Reducing perinatal mortality in Nepal using Helping Babies Breathe
2016 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 137, no 6, e20150117Article in journal (Refereed) Published
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 using a quality improvement cycle (QIC) in a tertiary hospital in Nepal.
Methods: The HBB QIC was implemented through a multi-faceted 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 trainings. 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 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 about half in the odds of intrapartum stillbirth (aOR=0.46, 95% CI 0.32-0.66) and first-day mortality (aOR=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. Prior to intervention, none of the babies received bag-and-mask ventilation within 1 minute of birth, compared to 83.9% of babies after.
Conclusion: 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.
Place, publisher, year, edition, pages
2016. Vol. 137, no 6, e20150117
intrapartum stillbirth, intrapartum-related neonatal death, Helping Babies Breathe, quality improvement cycle, Nepal
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Research subject International Health; Pediatrics
IdentifiersURN: urn:nbn:se:uu:diva-267919DOI: 10.1542/peds.2015-0117ISI: 000378520100001OAI: oai:DiVA.org:uu-267919DiVA: diva2:874835
FunderSwedish Society of Medicine