Ashish Kc1, Johan Wrammert2, Robert B Clark3, Uwe Ewald2, Ravi Vitrakoti4, Pushpa Chaudhary4, Asha Pun2, Hendrikus Raaijmakers2, Mats Målqvist2. 1. Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; Health Section, UNICEF Nepal Country Office, UN House, Pulchowk, Lalitpur, Nepal; aaashis7@yahoo.com. 2. Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; 3. Latter-Day Saints Charities, Salt Lake City, Utah; and. 4. Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.
Abstract
BACKGROUND AND OBJECTIVE: Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. METHODS: The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. RESULTS: The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32-0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31-0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09-0.17) and 62% (OR 0.38, 95% CI 0.29-0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after. CONCLUSIONS: The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.
BACKGROUND AND OBJECTIVE: Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. METHODS: The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. RESULTS: The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32-0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31-0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09-0.17) and 62% (OR 0.38, 95% CI 0.29-0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after. CONCLUSIONS: The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.
Authors: Beena D Kamath-Rayne; Sara K Berkelhamer; Ashish Kc; Hege L Ersdal; Susan Niermeyer Journal: Pediatr Res Date: 2017-05-24 Impact factor: 3.756
Authors: Rachel Umoren; Sherri Bucher; Chinyere Veronica Ezeaka; Fabian Esamai; Daniel S Hippe; Beatrice Nkolika Ezenwa; Iretiola Bamikeolu Fajolu; Felicitas M Okwako; John Feltner; Mary Nafula; Annet Musale; Olubukola A Olawuyi; Christianah O Adeboboye; Ime Asangansi; Chris Paton; Saptarshi Purkayastha Journal: BMJ Open Date: 2021-08-25 Impact factor: 2.692
Authors: Kimberly P Brathwaite; Fiona Bryce; Laurel B Moyer; Cyril Engmann; Nana A Y Twum-Danso; Beena D Kamath-Rayne; Emmanuel K Srofenyoh; Sebnem Ucer; Richard O Boadu; Medge D Owen Journal: Resusc Plus Date: 2020-05-21