Board 384 - Research Abstract Low-Dose High-Frequency Simulation Training Reduces Early Neonatal Mortality (Submission #993)

Abstract

Introduction/Background Globally, almost 4 million newborn infants die each year. The simulation-based Helping Babies Breathe (HBB) course, developed by the American Academy of Pediatrics to train providers in basic neonatal resuscitation, is under implementation in more than 55 low-resource countries, aiming to reduce early neonatal mortality worldwide. Tanzania was the first country to pilot test National implementation of HBB.1 In April 2010 Tanzanian master instructors conducted a one day HBB course at Haydom Lutheran Hospital in Northern Tanzania. Seven months later, in November 2010 staff from labor ward was tested simulating routine care of neonates and basic neonatal resuscitation. The pass-rate increased from 41% to 74% (p=0.016) and from 18% to 74% (p≤0.0001) respectively, however, no improvement of clinical management was observed in the delivery room during these seven months.2 Therefore, systematic low-dose high-frequency (LDHF) HBB simulation training in the labor ward was initiated by local HBB trainers supported by local leaders. The objective of this study was to determine whether implementation of LDHF HBB training would enhance performance of basic neonatal resuscitation in clinical practice, reduce the incidence of early neonatal mortality within 24 hours, and the number of fresh stillbirths. Methods An ongoing observational study in the delivery room started in July 2009. Trained research assistants (n=14), working shifts (3/24 hours), have observed every delivery and recorded data (e.g. perinatal characteristics, time to stimulation and bag mask ventilation and perinatal outcomes) on a data collection form. Implementation of LDHF HBB training started in February 2011. A newborn simulator was placed in the labor ward easily accessible for frequent practicing. Local HBB trainers have assisted and conducted frequent re-trainings supported by local leaders. Results Observational baseline data (01.02.10-31.01.11) includes 4876 deliveries/newborns. Observational after implementation data (01.02.11-31.01.12) includes 4743 deliveries/newborns. Birth attendants trained in HBB was 67.5% versus 90.8% (p≤ 0.0005) in the two periods. Number of neonates being stimulated was 704 (14.4%) versus 758 (16.0%) (p=0.032). Number of neonates in need of bag mask ventilation was 352 (7.2%) versus 259 (5.7%) (p=0.003). Early neonatal mortality was 11.1/1000 (n=54) versus 7.2/1000 (n=34) (p=0.047). Fresh stillbirth rate was 16.0/1000 (n=78) versus 14.4/1000 (n=68) (p=0.517). Conclusion LDHF in-situ HBB training facilitated by local HBB trainers improved clinical management and outcome of neonates at Haydom Lutheran Hospital. This was not the case after a one day HBB training. The significant reduction in neonatal mortality likely reflects the increase in babies being stimulated with induction of spontaneous breathing among newborns in primary apnea, reversing the asphyxial process and reducing the need for bag mask ventilation. Thus, transfer of new knowledge and skills into clinical practice with improved patient outcome was achievable through systematic LDHF in-situ simulation training supported by local trainers and leaders.