{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T13:14:47Z","timestamp":1794316487101,"version":"4.9.0"},"reference-count":30,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,21]],"date-time":"2020-12-21T00:00:00Z","timestamp":1608508800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"UNICEF Beijing Office and Hong Kong Committee","award":["Grand number 501 MCH"],"award-info":[{"award-number":["Grand number 501 MCH"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,12,5]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A pre-comparison and post-comparison study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>46 hospitals that provide delivery services participated in the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>EENC practices were introduced and implemented in the 46 hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>54\u2009335 newborns were delivered in the pre-EENC period (2016) and 58\u2009057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90\u2009min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-041829","type":"journal-article","created":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T18:20:21Z","timestamp":1608661221000},"page":"e041829","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions"],"prefix":"10.1136","volume":"10","author":[{"given":"Wen","family":"Qu","sequence":"first","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Yue","sequence":"additional","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Liuxing","family":"Yang","sequence":"additional","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Jin","sequence":"additional","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaona","family":"Huang","sequence":"additional","affiliation":[{"name":"Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobo","family":"Tian","sequence":"additional","affiliation":[{"name":"Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Martin","sequence":"additional","affiliation":[{"name":"School of Community Medicine, The University of Oklahoma, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Narayan","sequence":"additional","affiliation":[{"name":"Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2076-9485","authenticated-orcid":false,"given":"Tao","family":"Xu","sequence":"additional","affiliation":[{"name":"Child Health Care Department, National Center for Women and Children\u2019s Heath China Center for Disease Control, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,22]]},"reference":[{"key":"2025101810412080000_10.12.e041829.1","unstructured":"PMNCH, WHO, World Bank and AHPSR . Success factors for women\u2019s and children\u2019s health: policy and programme highlights from 10 fast-track countries. Geneva: WHO, 2014. http:\/\/www.who.int\/pmnch\/knowledge\/publications\/successfactors\/en\/index2.html"},{"key":"2025101810412080000_10.12.e041829.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60518-1"},{"key":"2025101810412080000_10.12.e041829.3","unstructured":"National Health Commission . China maternal and child health development report. Beijing: National Health Comission, 2019. http:\/\/www.nhc.gov.cn\/fys\/jdt\/201905\/bbd8e2134a7e47958c5c9ef032e1dfa2.shtml"},{"key":"2025101810412080000_10.12.e041829.4","unstructured":"WHO Reginal Office for the Western Pacific . Consultation on the draft regional action plan for healthy newborns in the Western Pacifc 2014\u20132018. Manila: WHO Reginal Office for the Western Pacific, 2013. https:\/\/apps.who.int\/iris\/handle\/10665\/208778"},{"key":"2025101810412080000_10.12.e041829.5","unstructured":"WHO Reginal Office for the Western Pacific . Action plan for healthy newborn infants in the Western Pacific region (2014\u20132020). Manila: WHO Reginal Office for the Western Pacific, 2014. https:\/\/iris.wpro.who.int\/handle\/10665.1\/10454"},{"key":"2025101810412080000_10.12.e041829.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2011.02215.x"},{"key":"2025101810412080000_10.12.e041829.7","unstructured":"WHO Reginal Office for the Western Pacific . Early essential newborn care clinical practice pocket guidee. Manila: WHO Regional Office for the Western Pacific, 2014. https:\/\/apps.who.int\/iris\/handle\/10665\/208158"},{"key":"2025101810412080000_10.12.e041829.8","unstructured":"World Health Organization, Regional Office for the Western Pacific . Second biennial progress report : 2016-2017 (Action Plan for Health Newborn Infants in the Western Pacific Region : 2014-2020. Manila: WHO Regional Office for the Western Pacific, 2018. https:\/\/apps.who.int\/iris\/handle\/10665\/272803"},{"key":"2025101810412080000_10.12.e041829.9","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.eclinm.2018.12.002","article-title":"Early essential newborn care is associated with reduced adverse neonatal outcomes in a tertiary hospital in Da Nang, Viet Nam: a pre- post- intervention study","volume":"6","author":"Tran","year":"2018","journal-title":"EClinicalMedicine"},{"key":"2025101810412080000_10.12.e041829.10","first-page":"540","article-title":"Early newborn care: creating a healthy start for every newborn in the Western Pacific","volume":"22","author":"Priya","year":"2019","journal-title":"Chinese J Perinatal Med"},{"key":"2025101810412080000_10.12.e041829.11","first-page":"750","article-title":"[Study on application and effects of coaching in popularizing early essential newborn care guideline]","volume":"25","author":"Li","year":"2017","journal-title":"Chinese J Child Health"},{"key":"2025101810412080000_10.12.e041829.12","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(18)32683-7","article-title":"Implementation of the early essential newborn care (EENC) on neonatal outcomes in West China: an observational study","volume":"392","author":"Qu","year":"2018","journal-title":"Lancet"},{"key":"2025101810412080000_10.12.e041829.13","unstructured":"WHO Reginal Office for the Western Pacific . Early essential newborn care module 3 \u2013 introducing and sustaining EENC in hospitals: routine childbirth and newborn care. Manila: WHO Reginal Office for the Western Pacific, 2013. https:\/\/apps.who.int\/bookorders\/anglais\/detart1.jsp?codlan=1&codcol=52&codcch=268"},{"key":"2025101810412080000_10.12.e041829.14","doi-asserted-by":"crossref","DOI":"10.1186\/s13006-017-0139-4","article-title":"Infant feeding pattern in the first six months of age in USA: a follow-up study","volume":"12","author":"Karmaus","year":"2017","journal-title":"Int Breastfeed J"},{"key":"2025101810412080000_10.12.e041829.15","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-18-00017"},{"key":"2025101810412080000_10.12.e041829.16","first-page":"363","article-title":"Knowledge, attitudes, and breast feeding practices of postnatal mothers: a cross sectional survey","volume":"9","author":"Vijayalakshmi","year":"2015","journal-title":"Int J Health Sci"},{"key":"2025101810412080000_10.12.e041829.17","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1038\/jp.2015.181","article-title":"What impact do essential newborn care practices have on neonatal mortality in low and lower-middle income countries? Evidence from Bangladesh","volume":"36","author":"Akter","year":"2016","journal-title":"J Perinatol"},{"key":"2025101810412080000_10.12.e041829.18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1496"},{"key":"2025101810412080000_10.12.e041829.19","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13147"},{"key":"2025101810412080000_10.12.e041829.20","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-S3-S15"},{"key":"2025101810412080000_10.12.e041829.21","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003519.pub4"},{"key":"2025101810412080000_10.12.e041829.22","first-page":"317","article-title":"The baby-friendly initiative: protecting, promoting and supporting breastfeeding","volume":"17","author":"Pound","year":"2012","journal-title":"Paediatr Child Health"},{"key":"2025101810412080000_10.12.e041829.23","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-4-6"},{"key":"2025101810412080000_10.12.e041829.24","unstructured":"National Health Comission . [Baby-friendly hospital guarantees breastfeeding]. Beijing: National Health Comission, 2019. http:\/\/www.nhc.gov.cn\/wjw\/ayyymd\/list.shtml"},{"key":"2025101810412080000_10.12.e041829.25","unstructured":"National Health Comission . Notice of conducting revision of baby-friendly hospital. Beijing: National Health Comission, 2014. http:\/\/www.nhc.gov.cn\/fys\/s3585\/201406\/556c0b7673e8470f9641c28d119a9f31.shtml"},{"key":"2025101810412080000_10.12.e041829.26","first-page":"2178","article-title":"[Current situation of newborn early essential health care service in county-level medical institutions of four provinces in western China]","volume":"34","author":"Yang","year":"2019","journal-title":"Maternal & Child Health Care of China"},{"key":"2025101810412080000_10.12.e041829.27","first-page":"188","article-title":"[Clinical effect observation of umbilical cord care in early essential newborn care]","volume":"06","author":"Chen","year":"2018","journal-title":"Pract J Clin Med"},{"key":"2025101810412080000_10.12.e041829.28","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(18)31185-1","article-title":"Dilemmas for nurses in China","volume":"392","author":"Yang","year":"2018","journal-title":"Lancet"},{"key":"2025101810412080000_10.12.e041829.29","unstructured":"Qu W , Yue Q , Wang Y . [Investigation on early essential newborn care in country and township health facilities in four provinces of western China]. Chinese J Child Healthcare 2020."},{"key":"2025101810412080000_10.12.e041829.30","first-page":"4965","article-title":"[Survey on the current situation and demand of neonatal capacity-building in the west region]","volume":"33","author":"Zhang","year":"2018","journal-title":"Maternal & Child Health Care of China"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-041829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:41:30Z","timestamp":1760809290000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-041829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,22]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bmjopen-2020-041829"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-041829","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}