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Many interventions reduce the mortality of low-birth-weight newborns; however, there is no empirical basis for measuring the effects of these interventions. A limited number of observational studies have compared the effectiveness of different interventions, but the findings are not consistent. This review examines the validity of the findings and implications for policy and future research. We identified trials, using controlled before-after studies (CBA) and interrupted time series (ITS), which evaluated quality-of-care interventions for infants less than or equal to 1,500 g. We evaluated the internal validity and the quality of the published studies and the quality of available quality-of-care data. Forty-eight of the 170 studies were assessed as having a low risk of bias in the majority of domains. Sixty-eight percent of studies had adequate control for maternal and newborn characteristics, and all studies took place in hospitals. The sensitivity analysis showed that interventions were most effective in research studies, which are more likely to provide evidence of benefit. However, the results are less consistent for newborns with less-severe disease and for potentially less-effective interventions. The quality of the available data is poor, but ITS studies have consistently shown a positive effect of interventions, irrespective of the risk group studied. The inconsistent findings of the observational studies could be due to problems with study design and poor data quality. These findings have limited usefulness for evaluating quality-of-care interventions. Using CBA to evaluate the effectiveness of quality-of-care interventions could make important contributions.Q:
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