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OBJECTIVE: To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. METHODS: A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. RESULTS: The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. CONCLUSION: Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

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BACKGROUND: Haiti has the highest rate of neonatal mortality in the Latin America and Caribbean region. While the rate of facility births in Haiti has doubled over the past two decades, there have been no comparable reductions in maternal or neonatal mortality. Little data is available on the clinical characteristics of complications and morbidities among newborns requiring hospitalization after birth and their contribution to neonatal mortality. There is a need to better understand the status of newborn clinical care capacity in Haiti to prioritize training and resources. METHODS: We performed a retrospective observational cohort study of neonates admitted to a large public referral hospital in southern Haiti in the first 2 years of operation of a new neonatal unit that we established. All neonate cases hospitalized in the unit in these 2 years were reviewed and analyzed to identify their clinical characteristics and outcomes. Multivariable logistic regression was used to identify independent risk factors of hospital mortality. We present the outcomes for 1399 neonates admitted to the unit during August 2017 and August 2019. RESULTS: The leading cause of death was prematurity, followed by hypoxia and infection. Inborn neonates had better rates of hospital survival than those born elsewhere; they were also more likely to be born via cesarean section and to be admitted immediately following birth. There were no differences between the proportion of premature or low-birth-weight babies born at the hospital or elsewhere. Mortality in the second year of the unit's operation was 12%, almost half that of the first year (21%). Multivariable regression analysis showed that mortality was consistently higher among premature and very low birthweight babies. CONCLUSIONS: With modest investments, we were able to halve the mortality on a neonatal unit in Haiti. Resources are needed to address prematurity as an important outcome since hospital mortality was significant in this group. To this end, investment in uninterrupted supplies of oxygen and antibiotics, as well as ensuring adequate newborn resuscitation, infection control, laboratory testing, and timely morbidity and mortality reviews would go a long way toward lowering hospital mortality in Haiti.

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RESUMEN Objetivo: La incertidumbre de una posible transmisión posnatal por SARS-CoV-2 genera un desafío entre aplicar o evitar los cuidados esenciales del recién nacido para prevenir la transmisión. La revisión sistemática tiene como objetivo describir el impacto de los cuidados esenciales del neonato en la transmisión posnatal del SARS-CoV-2. Métodos: Se realizó una revisión sistemática en bases de datos electrónicas, se incluyeron estudios observacionales, serie de casos y reporte de casos. Dos investigadores de forma independiente evaluaron los criterios de inclusión, la calidad metodológica y la extracción de datos. Resultados: Se tamizaron 208 estudios para una inclusión final de 9 artículos relevantes. El reporte de transmisión del virus SARS-CoV-2 está centrado en la posibilidad de transferencia por la leche materna y ausencia de información acerca de la transmisión por otros cuidados esenciales, sin embargo, se observa un bajo uso en la práctica clínica de los cuidados esenciales del recién nacido hijo de madre con COVID- 19. Conclusiones: La información es limitada sobre la posible transmisión del SARS-CoV-2 a través de los cuidados esenciales del recién nacido, sin embargo, la pandemia ha impactado de forma importante los mismos. Según los hallazgos en la literatura, es mayor el beneficio de estas intervenciones y las recomendaciones científicas promueven su aplicación empleando las medidas de protección personal para la madre y el personal de salud.

ABSTRACT Objective: The uncertainty of a possible postnatal transmission by SARS-CoV-2 creates a challenge between applying or avoiding essential newborn care to prevent transmission. The objective of the systematic review is to describe the impact of essential neonate care on the postnatal transmission of SARS-CoV-2. Methods: A systematic review was carried out in electronic databases, observational studies, case series, and case reports. Two investigators independently assessed the inclusion criteria, methodological quality, and data extraction. Results: 208 studies were screened for a final inclusion of 9 relevant articles. The transmission report of the SARS-CoV-2 virus is focused on the possibility of transfer through breast milk and the absence of information about transmission by other essential care, however, a low use, in clinical practice, of essential care for the newborn child of a mother with COVID-19, is observed. Conclusions: Information is limited on the possible transmission of SARS-CoV-2 through essential newborn care; however, the pandemic has had a significant impact on them. According to the findings in the literature, the benefit of these interventions is greater, and the scientific recommendations promote their application, using personal protection measures for the mother and the healthcare personnel.

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Resumen: Objetivo: Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Material y métodos: Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccionados al azar del Subsistema Automatizado de Egresos Hospitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según muestreo estratificado no proporcional. Resultados: Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la identificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones: La calidad de la atención a neonatos en hospitales es heterogénea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Abstract: Objective: To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods: Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as "standard compliance"/"non-compliance" by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results: No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is <50% on all other indicators. Conclusions: The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.

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BACKGROUND: Neonatal mortality comprises an increasing proportion of childhood deaths in the developing world. Essential newborn care practices as recommended by the WHO may improve neonatal outcomes in resource limited settings. Our objective was to pilot a Helping Babies Breathe and Essential Care for Every Baby (HBB and ECEB) implementation package using HBB-ECEB training combined with supportive supervision in rural Nicaragua. METHODS: We employed an HBB-ECEB implementation package in El Ayote and Santo Domingo, two rural municipalities in Nicaragua and used a pre- and post- data collection design for comparison. Following a period of pre-intervention data collection (June-August 2015), care providers were trained in HBB and ECEB using a train-the- trainer model. An external supportive supervisor monitored processes of care and collected data. Data on newborn care processes and short-term outcomes such as hypothermia were collected from facility medical records and analyzed using standard run charts. Home visits were used to determine breastfeeding rates at 7, 30 and 60 days. RESULTS: There were 480 institutional births during the study period (June 2015-June 2016). Following the HBB-ECEB implementation package, cord care improved (pre-intervention median 66%; post-intervention shift to ≥85%) and early skin-to-skin care improved (pre-intervention median 0%; post-intervention shift to ≥56%, with a high of 92% in June 2016). Rates of administration of ophthalmic ointment and vitamin K were high pre-intervention (median 97%) and remained high. Early initiation of breastfeeding increased with a pre-intervention median of 25% and post-intervention shift to ≥28%, with a peak of 81% in June 2016. Exclusive breastfeeding rates increased short-term but were not significantly different by 60-days of life (9% pre-intervention versus 21% post-intervention). CONCLUSIONS: The implementation of the HBB-ECEB programs combined with supportive supervision improved the quality of care for newborns in terms of cord care, early skin-to-skin care and early initiation of breastfeeding. The rates of administration of ophthalmic ointment and vitamin K were high pre- intervention and remained high afterwards. These findings show that HBB-ECEB programs implemented with supportive supervision can improve quality of care for newborns.

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BACKGROUND: Despite improvements in health-care utilization, disadvantages persist among rural, less educated, and indigenous populations in Ecuador. The United States Agency for International Development-funded Cotopaxi Project created a provincial-level network of health services, including community agents to improve access, quality, and coordination of essential obstetric and newborn care. We evaluated changes in participating facilities compared to non-participating controls. METHODS: The 21 poorest parishes (third-level administrative unit) in Cotopaxi were targeted from 2010 to 2013 for a collaborative health system performance improvement. The intervention included service reorganization, integration of traditional birth attendants (TBAs) with formal supervision, community outreach and education, and health worker technical training. Baseline (n = 462) and end-line (n = 412) household surveys assessed access, quality and use of care, and women's knowledge and practices. TBAs' knowledge and skills were assessed from simulations. Chart audits were used to assess facility obstetric and newborn care quality. Provincial government data were used for change in neonatal mortality between intervention and non-intervention parishes using weighted linear regression. RESULTS: The percentage of women receiving a postnatal visit within first 2 days of delivery increased from 53 to 81 in the intervention group and from 70 to 90 in the comparison group (p ≤ 0.001). Postpartum/counseling on newborn care increased 18% in the intervention compared with 5% in the comparison group (p ≤ 0.001). The project increased community and facility care quality and improved mothers' health knowledge. Intervention parishes experienced a nearly continual decline in newborn mortality between 2009 and 2012 compared with an increase in control parishes (p ≤ 0.001). CONCLUSION: The project established a comprehensive coordinated provincial-level network of health services and strengthened links between community, primary, and hospital health care. This improved access to, quality, use, and provision of essential obstetric and neonatal care and survival. Ecuador's Ministry of Health is scaling up the model nationally.

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OBJECTIVE: To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala. METHODS: A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care. RESULTS: Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P=0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P<0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P=0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P=0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P=0.012). CONCLUSION: Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork.

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Objetivo: este trabajo tiene como objetivo verificar el conocimiento que las enfermeras de la unidad de cuidados intensivos neonatales tienen sobre el dolor en el recién nacido. Metodología: enfoque cualitativo, exploratorio y descriptivo, el estudio fue realizado en un hospital de referencia en Aracaju, Sergipe. La muestra fue formada por enfermeras que participaron en la entrevista semiestructurada, aplicada después del consentimiento informado. Los datos fueron tabulados y seleccionados de acuerdo a las categorías, frecuencia y variables. Resultados: demostraron la percepción de las enfermeras sobre la interacción madre-recién nacido, la familia; el concepto y el reconocimiento del dolor por las enfermeras; los conocimientos de estas sobre las escalas de dolor; las actitudes enfermeras en el alivio del dolor; la percepción sobre la humanización de la unidad cuidados neonatales. Discusión: los profesionales deben realizar las medidas de alivio del dolor y promover la interacción con las familia, pero tienen dificultades en la aplicación de protocolos que permiten el manejo más adecuado del dolor y el estrés.

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Purpose: We aimed at verifying the knowledge nurses in neonatal intensive care units have on pain in preterm newborns. Methods: A qualitative, exploratory, descriptive approach was used, with the study being carried out in a reference hospital in Aracaju, Sergipe. A semi-structured interview was used in a sample of nurses giving their informed consent. Data were tabulated and selected based on categories, frequency, and variables. Results: Findings revealed nurses' perception on mother-newborn and family interaction; pain concept and recognition by nurses; nurses' knowledge on pain assessment scales; nurses' attitudes on pain relief; perception on neonatal care unit humanization. Discussion: Nurses should apply pain relief measures and promote interaction with families, but barriers exist to apply protocols allowing a more appropriate management of pain and stress.

Introdução/objetivo: este trabalho objetiva verificar o conhecimento que os enfermeiros de unidade de terapia intensiva neonatal possuem sobre a dor no recém-nascido.

Metodologia: de abordagem qualitativa, exploratória e descritiva, realizada num Hospital de referencia em Aracaju, Sergipe. A amostra contou com enfermeiros que participaram da entrevista semiestruturada, aplicadas após o consentimento livre e esclarecido. Os dados foram tabulados e selecionados de acordo com as categorias, frequências e variáveis. Resultados: os resultados enfatizaram: percepção dos enfermeiros quanto à interação mãe, recém-nascido, família; conceito e reconhecimento da dor pelos enfermeiros; conhecimento dos enfermeiros sobre escalas de dor; atitudes de enfermeiros no alívio da dor; percepções dos enfermeiros sobre a humanização na unidade de terapia intensiva neonatal. Discussão: os profissionais executam medidas de alívio da dor e promovem interação com a família, porém apresentam dificuldades na implantação de protocolos que viabilizem o manejo mais adequado da dor e do estresse.

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INTRODUCCIÓN. Existe escasa evidencia sobre el conocimiento, las percepciones y las prácticas sobre herramientas para la estimulación sensoriomotora, en pacientes en la unidad de cuidado intensivo neonatal. OBJETIVO. Facilitar herramientas de desarrollo sensoriomotor a padres y profesionales de salud de acuerdo a sus conocimientos y prácticas, para el manejo de los recién nacidos en riesgo. MATERIAL Y MÉTODOS. Investigación cualitativa que describe las experiencias manifiestas en grupos focales de profesionales de salud y padres sobre conocimientos y prácticas del desarrollo sensoriomotor. RESULTADOS. El personal de salud y los padres tenían conocimientos, limitados sobre el desarrollo sensoriomotor. Se apropiaron de las estrategias de estimulación sensoriomotoras. Los profesionales iniciaron el cambio con la implementación de las estrategias brindadas. CONCLUSIONES. El recién nacido en riesgo en una UCIN se beneficia de la creación de programas de atención sensoriomotora dirigidos a padres y profesionales de salud.

INTRODUCTION: There is limited evidence about knowledge, perceptions and practice on tools used for sensori-motor stimulation at the newborn care unit. OBJECTIVE: To provide parents and helth workers with tools aimed to sensorimotor development in patients admited to the newborn care unit. METHODS: Qualitative research describing experiences in focal groups made by health workers and parents about knowledges and practices on sensorimotor development. RESULTS: Parents and health workers had limited knowledges about sensorimotor development. They empowered the strategies about sensorimotor stimulation changing work scheemes at the unit. CONCLUSIONS: Patients at risk in the newborn care unit get benefit from sensorimotor programs pointed to healths workers and parents.

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