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Rawat M, Mani S, Gugino SF, Koenigsknecht C, Helman J, Nielsen L, Nair J, Munshi U, Chandrasekharan P, Lakshminrusimha S. Femoral Occlusion during Neonatal Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of Perinatal Cardiac Arrest. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1804. [PMID: 38002895 PMCID: PMC10670492 DOI: 10.3390/children10111804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar to epinephrine. Our objectives were to determine the impact of bilateral femoral occlusion during chest compressions on the incidence and timing of ROSC and hemodynamics. METHODOLOGY In this randomized study, 19 term fetal lambs in cardiac arrest were resuscitated based on the Neonatal Resuscitation Program guidelines and randomized into two groups: femoral occlusion or controls. Bilateral femoral arteries were occluded by applying pressure using two fingers during chest compressions. RESULTS Seventy percent (7/10) of the lambs in the femoral occlusion group achieved ROSC in 5 ± 2 min and three lambs (30%) did not receive epinephrine. ROSC was achieved in 44% (4/9) of the controls in 13 ± 6 min and all lambs received epinephrine. The femoral occlusion group had higher diastolic blood pressures, carotid and coronary blood flow. CONCLUSION Femoral occlusion resulted in faster and higher incidence of ROSC, most likely due to attaining increased diastolic pressures, coronary and carotid flow. This is a low-tech intervention that can be easily adapted in resource limited settings, with the potential to improve survival and neurodevelopmental outcomes.
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Affiliation(s)
- Munmun Rawat
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA; (S.F.G.); (P.C.)
| | - Srinivasan Mani
- Department of Pediatrics, University of Toledo, Toledo, OH 43606, USA
| | - Sylvia F. Gugino
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA; (S.F.G.); (P.C.)
| | - Carmon Koenigsknecht
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA; (S.F.G.); (P.C.)
| | - Justin Helman
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA; (S.F.G.); (P.C.)
| | - Lori Nielsen
- Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA; (S.F.G.); (P.C.)
| | - Jayasree Nair
- Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, USA
| | - Upender Munshi
- Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA;
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Medvedev MM, Tumukunde V, Kirabo-Nagemi C, Greco G, Mambule I, Katumba K, Waiswa P, Tann CJ, Elbourne D, Allen E, Ekirapa-Kiracho E, Pitt C, Lawn JE. Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda. BMC Health Serv Res 2023; 23:613. [PMID: 37301974 PMCID: PMC10257176 DOI: 10.1186/s12913-023-09624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Preterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000-1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings. METHODS We describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children's Fund. RESULTS Following the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m2 to 212 m2. Costs of improvements were lowest at the national referral hospital (financial: $31,354; economic: $45,051; 2020 USD) and varied across the four smaller hospitals (financial: $68,330-$95,796; economic: $99,430-$113,881). In a standardised 20-bed neonatal unit offering a level of care comparable to the four smaller hospitals, the total financial cost could be in the range of $70,000 to $80,000 if an existing space could be repurposed or remodelled, or $95,000 if a new unit needed to be constructed. Even after improvements, the facility assessments demonstrated broad variability in laboratory and pharmacy capacity as well as the availability of essential equipment and supplies. CONCLUSIONS These five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable. TRIAL REGISTRATION ClinicalTrials.gov, NCT02811432 . Registered: 23 June 2016.
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Affiliation(s)
- Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, 550 16th St., Box 1224, San Francisco, CA, 94158, USA.
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
| | - Victor Tumukunde
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Charity Kirabo-Nagemi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Giulia Greco
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Ivan Mambule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Kenneth Katumba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, New Mulago Hill Rd., Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Cally J Tann
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Neonatal Medicine, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, New Mulago Hill Rd., Kampala, Uganda
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
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Adaptation of Essential Care for Every Baby educational program to improve infant outcomes in the context of Zika. BMC Pediatr 2022; 22:669. [PMID: 36404307 PMCID: PMC9677636 DOI: 10.1186/s12887-022-03710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The outbreak and ongoing transmission of Zika virus provided an opportunity to strengthen essential newborn care and early childhood development systems through collaboration with the US Agency for International Development Applying Science to Strengthen and Improve Systems (USAID ASSIST). The objective was to create a system of sustainable training dissemination which improves newborn care-related quality indicators in the context of Zika. METHODS From 2018-19, USAID ASSIST supported a series of technical assistance visits by the American Academy of Pediatrics (AAP) in four Caribbean countries to strengthen the clinical capacity in care of children potentially affected by Zika through dissemination of Essential Care for Every Baby (ECEB), teaching QI methodology, coaching visits, and development of clinical care guidelines. ECEB was adapted to emphasize physical exam findings related to Zika. The first series of workshops were facilitated by AAP technical advisors and the second series were facilitated by the newly trained local champions. Quality of care was monitored with performance indicators at 134 health facilities. RESULTS A repeated measures (pre-post) ANOVA was conducted, revealing significant pre-post knowledge gains [F(1) = 197.9, p < 0.001] on knowledge check scores. Certain performance indicators related to ECEB practices demonstrated significant changes and midline shift on the run chart in four countries. CONCLUSION ECEB can be adapted to incorporate important local practices, causes of neonatal morbidity and mortality, and differing healthcare system structures, which, as one part of a larger technical assistance package, leads to improved performance of health systems.
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Oh TK, Choi CW, Song IA. Epidemiologic study of in-hospital cardiopulmonary resuscitation among pediatric patients: A retrospective, population-based cohort study in South Korea. Medicine (Baltimore) 2022; 101:e30445. [PMID: 36086791 PMCID: PMC10980375 DOI: 10.1097/md.0000000000030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to examine the clinical trends of in-hospital cardiopulmonary resuscitation (ICPR) and factors associated with live discharge following ICPR. As a national population-based cohort study, data were extracted from the South Korean National Inpatient Database. This study included 8992 pediatric patients under 18 years of age who underwent ICPR due to in-hospital cardiac arrest during hospitalization in South Korea between 2010 and 2019 (10 years). The annual prevalence, survival, duration of hospitalization, and total cost of hospitalization at ICPR were examined as clinical trends. In 2010, 7.94 per 100,000 pediatric patients received ICPR; the prevalence increased to 11.51 per 100,000 pediatric patients in 2019. The 10-year survival rates were similar, and the in-hospital, 6-month, and 1-year survival rates over 10 years were 44.0%, 34.0%, and 32.4%, respectively. The mean length of hospital stay at ICPR in 2010 was 20.7 (95% confidence interval [CI]: 19.3-22.2) days; this decreased to 16.6 (95% CI: 15.2-18.0) days in 2019. The mean total cost at ICPR was 11,081.1 (95% CI: 10,216.2-11,946.1) United States Dollars (USD) in 2010; this increased to 22,629.4 (95% CI: 20,588.3-24,670.5) USD in 2019. The prevalence of ICPR increased among pediatric patients in South Korea between 2010 and 2019; however, the survival rates were similar for the 10 years. The length of hospital stay at ICPR gradually decreased from 2010 through 2019, while the total cost of hospitalization at ICPR has gradually increased between 2010 and 2019.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Simulation-Based Neonatal Resuscitation Education for Undergraduate Anesthesia Students: A Pre- and Post-Evaluation of Knowledge and Clinical Skills. Anesthesiol Res Pract 2022; 2022:7628220. [PMID: 35783545 PMCID: PMC9249533 DOI: 10.1155/2022/7628220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Nearly one in five hundred babies unexpectedly need resuscitation at birth, and the need for resuscitation is often unpredictable. A large majority of these deaths occur in low-resource settings and are preventable. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Therefore, producing skilled health professionals in teaching institutions is mandatory to perform this activity. Objective. The study aimed a pre- and post-evaluation of knowledge and clinical skills performance of anesthesia students completing simulation-based neonatal resuscitation training at a Teaching Referral Hospital. Methods. A pre-post-intervention study was conducted on undergraduate final-year anesthesia students at Comprehensive and Specialized Teaching Referral Hospital, Ethiopia. We used a validated checklist to follow the students’ performance (American Heart Association, 2005, and Ogunlesi et al., 2012). The data were collected through this checklist. The collected data were analyzed with statistical package for social sciences (SPSS) version 20. Categorical variables were analyzed with chi-square test, and a
-value <0.05 was considered as statistically significant. Results. A total of 51 students participated in the study. Twenty of them were females. The pre-intervention knowledge of the respondents about aspects of evaluation for neonatal resuscitation was 90.2%, and post-intervention was 94.1%; the knowledge of the respondents about aspects of appropriate actions at pre- and post-interventions was 73.4% and 83.1%, respectively. Conclusions and recommendations: This study showed that there was improvement of post-interventions knowledge and clinical skills of undergraduate anesthesia students for both aspects of evaluation and appropriate actions for neonatal resuscitation. We recommend that students who attached clinical anesthesia practice should take at least simulation-based training at skill laboratories timely.
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Effectiveness of Nursing Risk Management in Neonatal Asphyxia Resuscitation Care. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5465472. [PMID: 35692571 PMCID: PMC9187469 DOI: 10.1155/2022/5465472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Objective To analyze the effectiveness of nursing risk management in neonatal asphyxia resuscitation care and to observe and summarize the nursing measures and outcomes. Methods A total of 60 neonatal asphyxia cases from January 2021 to December 2021 were recruited and assigned via a random number table method at a ratio of 1 : 1 to receive either routine care plus nursing risk management (the observation group, n = 30) or routine care (the control group, n = 30). Outcome measures included blood gas index, neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, nursing satisfaction, and complications. Results The differences in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) between the two groups before care were not statistically significant (P > 0.05), while after care, PaO2 in the observation group had a higher level of PaO2 and a lower level of PaCO2 than the control group (P < 0.01). The two groups showed similar Apgar scores and NBNA scores before care (P > 0.05), while after care, routine care plus nursing risk management resulted in higher Apgar scores and NBNA scores versus routine care alone (P < 0.01). The nursing satisfaction rate in the observation group (96.67%) was significantly higher than that of the control group (73.33%) (P=0.030). Nursing risk management plus routine care was associated with a significantly lower incidence of complications (6.67%) compared to routine care (26.67%) (P=0.038). Conclusion Nursing risk management in neonatal asphyxia resuscitation care showed outstanding outcomes in improving neonatal blood gas index, neurological function, and Apgar score, while reducing the occurrence of complications and achieving high nursing satisfaction.
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Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country. Pediatr Neonatol 2022; 63:125-130. [PMID: 34716129 DOI: 10.1016/j.pedneo.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study assessed the success rate and associated complications of hospital-wide neonatal endotracheal intubations by pediatric residents and neonatal fellows using direct laryngoscopy. Secondary objectives were to identify characteristics and indications for the procedure in a tertiary-care center. METHODS A cross-sectional observational study was conducted. We prospectively collected performance and infant outcome data after neonatal intubation between March 1, 2019 and February 29, 2020. RESULTS 171 intubations were observed in 105 infants. The median infant gestational age was 31.0 weeks (interquartile range [IQR]: 27.5-36.0 weeks). Fifty infants (48%) were very low birth weight (VLBW, <1500 g; median 1640 g [IQR: 870-2420 g]). The most common indication for intubation was respiratory failure (65%). Pediatric residents and neonatal fellows had overall success rates of 66% and 98%, respectively. The success rate for the first intubation attempt was higher with more advanced pediatric residency training (P < 0.001). The median attempts for each intubation were 1 (IQR: 1-2) for both VLBW and non-VLBW infants (P = 0.48). The adverse outcome rates were 5% and 3% for VLBW and non-VLBW infants, respectively (P = 0.53). More than 2 intubation attempts was the only significant independent risk factor for adverse outcomes (adjusted odds ratio 6.7; 95% CI 1.3-33.6; P = 0.02). CONCLUSIONS The success rate of pediatric residents for neonatal intubation was similar for VLBW and non-VLBW infants. The main indication was respiratory failure, and nearly half were infants with VLBW. To minimize adverse sequelae, written guidelines limiting the number of intubation attempts by junior trainees are warranted.
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Mutesu-Kapembwa K, Lakhwani J, Benkele RG, Machona S, Shamalavu MS, Chintende JM, Chisela SM, Kapoma S, Mwanza J, Chelu W, Mwendafilumba M, Kapembwa K, Gaertner VD. Bridging the gap in neonatal resuscitation in Zambia. Front Pediatr 2022; 10:1038231. [PMID: 36545665 PMCID: PMC9760668 DOI: 10.3389/fped.2022.1038231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Neonatal resuscitation has been poorly instituted in many parts of Africa and most neonatal resuscitation algorithms are adapted from environments with abundant resources. Helping Babies Breathe (HBB) is an algorithm designed for resource-limited situations and most other algorithms are designed for resource-rich countries. However, there are neonatal referral centers in resource-limited countries who may provide more advanced resuscitation. Thus, we developed a neonatal resuscitation algorithm for a resource-limited country (Zambia) which considers more advanced interventions in situations where they can be provided. The algorithm described in this paper is based on the Newborn Life Support algorithm from the UK as well as the HBB algorithm and accounts for all situations in a resource-limited country. Most importantly, it focuses on non-invasive ventilation but includes advice on more advanced resuscitation including intravenous access, fluid management, chest compressions and adrenaline for resuscitation. Although intubation skills are included in neonatal training workshops, it is not the main focus of the algorithm as respiratory support equipment is scarce or lacking in most health facilities in Zambia. A home-grown neonatal resuscitation algorithm for a resource-limited country such as Zambia is likely to bridge the gap between limited situations requiring only bag and mask ventilation and better equipped institutions where more advanced resuscitation is possible. This algorithm will be rolled out in all training institutions and delivery facilities across Zambia over the next months.
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Affiliation(s)
- Kunda Mutesu-Kapembwa
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.,Newborn Support Zambia, Lusaka, Zambia
| | - Jyoti Lakhwani
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Rodgers Gift Benkele
- Newborn Support Zambia, Lusaka, Zambia.,Paediatric Nurses Association of Zambia, Lusaka, Zambia
| | - Sylvia Machona
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.,Newborn Support Zambia, Lusaka, Zambia
| | - Mwila Sekeseke Shamalavu
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.,Midwives Association Zambia, Lusaka, Zambia
| | - Jean Musonda Chintende
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | | | - Sharon Kapoma
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.,Midwives Association Zambia, Lusaka, Zambia
| | - Jackson Mwanza
- Clinical Anaesthetist Association of Zambia (CAAZ), California, CA, United States
| | - Wisdom Chelu
- Clinical Anaesthetist Association of Zambia (CAAZ), California, CA, United States
| | | | | | - Vincent D Gaertner
- Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland.,Dr von Hauner University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Kamath AM, Thom MG, Johanns CK, Panhorst Harris K, Schwarzbauer K, Ochoa JC, Zuniga-Brenes P, Rios-Zertuche D, Mokdad AH, Hernandez B. Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica. BMC Pediatr 2021; 21:534. [PMID: 34852795 PMCID: PMC8638427 DOI: 10.1186/s12887-021-02999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. METHODS A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. RESULTS Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). CONCLUSION SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.
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Affiliation(s)
- Aruna M Kamath
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA. .,Department of Anesthesiology, University of Washington, Seattle, WA, USA.
| | - Maximilian G Thom
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Katie Panhorst Harris
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | | | - José C Ochoa
- Inter-American Development Bank, Washington, DC, USA
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
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Rent S, North K, Diego E, Bose C. Global Health Education and Best Practices for Neonatal-Perinatal Medicine Trainees. Neoreviews 2021; 22:e795-e804. [PMID: 34850151 DOI: 10.1542/neo.22-12-e795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neonatal-perinatal medicine (NPM) trainees are expressing an increased interest in global health. NPM fellowship programs are tasked with ensuring that interested fellows receive appropriate training and mentorship to participate in the global health arena. Global health engagement during fellowship varies based on a trainee's experience level, career goals, and academic interests. Some trainees may seek active learning opportunities through clinical rotations abroad whereas others may desire engagement through research or quality improvement partnerships. To accommodate these varying interests, NPM fellows and training programs may choose to explore institutional partnerships, opportunities through national organizations with global collaborators, or domestic opportunities with high-risk populations. During any global health project, the NPM trainee needs robust mentorship from professionals at both their home institution and their partner international site. Trainees intending to use their global health project to fulfill the American Board of Pediatrics (ABP) scholarly activity requirement must also pay particular attention to selecting a project that is feasible during fellowship and also meets ABP criteria for board eligibility. Above all, NPM fellows and training programs should strive to ensure equitable, sustainable, and mutually beneficial collaborations.
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Affiliation(s)
- Sharla Rent
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Krysten North
- Division of Neonatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Ellen Diego
- Division of Neonatology Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Carl Bose
- Division of Neonatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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Parsons AA, Rule ARL, Cheruiyot D, Sleeth C, Ronoh C, Mutai D, Schaffzin J, Kamath-Rayne BD. Perceptions of barriers and facilitators to disinfection of basic neonatal resuscitation equipment in a rural hospital in Kenya: A qualitative study. Midwifery 2021; 104:103200. [PMID: 34844179 DOI: 10.1016/j.midw.2021.103200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Allison A Parsons
- Division of Critical Care, Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States.
| | - Amy R L Rule
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Divisions of Neonatology and Hospital Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States
| | | | | | | | | | - Joshua Schaffzin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Beena D Kamath-Rayne
- Division of Global Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
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12
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Cavallin F, Lochoro P, Ictho J, Nsubuga JB, Ameo J, Putoto G, Trevisanuto D. Back rubs or foot flicks for neonatal stimulation at birth in a low-resource setting: A randomized controlled trial. Resuscitation 2021; 167:137-143. [PMID: 34438002 DOI: 10.1016/j.resuscitation.2021.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Approximately 15% of infants require stimulation in low-resource settings, but data on effectiveness of different stimulation approaches are limited. We aimed to compare two recommended approaches of stimulation (back rubs vs. foot flicks) in reducing the need for face-mask ventilation in newly born infants who were not crying immediately after birth in a low-resource setting. METHODS A single center, open-label, randomized, superiority trial was conducted at St. Kizito Hospital in Matany (Uganda) between November 2019 and May 2020. Newly born infants with expected birthweight > 1500 grams who were not crying immediately after birth were randomly assigned to stimulation using back rubs or foot flicks. The primary outcome measure was the success rate of the stimulation, defined as the achievement of an effective crying preventing the need for face-mask ventilation. RESULTS Success of stimulation was achieved in 76/93 neonates (82%) using back rubs and 68/93 neonates (73%) using foot flicks (risk ratio 1.12, 95% confidence interval 0.96-1.31). No procedure-associated complications arose during the study. Time to first cry was not statistically different between the two arms (mean difference -11 seconds, 95% confidence interval -39 to 18). CONCLUSIONS In newly born infants who were not crying immediately after birth, this trial did not provide a conclusive message in favor of back rubs or foot flicks. Nonetheless, we could not exclude a possible benefit of back rubs in avoiding the need for positive pressure ventilation and, possibly, further advanced resuscitative maneuvers. CLINICAL TRIALS REGISTRATION clinicalTrial.gov: NCT04056091.
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Affiliation(s)
| | | | | | | | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.
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13
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Liaqat M, Hussain M, Afzal M, Altaf M, Khan S, Gilani SA, Liaqat I. Efficacy of pedagogical framework in neonatal resuscitation skill learning in a resource-limited setting: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:436. [PMID: 34407810 PMCID: PMC8371841 DOI: 10.1186/s12909-021-02846-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. METHODS A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. RESULTS Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p < 0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p < 0.001) compared to the traditional group (31.2 ± 1.7). CONCLUSIONS The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).
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Affiliation(s)
- Mishal Liaqat
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan.
| | - Muhammad Hussain
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Muhammad Afzal
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Maryam Altaf
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Sadia Khan
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Iram Liaqat
- Department of Zoology, The Government College University, Lahore, Pakistan
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14
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Mooganayakanakote Siddappa A. A randomised trial of laryngeal mask airway in neonatal resuscitation. Acta Paediatr 2021; 110:2478-2479. [PMID: 33829550 DOI: 10.1111/apa.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
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15
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Patterson J, North K, Dempsey E, Ishoso D, Trevisanuto D, Lee AC, Kamath-Rayne BD. Optimizing initial neonatal resuscitation to reduce neonatal encephalopathy around the world. Semin Fetal Neonatal Med 2021; 26:101262. [PMID: 34193380 DOI: 10.1016/j.siny.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One million two hundred thousand neonatal lives are lost each year due to intrapartum-related events; 99% of these deaths occur in low- and lower middle-income countries. Neonates exposed to intrapartum-related events present with failure to breathe at birth. Quick and effective delivery room management of these neonates is critical in the prevention of brain injury. Given the prominent role of lung aeration in the cardiopulmonary transition at birth, the mainstay of neonatal resuscitation is effective ventilation. Basic neonatal resuscitation focuses on simple stimulation, airway positioning and clearing, and bag-mask ventilation. Although principles for basic neonatal resuscitation remain the same for high- and low-resource settings, guidelines may differ based on available human and material resources. Formal training in basic resuscitation reduces intrapartum-related neonatal mortality in low-resource settings. However, there remain opportunities to improve provider performance for increased impact with other strategies such as regular practice and continuous quality improvement.
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Affiliation(s)
- Jackie Patterson
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Krysten North
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Research Centre, University College Cork, Wilton, Cork, Ireland.
| | - Daniel Ishoso
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, PO Box 11850, Kinshasa, Democratic Republic of the Congo.
| | - Daniele Trevisanuto
- Department of Women's and Child Health, University of Padova, Via Giustiniani, 3, Padova, Italy.
| | - Anne Cc Lee
- Harvard Medical School; Director of Global AIM Lab, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA.
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16
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White AM, Mutai D, Cheruiyot D, Rule ARL, Mortensen JE, Schaffzin JK, Kamath-Rayne BD. Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7065. [PMID: 34281001 PMCID: PMC8297370 DOI: 10.3390/ijerph18137065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.
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Affiliation(s)
- Anne M. White
- University of Minnesota Masonic Children’s Hospital, University of Minnesota, Minneapolis, MN 55454, USA
| | | | | | - Amy R. L. Rule
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (A.R.L.R.); (J.E.M.); (J.K.S.)
| | - Joel E. Mortensen
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (A.R.L.R.); (J.E.M.); (J.K.S.)
| | - Joshua K. Schaffzin
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (A.R.L.R.); (J.E.M.); (J.K.S.)
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17
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Rent S, Winter J, Umoren R, Vaucher Y, Nelson BD, St Clair NE, Bose C, Ehret D. Recent interest in global health among American Academy of Pediatrics Newborn Specialists. J Perinatol 2021; 41:1525-1527. [PMID: 33239716 DOI: 10.1038/s41372-020-00869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/28/2020] [Accepted: 11/04/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Jameel Winter
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | | | - Nicole E St Clair
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carl Bose
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Ehret
- University of Vermont Larner College of Medicine, Burlington, VT, USA
- Vermont Oxford Network, Burlington, VT, USA
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18
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Theoretical knowledge and skill retention 3 and 6 months after a European Newborn Life Support provider course. Am J Emerg Med 2021; 49:83-88. [PMID: 34089968 DOI: 10.1016/j.ajem.2021.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The European Resuscitation Council Newborn Life Support Course (ERC- NLS) aims at training healthcare professionals, involved in perinatal care, in order to intervene efficiently and promptly to assist transition or resuscitate neonates who require help at birth. However, limited data exists for the retention of the theoretical knowledge and practical skills provided by the course. This study aims to evaluate the degree of knowledge and skill retention 3 and 6 months after the ERC-NLS provider course. METHODS This is a prospective study. Theoretical knowledge was evaluated using the ERC-approved NLS written test (50 True/False questions). Evaluation of technical skills included performance, on an Advanced Life Support neonatal maniquin (LAERDAL), of airway management, ventilation and support of circulation (21 detailed skills). The effect of certain factors on theoretical skill retention was also evaluated. RESULTS One hundred and sixteen (n = 116) participants were initially recruited in the study (12 males and 104 females). Theoretical knowledge was evaluated in 113 participants (3 participants missed follow-up appointments) and technical skills in 80 participants. The mean score for theoretical knowledge was 86.24% ± 5.3, 80.88% ± 7.43 and 80.04% ± 7.04 at baseline, at 3 and 6 months, respectively. This difference was significant among the three time points (baseline vs 3 months: p < 0.001; baseline vs 6 months: p < 0.001; 3 month's vs 6 months: p = 0.034). Although gender did not have an effect, doctors and participants of higher education yielded higher score of success. Regarding technical skills, 9 skills showed a continuous decline of performance from baseline to 6 months, while no difference existed for 12 skills. CONCLUSIONS Healthcare professionals after the NLS provider course retain satisfactory levels of theoretical knowledge and technical skills even at 6 months post-training, although, there is a decline compared to baseline. Further research is needed in order to establish the proper time and type of refreshment course in order to improve outcomes.
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Chaulagain DR, Malqvist M, Brunell O, Wrammert J, Basnet O, Kc A. Performance of health workers on neonatal resuscitation care following scaled-up quality improvement interventions in public hospitals of Nepal - a prospective observational study. BMC Health Serv Res 2021; 21:362. [PMID: 33874929 PMCID: PMC8054430 DOI: 10.1186/s12913-021-06366-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal. METHODS A prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions. RESULTS Out of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13-0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03-1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04-1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline. CONCLUSION QI intervention package improved health workers' performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.
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Affiliation(s)
- Dipak Raj Chaulagain
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden.
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | - Olivia Brunell
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | | | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden.,Society of Public Health Physicians Nepal (SOPHPHYN), Kathmandu, Nepal
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20
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda. BMC Med Inform Decis Mak 2021; 21:39. [PMID: 33541340 PMCID: PMC7863544 DOI: 10.1186/s12911-021-01406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. METHODS We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called "HBB Prompt". Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. RESULTS Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. CONCLUSIONS Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054 .
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, British Columbia Women’s Hospital, 1N55-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Hasan S. Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main Street West, HSC-2R104, Hamilton, ON L8S 4K1 Canada
| | - Niraj Mistry
- Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, 5 King’s College Road, Toronto, ON M5S 3G8 Canada
- Design Research, TD Bank Group, Toronto, ON Canada
| | - Douglas M. Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON Canada
- Neonatal Intensive Care Unit, St. Michael’s Hospital, 15014 - 30 Bond St, Toronto, M5B 1W8 ON Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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21
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Tadesse M, Hally S, Rent S, Platt PL, Eusterbrock T, Gezahegn W, Kifle T, Kukora S, Pollack LD. Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia. Front Pediatr 2021; 9:777978. [PMID: 34900877 PMCID: PMC8656416 DOI: 10.3389/fped.2021.777978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11-31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia. Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5-37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis. Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators. Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.
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Affiliation(s)
- Misrak Tadesse
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Suzanne Hally
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,School of Nursing, Endicott College, Boston, MA, United States
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Phillip L Platt
- Wax & Gold Inc., Amarillo, TX, United States.,Pediatrix Medical Group, Department of Neonatology, Baptist St Anthony's Hospital, Amarillo, TX, United States
| | - Thomas Eusterbrock
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
| | | | - Tsinat Kifle
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie Kukora
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Louis D Pollack
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
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22
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Helldén D, Myrnerts Höök S, Pejovic NJ, Mclellan D, Lubulwa C, Tylleskär T, Alfven T. Neonatal resuscitation practices in Uganda: a video observational study. BMJ Paediatr Open 2021; 5:e001092. [PMID: 34595356 PMCID: PMC8442103 DOI: 10.1136/bmjpo-2021-001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Neonatal mortality, often due to birth asphyxia, remains stubbornly high in sub-Saharan Africa. Guidelines for neonatal resuscitation, where achieving adequate positive pressure ventilation (PPV) is key, have been implemented in low-resource settings. However, the actual clinical practices of neonatal resuscitation have rarely been examined in these settings. The primary aim of this prospective observational study was to detail the cumulative proportion of time with ventilation during the first minute on the resuscitation table of neonates needing PPV at the Mulago National Referral Hospital in Kampala, Uganda. METHODS From November 2015 to January 2016, resuscitations of non-breathing neonates by birth attendants were video-recorded using motion sensor cameras. The resuscitation practices were analysed using the application NeoTapAS and compared between those taking place in the labour ward and those in theatre through Fisher's exact test and Wilcoxon rank-sum test. RESULTS From 141 recorded resuscitations, 99 were included for analysis. The time to initiation of PPV was 66 (42-102) s overall, and there was minimal PPV during the first minute in both groups with 0 (0-10) s and 0 (0-12) s of PPV, respectively. After initiating PPV the overall duration of interruptions during the first minute was 28 (18-37) s. Majority of interruptions were caused by stimulation (28%), unknown reasons (25%) and suction (22%). CONCLUSIONS Our findings show a low adherence to standard resuscitation practices in 2015-2016. This emphasises the need for continuous educational efforts and investments in staff and adequate resources to increase the quality of clinical neonatal resuscitation practices in low-resource settings.
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Affiliation(s)
- Daniel Helldén
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Susanna Myrnerts Höök
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nicolas J Pejovic
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Dan Mclellan
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Clare Lubulwa
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Thorkild Tylleskär
- Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tobias Alfven
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Blennow M, Trevisanuto D, Tylleskär T. A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation. N Engl J Med 2020; 383:2138-2147. [PMID: 33252870 DOI: 10.1056/nejmoa2005333] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Face-mask ventilation is the most common resuscitation method for birth asphyxia. Ventilation with a cuffless laryngeal mask airway (LMA) has potential advantages over face-mask ventilation during neonatal resuscitation in low-income countries, but whether the use of an LMA reduces mortality and morbidity among neonates with asphyxia is unknown. METHODS In this phase 3, open-label, superiority trial in Uganda, we randomly assigned neonates who required positive-pressure ventilation to be treated by a midwife with an LMA or with face-mask ventilation. All the neonates had an estimated gestational age of at least 34 weeks, an estimated birth weight of at least 2000 g, or both. The primary outcome was a composite of death within 7 days or admission to the neonatal intensive care unit (NICU) with moderate-to-severe hypoxic-ischemic encephalopathy at day 1 to 5 during hospitalization. RESULTS Complete follow-up data were available for 99.2% of the neonates. A primary outcome event occurred in 154 of 563 neonates (27.4%) in the LMA group and 144 of 591 (24.4%) in the face-mask group (adjusted relative risk, 1.16; 95% confidence interval [CI], 0.90 to 1.51; P = 0.26). Death within 7 days occurred in 21.7% of the neonates in the LMA group and 18.4% of those in the face-mask group (adjusted relative risk, 1.21; 95% CI, 0.90 to 1.63), and admission to the NICU with moderate-to-severe hypoxic-ischemic encephalopathy at day 1 to 5 during hospitalization occurred in 11.2% and 10.1%, respectively (adjusted relative risk, 1.27; 95% CI, 0.84 to 1.93). Findings were materially unchanged in a sensitivity analysis in which neonates with missing data were counted as having had a primary outcome event in the LMA group and as not having had such an event in the face-mask group. The frequency of predefined intervention-related adverse events was similar in the two groups. CONCLUSIONS In neonates with asphyxia, the LMA was safe in the hands of midwives but was not superior to face-mask ventilation with respect to early neonatal death and moderate-to-severe hypoxic-ischemic encephalopathy. (Funded by the Research Council of Norway and the Center for Intervention Science in Maternal and Child Health; NeoSupra ClinicalTrials.gov number, NCT03133572.).
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Affiliation(s)
- Nicolas J Pejovic
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Susanna Myrnerts Höök
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Josaphat Byamugisha
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Tobias Alfvén
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Clare Lubulwa
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Francesco Cavallin
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Jolly Nankunda
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Hege Ersdal
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Mats Blennow
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Daniele Trevisanuto
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Thorkild Tylleskär
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
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Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
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Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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25
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Gamtessa LC, Kebede KM. <p>Knowledge Outcome of Helping Babies Breathe Training in Southern Nations, Nationalities and People’s Region, Ethiopia: A Pre- and Post-Test Study</p>. RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s274235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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26
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Rent S, Valentine G, Ehret D, Kukora S. Global health training during neonatal fellowship: fellow and program director perspectives. J Perinatol 2020; 40:1253-1261. [PMID: 32152489 DOI: 10.1038/s41372-020-0639-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study explored the availability and perception of Global Health (GH) training opportunities in US-based Neonatal-Perinatal Medicine (NPM) fellowship programs. STUDY DESIGN Electronic surveys, containing discrete choice and open-ended questions, were distributed to current and recent fellows and to Program Directors (PDs). RESULTS Fifty-eight PDs and ninety-eight fellows completed the survey. Fellows reported declining GH participation from 48% in medical school to 21% in fellowship. Among the 42% of fellows reporting GH opportunities at their programs, 30% personally participated. Fewer than 30% of these programs offer structured classroom or online learning; 10% offer research opportunities. 72% of fellows stated that GH availability is moderately to extremely important, compared with 58% of PDs. PDs cited cost, scheduling, mentorship, and lack of suitable global partners as barriers to supporting fellows in GH. CONCLUSION NPM fellows place high importance on GH opportunities during fellowship, but only a minority engage in GH work.
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Affiliation(s)
| | - Gregory Valentine
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Danielle Ehret
- University of Vermont Larner College of Medicine, Burlington, VT, USA
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27
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Kc A, Lawn JE, Zhou H, Ewald U, Gurung R, Gurung A, Sunny AK, Day LT, Singhal N. Not Crying After Birth as a Predictor of Not Breathing. Pediatrics 2020; 145:peds.2019-2719. [PMID: 32398327 DOI: 10.1542/peds.2019-2719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Worldwide, every year, 6 to 10 million infants require resuscitation at birth according to estimates based on limited data regarding "nonbreathing" infants. In this article, we aim to describe the incidence of "noncrying" and nonbreathing infants after birth, the need for basic resuscitation with bag-and-mask ventilation, and death before discharge. METHODS We conducted an observational study of 19 977 infants in 4 hospitals in Nepal. We analyzed the incidence of noncrying or nonbreathing infants after birth. The sensitivity of noncrying infants with nonbreathing after birth was analyzed, and the risk of predischarge mortality between the 2 groups was calculated. RESULTS The incidence of noncrying infants immediately after birth was 11.1%, and the incidence of noncrying and nonbreathing infants was 5.2%. Noncrying after birth had 100% sensitivity for nonbreathing infants after birth. Among the "noncrying but breathing" infants, 9.5% of infants did not breathe at 1 minute and 2% did not to breathe at 5 minutes. Noncrying but breathing infants after birth had almost 12-fold odds of predischarge mortality (adjusted odds ratio 12.3; 95% confidence interval, 5.8-26.1). CONCLUSIONS All nonbreathing infants after birth do not cry at birth. A proportion of noncrying but breathing infants at birth are not breathing by 1 and 5 minutes and have a risk for predischarge mortality. With this study, we provide evidence of an association between noncrying and nonbreathing. This study revealed that noncrying but breathing infants require additional care. We suggest noncrying as a clinical sign for initiating resuscitation and a possible denominator for measuring coverage of resuscitation.
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Affiliation(s)
- Ashish Kc
- Uppsala University, Uppsala, Sweden; .,Society of Public Health Physicians Nepal, Kathmandu, Nepal.,Contributed equally as co-first authors
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Contributed equally as co-first authors
| | - Hong Zhou
- Peking University Health Science Center, Peking University, Beijing, China
| | | | | | | | | | - Louise Tina Day
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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28
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Higgins BV, Medvedev MM, Spindler H, Ghosh R, Longkumer O, Cohen SR, Das A, Gore A, Mahapatra T, Walker DM. Cohort study of neonatal resuscitation skill retention in frontline healthcare facilities in Bihar, India, after PRONTO simulation training. BMJ Paediatr Open 2020; 4:e000628. [PMID: 32399505 PMCID: PMC7204812 DOI: 10.1136/bmjpo-2019-000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Use of simulation in neonatal resuscitation (NR) training programmes has increased throughout low-income and middle-income countries. Many of such programmes have demonstrated a positive impact on NR knowledge and skill acquisition along with reduction of early neonatal mortality and fresh stillbirth rates. However, NR skill retention after simulation programmes remains a challenge. METHODS This study assessed facility level NR skill retention after PRONTO International's simulation training in Bihar, India. Training was conducted within CARE India's statewide in-job, on-site Apatkaleen Matritva evam Navjat Tatparta mentoring programme as part of a larger quality improvement and health systems strengthening initiative. Public sector facilities were initially offered training, facilitated by trained nursing graduates, during 8-month phases between September 2015 and January 2017. Repeat training began in February 2018 and was facilitated by peers. NR skills in simulated resuscitations were assessed at the facility level at the midpoint and endpoint of initial training and prior to and at the midpoint of repeat training. RESULTS Facilities administering effective positive pressure ventilation and assessing infant heart rate increased (31.1% and 13.1%, respectively, both p=0.03) from midinitial to postinitial training (n=64 primary health centres (PHCs) and 192 simulations). This was followed by a 26.2% and 20.9% decline in these skills respectively over the training gap (p≤0.01). A significant increase (16.1%, p=0.04) in heart rate assessment was observed by the midpoint of repeat training with peer facilitators (n=45 PHCs and 90 simulations). No significant change was observed in other skills assessed. CONCLUSIONS Despite initial improvement in select NR skills, deterioration was observed at a facility-level post-training. Given the technical nature of NR skills and the departure these skills represent from traditional practices in Bihar, refresher trainings at shorter intervals are likely necessary. Very limited evidence suggests peer simulation facilitators may enable such increased training frequency, but further study is required.
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Affiliation(s)
- Brennan V Higgins
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Susanna R Cohen
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Dilys M Walker
- School of Medicine and Department of Obstetrics-Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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29
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Cavallin F, Menga A, Brasili L, Maziku D, Azzimonti G, Putoto G, Trevisanuto D. Factors associated with mortality among asphyxiated newborns in a low-resource setting. J Matern Fetal Neonatal Med 2020; 35:1178-1183. [PMID: 32212882 DOI: 10.1080/14767058.2020.1743670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Neonatal asphyxia accounts for a quarter of neonatal deaths. We aimed to assess factors associated with mortality among asphyxiated neonates in a low-resource setting.Methods: A retrospective observational study evaluating all neonates who were admitted for asphyxia to the Neonatal Intensive Care Unit (NICU) at Tosamaganga Hospital (Tanzania) in 2017-2018. Inclusion criteria were: Apgar score <7 at 5 min and/or failure to initiate spontaneous breathing and/or presence of sentinel events and/or clinical signs suggesting encephalopathy not explained by other obvious factors or early convulsions. Newborns with congenital malformations, birth weight <2000 g or those who died in the delivery room were excluded.Results: NICU admission for perinatal asphyxia was 17.5%. In 169 neonates, mortality rate was 23% and was associated with being outborn, low 5-minute Apgar score, depressed clinical status at NICU admission, occurrence of infection or seizures within 24 h from admission, and receiving aminophylline during the hospital stay.Conclusions: Perinatal asphyxia was responsible for a relevant proportion of NICU admissions and neonatal deaths in a low-resource setting. Appropriate clinical examination remains the main asset in settings with limited availability of diagnostic tools. Improvements in antenatal and perinatal care are needed to reduce mortality in asphyxiated newborns. Future studies should assess long-term outcome in survivors.
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Affiliation(s)
| | - Alessandra Menga
- Doctors with Africa CUAMM, Iringa, Tanzania.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | | | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Iringa, Tanzania.,Tosamaganga Hospital, Iringa, Tanzania
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30
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Brathwaite KP, Bryce F, Moyer LB, Engmann C, Twum-Danso NA, Kamath-Rayne BD, Srofenyoh EK, Ucer S, Boadu RO, Owen MD. Evaluation of two newborn resuscitation training strategies in regional hospitals in Ghana. Resusc Plus 2020; 1-2:100001. [PMID: 34223288 PMCID: PMC8244248 DOI: 10.1016/j.resplu.2020.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kimberly P. Brathwaite
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 7009, Cincinnati, OH, 45229, USA
| | - Fiona Bryce
- Kybele, Inc., 116 Lowes Foods Drive #170, Lewisville, NC, 27023, USA
| | - Laurel B. Moyer
- Department of Neonatology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA
| | - Cyril Engmann
- Maternal, Newborn, and Child Health and Nutrition, PATH, 2201 Westlake Avenue, Seattle, WA, 98121, USA
- Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, 1959 NE Pacific St, Seattle, WA, 98195,, USA
| | - Nana A.Y. Twum-Danso
- TD Health, Accra, Ghana and Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Beena D. Kamath-Rayne
- American Academy of Pediatrics, Global Newborn and Child Health, 345 Park Boulevard, Itasca, IL, 60143, USA
| | | | - Sebnem Ucer
- Kybele, Inc., 116 Lowes Foods Drive #170, Lewisville, NC, 27023, USA
| | - Richard O. Boadu
- Department of Health Information Management, University of Cape Coast, Cape Coast, Ghana
| | - Medge D. Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157-1009, USA
- Corresponding author. Department of Anesthesiology Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC, 27157-1009, USA.
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Zhou M, Xi X, Li M, Wang S, Liu Z, Liu JQ. Video Laryngoscopy Improves the Success of Neonatal Tracheal Intubation for Novices but Not for Experienced Medical Staff. Front Pediatr 2020; 8:445. [PMID: 32850555 PMCID: PMC7423830 DOI: 10.3389/fped.2020.00445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: There is limited evidence on the use of video laryngoscopy (VL) in neonatal tracheal intubation (NTI) during neonatal resuscitation. In this study, we aimed to compare the difference between direct laryngoscopy (DL) and VL in NTI of trainees during neonatal resuscitation training. Materials and Methods: A prospective observational study was conducted during a neonatal resuscitation training course to examine three circumstances: NTI by experienced medical staff (EMS) and less-experienced medical staff (LEMS) in a neonatal resuscitation scenario; NTI by EMS and LEMS with an ongoing chest compression; and NTI by midwives who were novices in the procedure. The trainees were given scenarios or were shown demonstrations on newborn simulation manikins and were required to perform an NTI on a simulation manikin using DL and/or VL. The mean intubation time and success rate of intubation were measured. Results: The mean NTI time for EMS using VL (24.1 ± 7.2 s) was significantly longer than that using DL intubation (18.1 ± 6.9 s, P < 0.001), whereas there was no significant difference between using VL and DL for LEMS. EMS spent slightly less time on NTI than did LEMS using both VL and DL, but there were no statistically significant differences (both p > 0.05). The NTI success rate for EMS using VL (48.0%, 12/25) was significantly lower than that using DL (88.0%, 22/25, P = 0.004), while the NTI success rate for LEMS using VL (68.2%, 15/22 vs. 40.9%, 9/22) was higher than that using DL, but there was no statistical significance. When NTI was required with ongoing chest compressions, there was no significant difference in the mean NTI time and success rate between using VL and DL for EMS or LEMS. In the group of midwives who were novices in NTI, after they watched a demonstration teaching NTI, the intubation time using VL (19.6 ± 9.0 s) was significantly shorter than that using DL (28.0 ± 6.7 s, P < 0.001). The success rate of NTI using VL was significantly higher (96.2%; 25/26) than that using DL (69.2%; 18/26). Conclusion: The video laryngoscopy could be an effective training tool for inexperienced staff in developing the skill of tracheal intubation.
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Affiliation(s)
- Ming Zhou
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaohong Xi
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Li
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Silu Wang
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang-Qin Liu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Shukla V, Mwenechanya M, Carlo WA. Dealing with neonatal emergencies in low-resource settings. Semin Fetal Neonatal Med 2019; 24:101028. [PMID: 31744767 DOI: 10.1016/j.siny.2019.101028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe the development and delivery of neonatal care including trends and impacts of major interventions on neonatal mortality particularly in low-resource settings. Low- and middle-income countries continue to be major contributors to neonatal mortality. Although there has been progress in reducing neonatal mortality, neonatal deaths are contributing an increasing percentage of childhood mortality. Several interventions targeting neonatal care such as neonatal resuscitation and essential newborn care have contributed to improved outcomes. However, there are still many neonatal deaths that are preventable with known effective interventions. This review addresses interventions proven effective in reducing neonatal mortality, challenges to implement them, and future directions of implementing these interventions in low- and middle-income countries.
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Affiliation(s)
- Vivek Shukla
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
| | - Musaku Mwenechanya
- University Teaching Hospital- Children's Hospital, Nationalist Road, Lusaka, Zambia
| | - Waldemar A Carlo
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA.
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Effect of skill drills on neonatal ventilation performance in a simulated setting- observation study in Nepal. BMC Pediatr 2019; 19:387. [PMID: 31656188 PMCID: PMC6816148 DOI: 10.1186/s12887-019-1723-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022] Open
Abstract
Aim Maintaining neonatal resuscitation skills among health workers in low resource settings will require continuous quality improvement efforts. We aimed to evaluate the effect of skill drills and feedback on neonatal resuscitation and the optimal number of skill drills required to maintain the ventilation skill in a simulated setting. Methods An observational study was conducted for a period of 3 months in a referral hospital of Nepal. Sixty nursing staffs were trained on Helping Babies Breathe (HBB) 2.0 and daily skill drills using a high-fidelity manikin. The high-fidelity manikin had different clinical case scenarios and provided feedback as “well done” or “improvement required” based on the ventilation performance. Adequate ventilation was defined as bag-and-mask ventilation at the rate of 40–60 breaths per minute. The effective ventilation was defined as adequate ventilation with a “well done” feedback. We assessed the correlation of number skill drills and clinical case scenario with adequate ventilation rate using pearson’s correlation. We assessed the correlation of number of skill dills performed by each participant with effective ventilation using Mann Whitney test. Results Among the total of 60 nursing staffs, all of them were competent with an average score of 12.73 ± 1.09 out of 14 (p < 0.001) on bag-and-mask ventilation skill checklist. Among the trained staff, 47 staffs participated in daily skill drills who performed a total of 331 skill drills and 68.9% of the ventilations were done adequately. Among the 47 nursing staffs who performed the skill drills, 228 (68.9%) drills were conducted at a ventilation rate of 40–60 breathes per minute. There was no correlation of the adequate ventilation with skill drill category (p = 0.88) and the level of skill performed (p = 0.28). Out of 47 participants performing the skill drills, 74.5% of them had done effective ventilation with a mean average of 8 skill drills (SD ± 4.78) (p-value- 0.032). Conclusion In a simulated setting, participants who had an average skill drill of 8 in 3 months had effective ventilation. We demonstrated optimal skill drill sessions for maintain the neonatal resuscitation competency. Further evaluation will be required to validate the findings in a scale up setting.
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KC A, Ewald U, Basnet O, Gurung A, Pyakuryal SN, Jha BK, Bergström A, Eriksson L, Paudel P, Karki S, Gajurel S, Brunell O, Wrammert J, Litorp H, Målqvist M. Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial. PLoS Med 2019; 16:e1002900. [PMID: 31498784 PMCID: PMC6733443 DOI: 10.1371/journal.pmed.1002900] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. METHODS AND FINDINGS We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided. CONCLUSION These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care. TRIAL REGISTRATION ISRCTN30829654.
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Affiliation(s)
- Ashish KC
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
- Society of Public Health Physician Nepal, Kathmandu, Nepal
- * E-mail:
| | - Uwe Ewald
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | | | | | | | - Bijay Kumar Jha
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Anna Bergström
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
- UCL Institute for Global Health (IGH), University College London, London, United Kingdom
| | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Prajwal Paudel
- Nepal Health Research Council, RamshahPath, Kathmandu, Nepal
| | | | | | - Olivia Brunell
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Johan Wrammert
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Helena Litorp
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
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Kamath-Rayne BD, Tabangin ME, Taylor RG, Geis GL. Retention of Basic Neonatal Resuscitation Skills and Bag-Mask Ventilation in Pediatric Residents Using Just-in-Place Simulation of Varying Frequency and Intensity: A Pilot Randomized Controlled Study. Hosp Pediatr 2019; 9:681-689. [PMID: 31371386 DOI: 10.1542/hpeds.2018-0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pediatric residents quickly lose neonatal resuscitation (NR) skills after initial training. Helping Babies Breathe is a skills-based curriculum emphasizing basic NR skills needed within the "Golden Minute" after birth. With this pilot study, we evaluated the feasibility of implementing a Golden Minute review and the impact on overall performance and bag-mask ventilation (BMV) skills in pediatric interns during and/or after their NICU rotation, with varying frequency and/or intensity of "just-in-place" simulation. METHODS During their NICU rotation, interns at 1 delivery hospital received the Golden Minute module and hands-on simulation practice. All enrolled interns were randomly assigned to weekly retraining or no retraining for their NICU month and every 1- or 3-month retraining post-NICU for the remainder of their intern year, based on a factorial design. The primary measure was the score on a 21-item evaluation tool administered at the end of intern year, which was compared to the scores received by interns at another hospital (controls). RESULTS Twenty-eight interns were enrolled in the intervention. For the primary outcome, at the end of intern year, the 1- and 3-month groups had higher scores (18.8 vs 18.6 vs 14.4; P < .01) and shorter time to effective BMV (10.6 vs 20.4 vs 52.8 seconds; P < .05 for both comparisons) than those of controls. However, the 1- and 3-month groups had no difference in score or time to BMV. CONCLUSIONS This pilot study revealed improvement in simulated performance of basic NR skills in interns receiving increased practice intensity and/or frequency than those who received the current standard of NR training.
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Affiliation(s)
- Beena D Kamath-Rayne
- Perinatal Institute and
- Global Child Health, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Regina G Taylor
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
- Emergency Medicine, and
| | - Gary L Geis
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
- Emergency Medicine, and
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Groothuis E, Van Genderen K. Helping Babies Breathe: Improving Neonatal Resuscitation and Global Neonatal Mortality. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Muneer A, Bari A, Haider A, Ali AS. Knowledge of clinicians/pediatricians about neonatal resuscitation in a tertiary care hospital. Pak J Med Sci 2019; 35:775-779. [PMID: 31258593 PMCID: PMC6572989 DOI: 10.12669/pjms.35.3.987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To analyze the knowledge of the doctors dealing with pediatric patients about neonatal resuscitation. Methods This was a cross sectional study conducted at The Lahore General Hospital over one year. Total 137 doctors related to pediatrics with different job descriptions were enrolled and requested to fill a questionnaire proforma regarding their knowledge about basic equipment required and about neonatal resuscitation steps. Data was entered and analyzed using SPSS 20. Results Out of 137 participants, majority (71%) had >2 years of experience in pediatrics and 52.5% had higher postgraduate qualification. Neonatal resuscitation workshop was attended by 57% doctors. In resuscitation of newborns at the time of delivery, resuscitating doctors were assisted by nurse in 50%, by junior doctor in 35%, paramedic staff 11% and it was done by single doctor in 4% cases. Oxygen (central or O2 cylinder) and warmer facilities were available in 90% and 82% of health facilities respectively. Majority (86%) of participants were of view that every neonate must be attended at birth. Not a single doctor followed all the standard steps of neonatal resuscitation although 90% had knowledge about resuscitation equipment and common resuscitation drugs. Conclusion Pediatric health care professionals had knowledge about neonatal resuscitation but there are gaps in the practical application. There is a strong need of frequent neonatal resuscitation workshops for improving neonatal outcomes.
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Affiliation(s)
- Ayesha Muneer
- Dr. Ayesha Muneer, F.C.P.S. Assistant Professor of Pediatric Medicine , The Lahore General Hospital, Lahore, Pakistan
| | - Attia Bari
- Dr. Attia Bari, MCPS, DCH, F.C.P.S, MHPE. Associate Professor, Pediatric Medicine, The Children's Hospital Lahore
| | - Arslan Haider
- Dr. Arslan Haider, (Pediatric FCPS Part II resident), The Lahore General Hospital, Lahore, Pakistan
| | - Agha Shabbir Ali
- Prof. Agha Shabbir Ali, MCPS, F.C.P.S. Pediatric Medicine, The Lahore General Hospital, Lahore, Pakistan
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Tabangin ME, Josyula S, Taylor KK, Vasquez JC, Kamath-Rayne BD. Resuscitation skills after Helping Babies Breathe training: a comparison of varying practice frequency and impact on retention of skills in different types of providers. Int Health 2019; 10:163-171. [PMID: 29618017 DOI: 10.1093/inthealth/ihy017] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/20/2018] [Indexed: 11/12/2022] Open
Abstract
Background Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Methods Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. Results In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Conclusions Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.
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Affiliation(s)
- M E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - S Josyula
- School of Medicine, Ohio State University, Columbus, OH, USA
| | - K K Taylor
- School of Medicine, Harvard University, Cambridge, MA, USA
| | - J C Vasquez
- Hospital Enrique Aguilar Cerrato, La Esperanza, Honduras
| | - B D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Kamath-Rayne BD, Thukral A, Visick MK, Schoen E, Amick E, Deorari A, Cain CJ, Keenan WJ, Singhal N, Little GA, Niermeyer S. Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:538-551. [PMID: 30287531 PMCID: PMC6172134 DOI: 10.9745/ghsp-d-18-00147] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/27/2018] [Indexed: 12/03/2022]
Abstract
The revised neonatal resuscitation curriculum updates not only the science of resuscitation but also the educational and implementation approaches needed to further enhance neonatal survival, including promoting ongoing practice to retain skills and linkages with quality improvement initiatives. Background: Helping Babies Breathe (HBB), a skills-based program in neonatal resuscitation for birth attendants in resource-limited settings, has been implemented in over 80 countries since 2010. Implementation studies of HBB incorporating low-dose high-frequency practice and quality improvement show substantial reductions in fresh stillbirth and first-day neonatal mortality. Revision of the program aimed to further augment provider and facilitator skills and address gaps in implementation with the goal of improving neonatal survival. Methods: The Utstein Formula for Survival—Medical Science X Educational Efficiency X Local Implementation = Survival—provided a framework for the revisions. The 2015 Neonatal Resuscitation Consensus on Science and Treatment Recommendations by the International Liaison Committee on Resuscitation informed scientific updates, which were harmonized with the 2012 World Health Organization Basic Newborn Resuscitation Guidelines. Published literature and program reports, consensus guidelines on reprocessing equipment, systematic collection of suggestions from frontline users, and responses to a semistructured online questionnaire informed educational/implementation revisions. Links to maternal care were added. Draft materials underwent Delphi review and field testing in India and Sierra Leone. An Utstein-style meeting of stakeholders identified key actions for successful implementation. Results: Scientific revisions included expectant management of infants with meconium-stained amniotic fluid, limitation of suctioning, and initiating and continuing effective ventilation until spontaneous respirations. Frontline users (N=102) suggested augmented simulation methods to build confidence and competence and additional guidance for facilitators on implementation. Users identified a need for sufficient practice during the workshop, systematized ongoing practice, and enough simulators for participants. Field trials refined approaches to self-reflection, feedback and debriefing, and quality improvement. Utstein meeting stakeholders validated the importance of quality improvement and use of data to improve outcomes. Conclusions: The second edition of HBB provides a newer paradigm of learning for providers that incorporates workshop practice, self-reflection, and feedback and debriefing to reinforce learning as well as the promotion of mentorship and development of facilitators, systems for low-dose high-frequency practice in facilities, and quality improvement related to neonatal resuscitation.
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Affiliation(s)
- Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, and Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Eileen Schoen
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Erick Amick
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Carrie Jo Cain
- World Hope International, Alexandria, VA, USA and Freetown, Sierra Leone
| | - William J Keenan
- Division of Neonatology, Saint Louis University, St. Louis, MO, USA
| | - Nalini Singhal
- Division of Neonatology, University of Calgary, Alberta, Canada
| | - George A Little
- Division of Neonatology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Niermeyer
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
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Pietravalle A, Cavallin F, Opocher A, Madella S, Cavicchiolo ME, Pizzol D, Putoto G, Trevisanuto D. Neonatal tactile stimulation at birth in a low-resource setting. BMC Pediatr 2018; 18:306. [PMID: 30236090 PMCID: PMC6146550 DOI: 10.1186/s12887-018-1279-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. To evaluate the occurrence, patterns and response to tactile stimulation at birth in a low-resource setting. METHODS We reviewed 150 video recordings of neonatal resuscitation at Beira Central Hospital (Beira, Mozambique). Timing, method, duration and response to tactile stimulation were evaluated. RESULTS One hundred two out of 150 neonates (68.0%) received stimulation, while the remaining 48 (32.0%) received positive pressure ventilation and/or chest compressions directly. Overall, 546 stimulation episodes (median 4 episodes per subject, IQR 2-7) were performed. Median time to the first stimulation episode was 134 s (IQR 53-251); 29 neonates (28.4%) received stimulation within the first minute after birth. Multiple techniques of stimulation were administered in 66 neonates (64.7%), while recommended techniques (rubbing the back or flicking the soles of the feet) only in 9 (8.8%). Median duration of stimulation was 17 s (IQR 9-33). Only 9 neonates (8.8%) responded to stimulation. CONCLUSIONS In a low-resource setting, stimulation of newly born infants at birth is underperformed. Adherence to international guidelines is low, resulting in delayed initiation, inadequate technique, prolonged duration and low response to stimulation. Back rubs may provide some benefits, but large prospective studies comparing different methods of stimulation are required.
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Affiliation(s)
- Andrea Pietravalle
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | | | - Anna Opocher
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | - Stefania Madella
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | - Maria Elena Cavicchiolo
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
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Yangthara B, Horrasith S, Paes B, Kitsommart R. Predictive factors for intensive birth resuscitation in a developing-country: a 5-year, single-center study. J Matern Fetal Neonatal Med 2018; 33:570-576. [PMID: 29973079 DOI: 10.1080/14767058.2018.1497602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To identify risk factors outlined in the International Liaison Committee on Resuscitation (ILCOR) 2010 guideline and requirement for high-intensity resuscitation.Study design: A retrospective cross-sectional study of infants born to high-risk mothers from 2011 to 2015.Results: Totally 11,446 infants were analyzed; 37% were preterm, 36% were low-birth weight infants or less. 1506 infants required respiratory support; 82 (0.7%) and 61 (0.5%) infants needed chest compression and/or epinephrine. Very-preterm infants received more intensive resuscitation than moderate preterm or term infants. Breech presentation, maternal infection and maternal diabetes were significantly associated with need for respiratory support. Fetal anomalies, breech presentation, oligohydramnios, and multiple gestation were significantly associated with need for hemodynamic support.Conclusion: Most infants defined in the ILCOR 2010 guideline required nonintensive ventilation. Very-preterm infants, fetal anomalies, and breech presentation necessitate neonatal attendance at delivery. In developing countries, maternal infection and diabetes remain high-risk criteria despite deletion from the ILCOR 2016 guideline.
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Affiliation(s)
- Buranee Yangthara
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Siriluck Horrasith
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Hamilton, Canada
| | - Ratchada Kitsommart
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
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Niermeyer S, Perlman JM. Helping Babies Breathe: When Less Is More. Neonatology 2018; 114:124-126. [PMID: 29804105 DOI: 10.1159/000489081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Susan Niermeyer
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey M Perlman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Weill Cornell Medicine, New York, New York, USA
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Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training. J Perinatol 2017; 37:1153-1160. [PMID: 28726790 DOI: 10.1038/jp.2017.110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. METHODS Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. RESULTS Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. CONCLUSION In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.
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Enweronu-Laryea C, Robertson NJ. Helping babies breathe can reduce deaths with the right combination of training and expertise. Acta Paediatr 2017; 106:1552-1553. [PMID: 28876487 DOI: 10.1111/apa.13988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 10/18/2022]
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