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Table 3 Early neonatal mortality by received care around delivery indicator

From: Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network’s Maternal and Newborn Health Registry

Care around delivery (CAD) indicators Neonatal mortality 0–6 daysa Risk of neonatal mortality 0–6 days
Received care around delivery Care versus no care, unadjustedb N = 150,848 Care versus no care, adjustedc N = 142,469
Yes n/N (rate/1000) No n/N (rate/1000) RR (95% CI) P-value RR (95% CI) P-value
All 8 CAD indicators 167/30,006 (5.6) 2,758/120,842 (22.8) 0.26 (0.18, 0.37)  < .0001 0.81 (0.77, 0.85)  < .0001
CAD1: Delivery in a hospital versus clinic 1,901/91,437 (20.8) 1,024/59,411 (17.2) 0.87 (0.76, 1.00) 0.06 0.94 (0.89, 1.00) 0.04
CAD2: Skilled birth attendant at delivery 1,667/75,359 (22.1) 1,258/75,489 (16.7) 0.92 (0.74, 1.14) 0.44 1.10 (1.04, 1.16)  < 0.01
CAD3: Fetal heart rate assessed prior to delivery 2,585/142,177 (18.2) 340/8,671 (39.2) 0.97 (0.79, 1.21) 0.81 1.14 (1.04, 1.24)  < 0.01
CAD4: New gloves for delivery 2,905/150,463 (19.3) 20/385 (51.9) 0.72 (0.39, 1.33) 0.30 0.83 (0.60, 1.15) 0.27
CAD5: Clean cord practices 2,881/148,877 (19.4) 44/1,971 (22.3) 0.62 (0.41, 0.95) 0.03 0.97 (0.81, 1.17) 0.76
CAD6: Early initiation of breast feeding (within 1 h of birth) 691/113,352 (6.1) 2,234/37,496 (59.6) 0.09 (0.07, 0.12)  < .0001 0.43 (0.39, 0.49)  < .0001
CAD7: Skin-to-skin practices (immediately after birth) 949/96,602 (9.8) 1,976/54,246 (36.4) 0.67 (0.53, 0.86)  < 0.01 0.79 (0.73, 0.87)  < .0001
CAD8: Delayed bathing (> 6 h of birth) 2,823/135,742 (20.8) 102/15,106 (6.8) 3.10 (2.26, 4.27)  < .0001 1.47 (1.32, 1.64)  < .0001
  1. aColumns present n = the number of neonatal deaths on days 0–6; N = number of live births when CAD is present or absent; and the day 0–6 neonatal mortality rate per 1,000 births within each care around delivery indicator for care present or absent
  2. bUnadjusted relative risks, 95% confidence intervals and p-values are obtained from a Poisson model for early neonatal mortality including the 8 care around delivery indicators and site with generalized estimating equations to account for the correlation of outcomes within cluster. The relative risks and p-values for all 8 CAD indicators index come from a separate Poisson model including the all 8 CAD indicators index and site
  3. cAdjusted relative risks, 95% confidence intervals and p-values are obtained from a Poisson model for early neonatal mortality including the 8 care around delivery indicators and site adjusting for parity (0, 1–2, 3+ (ref)), delivery mode(vaginal, cesarean (ref)), at least one maternal condition (yes, no (ref)), gestational age < 34 weeks (yes, no (ref)), birth weight < 1500 g (yes, no (ref)) and at least one neonatal condition (yes, no (ref)) with generalized estimating equations to account for the correlation of outcomes within cluster. The relative risks and p-values for all 8 CAD indicators index come from a separate Poisson model including the all 8 CAD indicators index, site and the covariates described above