REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal

Gurung, Rejina; Gurung, Abhishek; Basnet, Omkar; Eilevstjønn, Joar; Myklebust, Helge; Girnary, Sakina; Shrestha, Shree Krishna; Singh, Dipendra Raman; Bastola, Laxman; Paudel, Prajwal; Baral, Sandhya; Kc, Ashish

doi:10.1186/s12884-020-03456-z

Cited by 13 publications

(13 citation statements)

References 21 publications

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“…Therefore, successful neonatal resuscitation training programme need to focus on the sustainability of competence and translate the generated knowledge into clinical practice to tackle medical problems and reduce neonatal mortality and morbidity ( 38 ). An example is the recently tested Rapid Feedback for quality Improvement in Neonatal rEsuscitation (REFINE) initiative in Nepal to improve resuscitation competencies using the HBB programme ( 39 ). This programme is designed with a combination of theory and simulation sessions with real-time feedback via a high-fidelity neonatal mannequin.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study

et al. 2021

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Background: Neonatal mortality rates remain high in Sub-Saharan African countries. Improving the newborn resuscitation skills of healthcare professionals is important in addressing this challenge. The aim of this study was to evaluate a neonatal resuscitation training programme delivered over a two-year period for healthcare professionals in Zanzibar, Tanzania.Methods: A pre- and post-intervention study was designed. We delivered neonatal resuscitation training over a 2-day period in 2017 and 2 days of refresher training in 2018. Knowledge was evaluated by a self-designed survey (11 items with a total score of 22) before and after the two training periods, and skills were evaluated by a skills checklist (six domains with 25 items with a total score of 50) completed by the trainers based on their observations. Statistical analysis included differences in the knowledge and skills scores before and after the training sessions and between the two periods.Results: A total of 23 healthcare professionals participated and completed both neonatal resuscitation training sessions. The knowledge mean scores before and after the training in 2017 increased from 9.60 to 13.60 (95% CI: −5.900; −2.099, p < 0.001), and in 2018, the scores increased from 10.80 to 15.44 (95% CI: −6.062; −3.217, p < 0.001). The mean knowledge scores post-training over time were 13.60 in 2017 and 15.44 in 2018 (95% CI: −3.489; 0.190, p = 0.030). The resuscitation skills performance between the two time periods increased from a mean of 32.26 (SD = 2.35) to a mean of 42.43 (SD = 1.73) (95% CI: −11.402; −8.945, p < 0.001).Conclusion: The neonatal resuscitation training programme increased the theoretical knowledge and resuscitation skills before and after the two training sessions and over time after a 9-month period. Continuous neonatal resuscitation training based on the local needs in resource-limited countries is essential to provide confidence in healthcare professionals to initiate resuscitation and to improve newborn outcomes.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study

et al. 2021

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“…We conducted a prospective cohort study in nine hospitals in Nepal where larger quality improvement studies, REFINE [ 36 ] and SUSTAIN [ 37 ] have been implemented since 2019. Our study assessed two components: 1) disruption in maternity services, and 2) respectful maternity care, defined as the provision and experience of institutional delivery care.…”

Section: Methodsmentioning

confidence: 99%

“…All hospitals provide Comprehensive and Emergency Obstetric and Neonatal Care services (CEmONC). The nine hospitals, distributed across all seven provinces, covered 11 · 2% of the national number of births for 2019 [ 36 , 37 ]. From March-August 2020, the Government of Nepal reported 39 459 COVID-19 cases with wide variations across the provinces (Figures S3-6 in the Online Supplementary Document ) and with a national lockdown imposed for this period.…”

Section: Methodsmentioning

confidence: 99%

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The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

Peterson

Gurung

et al. 2021

J Glob Health

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Background The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. Methods We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women’s residence in a COVID-19 hotspot area. Results The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% ( P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% ( P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% ( P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women’s residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001). Conclusions The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a “building-back-better” approach in post-pandemic period.

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“…This was a nested observational study within two quality improvement studies SUSTAIN 15 and REFINE 16 done in nine hospitals of Nepal.…”

Section: Methodsmentioning

confidence: 99%

Impact of stimulation among non-crying neonates with intact cord versus clamped cord on birth outcomes: observation study

Budhathoki

Thapa

et al. 2021

bmjpo

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BackgroundStimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.MethodsThis is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.ResultsAmong non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, p<0.0001). The use of bag-and-mask ventilation was lower among those who were stimulated with the cord intact than those who were stimulated with cord clamped (18.0% vs 32.4%, p<0.0001). The proportion of neonates with Apgar Score ≤3 at 1 min was lower with the cord intact than with cord clamped (7.6% vs 11.5%, p=0.001). In multivariate analysis, neonates with intact cord had 84% increased odds of spontaneous breathing (adjusted OR, 1.84; 95% CI: 1.48 to 2.29) compared with those with cord clamped.ConclusionsStimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.

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REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal

Cited by 13 publications

References 21 publications

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study

The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

Impact of stimulation among non-crying neonates with intact cord versus clamped cord on birth outcomes: observation study

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