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Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe.
Pediatrics 2016; 137(6)Ped

Abstract

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.

Authors+Show Affiliations

Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; Health Section, UNICEF Nepal Country Office, UN House, Pulchowk, Lalitpur, Nepal; aaashis7@yahoo.com.Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;Latter-Day Saints Charities, Salt Lake City, Utah; and.Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27225317

Citation

Kc, Ashish, et al. "Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe." Pediatrics, vol. 137, no. 6, 2016.
Kc A, Wrammert J, Clark RB, et al. Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe. Pediatrics. 2016;137(6).
Kc, A., Wrammert, J., Clark, R. B., Ewald, U., Vitrakoti, R., Chaudhary, P., ... Målqvist, M. (2016). Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe. Pediatrics, 137(6), doi:10.1542/peds.2015-0117.
Kc A, et al. Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe. Pediatrics. 2016;137(6) PubMed PMID: 27225317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe. AU - Kc,Ashish, AU - Wrammert,Johan, AU - Clark,Robert B, AU - Ewald,Uwe, AU - Vitrakoti,Ravi, AU - Chaudhary,Pushpa, AU - Pun,Asha, AU - Raaijmakers,Hendrikus, AU - Målqvist,Mats, PY - 2016/01/04/accepted PY - 2016/5/27/entrez PY - 2016/5/27/pubmed PY - 2017/6/16/medline JF - Pediatrics JO - Pediatrics VL - 137 IS - 6 N2 - 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/27225317/Reducing_Perinatal_Mortality_in_Nepal_Using_Helping_Babies_Breathe_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=27225317 DB - PRIME DP - Unbound Medicine ER -