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Text
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URL Address
<a href="http://doi.org/10.1542/peds.2015-0117" target="_blank" rel="noreferrer">http://doi.org/10.1542/peds.2015-0117</a>
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Title
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Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe
Publisher
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Pediatrics
Date
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2016
Subject
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Quality Improvement; Female; Guideline Adherence; Humans; Infant; Nepal/epidemiology; Newborn; Perinatal Death/prevention & Control; Perinatal Mortality/trends; Pregnancy; Resuscitation/education/standards/utilization; Stillbirth/epidemiology
Creator
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Kc A; Wrammert J; Clark RB; Ewald U; Vitrakoti R; Chaudhary P; Pun A; Raaijmakers H; Malqvist M
Description
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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.
Identifier
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<a href="http://doi.org/10.1542/peds.2015-0117" target="_blank" rel="noreferrer">10.1542/peds.2015-0117</a>
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2016
Chaudhary P
Clark RB
Ewald U
Female
Guideline Adherence
Humans
Infant
Kc A
Malqvist M
Nepal/epidemiology
Newborn
Pediatrics
Perinatal Death/prevention & Control
Perinatal Mortality/trends
Pregnancy
Pun A
Quality Improvement
Raaijmakers H
Resuscitation/education/standards/utilization
Stillbirth/epidemiology
Vitrakoti R
Wrammert J