Designated Neonatal Resuscitation and Transport Team Implementation Improves Neonatal Outcomes in Low Resource Settings

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

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Factors Related to Maternal Adverse Outcomes in Pregnant Women with Cardiac Disease in Low-resource Settings

European Cardiology Review ◽

10.15420/ecr.2020.04 ◽

2020 ◽

Vol 15 ◽

Author(s):

Philippe Amubuomombe Poli ◽

Elkanah Omenge Orang’o ◽

Ann Mwangi ◽

Felix Ayub Barasa

Keyword(s):

Pregnant Women ◽

Cardiac Disease ◽

Premature Death ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

Low Resource Settings ◽

Neonatal Deaths ◽

Low Resource ◽

Resource Limited ◽

Maternal And Neonatal Outcomes

Background: Cardiac disease is an important life-threatening complication during pregnancy. It is frequently seen in pregnant women living in resource-limited areas and often results in premature death. Aim: The aim of this hospital-based longitudinal study was to identify factors related to adverse maternal and neonatal outcomes in pregnant women with cardiac disease in low-resource settings. Methods: The study enrolled 91 pregnant women with congenital or acquired cardiac disease over a period of 2 years in Kenya. Results: Maternal and early neonatal deaths occurred in 12.2% and 12.6% of cases, respectively. The risk of adverse outcomes was significantly increased in those with pulmonary oedema (OR 11, 95% CI [2.3–52]; p=0.002) and arrhythmias (OR 16.9, 95% CI [2.5–113]; p=0.004). Limited access to care was significantly associated with adverse maternal outcomes (p≤0.001). Conclusion: Many factors contribute to adverse maternal and neonatal outcomes in pregnant women with cardiac disease. Access to comprehensive specialised care may help reduce cardiac-related complications during pregnancy.

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Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02987-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Shannon Findlay ◽

Morgan Swanson ◽

Christian Junker ◽

Mitchell Kinkor ◽

Karisa K. Harland ◽

...

Keyword(s):

Community Health ◽

Neonatal Mortality ◽

Health Workers ◽

Neonatal Resuscitation ◽

Neonatal Health ◽

Low Resource Settings ◽

Low Resource ◽

Helping Babies Breathe ◽

Community Health Initiative

Abstract Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health.

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Obstetrics and Gynaecology

Global Anaesthesia ◽

10.1093/med/9780198809821.003.0008 ◽

2020 ◽

pp. 157-196

Author(s):

Rachel Collis ◽

Rebecca Jones ◽

Sarah O’Neill

Keyword(s):

Caesarean Section ◽

Neonatal Resuscitation ◽

Pregnant Patient ◽

Practical Advice ◽

Low Resource Settings ◽

Obstetric Anaesthesia ◽

Low Resource ◽

Obstetrics And Gynaecology ◽

Obstetric Haemorrhage ◽

Obstetric Surgery

In low-resource settings, obstetrics and gynaecology frequently forms a large part of the anaesthetist’s workload. The chapter serves both as an aide-memoire for those who are not regular practitioners in obstetric anaesthesia and as a guide to adapting your practice in low-resource settings. It contains practical advice on analgesia in labour and anaesthesia for Caesarean section, including spinal, general anaesthesia, and local anaesthesia techniques. It contains advice on drug alternatives in the absence of commonly used obstetric drugs, e.g. spinal bupivacaine. There are also sections on management of pre-eclampsia and obstetric haemorrhage, both of which are commonly encountered in low-resource settings. Neonatal resuscitation and non-obstetric surgery in the pregnant patient are also covered.

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High-Frequency, Low-Dose Education to Improve Neonatal Outcomes in Low-Resource Settings

Advances in Neonatal Care ◽

10.1097/anc.0000000000000938 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Lori A. Spies ◽

Cheryl Riley ◽

Rakhi Nair ◽

Naveed Hussain ◽

M. Padmanabh Reddy

Keyword(s):

High Frequency ◽

Low Dose ◽

Neonatal Outcomes ◽

Low Resource Settings ◽

Low Resource

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Decision making and situational awareness in neonatal resuscitation in low resource settings

Resuscitation ◽

10.1016/j.resuscitation.2018.10.034 ◽

2019 ◽

Vol 134 ◽

pp. 41-48 ◽

Cited By ~ 6

Author(s):

Maria Elena Cavicchiolo ◽

Francesco Cavallin ◽

Alex Staffler ◽

Damiano Pizzol ◽

Eduardo Matediana ◽

...

Keyword(s):

Decision Making ◽

Situational Awareness ◽

Neonatal Resuscitation ◽

Low Resource Settings ◽

Low Resource

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Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316319 ◽

2019 ◽

pp. archdischild-2018-316319 ◽

Cited By ~ 1

Author(s):

Jorien M D Versantvoort ◽

Mirjam Y Kleinhout ◽

Henrietta D L Ockhuijsen ◽

Kitty Bloemenkamp ◽

Willem B de Vries ◽

...

Keyword(s):

Systematic Review ◽

Neonatal Mortality ◽

Data Extraction ◽

Neonatal Resuscitation ◽

Eligibility Criteria ◽

Low Resource Settings ◽

Low Resource ◽

Helping Babies Breathe ◽

Simulation Based ◽

Registration Number

BackgroundAn important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. ‘Helping Babies Breathe’ (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method.Data sourcesCochrane, CINAHL, Embase, PubMed and Scopus.Study eligibility criteriaConducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality.Study appraisalIncluded studies were reviewed independently by two researchers in terms of methodological quality.Data extractionData were extracted by two independent reviewers and crosschecked by one additional reviewer.ResultsSeven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31–0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37–0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method.LimitationsIncluded studies in were predominantly of moderate quality, therefore no strong recommendations can be made.Conclusions and implications of key findingsDue to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the ‘Helping Babies Breathe’ training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period.PROSPERO registration numberCRD42018081141.

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Neonatal resuscitation practices in Uganda: a video observational study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001092 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001092

Author(s):

Daniel Helldén ◽

Susanna Myrnerts Höök ◽

Nicolas J Pejovic ◽

Dan Mclellan ◽

Clare Lubulwa ◽

...

Keyword(s):

Observational Study ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Sub Saharan Africa ◽

Positive Pressure ◽

Clinical Practices ◽

Exact Test ◽

Low Resource Settings ◽

Low Resource ◽

Sub Saharan

BackgroundNeonatal mortality, often due to birth asphyxia, remains stubbornly high in sub-Saharan Africa. Guidelines for neonatal resuscitation, where achieving adequate positive pressure ventilation (PPV) is key, have been implemented in low-resource settings. However, the actual clinical practices of neonatal resuscitation have rarely been examined in these settings. The primary aim of this prospective observational study was to detail the cumulative proportion of time with ventilation during the first minute on the resuscitation table of neonates needing PPV at the Mulago National Referral Hospital in Kampala, Uganda.MethodsFrom November 2015 to January 2016, resuscitations of non-breathing neonates by birth attendants were video-recorded using motion sensor cameras. The resuscitation practices were analysed using the application NeoTapAS and compared between those taking place in the labour ward and those in theatre through Fisher’s exact test and Wilcoxon rank-sum test.ResultsFrom 141 recorded resuscitations, 99 were included for analysis. The time to initiation of PPV was 66 (42–102) s overall, and there was minimal PPV during the first minute in both groups with 0 (0–10) s and 0 (0–12) s of PPV, respectively. After initiating PPV the overall duration of interruptions during the first minute was 28 (18–37) s. Majority of interruptions were caused by stimulation (28%), unknown reasons (25%) and suction (22%).ConclusionsOur findings show a low adherence to standard resuscitation practices in 2015–2016. This emphasises the need for continuous educational efforts and investments in staff and adequate resources to increase the quality of clinical neonatal resuscitation practices in low-resource settings.

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