Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study

Abstract

BackgroundAbout three – quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital.MethodsDirect observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics.ResultsNurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h.ConclusionsMentorship and regular cost – effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1127-6) contains supplementary material, which is available to authorized users.

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

“…Besides the above, although secretion obstruct babies airway and worsening asphyxia, our findings showed that newborns born with meconium (stained amniotic fluid in the airway who did not start breathing on their own) had no effect on chances of survival after neonatal resuscitation. However, this contradicts with other study done in Kenya [27,28] which demonstrated that meconium presence was a predictor of survival of neonates after neonatal resuscitation. The possible justification could be, competency of health workers were good in airway clearance in presence of meconium in babies who did not start breathing on their own.…”

Readiness to treat and factors associated with survival of newborns with breathing difficulties in Ethiopia

“…With all the challenges mentioned above, simple investments of procuring and distributing neonatal resuscitation equipment (neonatal size self-inflating bag and mask and suction aspirators) to mid-level health facilities like health centers and clinics can avert many infant deaths due to breathing difficulties at birth. In addition, the availability of health workers who attend delivery and trained in Helping Babies Breathe (HBB) is a crucial step to improve survival of these babies from breathing difficulties [14, 15].…”

Adherencia a la estrategia minuto de oro en sala de partos de una institución de segundo nivel, de Cali (Colombia), junio-agosto de 2017: estudio de corte transversal

“…Por otro lado, al evaluar el cuidado del cordón umbilical, después de la intervención hallaron un cumplimiento del 85 %, similar al reportado en el presente estudio. El hallazgo anterior se suma al reportado por Shikuku et al (25) los cuales, en un total de 138 reanimaciones neonatales realizadas en las salas de parto del Hospital General Regional del condado de Kakamega, en Kenia, evidenciaron que en el 100 % de los casos en los que el recién nacido no respondió a la estimulación inicial y el mantenimiento de la vía respiratoria se procedió de forma acertada a suministrar ventilación con bolsa y máscara. En el 71 % de las reanimaciones se mantuvo un ambiente cálido.…”