Jackie Patterson1, Sara Berkelhamer2, Daniel Ishoso3, Pooja Iyer4, Casey Lowman5, Melissa Bauserman6, Joar Eilevstjønn7, Ingunn Haug7, Adrien Lokangaka3, Beena Kamath-Rayne5, Eric Mafuta3, Helge Myklebust7, Tracy Nolen4, Janna Patterson5, Nalini Singhal8, Antoinette Tshefu3, Carl Bose6. 1. Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA. Electronic address: jackie_patterson@med.unc.edu. 2. Department of Pediatrics, University of Washington, Seattle, WA 98105, USA. 3. School of Public Health, University of Kinshasa, PO Box 11850, Kinshasa, Congo. 4. RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. 5. American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, USA. 6. Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA. 7. Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, P.O. Box 377, N-4002 Stavanger, Norway. 8. Department of Pediatrics, University of Calgary, 28 Oki Drive NW, Calgary, Alberta T3B 6A8, Canada.
Abstract
AIM: To evaluate the effect of resuscitation training and continuous electronic heart rate (HR) monitoring of non-breathing newborns on identification of stillbirth. METHODS: We conducted a pre-post interventional trial in three health facilities in the Democratic Republic of the Congo. We collected data on a retrospective control group of newborns that reflected usual resuscitation practice (Epoch 1). In the prospective, interventional group, skilled birth attendants received resuscitation training in Helping Babies Breathe and implemented continuous electronic HR monitoring of non-breathing newborns (Epoch 2). Our primary outcome was the incidence of stillbirth with secondary outcomes of fresh or macerated stillbirth, neonatal death before discharge and perinatal death. Among a subset, we conducted expert review of electronic HR data to estimate misclassification of stillbirth in Epoch 2. We used a generalized estimating equation, adjusted for variation within-facility, to compare risks between EPOCHs. RESULTS: There was no change in total stillbirths following resuscitation training and continuous electronic HR monitoring of non-breathing newborns (aRR 1.15 [0.95, 1.39]). We observed an increased rate of macerated stillbirth (aRR 1.58 [1.24, 2.02]), death before discharge (aRR 3.31 [2.41, 4.54]), and perinatal death (aRR 1.61 [1.38, 1.89]) during the intervention period. In expert review, 20% of newborns with electronic HR data that were classified by SBAs as stillborn were liveborn. CONCLUSION: Resuscitation training and use of continuous electronic HR monitoring did not reduce stillbirths nor eliminate misclassification.
AIM: To evaluate the effect of resuscitation training and continuous electronic heart rate (HR) monitoring of non-breathing newborns on identification of stillbirth. METHODS: We conducted a pre-post interventional trial in three health facilities in the Democratic Republic of the Congo. We collected data on a retrospective control group of newborns that reflected usual resuscitation practice (Epoch 1). In the prospective, interventional group, skilled birth attendants received resuscitation training in Helping Babies Breathe and implemented continuous electronic HR monitoring of non-breathing newborns (Epoch 2). Our primary outcome was the incidence of stillbirth with secondary outcomes of fresh or macerated stillbirth, neonatal death before discharge and perinatal death. Among a subset, we conducted expert review of electronic HR data to estimate misclassification of stillbirth in Epoch 2. We used a generalized estimating equation, adjusted for variation within-facility, to compare risks between EPOCHs. RESULTS: There was no change in total stillbirths following resuscitation training and continuous electronic HR monitoring of non-breathing newborns (aRR 1.15 [0.95, 1.39]). We observed an increased rate of macerated stillbirth (aRR 1.58 [1.24, 2.02]), death before discharge (aRR 3.31 [2.41, 4.54]), and perinatal death (aRR 1.61 [1.38, 1.89]) during the intervention period. In expert review, 20% of newborns with electronic HR data that were classified by SBAs as stillborn were liveborn. CONCLUSION: Resuscitation training and use of continuous electronic HR monitoring did not reduce stillbirths nor eliminate misclassification.