Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe
| Autor: | Asha Pun, Pushpa Chaudhary, Mats Målqvist, Ashish Kc, Johan Wrammert, Uwe Ewald, Ravi Vitrakoti, Hendrikus Raaijmakers, Robert B Clark |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Perinatal Death Resuscitation 03 medical and health sciences 0302 clinical medicine Nepal Pregnancy 030225 pediatrics medicine Humans 030212 general & internal medicine Intensive care medicine Perinatal Mortality Fetal death Neonatal mortality business.industry Guideline adherence Perinatal mortality Infant Newborn Stillbirth medicine.disease Quality Improvement Pediatrics Perinatology and Child Health Female Suction drainage Guideline Adherence business |
| Zdroj: | Pediatrics. 137 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2015-0117 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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