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Pike H, Kolstad V, Eilevstjønn J, Davis PG, Ersdal HL, Rettedal S. Newborn resuscitation timelines: Accurately capturing treatment in the delivery room. Resuscitation 2024; 197:110156. [PMID: 38417611 DOI: 10.1016/j.resuscitation.2024.110156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES To evaluate the use of newborn resuscitation timelines to assess the incidence, sequence, timing, duration of and response to resuscitative interventions. METHODS A population-based observational study conducted June 2019-November 2021 at Stavanger University Hospital, Norway. Parents consented to participation antenatally. Newborns ≥28 weeks' gestation receiving positive pressure ventilation (PPV) at birth were enrolled. Time of birth was registered. Dry-electrode electrocardiogram was applied as soon as possible after birth and used to measure heart rate continuously during resuscitation. Newborn resuscitation timelines were generated from analysis of video recordings. RESULTS Of 7466 newborns ≥28 weeks' gestation, 289 (3.9%) received PPV. Of these, 182 had the resuscitation captured on video, and were included. Two-thirds were apnoeic, and one-third were breathing ineffectively at the commencement of PPV. PPV was started at median (quartiles) 72 (44, 141) seconds after birth and continued for 135 (68, 236) seconds. The ventilation fraction, defined as the proportion of time from first to last inflation during which PPV was provided, was 85%. Interruption in ventilation was most frequently caused by mask repositioning and auscultation. Suctioning was performed in 35% of newborns, in 95% of cases after the initiation of PPV. PPV was commenced within 60 s of birth in 49% of apnoeic and 12% of ineffectively breathing newborns, respectively. CONCLUSIONS Newborn resuscitation timelines can graphically present accurate, time-sensitive and complex data from resuscitations synchronised in time. Timelines can be used to enhance understanding of resuscitation events in data-guided quality improvement initiatives.
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Affiliation(s)
- Hanne Pike
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Vilde Kolstad
- Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway
| | - Siren Rettedal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway.
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Diggikar S, Ramaswamy VV, Koo J, Prasath A, Schmölzer GM. Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies. Neonatology 2024:1-10. [PMID: 38467119 DOI: 10.1159/000537800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes. SUMMARY Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials. KEY MESSAGES This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.
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Affiliation(s)
| | | | - Jenny Koo
- Sharp Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Arun Prasath
- Department of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dhungana R, Chalise M, Clark RB. An assessment of immediate newborn care readiness and availability in Nepal. Glob Health Action 2023; 16:2289735. [PMID: 38085010 PMCID: PMC10795551 DOI: 10.1080/16549716.2023.2289735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities. OBJECTIVE This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not. METHODS Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability. RESULTS The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services. CONCLUSION This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.
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Affiliation(s)
| | | | - Robert B. Clark
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Yoosoof F, Liyanage I, de Silva R, Samaraweera S. Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study. BMC Med Educ 2022; 22:839. [PMID: 36471390 PMCID: PMC9721000 DOI: 10.1186/s12909-022-03926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The flipped skills lab is a student-centred approach which incorporates pre-class preparation (pre-skill conceptualization) followed by repeated, hands-on practice for practical skills training. Objective measures of skills acquisition in the flipped literature are few and conflicting. The importance of pre-skill conceptualization in flipped skills training suggests that pedagogically informed pre-skill conceptualization can enhance outcomes. METHODS A mixed quasi-experimental study was conducted on 41 final year medical students who followed a flipped newborn resuscitation skills lab. Pre-class preparatory material covered conceptual and procedural knowledge. Students in the traditional group (n = 19) and those in the interventionalmental group (n = 22) received identical reading material covering conceptual knowledge. Procedural knowledge was shared with the interventional group as demonstration videos, while the traditional group received a PowerPoint presentation with text and images covering the same material. Knowledge acquisition was assessed by 20 single best answer questions before and after hands-on practice in the skills lab and skill performance was tested post-intervention with a simulated scenario. Students' perceptions were collected by survey. Quantitative data was analysed using Wilcoxon Signed Ranks test and Mann-Whitney U test as appropriate. Qualitative data was analysed by thematic analysis. RESULTS Overall student rating of the intervention was positive with ratings of 4.54 and 4.46 out of 5 by the traditional group and the experimental group respectively. Post-intervention skill performance in the experimental group was significantly better (p < .05) in the interventional group (M = 87.86%, SD = 5.89) than in the traditional group (M = 83.44, SD = 5.30) with a medium effect size (r = .40). While both groups showed significant knowledge gains, only students in the experimental group showed a statistically significant gain in procedural knowledge (p < .05) following the flipped skills lab. Finally, while both groups self-reported feeling more knowledgeable and confident following the intervention, the level of confidence was superior in the experimental group. CONCLUSIONS Flipping the skills lab with pre-skill conceptualisation combining text-based conceptual knowledge and video-based procedural knowledge followed by simulation-based hands-on practice improves procedural knowledge and skills acquisition in newborn resuscitation training for medical students. This study shows that in addition to temporal benefits, pedagogically informed pre-skill conceptualization can confer procedure-specific cognitive and emotional benefits supporting skills acquisition.
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Affiliation(s)
- Farah Yoosoof
- Department of Paediatrics, General Sir John Kotelawala Defence University, Rathmalana, 10390 Sri Lanka
| | - Indika Liyanage
- Department of Paediatrics, General Sir John Kotelawala Defence University, Rathmalana, 10390 Sri Lanka
| | - Ranjith de Silva
- Sri Lanka College of Obstetricians and Gynaecologists, No.112 Model Farm Rd, Colombo, Sri Lanka
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Kamau PT, Koech M, Hecht SM, McHenry MS, Songok J. Assessment of neonatal resuscitation skills among healthcare workers in Uasin Gishu County, Kenya. SAGE Open Med 2022; 10:20503121221119296. [PMID: 36051784 PMCID: PMC9424879 DOI: 10.1177/20503121221119296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Neonatal resuscitation is key in preventing neonatal mortality. The objective of this study was to assess the competence of healthcare workers in basic neonatal resuscitation at six hospitals in Uasin Gishu County in Kenya. Methods This was a cross-sectional study of healthcare workers based on the labor and delivery wards. Results Of the 46 healthcare workers who were assessed with a written examination and skills assessment, 85% were nurses. While 46% were able to pass the written examination, none demonstrated all required steps of newborn resuscitation during the skills assessment by simulation. No significant associations were present between the pass rate of the written examination and years of experience, role, or prior in-service training. All of the hospitals had the basic equipment required for neonatal resuscitation. Conclusion There is a need to further develop the neonatal resuscitation skills among healthcare workers in the labor and delivery wards in Uasin Gishu County, Kenya.
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Affiliation(s)
| | - Myra Koech
- Department of Pediatrics and Child Health, School of Medicine, Moi University, Eldoret, Kenya
| | - Shaina M Hecht
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Megan S McHenry
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Julia Songok
- Department of Pediatrics and Child Health, School of Medicine, Moi University, Eldoret, Kenya
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Peder Aleksander B, Hege Langli E, Joanna H, Anastasia U, Knut Ø, Siren IR. Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns. Resuscitation 2021; 170:222-9. [PMID: 34915085 DOI: 10.1016/j.resuscitation.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/16/2022]
Abstract
AIM T-piece resuscitators are commonly used for respiratory support during newborn resuscitation. This study aimed to describe delivered pressures and tidal volumes when resuscitating term newborns immediately after birth, using the NeoPuff T-piece resuscitator. METHOD Observational study from June 2019 through March 2021 at Stavanger University Hospital, Norway, including term newborns ventilated with a T-piece resuscitator after birth, with consent to participate. Ventilation parameters of the first 100 inflations from each newborn were recorded by respiration monitors and divided into an early (inflation 1-20) and a late (inflation 21-100) phase. RESULTS Of the 7730 newborns born, 232 term newborns received positive pressure ventilation. Of these, 129 newborns were included. In the early and the late phase, the median (interquartile range) peak inflating pressure was 30 (28-31) and 30 (27-31) mbar, and tidal volume was 4.5 (1.6-7.8) and 5.7 (2.2-9.8) ml/kg, respectively. Increased inflation times were associated with an increase in volume before plateauing at an inflation time of 0.41 s in the early phase and 0.50 s in the late phase. Inflation rates exceeding 32 per minute in the early phase and 41 per minute in the late phase were associated with lower tidal volumes. CONCLUSION There was a substantial variation in tidal volumes despite a relatively stable peak inflating pressure. Delivered tidal volumes were at the lower end of the recommended range. Our results indicate that an inflation time of approximately 0.5 s and rates around 30-40 per minute are associated with the highest delivered tidal volumes.
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Mubeen K, Baig M, Abbas S, Adnan F, Lakhani A, Bhamani SS, Rehman B, Shahid S, Jan R. Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan. BMC Pediatr 2021; 21:555. [PMID: 34876070 PMCID: PMC8653596 DOI: 10.1186/s12887-021-03014-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan. Method A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran’s Q tests were applied for data analysis. Participants’ feedback was also obtained at the end of each training, which was analyzed through descriptive statistics. Results Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected. Conclusion The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.
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Affiliation(s)
- Kiran Mubeen
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan.
| | - Marina Baig
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
| | - Sadia Abbas
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
| | - Farzana Adnan
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
| | - Arusa Lakhani
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
| | | | - Bushra Rehman
- Integrated Reproductive Maternal, Newborn, Child Health and Nutrition program, Punjab (IRMNCH), Lahore, Pakistan
| | - Shahnaz Shahid
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
| | - Rafat Jan
- Aga Khan University School of Nursing and Midwifery (AKUSONAM), Karachi, Pakistan
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Kamala BA, Ersdal HL, Mduma E, Moshiro R, Girnary S, Østrem OT, Linde J, Dalen I, Søyland E, Bishanga DR, Bundala FA, Makuwani AM, Richard BM, Muzzazzi PD, Kamala I, Mdoe PF. SaferBirths bundle of care protocol: a stepped-wedge cluster implementation project in 30 public health-facilities in five regions, Tanzania. BMC Health Serv Res 2021; 21:1117. [PMID: 34663296 PMCID: PMC8524841 DOI: 10.1186/s12913-021-07145-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background The burden of stillbirth, neonatal and maternal deaths are unacceptably high in low- and middle-income countries, especially around the time of birth. There are scarce resources and/or support implementation of evidence-based training programs. SaferBirths Bundle of Care is a well-proven package of innovative tools coupled with data-driven on-the-job training aimed at reducing perinatal and maternal deaths. The aim of this project is to determine the effect of scaling up the bundle on improving quality of intrapartum care and perinatal survival. Methods The project will follow a stepped-wedge cluster implementation design with well-established infrastructures for data collection, management, and analysis in 30 public health facilities in regions in Tanzania. Healthcare workers from selected health facilities will be trained in basic neonatal resuscitation, essential newborn care and essential maternal care. Foetal heart rate monitors (Moyo), neonatal heart rate monitors (NeoBeat) and skills trainers (NeoNatalie Live) will be introduced in the health facilities to facilitate timely identification of foetal distress during labour and improve neonatal resuscitation, respectively. Heart rate signal-data will be automatically collected by Moyo and NeoBeat, and newborn resuscitation training by NeoNatalie Live. Given an average of 4000 baby-mother pairs per year per health facility giving an estimate of 240,000 baby-mother pairs for a 2-years duration, 25% reduction in perinatal mortality at a two-sided significance level of 5%, intracluster correlation coefficient (ICC) to be 0.0013, the study power stands at 0.99. Discussion Previous reports from small-scale Safer Births Bundle implementation studies show satisfactory uptake of interventions with significant improvements in quality of care and lives saved. Better equipped and trained birth attendants are more confident and skilled in providing care. Additionally, local data-driven feedback has shown to drive continuous quality of care improvement initiatives, which is essential to increase perinatal and maternal survival. Strengths of this research project include integration of innovative tools with existing national guidelines, local data-driven decision-making and training. Limitations include the stepwise cluster implementation design that may lead to contamination of the intervention, and/or inability to address the shortage of healthcare workers and medical supplies beyond the project scope. Trial registration Name of Trial Registry: ISRCTN Registry. Trial registration number: ISRCTN30541755. Date of Registration: 12/10/2020. Type of registration: Prospectively Registered.
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Affiliation(s)
- Benjamin A Kamala
- Department of Research, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania. .,School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Hege L Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Estomih Mduma
- Department of Research, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania
| | - Robert Moshiro
- Department of Research, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania.,Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Paediatric Association of Tanzania, Dar es Salaam, Tanzania
| | | | | | - Jørgen Linde
- Obstetric Department, Stavanger University Hospital, Stavanger, Norway
| | - Ingvild Dalen
- Obstetric Department, Stavanger University Hospital, Stavanger, Norway
| | | | - Dunstan R Bishanga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Felix Ambrose Bundala
- Reproductive and Child Health Section, Ministry of Health Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Ahmad M Makuwani
- Reproductive and Child Health Section, Ministry of Health Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Boniphace Marwa Richard
- Department of Health, President's Office- Regional Authority and Local Government, Dodoma, Tanzania
| | | | - Ivony Kamala
- Department of Research, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania.,Tanzania Midwifery Association (TAMA), Dar es Salaam, Tanzania
| | - Paschal F Mdoe
- Department of Research, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania
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Holte K, Ersdal H, Klingenberg C, Eilevstjønn J, Stigum H, Jatosh S, Kidanto H, Størdal K. Expired carbon dioxide during newborn resuscitation as predictor of outcome. Resuscitation 2021; 166:121-128. [PMID: 34098031 DOI: 10.1016/j.resuscitation.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. METHODS Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0-30 s, 30.1-60 s and 60.1-300 s). RESULTS Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 <2% and HR < 100 bpm, ECO2 reached ≥2% before HR ≥ 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO2 reached ≥2% and 44% per minute before HR reached ≥100 bpm. CONCLUSIONS Higher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival.
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Affiliation(s)
- Kari Holte
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Norway; Faculty of Health Sciences, University of Stavanger, Norway.
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, Norway; Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway; Paediatric Research Group, Faculty of Health Sciences, University of Tromsø - Arctic University of Norway, Tromsø, Norway
| | - Joar Eilevstjønn
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | - Hein Stigum
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hussein Kidanto
- Medical College, Agakhan University, Dar es Salaam, Tanzania
| | - Ketil Størdal
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Norway; Norwegian Institute of Public Health, Oslo, Norway; Department of Paediatric Research, Faculty of Medicine, University of Oslo, Norway
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Gurung R, Gurung A, Basnet O, Eilevstjønn J, Myklebust H, Girnary S, Shrestha SK, Singh D, Bastola L, Paudel P, Baral S, Kc A. REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal. BMC Pregnancy Childbirth 2020; 20:756. [PMID: 33272242 PMCID: PMC7712979 DOI: 10.1186/s12884-020-03456-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. METHODS A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. DISCUSSION This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN18148368 , date of registration-31 July 2018.
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Affiliation(s)
| | | | | | | | | | - Sakina Girnary
- Laerdal Medicine/Laerdal Global Health, Stavanger, Norway
| | | | - Dela Singh
- Pokhara Academy of Health Sciences, Pokhara, Nepal
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Ashish Kc
- Society of Public Health Physician Nepal, Kathmandu, Nepal. .,Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 1 tr, 752 37, Uppsala, Sweden.
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12
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Umunyana J, Sayinzoga F, Ricca J, Favero R, Manariyo M, Kayinamura A, Tayebwa E, Khadka N, Molla Y, Kim YM. A practice improvement package at scale to improve management of birth asphyxia in Rwanda: a before-after mixed methods evaluation. BMC Pregnancy Childbirth 2020; 20:583. [PMID: 33023484 PMCID: PMC7539497 DOI: 10.1186/s12884-020-03181-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/14/2020] [Indexed: 11/12/2022] Open
Abstract
Background Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n = 172) in ten districts in Rwanda from 2015 to 2018. Methods A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to 1 year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results Nearly 40 % (n = 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n = 456), 60 % demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of 5 months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 min of birth (19% reduction, p = 0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.
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Affiliation(s)
- Jacqueline Umunyana
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | | | - Jim Ricca
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA.
| | - Rachel Favero
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA.
| | - Marcel Manariyo
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Assumpta Kayinamura
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Edwin Tayebwa
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Neena Khadka
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Yordanos Molla
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Young-Mi Kim
- Jhpiego Corporation, 1615 Thames St., Baltimore, MD, USA
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13
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Urdal J, Engan K, Eftestøl T, Naranjo V, Haug IA, Yeconia A, Kidanto H, Ersdal H. Automatic identification of stimulation activities during newborn resuscitation using ECG and accelerometer signals. Comput Methods Programs Biomed 2020; 193:105445. [PMID: 32283386 DOI: 10.1016/j.cmpb.2020.105445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Early neonatal death is a worldwide challenge with 1 million newborn deaths every year. The primary cause of these deaths are complications during labour and birth asphyxia. The majority of these newborns could have been saved with adequate resuscitation at birth. Newborn resuscitation guidelines recommend immediate drying, stimulation, suctioning if indicated, and ventilation of non-breathing newborns. A system that will automatically detect and extract time periods where different resuscitation activities are performed, would be highly beneficial to evaluate what resuscitation activities that are improving the state of the newborn, and if current guidelines are good and if they are followed. The potential effects of especially stimulation are not very well documented as it has been difficult to investigate through observations. In this paper the main objective is to identify stimulation activities, regardless if the state of the newborn is changed or not, and produce timelines of the resuscitation episode with the identified stimulations. METHODS Data is collected by utilizing a new heart rate device, NeoBeat, with dry-electrode ECG and accelerometer sensors placed on the abdomen of the newborn. We propose a method, NBstim, based on time domain and frequency domain features from the accelerometer signals and ECG signals from NeoBeat, to detect time periods of stimulation. NBstim use causal features from a gliding window of the signals, thus it can potentially be used in future realtime systems. A high performing feature subset is found using feature selection. System performance is computed using a leave-one-out cross-validation and compared with manual annotations. RESULTS The system achieves an overall accuracy of 90.3% when identifying regions with stimulation activities. CONCLUSION The performance indicates that the proposed NBstim, used with signals from the NeoBeat can be used to determine when stimulation is performed. The provided activity timelines, in combination with the status of the newborn, for example the heart rate, at different time points, can be studied further to investigate both the time spent and the effect of different newborn resuscitation parameters.
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Affiliation(s)
- Jarle Urdal
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway.
| | - Kjersti Engan
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway.
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniera (I3B), Universitat Politécnica de Valéncia, Spain
| | | | | | - Hussein Kidanto
- School of Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Hege Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Norway; Dep. of Health Sciences, University of Stavanger, Norway
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14
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Solevåg AL, Garcia-Hidalgo C, Cheung PY, Lee TF, O'Reilly M, Schmölzer GM. Ventilation with 18, 21, or 100% Oxygen during Cardiopulmonary Resuscitation of Asphyxiated Piglets: A Randomized Controlled Animal Trial. Neonatology 2020; 117:102-110. [PMID: 31896112 DOI: 10.1159/000504494] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In previous piglet experiments of profound asphyxia and cardiac arrest, recovery was similar when 21 and 100% oxygen were used for positive pressure ventilation (PPV). There was no consistent reduction in inflammation and oxidative stress in piglets ventilated with 21 or 100% oxygen. OBJECTIVES We aimed to investigate hypoxic resuscitation, i.e., PPV with 18% oxygen, in profoundly asphyxiated piglets with cardiac arrest. We hypothesized that resuscitation with 18% oxygen would result in less inflammation and oxidative stress compared to 21 or 100% oxygen. METHOD Twenty-four piglets were exposed to 30 min of normocapnic hypoxia followed by asphyxia until asystole. The piglets were randomized to PPV with 18% oxygen (n = 8), 21% oxygen (n = 8), or 100% oxygen (n = 8), and resuscitated with chest compressions and intravenous epinephrine. Return of spontaneous circulation (ROSC) was defined as an unassisted heart rate ≥100 bpm for 15 s. Lactate, GSH (total glutathione), GSSG (oxidized glutathione), and GSSG/GSH ratio were measured in myocardial and frontoparietal cortex homogenates. Interleukin (IL)-8, IL-6, IL-1β and tumor necrosis factor α were measured in frontoparietal cortex homogenates. RESULTS There was no difference in time to ROSC or inflammation and oxidative stress in the 3 oxygen groups. CONCLUSIONS Resuscitation with 18% oxygen did not result in differences in inflammation and oxidative stress when compared to 21 or 100% oxygen.
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Affiliation(s)
- Anne Lee Solevåg
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway,
| | - Catalina Garcia-Hidalgo
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tze-Fun Lee
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Megan O'Reilly
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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15
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Herrick HM, Glass KM, Johnston LC, Singh N, Shults J, Ades A, Nadkarni V, Nishisaki A, Foglia EE. Comparison of Neonatal Intubation Practice and Outcomes between the Neonatal Intensive Care Unit and Delivery Room. Neonatology 2020; 117:65-72. [PMID: 31563910 PMCID: PMC7098841 DOI: 10.1159/000502611] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Characteristics of neonatal tracheal intubations (TI) may vary between the neonatal intensive care unit (NICU) and delivery room (DR). The impact of the setting on TI outcomes is not well characterized. OBJECTIVE The aim of this study was to define variation in neonatal TI practice between settings, and identify the association between setting and TI success and safety outcomes. DESIGN This was a retrospective cohort study of TIs in the National Emergency Airway Registry for Neonates from October 2014 to September 2017. The setting (NICU vs. DR) was the exposure of interest. The outcomes were first attempt success, course success, success within 4 attempts, adverse TI-associated events, severe desaturation, and bradycardia. We compared TI characteristics and outcomes between settings in univariable analysis. Factors significant in univariable analysis (p < 0.1) were included in a logistic regression model, with adjustment for clustering by center, to identify the independent impact of the setting on TI outcomes. RESULTS There were 3,145 TI encounters (2279 NICU, 866 DR) in 9 centers. Almost all baseline characteristics significantly varied between settings. First attempt success rates were 48% (NICU) and 46% (DR). In multivariable analysis, the setting was not associated with first attempt success. DR was associated with a higher adjusted OR (aOR) of success within 4 attempts (1.48, 95% CI 1.06-2.08) and a lower aOR for bradycardia (0.43, 95% CI 0.26-0.71). CONCLUSION Significant differences in patient, provider, and practice characteristics exist between NICU and DR TIs. There is substantial room for improvement in first attempt success rates. These results suggest interventions to improve safety and success need to be targeted to the distinct setting.
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Affiliation(s)
- Heidi Meredith Herrick
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lindsay C Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Neetu Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Justine Shults
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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16
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Gomo ØH, Eilevstjønn J, Holte K, Yeconia A, Kidanto H, Ersdal HL. Delivery of Positive End-Expiratory Pressure Using Self-Inflating Bags during Newborn Resuscitation Is Possible Despite Mask Leak. Neonatology 2020; 117:341-348. [PMID: 32610333 DOI: 10.1159/000507829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventilation is the key intervention to resuscitate non-breathing newborns. Positive end-expiratory pressure (PEEP) may facilitate lung-liquid clearance and help establish functional residual capacity. OBJECTIVES The aim of this study was to describe how mask leak and ventilation rates affect delivered PEEP and tidal volumes during newborn resuscitations using a self-inflating bag with an integrated PEEP valve. METHODS This was an observational study including near-term/term newborns who received bag-mask ventilation (BMV) with a new self-inflating bag with a novel 6 mbar PEEP valve, without external gas flow, between October 1, 2016 and June 30, 2018 in rural Tanzania. Helping Babies Breathe-trained midwives performed most of the resuscitations. Pressures and flow were continuously measured and recorded by resuscitation monitors. RESULTS In total, 198 newborns with a median gestation of 39 weeks (25th, 75th percentiles 37, 40) and birth weight of 3,100 g (2,580, 3,500) were included. The median delivered PEEP and expired (tidal) volume at different levels of mask leak were 6.0 mbar and 11.3 mL/kg at 0-20% mask leak, 5.5 mbar and 9.3 mL/kg at 20-40%, 5.2 mbar and 7.8 mL/kg at 40-60%, 4.6 mbar and 5.0 mL/kg at 60-80%, and 1.0 mbar and 0.6 mL/kg at 80-100% mask leak. A high ventilation rate (>60/min) nearly halved expired volumes compared to <60/min for 0-60% leak. The BMV rate had a negligible effect on peak inflation pressure (PIP) and PEEP. CONCLUSIONS Mask leak up to 80% did not impair the provision of recommended PEEP or tidal volumes during BMV with a self-inflating bag. High or low ventilation rates did not significantly affect PIP or PEEP. Expired volumes were reduced at ventilation rates >60/min.
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Affiliation(s)
| | - Joar Eilevstjønn
- Research and Development Department, Laerdal Medical, Stavanger, Norway
| | - Kari Holte
- Neonatal Department, Østfold Hospital Trust, Grålum, Norway
| | - Anita Yeconia
- Research Department, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Hussein Kidanto
- Medical College, Aga Khan University, Dar es Salaam, Tanzania.,Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Hege Langli Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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17
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Bjorland PA, Ersdal HL, Øymar K, Rettedal SI. Compliance with Guidelines and Efficacy of Heart Rate Monitoring during Newborn Resuscitation: A Prospective Video Study. Neonatology 2020; 117:175-181. [PMID: 32248187 PMCID: PMC9533428 DOI: 10.1159/000506772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Newborn resuscitation guidelines recommend initial assessment of heart rate (HR) and initiation of positive pressure ventilation (PPV) within 60 s after birth in non-breathing newborns. Pulse oximeter (PO) and electrocardiogram (ECG) are suggested methods for continuous HR monitoring during resuscitation. Our aim was to evaluate compliance with guidelines and the efficacy of PO versus ECG monitoring in real-life newborn resuscitations. METHODS In this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth. RESULTS 104 resuscitations were analysed. Median (IQR) time from birth to arrival at the resuscitation bay was 48 (22-68) s (n = 62), to initial HR assessment 70 (47-118) s (n = 61), and to initiation of PPV 78 (42-118) s (n = 62). Initial HR assessment (stethoscope or palpation) and initiation of PPV were achieved within 60 s for 35% of the resuscitated newborns. Time to initial HR assessment and initiating PPV was significantly longer following vaginal deliveries than caesarean sections: 84 (70-139) versus 44 (30-66) s (p < 0.001) and 93 (73-139) versus 38 (30-66) s (p < 0.001). Time from birth and sensor application to provision of a reliable HR signal from PO versus ECG was 348 (217-524) (n = 42) versus 174 (105-277) s (n = 30) (p < 0.001) and 199 (77-352) (n = 65) versus 16 (11-22) s (n = 52) (p < 0.001). CONCLUSION Initial HR assessment and initiation of PPV were achieved within 60 s after birth in only 1/3 of newborn resuscitations. When applied for continuous HR monitoring, ECG was superior to PO in time to achieve reliable HR signals in real-life resuscitations.
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Affiliation(s)
- Peder Aleksander Bjorland
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway, .,Department of Clinical Science, University of Bergen, Bergen, Norway,
| | - Hege Langli Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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18
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Jain D, D'Ugard C, Aguilar A, Del Moral T, Bancalari E, Claure N. Use of a Mechanical Ventilator with Respiratory Function Monitoring Provides More Consistent Ventilation during Simulated Neonatal Resuscitation. Neonatology 2020; 117:151-158. [PMID: 31593960 DOI: 10.1159/000503257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Positive pressure ventilation (PPV) with T-Piece and self-inflating bag (SIB) during neonatal resuscitation after birth is associated with variability in ventilation. The use of a ventilator with respiratory function monitoring (RFM) for PPV, however, has not been evaluated. OBJECTIVE To determine if ventilator + RFM can reduce ventilation variability compared to T-Piece and SIB in a preterm manikin at different combinations of target tidal volume (VT) and lung compliance (CL). METHODS Twenty clinicians provided PPV via mask and endotracheal tube (ETT) using SIB, T-Piece, T-Piece + RFM and Ventilator + RFM to a manikin with adjustable lung CL. Three combinations of CL and target VT: Low CL-Low VT, Low CL-High VT and High CL-Low VT were used in a random order. RESULTS The use of ventilator + RFM for PPV via ETT during High CL-Low VT period reduced the proportion of breaths with expiratory VT above target when compared to the other 3 devices (56 ± 35%, 85 ± 20%, 90 ± 25%, 92 ± 12% for ventilator + RFM, T-Piece + RFM, T-Piece, SIB, respectively; p < 0.05). During PPV via both mask and ETT, ventilator + RFM maintained the set Ti and rate, whereas SIB and T-Piece use resulted in higher rates, and T-Piece in higher proportion of breaths with prolonged Ti. During PPV via mask, ventilator + RFM reduced gas leakage compared to other devices. CONCLUSION In this simulation study, use of a mechanical ventilator with RFM led to an overall improvement in volume targeting at different settings of CL and reduced the gas leak during mask ventilation. The efficacy and safety of using this strategy to neonatal resuscitation in the delivery room needs to be evaluated.
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Affiliation(s)
- Deepak Jain
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA,
| | - Carmen D'Ugard
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Ana Aguilar
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Teresa Del Moral
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Eduardo Bancalari
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Nelson Claure
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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19
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Merali HS, Tessaro MO, Ali KQ, Morris SK, Soofi SB, Ariff S. A novel training simulator for portable ultrasound identification of incorrect newborn endotracheal tube placement - observational diagnostic accuracy study protocol. BMC Pediatr 2019; 19:434. [PMID: 31722685 PMCID: PMC6852924 DOI: 10.1186/s12887-019-1717-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children. Methods This will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods. Discussion This study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support. Trial registration ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.
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Affiliation(s)
- Hasan S Merali
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, 1280 Main Street West, HSC-2R104, Hamilton, ON, L8S 4K1, Canada
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Emergency Point-of-Care Ultrasound Program, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Khushboo Q Ali
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Department of Pediatrics Faculty of Medicine, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Sajid B Soofi
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Abstract
The Neonatal Resuscitation Program meets the education and training needs of health care professionals in the United States who manage newborns in hospitals. The Neonatal Resuscitation Program 7th edition materials were required for use on January 1, 2017. The Neonatal Resuscitation Program focuses on optimal resuscitation readiness and effective communication. This article briefly describes the preparation and principles of newborn resuscitation and selected components of the Neonatal Resuscitation Program Flow Diagram. Five resuscitation scenarios of increasing complexity are used to illustrate how the guidelines are integrated into clinical practice.
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21
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Okonkwo IR, Ezeaka VC, Mustapha B, Ezeanosike O, Tongo O, Okolo AA, Olateju EK, Oruamabo R, Ibe B. Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action. Afr Health Sci 2019; 19:1563-1565. [PMID: 31148984 PMCID: PMC6531942 DOI: 10.4314/ahs.v19i1.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. OBJECTIVES To ascertain the resuscitation practices in communities lacking bag-mask-valve devices. METHODS Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. RESULTS Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. CONCLUSION There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy.
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Affiliation(s)
| | | | - Bello Mustapha
- Department of Paediatrics, University of Maiduguri Teaching Hospital, Maiduguri
| | - Obum Ezeanosike
- Department of Paediatrics, Federal Teaching Hospital Abakaliki
| | - Olukemi Tongo
- Department of Paediatrics, University College Hospital Ibadan
| | - Angela A Okolo
- Department of Paediatrics, Federal medical centre, Asaba
| | | | - Raphael Oruamabo
- Department of Paediatrics, Rivers State University of Science and Technology
| | - Bede Ibe
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu
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22
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Drake M, Bishanga DR, Temu A, Njozi M, Thomas E, Mponzi V, Arlington L, Msemo G, Azayo M, Kairuki A, Meda AR, Isangula KG, Nelson BD. Structured on-the-job training to improve retention of newborn resuscitation skills: a national cohort Helping Babies Breathe study in Tanzania. BMC Pediatr 2019; 19:51. [PMID: 30732580 PMCID: PMC6366017 DOI: 10.1186/s12887-019-1419-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania. Methods An initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site to others who were not trained. After a noted drop in skills, the program developed structured on-the-job training guidance and included this in the training. The approaches were implemented sequentially in 8 regions each with nurses/ midwives, other clinicians and medical attendants who had not received HBB training before. Newborn resuscitation skills were assessed immediately after training and 4–6 weeks after training using a validated objective structured clinical examination, and retention, measured through degree of skills drop, was compared between the two training approaches. Results Eight thousand, three hundred and ninety-one providers were trained and assessed: 3592 underwent the initial training approach and 4799 underwent the modified approach. Immediately post-training, average skills scores were similar between initial and modified training groups: 80.5 and 81.3%, respectively (p-value 0.07). Both groups experienced statistically significant drops in newborn resuscitation skills over time. However, the modified training approach was associated with significantly higher skills scores 4–6 weeks post training: 77.6% among the modified training approach versus 70.7% among the initial training approach (p-value < 0.0001). Medical attendant cadre showed the greatest skills retention. Conclusions A modified training approach consisting of structured OJT, guidance and tools improved newborn resuscitation skills retention among health care providers. The study results give evidence for including on-site training as part of efforts to improve provider performance and strengthen quality of care. Electronic supplementary material The online version of this article (10.1186/s12887-019-1419-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary Drake
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania. .,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands.
| | - Dunstan R Bishanga
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania.,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands
| | - Akwila Temu
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Mustafa Njozi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Erica Thomas
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Victor Mponzi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Lauren Arlington
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Georgina Msemo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Allan Kairuki
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Amunga R Meda
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Brett D Nelson
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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23
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Linde JE, Perlman JM, Øymar K, Schulz J, Eilevstjønn J, Thallinger M, Kusulla S, Kidanto HL, Ersdal HL. Predictors of 24-h outcome in newborns in need of positive pressure ventilation at birth. Resuscitation 2018; 129:1-5. [PMID: 29802862 DOI: 10.1016/j.resuscitation.2018.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/17/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Birth asphyxia, defined as 5-minute Apgar score <7 in apneic newborns, is a major cause of newborn mortality. Heart rate (HR) response to ventilation is considered an important indicator of effective resuscitation. OBJECTIVES To describe the relationship between initial HR in apneic newborns, HR responses to ventilation and 24-h survival or death. METHODS In a Tanzanian hospital, data on all newborns ≥34 weeks gestational age resuscitated between June 2013-January 2017 were recorded using self-inflating bags containing sensors measuring ventilation parameters and expired CO2, dry-electrode electrocardiography sensors, and trained observers. RESULTS 757 newborns of gestational age 38 ± 2 weeks and birthweight 3131 ± 594 g were included; 706 survived and 51 died. Fetal HR abnormalities (abnormal, undetectable or not assessed) increased the risk of death almost 2-fold (RR = 1.77; CI: 1.07, 2.96, p = 0.027). For every beat/min increase in first detected HR after birth the risk of death was reduced by 2% (RR = 0.98; CI: 0.97, 0.99, p < 0.001). A decrease in HR to <100 beats/minute when ventilation was paused increased the risk of death almost 2-fold (RR = 1.76; CI: 0.96, 3.20, p = 0.066). An initial rapid increase in HR to >100 beats/min in response to treatment reduced the risk of dying by 75% (RR = 0.25; CI: 0.14, 0.44, p < 0.001). A 1% increase in expired CO2 was associated with 28% reduced risk of death (RR = 0.72; CI: 0.62,0.85, p < 0.001). CONCLUSIONS The risk of death in apneic newborns can be predicted by the fetal HR (absent or abnormal), initial newborn HR (bradycardia), and the HR response to ventilation. These findings stress the importance of reliable fetal HR monitoring during labor and providing effective ventilation following birth to enhance survival.
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Affiliation(s)
- J E Linde
- Stavanger University Hospital, Norway; University of Stavanger, Norway.
| | - J M Perlman
- Department of Pediatrics, Weil Cornell, NY, USA.
| | - K Øymar
- Stavanger University Hospital, Norway.
| | - J Schulz
- Stavanger University Hospital, Norway; University of Stavanger, Norway.
| | | | | | | | | | - H L Ersdal
- Stavanger University Hospital, Norway; University of Stavanger, Norway.
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24
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Finn D, Roehr CC, Ryan CA, Dempsey EM. Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge. Neonatology 2017; 112:163-171. [PMID: 28571020 DOI: 10.1159/000475456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/03/2017] [Indexed: 01/14/2023]
Abstract
Volume resuscitation (VR) for the treatment of newborn shock is a rare but potentially lifesaving intervention. Conducting clinical studies to assess the effectiveness of VR in the delivery room during newborn stabilization is challenging. We review the available literature and current management guidelines to determine which infants will benefit from VR, the frequency of VR, and the choice of agents used. In addition, the potential role for placental transfusion in the prevention of newborn shock is explored.
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Affiliation(s)
- Daragh Finn
- Department of Paediatrics and Child Health, Cork University Maternity Hospital and University College Cork, Cork, Ireland
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25
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Chaudhury S, Arlington L, Brenan S, Kairuki AK, Meda AR, Isangula KG, Mponzi V, Bishanga D, Thomas E, Msemo G, Azayo M, Molinier A, Nelson BD. Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania. BMC Health Serv Res 2016; 16:681. [PMID: 27908286 PMCID: PMC5134300 DOI: 10.1186/s12913-016-1924-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. Methods We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Results Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. Conclusion HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.
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Affiliation(s)
- Sumona Chaudhury
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Lauren Arlington
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Shelby Brenan
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Amunga Robson Meda
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | | | | | | | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Alice Molinier
- Children's Investment Fund Foundation, London, W1S 2FT, UK
| | - Brett D Nelson
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA.,Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
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26
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Close K, Karel M, White M. A pilot program of knowledge translation and implementation for newborn resuscitation using US Peace Corps Volunteers in rural Madagascar. Global Health 2016; 12:73. [PMID: 27852328 PMCID: PMC5112704 DOI: 10.1186/s12992-016-0207-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 10/18/2016] [Indexed: 05/29/2023] Open
Abstract
Background Prevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings. Mercy Ships is a non-governmental organisation providing free healthcare education in sub-Saharan Africa and in an attempt to reach more rural areas of Madagascar with our neonatal resuscitation training we designed a novel approach in collaboration with US Peace Corps Volunteers (PCV). PCVs work in rural areas and contribute to locally determined public health initiatives. Method We used a model of knowledge translation and implementation to train non-medical PCVs in HBB who would then train rural healthcare workers. Bulb suction and a self-inflating bag were donated to each health centre. We evaluated knowledge translation and behaviour change at 4 months using the Kirkpatrick model of evaluation. Results Ten PCVs received training and then trained 42 healthcare workers in 10 rural health centres serving a combined population of over 1 million. Both PCVs and rural healthcare workers showed significant increases in knowledge and skills (p < 0.001). The commonest behaviour changes persisting at 4 months were adequate preparation before delivery; use of rubbing and drying as a means of stimulation instead of foot tapping or back slapping; and use of the self-inflating bag to give respirations. Anecdotal evidence of changes in neonatal outcome were reported in several health care centres. Conclusion Our study demonstrates that non-medically trained PCVs can be used to successfully train rural healthcare workers in newborn resuscitation using the HBB algorithm and this results in improvements in personal and organizational practice at 4 months, including anecdotal evidence of improved patient outcome. Our novel method of training, including the provision of essential equipment, may be another tool in the armamentarium of those seeking to disseminate good practice to the most rural areas. Electronic supplementary material The online version of this article (doi:10.1186/s12992-016-0207-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristin Close
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Toamasina, Madagascar
| | | | - Michelle White
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Toamasina, Madagascar.
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27
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Smit E, Liu X, Gill H, Jary S, Wood T, Thoresen M. The effect of resuscitation in 100% oxygen on brain injury in a newborn rat model of severe hypoxic-ischaemic encephalopathy. Resuscitation 2015; 96:214-9. [PMID: 26300234 DOI: 10.1016/j.resuscitation.2015.07.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
AIM Infants with birth asphyxia frequently require resuscitation. Current guidance is to start newborn resuscitation in 21% oxygen. However, infants with severe hypoxia-ischaemia may require prolonged resuscitation with oxygen. To date, no study has looked at the effect of resuscitation in 100% oxygen following a severe hypoxic-ischaemic insult. METHODS Postnatal day 7 Wistar rats underwent a severe hypoxic-ischaemic insult (modified Vannucci unilateral brain injury model) followed by immediate resuscitation in either 21% or 100% oxygen for 30 min. Seven days following the insult, negative geotaxis testing was performed in survivors, and the brains were harvested. Relative ipsilateral cortical and hippocampal area loss was assessed histologically. RESULTS Total area loss in the affected hemisphere and area loss within the hippocampus did not significantly differ between the two groups. The same results were seen for short-term neurological assessment. No difference was seen in weight gain between pups resuscitated in 21% and 100% oxygen. CONCLUSION Resuscitation in 100% oxygen does not cause a deleterious effect on brain injury following a severe hypoxic-ischaemic insult in a rat model of hypoxia-ischaemia. Further work investigating the effects of resuscitation in 100% oxygen is warranted, especially for newborn infants with severe hypoxic-ischaemic encephalopathy.
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Affiliation(s)
- Elisa Smit
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Xun Liu
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Hannah Gill
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Sally Jary
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Thomas Wood
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marianne Thoresen
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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28
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Abstract
Intrapartum-related hypoxia leading to deaths and disabilities continues to be a global challenge, especially in resource-limited settings. Primary prevention during labour is likely to have a significant impact, but secondary prevention with focus on immediate basic stabilization at birth can effectively reduce a large proportion of these adverse outcomes as demonstrated in the resource-rich settings. Infants who fail to initiate and establish spontaneous respirations at birth often respond to early interventions such as drying, stimulation, clearing the airways, as well as bag mask ventilation applied within the first minute after birth. Simple resuscitation education such as 'Helping Babies Breathe', which focuses on the very basic steps and pays attention to comprehensive program development with local ownership and accountability, can help transfer competency into clinical practice and lead to sustainable programs impacting neonatal mortality and morbidity.
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Affiliation(s)
- H L Ersdal
- Department of Anaesthesiology & Intensive Care and SAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway.
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