Abstract
BackgroundEach year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal.MethodsCCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared.ResultsDuring the study period 1827 newborns were taken to the resuscitation table, and more than half of them (53.3%) were noted as not crying prior to resuscitation.Suction was used in almost 90% of newborns brought to the resuscitation table, whereas bag-and-mask ventilation was only used in less than 10%. The chance to receive ventilation with bag-and-mask for a newborn not crying when brought to the resuscitation table was higher for boys (AdjOR 1.44), low birth weight babies (AdjOR 1.68) and babies that were delivered by caesarean section (AdjOR 1.64).The reliability of the observational form varied considerably amongst the different variables analyzed, but was high for all variables concerning the use of bag-and-mask ventilation and the variable whether suction was used or not, all matching in over 91% of the forms.ConclusionsCCD camera technique was a feasible method to assess resuscitation practices in this low resource hospital setting. In most aspects, the staff did not adhere to guidelines regarding neonatal resuscitation. The use of bag-and-mask ventilation was inadequate, and suction was given excessively in terms of protocol. Further studies exploring the underlying causes behind the lack of adherence to the neonatal resuscitation guidelines should be conducted.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2431-14-233) contains supplementary material, which is available to authorized users.
Highlights
Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications
Studies have shown that providing basic neonatal resuscitation training at birth facilities in low and middle income countries reduce deaths related to birth asphyxiation by an average of about 30% [1], and the need for clinical guidelines on basic newborn resuscitation suitable for settings with limited resources is universally recognized [4]
The aim of the main project is to evaluate and improve neonatal resuscitation and survival in a tertiary hospital in Kathmandu [12]. This will be achieved by using the Helping Babies Breathe (HBB) protocol; a neonatal resuscitation guideline developed in association with the American Academy of Paediatrics, designed to train birth attendants in developing countries the essential skill of new born resuscitation [13]
Summary
Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Studies have shown that providing basic neonatal resuscitation training at birth facilities in low and middle income countries reduce deaths related to birth asphyxiation by an average of about 30% [1], and the need for clinical guidelines on basic newborn resuscitation suitable for settings with limited resources is universally recognized [4]. A basic protocol regarding neonatal resuscitation in low-resource settings can be obtained in the World Health Organization (WHO)’s Pocket Book of Hospital Care for Children, issued in 2005 This states that if a baby is not breathing properly after 30 seconds of initial drying, stimulation, and clearing of the airways (when necessary), bag-and-mask ventilation should be initiated [5]. Further research is required in several areas concerning neonatal resuscitation in settings with limited resources [4]
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