Implementation of the Early Essential Newborn Care (EENC) on neonatal outcomes in west China: an observational study

Background

West China exhibits poorer newborn health outcomes than in other parts of mainland China. Therefore, we aimed to investigate the effect of the Early Essential Newborn Care (EENC) on neonatal outcomes in west China.

Methods

We did an observational study of 14 counties in three west provinces of China. Licensed doctors, nurses from obstetrics and paediatrics, and midwives in each county were trained by experienced EENC facilitators. 3 months after the first EENC coaching, we did a quality control assessment to examine the effects of the EENC coaching. We examined hospitals that had the highest number of births in each county and selected post-partum mothers to be interviewed and have their medical records checked by convenience sampling. Institutional ethics approval to do this study was obtained from the Institutional Review Boards at National Centre for Women and Children's Health Care, Chinese Center for Disease Control and Prevention. We obtained written informed consent from all participants.

Findings

Between March 25, 2018, and May 5, 2018, we examined 14 hospitals with the highest number of births in each county, of which we selected 126 post-partum mothers. EENC has turned out to be a useful and practical tool in west China. Out of the core interventions, some practices were relatively easy to implement, such as no routine suctioning for newborn babies (increasing from 0 at baseline to 100% after EENC coaching) and bathing after 24?h of birth (from 24% to 85%). However, hospitals encountered different kinds of difficulties in the EENC implementation. For example, 90 min of skin-to-skin contact was often interrupted because of inadequate facility resources (increasing from 0 to 62%). It was also noticed that hospitals that could guarantee 90 min of skin-to-skin contact could ensure early breastfeeding initiation (p=0·002), and successful first-time breast milk intake is associated with exclusive breastfeeding from birth till interview time (p=0·001).

Interpretation

Hospitals need to remove all the obstacles and emphasise on the EENC recommended practices, including receiving 90 min of uninterrupted skin-to-skin contact within 1 min of birth, initiation of early and exclusive breastfeeding, and the use of neonatal nasal intermittent positive pressure ventilation. Additional communications should be encouraged among medical professionals from different regions, so ideas could be shared.

Funding

Hong Kong Committee for UNICEF.