High mortality rates for very low birth weight infants in developing countries despite training

Pediatrics. 2010 Nov;126(5):e1072-80. doi: 10.1542/peds.2010-1183. Epub 2010 Oct 11.


Objective: The goal was to determine the effect of training in newborn care and resuscitation on 7-day (early) neonatal mortality rates for very low birth weight (VLBW) infants. The study was designed to test the hypothesis that these training programs would reduce neonatal mortality rates for VLBW infants.

Methods: Local instructors trained birth attendants from 96 rural communities in 6 developing countries in protocol and data collection, the World Health Organization Essential Newborn Care (ENC) course, and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP), by using a train-the-trainer model. To test the impact of ENC training, data on infants of 500 to 1499 g were collected by using a before/after, active baseline, controlled study design. A cluster-randomized, controlled trial design was used to test the impact of the NRP.

Results: A total of 1096 VLBW (500-1499 g) infants were enrolled, and 98.5% of live-born infants were monitored to 7 days. All-cause, 7-day neonatal mortality, stillbirth, and perinatal mortality rates were not affected by ENC or NRP training.

Conclusions: Neither ENC nor NRP training of birth attendants decreased 7-day neonatal, stillbirth, or perinatal mortality rates for VLBW infants born at home or at first-level facilities. Encouragement of delivery in a facility where a higher level of care is available may be preferable when delivery of a VLBW infant is expected.

Trial registration: ClinicalTrials.gov NCT00136708.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cause of Death
  • Curriculum
  • Developing Countries*
  • Female
  • Home Childbirth
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / mortality*
  • Infant, Very Low Birth Weight*
  • Inservice Training*
  • Midwifery / education*
  • Neonatology / education*
  • Pregnancy
  • Resuscitation / education*
  • Resuscitation / mortality
  • Stillbirth / epidemiology
  • Survival Rate
  • Teaching

Associated data

  • ClinicalTrials.gov/NCT00136708