Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting.
Study Design: Observational.
Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India
Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available.
Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out).
Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager.
What is already known about this subject?
- Low resource settings face staff shortages, especially nursing staff.
- Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health.
- A substantial proportion of neonatal deaths occur among moderately low birth weight babies.
What does this study add?
- It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm.
- A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources.
How might this impact on clinical practice or future developments?
The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.
UNICEF. Child survival and the SDGs. [Internet]. 2017. [cited 2019 Mar 28]. Available from: https://data.unicef.org/topic/child-survival/child-survival-sdgs/.
Vesel L, Manu A, Lohela TJ, Gabrysch S, Okyere E, ten Asbroek AHA, et al. Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data. BMJOpen. 2013; 3: e002326.
Opondo C, Ntoburi S, Wagai J, Wafula J, Wasunna A, Were F, et al. Are hospitals prepared to support newborn survival? – An evaluation of eight first-referral level hospitals in Kenya. Trop Med Int Health. 2009; 14(10): 1165–1172.
Daga SR, Chandrashekhar L, Pol PP, Patole S. Appropriate technology in keeping babies warm in India.Ann Trop Paediatr. 1986; 6: 23-25.
Daga SR. Styropor box for maintaining the warm chain in newborn care. Int Child Health. 1997; 8: 69-73.
Daga SR. Simplified monitoring of sick newborns. Trop Doctor. 1998; 28: 228-32.
Daga S, Daga A. Neonatal intensive care in the developing countries: conservative or aggressive approach? Child Health in the Tropics: Sixth Nutricia – Cow & Gate Symposium Leuven, 18-21 October 1983. Springer: Dordrecht, 1983: 233-245.
Borulkar PD, Borulkar SP, Dhole RK, Daga SR. Special care for newborns at a community hospital: a 5-year experience. Trop Doctor. 1998; 28: 201–203.
World Health Organization. Newborns: reducing mortality. [Internet]. 2018. [cited 2019 Mar 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality.
Belizán JM, McClure EM, Goudar SS, Pasha O, Fabian EF, Patel A, et al. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol, 2012; 29(08): 649-656.
Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z. Ending preventable newborn deaths in a generation. Int J Gynecol Obstet. 2015; 131: S43–S48.
Almeida MFB, Ginsberg R, Sancho GA, Rosa IRM, Lamy ZC, Martinez FE, et al. Hypothermia and early neonatal mortality in preterm infants. J Pediatr. 2014; 164: 271-275.
World Health Organization. Thermal Protection of the Newborn: A Practical Guide. World Health Organization: Geneva, 1997.
Liu Y, Shah PS, Ye XY, Warre R, Piedboeuf B,Deshpandey A, et al. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr. 2015; 169(4): e150277.
Edmond KM, Zandoh C, Quigley MA, Amenga-EtegoS, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006; 117: e380-e386.
UNFPA. The State of the World's Midwifery 2014.UNFPA: New York, 2014.
UNFPA, ICM, and WHO. State of the World's Midwifery 2011: Delivering Health, Saving Lives. UNFPA: New York, 2011.