Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival

Ashish Kc,Kedar Baral,Mats Målqvist,Robert Clark,Sheela Verma,Dhan Raj Aryal,Naresh P Kc,Ravi Vitrakoti,Johan Wrammert,Uwe Ewald

doi:10.1186/1471-2431-12-159

Abstract

BackgroundReducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.Methods/DesignThe study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention.DiscussionAlong with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.Trial registrationISRCTN97846009

Highlights

Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade
Study objective This study aims to assess the impact of Helping Babies Breathe (HBB) at a tertiary hospital in Nepal on perinatal outcomes and performance of skilled birth attendants on management of intrapartum related neonatal hypoxia
In low resource healthcare setting with multiple and complex factors determining the performance of health worker, identifying a specific solution to improve performance would be crucial

Summary

Introduction

Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements. The Millennium Development Goals 4 and 5, aimed respectively at reducing child mortality and improving maternal health, [1], are inextricably linked [2,3]. Though there has been significant progress in reducing the under-five mortality in the last decade, the rate of reduction in neonatal death has been relatively slow, with still more than 40% of child deaths occurring in the most (99%) intrapartum-related deaths occur in low and middle income countries with 60 million births each year outside health facilities and up to one-half without a skilled birth attendant [9,10]. Among the survivors of intrapartum-related hypoxia “birth asphyxia”, one million may develop cerebral palsy, learning difficulties, or other forms of disability each year [13]

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