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

Table 3 Early neonatal mortality by received care around delivery indicator

Care around delivery (CAD) indicators	Neonatal mortality 0–6 days^a		Risk of neonatal mortality 0–6 days
	Received care around delivery		Care versus no care, unadjusted^b N = 150,848		Care versus no care, adjusted^c 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

^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
^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
^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

ISSN: 1742-4755