Ministry of Health of Vietnam, Ha Noi, VietnamMaternal and Child Health Department, Ministry of Health of Vietnam, Ha Noi, VietnamUniversal Health Coverage team, World Health Organization Representative Office in Vietnam, Ha Noi, VietnamBackground To improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.Methods Maternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.Findings A total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).Conclusion The EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.https://bmjopenquality.bmj.com/content/10/3/e001089.full |
| spellingShingle | Zhao Li Howard Lawrence Sobel Priya Mannava John Charles Scott Murray Hoang Thi Tran Le Thi Huynh Phuong Thi Thu Nguyen Hoang Thi Nam Giang Tuyen Thi Mong Le Tuan Anh Hoang Vinh Duc Nguyen Nga Thi Quynh Pham Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study BMJ Open Quality |
| title | Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study |
| title_full | Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study |
| title_fullStr | Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study |
| title_full_unstemmed | Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study |
| title_short | Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study |
| title_sort | early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in da nang vietnam a pre post intervention study |
| url | https://bmjopenquality.bmj.com/content/10/3/e001089.full |
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