Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

Title

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

Creator

Kc A; Wrammert J; Clark RB; Ewald U; Vitrakoti R; Chaudhary P; Pun A; Raaijmakers H; Malqvist M

Publisher

Pediatrics

Date

2016

Subject

Quality Improvement; Female; Guideline Adherence; Humans; Infant; Nepal/epidemiology; Newborn; Perinatal Death/prevention & Control; Perinatal Mortality/trends; Pregnancy; Resuscitation/education/standards/utilization; Stillbirth/epidemiology

Description

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.

Rights

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Citation List Month

n/a

Citation

Kc A; Wrammert J; Clark RB; Ewald U; Vitrakoti R; Chaudhary P; Pun A; Raaijmakers H; Malqvist M, “Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe,” Pediatric Palliative Care Library, accessed October 21, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11215.

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