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The Impact

Measurement of outcomes of changes in medical practice is demanding, and consequently, new treatments are frequently implemented without assessment of their effect so that the value of often complex and expensive interventions is frequently unclear. This is especially true of interventions which aim to change practice at a systemic level, particularly in the setting of restricted resources.

However, mindful of the need for proper evaluation, Newborns Vietnam has implemented and validated the effect of a complex system-wide intervention to improve neonatal care at the Da Nang Hospital for Women and Children. An initial study defined the critical issues associated with the very high infant mortality in the hospital and defined a series of targets where improved medical and nursing practice should lead to improved infant survival. A system-wide intervention programme was then established, and equivalent data collected during and after the intervention.

Newborns Vietnam conducted a prospective audit of all admissions to the neonatal unit of Da Nang Hospital during and after this intervention (1st November 2013 to 31st October 2015). The overall case fatality rate during this period was significantly reduced from 8.6% to 3.5% (Fisher’s exact test p<0.0001).

This fall in mortality was associated with a reduction in hospital-acquired infection and halving of the number of infants treated with antibiotics.

A parallel study of nursing and parental views and attitudes noted a growth in professional satisfaction amongst nursing staff and increased engagement from parents, both of which are important elements of sustained high-quality neonatal care. The study is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505145/

The research was funded by The Peter Stebbings Memorial Trust.

PILOT NEONATAL INTENSIVE CARE PROGRAMME -
DA NANG HOSPITAL FOR WOMEN & CHILDREN
2013-2016

  • 50%
    REDUCTION

    in motarlity in 2013-2015.

  • 30%
    DECREASE

    in the rate of positive blood cultures (late onset sepsis – cultures done >72 hours of age) in 2014 and 2015.

  • 20%
    REDUCTION

    in risk of dying where sepsis was the primary cause or a recognised major contributor to death.

  • 23%
    DECREASE

    in the antibiotic days and number of babies on prolonged courses of antibiotics (>10 days).

  • Antibiotic Stewardship

    to prevent emergence of resistance is a vital measure in any infection prevention programme.

  • 70%
    Increase

    in breastfeeding.

Improvements in
gestational age survival

2010 – 201128 weeks72.7%
2010 – 201130 – 31 weeks44.8%
2013 – 201528 weeks31.8%
2013 – 201530 – 31 weeks11.1%
2015 – 201628 weeks18.2%
2015 – 201630 – 31 weeks7.3%