Increased perinatal survival and improved ventilation skills over a five-year period: An observational study

Abstract

Background and aim The Helping Babies Breathe program gave major reductions in perinatal mortality in Tanzania from 2009 to 2012. We aimed to study whether this effect was sustained, and whether resuscitation skills changed with continued frequent training. Methods We analysed prospective data covering all births (n = 19,571) at Haydom Lutheran Hospital in Tanzania from July 2013-June 2018. Resuscitation training was continued during this period. All deliveries were monitored by an observer recording the timing of events and resuscitation interventions. Heart rate was recorded by dry-electrode ECG and bag-maskventilation by sensors attached to the resuscitator device. We analyzed changes over time in outcomes, use of resuscitation interventions and performance of resuscitation using binary regression models with the log-link function to obtain adjusted relative risks. Results With introduction of user fees for deliveries since 2014, the number of deliveries decreased by 30% from start to the end of the five-year period. An increase in low heart rate at birth and need for bag-mask-ventilation indicate a gradual selection of more vulnerable newborns delivered in the hospital over time. Despite this selection, newborn deaths <24 hours did not change significantly and was maintained at an average of 8.8/1000 live births. The annual reductions in relative risk for perinatal death adjusted for vulnerability factors was 0.84 (95%CI 0.76-0.94). During the five-year period, longer duration of bag-mask ventilation sequences without interruption was observed. Delivered tidal volumes were increased and mask leak was decreased during ventilation. The time to initiation or total duration of ventilation did not change significantly.

A Randomised Controlled Study of Low-Dose High-Frequency In-Situ Simulation Training to Improve Newborn Resuscitation

“…We chose to evaluate a LDHFST strategy, the pedagogical principles of which are established [ 31 , 32 ]. This approach has been shown to maintain simulated skills, contribute to improved clinical performance and to maintain PPV skills in real life in low-resource settings [ 12 , 33 , 34 ]. One study identifies reduced neonatal mortality in such a setting [ 11 ], while another projects reduced mortality with on-going simulation-based performance improvements [ 35 ].…”

“…Low-dose, high-frequency simulation training (LDHFST) training shows promise in promoting retention of acquired skills [ 9 , 10 ]. Studies from low-resource countries have identified LDHFST as an effective means of not only increasing competence in the simulated situation, but also improving skills and changing practice in the clinical situation [ 11 , 12 ].…”

Delivery Room ST Segment Analysis to Predict Short Term Outcomes in Near-Term and Term Newborns

“…We used data collected between 01.07.13 and 30.06.18 at Haydom Lutheran Hospital, a rural Tanzanian referral hospital with 3.600–4.600 annual deliveries [ 17 ]. Newborn resuscitation was mainly the responsibility of midwives.…”

Expired carbon dioxide during newborn resuscitation as predictor of outcome

“…16 We used data collected between March 1st 2013 and June 1st 2017 at Haydom Lutheran Hospital, a rural Tanzanian referral hospital with 3600À4600 deliveries annually. 17 The local procedure for newborn resuscitation followed Helping Babies Breathe (HBB) emphasizing stimulation and early initiation of BMV, excluding chest compressions, intubation and medication. 18 Newborn resuscitation was mainly the responsibility of midwives.…”