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Table 3 Multidimensional care (MDC) for neonatal asphyxia, by second-phase followup

From: Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica

 

% (95% CI)

Baseline

Second phase

Multidimensional care (MDC) for neonatal asphyxia

51.9 (43.0–60.8)

68.1 (58.9–76.3)

Country

 Mexico

44.7 (30.2–59.0)

65.7 (47.8–80.9)

 Nicaragua

52.9 (35.1–70.2)

65.0 (48.3–79.4)

 Honduras

76.2 (52.8–91.8)

85.7 (67.3–96.0)

 Guatemala

44.4 (25.5–64.7)

50.0 (24.7–75.4)

Facility levela

 Basic facilities

50.0 (27.2–72.8)

63.0 (50.9–74.0)

 Comprehensive facilities

52.3 (42.5–62.0)

76.1 (61.2–87.4)

Disease severity

 Asphyxia only

55.6 (45.2–65.6)

66.7 (56.1–76.1)

 Comorbidities (low birthweight, prematurity, and/or sepsis)

40.0 (22.7–59.4)

73.1 (52.2–88.4)

Multidimensional care (MDC) componentsb

 Skilled provider at birth

79.1 (71.0–85.7)

92.4 (86.1–96.5)

 Immediate assessment

93.8 (88.2–97.3)

93.3 (87.2–97.1)

 Initial stabilization

77.5 (69.3–84.4)

79.0 (70.6–95.9)

 Basic/advanced resuscitation

38.7 (21.8–57.8)

65.7 (47.8–80.9)

Basic/advanced resuscitation requirementsc

 Referral in basic facilities

100.0 (47.8–100)

76.2 (52.8–91.8)

 PPV ETT CPR

71.0 (52.0–85.8)

91.4 (76.9–98.2)

 Oxygen use (if < 32 weeks gestational age)

NULL

50.0 (1.3–98.7)

 Pulse oximeter use in comprehensive facilities

34.6 (17.2–55.7)

78.6 (49.2–95.3)

  1. a Basic facilities = Health centers. Comprehensive facilities = Referral hospitals
  2. b Skilled provider at birth = doctor (or nurse in Guatemala) in basic facilities, or specialist (pediatrician, neonatologist, surgeon, obstetrician) in comprehensive facilities. Immediate assessment = Apgar score recorded at 1 min and 5 min. Initial stabilization = drying or stimulation; heat application. Basic/advance resuscitation if Apgar score ≤ 3 at 1 min = ventilation with self-inflating bag, or chest compressions, or endotracheal intubation
  3. c Referral if Apgar score ≤ 3 at 5 min if at basic facility. PPV positive-pressure ventilation, ETT endotracheal tube, CPR cardiopulmonary resuscitation