To evaluate the effects of the second phase of Neonatal Resuscitation Program (NRP) in China.

A mail survey and an onsite assessment were conducted to collect data. (1) Mail survey: Different levels of domestic hospitals (except those in Tibet, Hong Kong, Macao and Taiwan) were randomly selected to collect information on in-hospital NRP training, resuscitation equipments, incidence of birth asphyxia and neonatal mortality caused by birth asphyxia from year 2010 to 2014. (2) Onsite assessment: One provincial level, two prefecture level and two county level hospitals or healthcare institutions were randomly selected in four provinces. A questionnaire survey was conducted among randomly selected health workers including midwives, obstetricians and pediatricians. Megacode performance of those health workers was evaluated. Trend Chi-square test was used for statistical analysis.

(1) Questionnaires were gathered from 347 hospitals via the mail survey with a response rate of 74.6% (347/465). In the 347 hospitals, 97.5% (10 410/10 674) of the obstetricians, paediatricians, and midwives received in-hospital training, and 72.7% (7 765/10 674) of them received training from county or above level. (2) In the onsite assessment of the four provinces, 205 health workers were randomly selected and completed the questionnaire survey. Among them, 85.4% (175/205) received training more than three times, 52.7% (108/205) received over two days of training in the previous training workshops, but only 62.0% (127/205) could share one set of training manikin with less than eight trainees in training workshops. Megacode performance of 96 health workers was evaluated. The results showed that all of the health workers were qualified in terms of total score and achieved an average score of over 1.5 in the performance of every primary resuscitation skill. Health workers attained relatively high scores in performing initial steps in resuscitation and tracheal intubation, and in identifying the indication of chest compression and epinephrine administration. However, their average scores in preparation for resuscitation, positive pressure ventilation and teamwork were relatively low. (3) Over 90% of the 347 hospitals had basic resuscitation equipment such as neonatal bag and mask, devices for tracheal intubation and radiation warmer. But fewer were equipped with umbilical venous catheter, T-piece or oxygen-air blender, especially at the county level hospitals. The incidence of neonatal asphyxia decreased from 2.33%(7 810/335 190) in 2010 to 1.79% (9 227/515 481) in 2014. The mortality from asphyxia at birth decreased from 2.41 to 1.64 per 10 000 live births [(81/335 190) and (85/515 481)]. Trend analysis revealed that the incidence of neonatal asphyxia (χ²_trend=20.56, P<0.01) and the mortality at birth (χ²_trend=77.34, P<0.01) declined over time.

The second phase of NRP has promoted the generalization of the neonatal resuscitation technology and resulted in decreased incidence of asphyxia and asphyxial mortality. Future programs should focus on measures to improve practical skills and teamwork, to increase the allocation of resuscitation equipment and to strengthen trainings among obstetricians and midwives.

Asphyxia neonatorum; Resuscitation; Incidence; Mortality; Treatment outcome