UAB study could save a million lives per year

BIRMINGHAM, AL (WBRC) – A study led by the director of UAB's Division of Neonatology has found that the training of birth attendants in newborn-care techniques could reduce stillbirths by more than 30% and possibly save 1-million lives worldwide per year.

UAB's Dr. Waldemar A. Carlo spearheaded the study that was designed to train all types of birth attendants in 96 communities worldwide.

"The birth attendants were trained to do several easy steps that are critical for babies to survive at birth and be kept alive through the first week of life," said Carlo, the lead author who worked with a large group of American and international colleagues. "We selected the World Health Organization course on essential newborn care because it contains what we believed are the essential interventions necessary to sustain life in many infants and created an educational package that included interventions that could be used by any birth attendant anywhere in the world."

Birth attendants were trained by local trainers in rural communities in Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia using the World Health Organization's newborn-care course and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program.

The goal was to see if training birth attendants to use these interventions would reduce perinatal and neonatal mortality in the first week of life in infants weighing at least 1500 grams in rural communities in developing countries.

The stillbirth rate decreased significantly for nurses/midwives and traditional birth attendants following essential newborn care training. The stillbirth rate also decreased among home deliveries. There was not a significant decrease in all-cause first week mortality or stillbirth for those using the in-depth neonatal resuscitation program.

Carlo said it is plausible that the observed reduction in stillbirths may be due to essential newborn-care training. Live-born infants without obvious signs of life may have been misidentified as stillbirths before this training; such misclassifications have been reported in the literature. After training, resuscitation was more likely, and stillbirths decreased.

Carlo added that though the data show that training in basic neonatal care has an important role in improving perinatal outcomes in the developing world, more scaled-up research is needed to prove that the training reduces mortality in other health-care systems.