Improved postnatal care is needed to maintain gains in neonatal survival after the implementation of the Helping Babies Breathe initiative.
OBJECTIVE
Helping Babies Breathe (HBB) is a neonatal resuscitation protocol proven to reduce intrapartum-related mortality in low-income settings. The aim of this study was to describe the timing and causes of neonatal in-hospital deaths before and after HBB training at a maternity health facility in Nepal.


METHODS
A prospective cohort study was conducted at the facility between July 2012 and September 2013. All 137 staffs, including medical doctors and midwives, were trained in January 2013. The causes of 299 neonatal deaths and the day of death, up to 27 days, were collected before and after the training course.


RESULTS
Deaths caused by intrapartum-related complications were reduced from 51% to 33%. Preterm infants survived for more days (p < 0.01) during the neonatal period, but overall in-hospital neonatal mortality was unchanged (p = 0.46) after training. The survival rates linked to complications of infection, congenital anomalies and other causes were unaffected by the intervention.


CONCLUSIONS
The continuum of postnatal care for newborn infants needs to be strengthened after Helping Babies Breathe training, to maintain the gains in neonatal survival on the day of delivery. Additional interventions in the postnatal period are therefore required to increase neonatal survival at facilities in low-income settings.
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.|Children's University Hospital, Akademiska Sjukhuset, Uppsala, Sweden.
J
J
Wrammert
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.|Health Section, UNICEF Nepal Country office, Leknath Marg, Nepal.
A
A
Kc
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
U
U
Ewald
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
M
M
Målqvist
D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011181:Postnatal Care; D011247:Pregnancy; D011446:Prospective Studies; D012151:Resuscitation; D055815:Young Adult
Cause of death; Low-income settings; Neonatal resuscitation; Perinatal mortality; Postnatal