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From 2008 to 2009, the National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, surveyed 322 hospitals to evaluate the effectiveness of NRP implementation in the first stage (2004–2009) (1). Efficacy of NRP implementation in the second stage (2011–2016) was evaluated by mail survey of 347 hospitals from October to November 2016 (9). Detailed descriptions of sampling methods and results have been published (1,9). The 2016 NRP evaluation showed that more than 90% of health facilities in programme areas established an in-hospital neonatal resuscitation working group responsible for technical training and quality control. Neonatal resuscitation training was conducted in more than 95% of enrolled health facilities (9). During NRP implementation, the incidence of neonatal asphyxia (defined as Apgar score ≤7 at 1 minute) decreased by 77.5%, from 6.32% in 2003 to 1.42% in 2020, while neonatal mortality due to birth asphyxia in the delivery room decreased by 75%, from 0.76‰ in 2003 to 0.19‰ in 2020 (Table 1, Figure 1). As a result, neonatal resuscitation techniques have been substantiated to be lifesaving for newborns.
Year Live births Asphyxia incidence Asphyxia death Cases Crude rate (%) Z* P Cases Crude rate (‰) Z* P The first stage of NRP† 2003 237,140 14,998 6.32 ‒77.671 <0.001 179 0.76 ‒7.782 <0.001 2004 295,567 16,395 5.55 169 0.57 2005 317,069 14,254 5.50 166 0.52 2006 344,147 15,304 4.45 157 0.46 2007 408,247 13,933 3.41 168 0.41 2008 428,261 12,594 2.94 146 0.34 The second stage of NRP§ 2010 335,190 7,810 2.33 ‒20.162 <0.001 81 0.24 ‒2.686 0.007 2011 385,694 8,755 2.27 86 0.22 2012 407,451 8,719 2.14 85 0.21 2013 434,287 8,555 1.97 83 0.19 2014 515,481 9,227 1.79 85 0.16 Surveillance data from MCH institutions¶ 2017 2,694,010 43,032 1.60 ‒18.794 <0.001 1,273 0.47 ‒21.888 <0.001 2018 2,488,254 36,733 1.48 1,250 0.50 2019 2,602,198 35,961 1.38 560 0.22 2020 2,400,961 34,155 1.42 446 0.19 Abbreviation: MCH=maternal and child health; NRP=neonatal resuscitation programme; PLADs=provincial-level administrative divisions.
* Cochran-Armitage trend test. A negative value of Z implies a decreasing trend of asphyxia incidence and mortality rate. P value <0.05 is considered statistically significant.
† The first stage of NRP was launched in 20 PLADs of western and central China between 2004 and 2009, and the final effectiveness evaluation was conducted.
§ The second stage of NRP was launched in 31 PLADs and Xinjiang Production and Construction Corps (XPCC) of the mainland of China between 2011 and 2016, and the final effectiveness evaluation was conducted by a random sample survey in 347 hospitals.
¶ The third stage of NRP was launched in 31 PLADs and XPCC of the mainland of China between 2017 and 2021, and the effectiveness evaluation was based on surveillance data of all secondary and tertiary MCH institutions. The surveillance data were collected from the MCH institutions surveillance system of the National Center for Women and Children’s Health, China CDC.Table 1. Trends in asphyxia incidence and mortality rate during 2003‒2008, 2010‒2014, and 2017‒2020.
Figure 1.Trends of neonatal asphyxia incidence and mortality rate in China, 2003‒2020.
Note: Data from 2003‒2008, 2010‒2014, and 2017‒2020 were obtained from a random sample survey in 322 hospitals, a random sample survey in 347 hospitals, and the surveillance data of all secondary and tertiary MCH institutions, respectively.
Abbreviation: MCH=maternal and child health.
* The abrupt increase in asphyxia mortality rate in 2017 and 2018 may be associated with the increased proportion of pregnant women of advanced maternal age (>35 years) after the implementation of the “universal two-child policy” released in October 2015.
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