Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Abstract

Background: The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored. Objective: To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting. Methods: Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression. Results: A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24–2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34–0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups. Conclusions: Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.

Filming for auditing of real-life emergency teams: a systematic review

“…A further eight studies were identified by checking the references lists. Among these 165 studies, 50 were eligible according to the inclusion criteria (online supplementary table S1),4 5 8 13 21–66 and five of these evaluated the impact of video review in regards to improvement in patient care (PICOS)8 21 23 41 62 (figure 1).…”

“…There were 6 cohort or case–control studies,8 21–23 27 42 27 cross-sectional studies24 25 28 30 33–40 43 44 46 47 49 51–54 56–59 65 66 and 17 case reports or series4 5 13 26 27 29 31 32 45 48 50 55 60–64 (figure 2). There were no trials or protocols of RCTs.…”

“…We identified five categories of team: cardiac arrest team (n=7),41–47 neonatal resuscitation team (n=18),48–65 trauma team (n=15),4 5 8 13 21–31 paediatric trauma team (n=9)32–40 and obstetric emergency team (n=1) 66. The 50 studies were conducted at 30 different hospitals situated in the USA (n=12), Australia (n=1), Europe (n=11) and Asia (n=5) (figure 2).…”

“…The technical solution was described in 43 of the studies. The procedure of filming was continuous video recording (n=6),4 28 31 43 56 58 manual activation where you have to ‘press the button’ (n=20)5 8 13 23 24 26 27 29 32 33 44–47 50 53–55 57 64 or recording automatically activated either by motion triggers (n=3)48 59 60 or Bluetooth in the team leader’s telephone which activated the camera when the leader entered the room (n=1) 66…”

“…In 20 studies, the cameras were placed either as a bird’s eye view or at a high angle. In bird’s eye view, the camera is placed directly above the patient; for example, the camera could be mounted on the radiant heater above the neonatal resuscitation table 48 50 53 57–60 62 63. In high angle view, the cameras were mounted in the ceiling in the corner presenting an oblique view 32 33 41 45–47 66.…”