Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training

Goudar, Shivaprasad S.; Somannavar, Manjunath S; Clark, Robert B.; Lockyer, Jocelyn; Revankar, Amit; Fidler, Herta; Sloan, Nancy L.; Niermeyer, Susan; Keenan, William; Singhal, Nalini

doi:10.1542/peds.2012-2112

Cited by 184 publications

(172 citation statements)

References 23 publications

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“…A large study in India demonstrated that a single course provided 6–8 months after initial training can also increase trainees’ simulation scores back to the high level initially attained [11], but did not evaluate retention past the immediate post-refresher period. To date, our results appear to be unique in demonstrating that performance following an HBB refresher course is more sustained than after the initial course alone.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the largest, most methodologically sound studies evaluating the HBB’s impact demonstrate a decrease in either newborn mortality rate (NMR) or fresh stillbirth rate (FSR) from before to after training mostly at large hospitals where data collection occurred before HBB was provided [11–15]. As discussed above, since the relative burden of newborn mortality is likely more significant in rural regions not regularly attended by physicians, birth attendants working in these areas are in greater need of resuscitation skills and therefore are a more ideal target population for HBB.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to outcomes relating to skills retention, previous research has also demonstrated an association between HBB training and either decreased newborn mortality rate or decreased fresh stillbirth rate (suggesting many apneic newborns were improperly labeled as stillborn) [11–15]. However, although some of these studies included low-volume rural clinics, the majority of births evaluated in these studies occurred in hospitals or larger clinics staffed full-time by physicians.…”

Section: Introductionmentioning

confidence: 99%

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Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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Background: The Helping Babies Breathe (HBB) program teaches basic newborn resuscitation techniques to birth attendants in low-resource settings. Previous studies have demonstrated a decrease in mortality following training, mostly in large hospitals. However, low-volume clinics in rural regions with no physician immediately available likely experience a greater relative burden of newborn mortality. This study aimed to determine the impact of HBB trainings provided to rural Ghanaian midwives on their skills retention and on first 24 hour mortality of the newborns they serve. Methods: American Acadamy of Paediatrics (AAP)-trained Master Trainers conducted two 2-day HBB trainings and 2-day refresher courses one year later for 48 midwives from Ghanaian rural health clinics. Trainee skills were evaluated by Objective Structured Clinical Examination (OSCE) at three time points: immediately after training, four months after training, and four months after the refresher. Midwives recorded the single highest level of resuscitation performed on each newborn delivered for one year. Results: 48 midwives attended the two trainings, 32 recorded data from 2,383 deliveries, and 13 completed OSCE simulations at all three time points. The midwives’ OSCE scores decreased from immediately after training (94.9%) to four months later (81.2%, p < 0.00001). However, four months following the refresher course, scores improved to the same high level attained initially (92.7%, p = 0.0013). 5.0% of neonates required bag-mask ventilation and 0.71% did not survive, compared with a nationwide first 24 hour mortality estimate of 1.7%. Conclusions: The midwives’ performance on the simulation exercise indicates that an in-depth refresher course provided one year after the initial training likely slows the decay in skills that occurs after initial training. Our finding that 5.0% of newborns required bag-mask ventilation is consistent with global estimates. Our observed first 24 hour mortality rate of 0.71% is lower than nationwide estimates, indicating the training likely prevented deaths due to birth asphyxia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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“…This study focused on evaluating differences in steps of neonatal resuscitation between LBW and NBW infants; therefore it is difficult to compare with previous observational studies of HBB interventions. However, HBB training in Nepal and India resulted in an increased rate of ventilation whereas the same intervention in Tanzania demonstrated a lower rate of ventilation after training [6–8]. …”

Section: Discussionmentioning

confidence: 99%

“…The Helping Babies Breathe (HBB) protocol was developed to respond to the need for increased coverage of clinical skills regarding neonatal resuscitation in low-income settings [5]. Studies on outcomes in low-income settings after training in HBB have demonstrated a reduction in intrapartum stillbirths along with reduced or unchanged early neonatal mortality [6–8]. The results imply that newborns who would have previously been classified as stillbirths were successfully resuscitated post-training.…”

Section: Introductionmentioning

confidence: 99%

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

Wrammert

Zetterlund

et al. 2017

Global Health Action

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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.

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In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries

Opiyo

English

2015

Cochrane Database of Systematic Reviews

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BackgroundA variety of in-service emergency care training courses are currently being promoted as a strategy to improve the quality of care provided to seriously ill newborns and children in low-income countries. Most courses have been developed in high-income countries. However, whether these courses improve the ability of health professionals to provide appropriate care in low-income countries remains unclear. This is the first update of the original review.ObjectivesTo assess the effects of in-service emergency care training on health professionals' treatment of seriously ill newborns and children in low-income countries.Search methodsFor this update, we searched the Cochrane Database of Systematic Reviews, part of The Cochrane Library (http://www.cochranelibrary.com); MEDLINE, Ovid SP; EMBASE, Ovid SP; the Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library (http://www.cochranelibrary.com) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Knowledge/Science and eight other databases. We performed database searches in February 2015. We also searched clinical trial registries, websites of relevant organisations and reference lists of related reviews. We applied no date, language or publication status restrictions when conducting the searches.Selection criteriaRandomised trials, non-randomised trials, controlled before and after studies and interrupted-time-series studies that compared the effects of in-service emergency care training versus usual care were eligible for inclusion. We included only hospital-based studies and excluded community-based studies. Two review authors independently screened and selected studies for inclusion.Data collection and analysisTwo review authors independently extracted data and assessed study risk of bias and confidence in effect estimates (certainty of evidence) for each outcome using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). We described results and presented them in GRADE tables.Main resultsWe identified no new studies in this update. Two randomised trials (which were included in the original review) met the review eligibility criteria. In the first trial, newborn resuscitation training compared with usual care improved provider performance of appropriate resuscitation (trained 66% vs usual care 27%, risk ratio 2.45, 95% confidence interval (CI) 1.75 to 3.42; moderate certainty evidence) and reduced inappropriate resuscitation (trained mean 0.53 vs usual care 0.92, mean difference 0.40, 95% CI 0.13 to 0.66; moderate certainty evidence). Effect on neonatal mortality was inconclusive (trained 28% vs usual care 25%, risk ratio 0.77, 95% CI 0.40 to 1.48; N = 27 deaths; low certainty evidence). Findings from the second trial suggest that essential newborn care training compared with usual care probably slightly improves delivery room newborn care practices...

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Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training

Abstract: HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.

Cited by 184 publications

References 23 publications

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

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

In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries

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