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  • Original Article
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Quality improvement

Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training

Abstract

Background:

To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions.

Methods:

Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed.

Results:

Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation.

Conclusion:

In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.

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References

  1. Lee AC, Cousens S, Wall SN, Niermeyer S, Darmstadt GL, Carlo WA et al. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health 2011; 11 (Suppl 3): S12.

    Article  Google Scholar 

  2. Lawn JE, Kinney M, Lee AC, Chopra M, Donnay F, Paul VK et al. Reducing intrapartum-related deaths and disability: can the health system deliver? Int J Gynaecol Obstet 2009; 107 (Suppl 1): S123–S140 S40-2.

    Article  Google Scholar 

  3. Berkelhamer SK, Kamath-Rayne BD, Niermeyer S . Neonatal resuscitation in low-resource settings. Clin Perinatol 2016; 43 (3): 573–591.

    Article  Google Scholar 

  4. Hill K, Clark P, Narayanan I, Wright LL DV . Improving Quality of Basic Newborn Resuscitation in Low-resource Settings: A Framework For Managers and Skilled Birth Attendants. USAID ASSIST Project: Bethesda, MD, USA, 2014.

    Google Scholar 

  5. Kamath-Rayne BD, Griffin JB, Moran K, Jones B, Downs A, McClure EM et al. Resuscitation and obstetrical care to reduce intrapartum-related neonatal deaths: A MANDATE Study. Matern Child Health J 2015; 19 (8): 1853–1863.

    Article  Google Scholar 

  6. Ersdal HL, Singhal N . Resuscitation in resource-limited settings. Semin Fetal Neonatal Med 2013; 18 (6): 373–378.

    Article  CAS  Google Scholar 

  7. Niermeyer S, Keenan W, Little G, Singhal N Helping Babies Breathe: Facilitator Flip Chart: American Academy of Pediatrics, Laerdal Global Health. Available at http://internationalresources.aap.org/Resource/ShowFile?documentName=hbb_flipchart_english.pdf (accessed on 2010)..

  8. Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z et al. Ending preventable newborn deaths in a generation. Int J Gynaecol Obstet 2015; 131 (Suppl 1): S43–S48.

    Article  Google Scholar 

  9. Ersdal HL, Linde J, Auestad B, Mduma E, Lyanga S, Svensen E et al. Timing of cord clamping in relation to start of breathing or ventilation among depressed neonates-an observational study. BJOG 2016; 123 (8): 1370–1377.

    Article  CAS  Google Scholar 

  10. Goudar SS, Somannavar MS, Clark R, Lockyer JM, Revankar AP, Fidler HM et al. Stillbirth and newborn mortality in India after Helping Babies Breathe training. Pediatrics 2013; 131 (2): e344–e352.

    Article  Google Scholar 

  11. Msemo G, Massawe A, Mmbando D, Rusibamayila N, Manji K, Kidanto HL et al. Newborn mortality and fresh stillbirth rates in Tanzania after Helping Babies Breathe training. Pediatrics 2013; 131 (2): e353–e360.

    Article  Google Scholar 

  12. KC A, Wrammert J, Clark RB, Ewald U, Vitrakoti R, Chaudhary P et al. Reducing perinatal mortality in nepal using Helping Babies Breathe. Pediatrics 2016; 137 (6): e20150117.

    Article  Google Scholar 

  13. Ersdal HL, Vossius C, Bayo E, Mduma E, Perlman J, Lippert A et al. A one-day "Helping Babies Breathe" course improves simulated performance but not clinical management of neonates. Resuscitation 2013; 84: 1422–1427.

    Article  CAS  Google Scholar 

  14. Singhal N, Lockyer J, Fidler H, Keenan W, Little G, Bucher S et al. Helping Babies Breathe: global neonatal resuscitation program development and formative educational evaluation. Resuscitation 2011; 83 (1): 90–96.

    Article  Google Scholar 

  15. Secretaría de Salud [Honduras], Instituto Nacional de Estadística (INE)Encuesta Nacional de Demografía y Salud 2011-2012: Informe Resumen. ICF International: Tegucigalpa, Honduras, 2013.

  16. Seto TL, Tabangin ME, Josyula S, Taylor KK, Vasquez JC, Kamath-Rayne BD . Educational outcomes of Helping Babies Breathe training at a community hospital in Honduras. Perspect Med Educ 2015; 4 (5): 225–232.

    Article  Google Scholar 

  17. Thor J, Lundberg J, Ask J, Olsson J, Carli C, Harenstam K et al. Application of statistical process control in healthcare improvement: systematic review. Qual Saf Health Care 2007; 16: 387–399.

    Article  Google Scholar 

  18. Kamath-Rayne BD, Berkelhamer SK, Ashish KC, Ersdal HL, Niermeyer S . Neonatal resuscitation in global health settings-an examination of the past to prepare for the future. Pediatr Res 2017 (doi:10.1038/pr.2017.48; e-pub ahead of print).

  19. Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet 2009; 107 (Suppl 1): S5–18, S9.

    Article  Google Scholar 

  20. Kak LP, Johnson J, McPherson R, Keenan W, Schoen E. Helping Babies Breathe: Lessons Learned Guiding the Way forward. A 5-Year Report From the HBB Global Development Alliance. Available from https://www.aap.org/en-us/Documents/hbb_report_2010-2015.pdf. (accessed on 2016).

  21. Soreide E, Morrison L, Hillman K, Monsieurs K, Sunde K, Zideman D et al. The formula for survival in resuscitation. Resuscitation 2013; 84 (11): 1487–1493.

    Article  Google Scholar 

  22. Rule ARL, Maina E, Cheruiyot D, Mueri P, Simmons JM, Kamath-Rayne BD . Using quality improvement to decrease birth asphyxia rates after Helping Babies Breathe in Kenya. Acta Paediatr 2017 (doi:10.1111/apa.13940; e-pub ahead of print).

  23. World Health OrganizationStandards For Improving Quality of Maternal and Newborn Care in Health Facilities. WHO: Geneva, Switzerland. Available at http://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en/ (accessed on 2016).

  24. Niermeyer S, Kamath-Rayne B, Keenan W, Little G, Singhal N, Visick M Helping Babies Breathe: Facilitator Flip Chart: American Academy of Pediatrics, Laerdal Global Health, 2nd edn. Available from http://internationalresources.aap.org/Resource/ShowFile?documentName=HBB_Flipbook_Second_Edition_20-00371_Rev_E.pdf (accessed on 2016)..

  25. Bose C, Hermida J . Improving Care of Mothers and Babies: A Guide for Improvement Teams. American Academy of Pediatrics, University Research Co LLC, 2016 Available from http://internationalresources.aap.org/Resource/ShowFile?documentName=Improving%20Care%20of%20Mothers%20and%20Babies_Asia%20Version_Eng.%202016.pdf (updated 5 September 2017)..

    Google Scholar 

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Acknowledgements

This study was funded by the Perinatal Institute, Cincinnati Children’s Hospital Medical Center. We thank the patients and medical staff at Hospital Enrique Aguilar Cerrato for their participation in the study. We acknowledge the University of Cincinnati Center for Clinical and Translational Science and Training grant support (UL1-RR026314), and the support of Dr. Eric Hall and Mr. Matthew Leonard, who assisted in the design of our Redcap database. This study was funded by the Perinatal Institute, Cincinnati Children’s Hospital Medical Center. The sponsor played no role in the study design, analysis or interpretation of data, nor writing of the manuscript.

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Correspondence to B D Kamath-Rayne.

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Competing interests

Beena Kamath-Rayne serves on the American Academy of Pediatrics Helping Babies Survive Planning Group and is the Associate Editor for the second edition of Helping Babies Breathe. The other authors have no conflicts of interest to disclose.

Dr. Beena Kamath-Rayne wrote the first draft of the manuscript and no one received any payment to work on the manuscript.

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Kamath-Rayne, B., Josyula, S., Rule, A. et al. Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training. J Perinatol 37, 1153–1160 (2017). https://doi.org/10.1038/jp.2017.110

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