Neonatal Resuscitation Equipment Research Articles

Preparedness for severe maternal morbidity in European hospitals: The MaCriCare study

PurposeTo evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). MethodsFrom September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection. Results1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database. ConclusionGaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control.

Use of eye-tracking to evaluate human factors in accessing neonatal resuscitation equipment and medications for advanced resuscitation: A simulation study.

Emergency neonatal resuscitation equipment is often organized into "code carts". Simulation studies previously examined human factors of neonatal code carts and equipment; however, visual attention analysis with eye-tracking might further inform equipment design. To evaluate human factors of neonatal resuscitation equipment by: (1) comparing epinephrine preparation speed from adult pre-filled syringe vs. medication vial, (2) comparing equipment retrieval times from two carts and (3) utilizing eye-tracking to study visual attention and user experience. We conducted a 2-site randomized cross-over simulation study. Site 1 is a perinatal NICU with carts focused on airway management. Site 2 is a surgical NICU with carts improved with compartments and task-based kits. Participants were fitted with eye-tracking glasses then randomized to prepare two epinephrine doses using two methods, starting with an adult epinephrine prefilled syringe or a multiple access vial. Participants then obtained items for 7 tasks from their local cart. Post-simulation, participants completed surveys and semi-structured interviews while viewing eye-tracked video of their performance. Epinephrine preparation times were compared between the two methods. Equipment retrieval times and survey responses were compared between sites. Eye-tracking was analyzed for areas of interest (AOIs) and gaze shifts between AOIs. Interviews were subject to thematic analysis. Forty HCPs participated (20/site). It was faster to draw the first epinephrine dose using the medication vial (29.9s vs. 47.6s, p < 0.001). Time to draw the second dose was similar (21.2s vs. 19s, p = 0.563). It was faster to obtain equipment from the Perinatal cart (164.4s v 228.9s, p < 0.027). Participants at both sites found their carts easy to use. Participants looked at many AOIs (54 for Perinatal vs. 76 for Surgical carts, p < 0.001) with 1 gaze shifts/second for both.Themes for epinephrine preparation include: Facilitators and Threats to Performance, and Discrepancies due to Stimulation Conditions. Themes for code carts include: Facilitators and Threats to Performance, Orienting with Prescan, and Suggestions for Improvement. Suggested cart improvements include: adding prompts, task-based grouping, and positioning small equipment more visibly. Task-based kits were welcomed, but more orientation is needed. Eye-tracked simulations provided human factors assessment of emergency neonatal code carts and epinephrine preparation.

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

BackgroundAn intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice.MethodsThe Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach.DiscussionThe SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping.Trial registrationClinicaltrials.gov, NCT04070560. Registered 28 August 2019.

Perceptions of barriers and facilitators to disinfection of basic neonatal resuscitation equipment in a rural hospital in Kenya: A qualitative study

Perceptions of barriers and facilitators to disinfection of basic neonatal resuscitation equipment in a rural hospital in Kenya: A qualitative study

Get Me a Mask! The Challenge of Equipment Supply Chains.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future.

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

Neonatal resuscitation: EN-BIRTH multi-country validation study

BackgroundAnnually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage.MethodsThe EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017–2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation.ResultsAmong 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV accuracy was higher (sensitivity 12.4–48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure.ConclusionsPopulation-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.

Evaluation of Neonatal Resuscitation Knowledge and Procedures According to the “Helping Babies Breathe” (HBB) Program by Qualified Health Care Staff at the Sikasso Hospital Level in Mali

Introduction: Perinatal asphyxia is one of the leading causes of perinatal death. According to the WHO, two thirds of these deaths can be prevented with simple and effective interventions. The HBB (Helping Babies Breathe) program provides effective care for asphyxiant newborns regardless of the level of care. Objective: The objective of our work was to assess the knowledge of neonatal resuscitation equipment and procedures according to the HBB program by qualified nursing staff at the level of referral health structures in the Sikasso region of Mali. Methodology: This is a multicenter cross-sectional survey over a period of 4 months. It was carried out in two maternities and two referral neonatal units in Sikasso. The target population studied was made up of the nursing staff involved in the reception and care of newborns in the delivery room, in postpartum suites and in neonatal departments. Results: Eighty percent (112/141) of targeted caregivers were interviewed. More than half (44%) had more than 6 years of experience in neonatal care. Only 27% had received training in neonatal resuscitation including HBB. The most cited materials used for resuscitation were the mucus aspirator (82%), the ventilation bag (67%) and the heated table (60%). The bestknown resuscitation procedures were airway aspiration (82%), mask ventilation (60%), and hypothermia control (48%). Conclusion: Knowledge of newborn resuscitation remains very insufficient in the reference structures in Sikasso. It is necessary to implement a strategic plan for continuous training of staff with periodic monitoring in health structures.

High-level disinfection of re-usable neonatal resuscitation equipment through boiling and steaming

Infection and asphyxia are two major causes of neonatal death globally. Where single-use resuscitation devices or sterilization of re-usable devices are unavailable, there is a need for effective, low-cost methods of high-level disinfection. Laboratory validation examined the efficacy of boiling and enclosed steaming (without pressure) as methods for attaining high-level disinfection of re-usable neonatal resuscitation equipment. The microbial load extracted and measured for each test article met internationally accepted standards for high-level disinfection. Boiling and steaming are low-cost, effective methods for reprocessing re-usable neonatal resuscitation devices in low- and middle-income countries.

Keep it Simple: Soap and Water for Adequate Reprocessing of Neonatal Resuscitation Equipment in Low-Resource Settings

Keep it Simple: Soap and Water for Adequate Reprocessing of Neonatal Resuscitation Equipment in Low-Resource Settings

Multi-level perceptions of barriers and facilitators to reprocessing of basic neonatal resuscitation equipment in a resource-limited, rural hospital in Kenya

Multi-level perceptions of barriers and facilitators to reprocessing of basic neonatal resuscitation equipment in a resource-limited, rural hospital in Kenya

Keep it Simple: Soap and Water for Adequate Reprocessing of Neonatal Resuscitation Equipment in Low-Resource Settings

Purpose: Adequate reprocessing (disinfection) of neonatal resuscitation equipment may prevent neonatal sepsis. As such, PATH developed consensus guidelines for reprocessing that were strongly recommended by Helping Babies Breathe, 2nd Edition. However, early feedback from low-resource settings reports these guidelines are not easy to implement and sustain in the locales for which they were designed. The purpose of this pilot study …

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

BackgroundBirth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia.MethodWe used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge.ResultsThe finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09–3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate.ConclusionOnly half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment’s. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria.

Introduction:Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment.Methods:this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs.Results:all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders.Conclusion:primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.

Sign in, time out, sign out checklist-changing practice through interdepartmental teamwork to improve safety at caesarean section.

Three similar clinical incidences over a three-month period highlighted an issue with the readiness and availability of neonatal resuscitation personnel and equipment at the time of caesarean section (CS). This identified a potential risk to the wellbeing of the mother and baby that had to be addressed. A joint venture was undertaken with the maternity and theatre directorates. A maternity-specific checklist in use in the UK maternity services was sourced, adapted and implemented. No further incidents have been reported since with resulting overall enhanced safety of pregnant women and newborn babies in the unit.

Translating continuing professional development education to nursing practice in Rwanda: Enhancing maternal and newborn health

IntroductionApproximately 99% of the three million neonatal deaths that occur annually are in developing countries. In Rwanda, neonatal asphyxia is the leading cause of neonatal mortality accounting for 38% of all neonatal deaths. The Helping Babies Breathe (HBB©) course was initiated by the American Academy of Pediatrics (AAP) in 2010 to reduce neonatal mortality in resource limited areas. Despite the provision of HBB© courses to practicing nurses in Rwanda, little is known about nurses’ experiences of applying the knowledge and skills acquired from those courses to practice. This study was conducted in 2014 in five district hospitals (Nyamata, Rwamagana, Gahini, Kiziguro, and Kibungo) located in the Eastern Province of Rwanda. PurposeExplore nurses’ experiences of translating continuing professional development (CPD) education utilizing the HBB© course to nursing practice in Rwanda. MethodsQualitative descriptive design. A purposive sample of 10 nurses participated in individual interviews. NVIVO computer software was used to manage qualitative data. Content analysis was used for generating categories from the data. FindingsThree categories emerged from the analysis: 1) application of competencies acquired from education sessions to practice, 2) benefits of CPD, and 3) facilitators and barriers to the application of competencies into practice. Qualitative interviews revealed that Nurses’ perceived confidence in performing newborn resuscitation improved after taking part in HBB© courses. Nonetheless, nurses voiced the existence of conditions in their work environment that hindered their ability to apply the acquired knowledge and skills including insufficient materials, shortages of nurses, and potential inadequate human resource allocation. Recommendations and conclusionRegular offerings of newborn resuscitation CPD courses to health professionals in developing countries could increase their knowledge and skills, which could potentially reduce neonatal mortality. The findings from this study underscore a need to attend to the shortages of nurses and lack of neonatal resuscitation materials and equipment in Rwanda. Collaborative efforts can continue to enable nurses to effectively utilize competencies acquired from CPD courses in developing countries.

Etiological Factors&amp; Clinical Courses of Birth Asphyxia in Rural and Urban Population of Kishanganj District.

Problem statement : perinatal asphyxia, neonatal or birth asphyxia is a medical condition from deprivation of oxygen to a newborn infant long enough during the process to cause physical usually to the brain. And it is almost all neonatal deaths occur in our rural and urban area. Where the majority is delivered at homes with negligible antenatal care and poor prenatal services.Methods: In this collaborative study conducted prospective, descriptive study. As a case of 150 newborn babies and as a control 1190 newborn babies are fulfilled the selection criteria for prenatal and birth asphyxia .Results: Incidence of birth asphyxia in relation to ante partum and intrapartum factors. And shows that mother with complication like eclampsia, APH, PROM, cord accidents, failed progress of labor, obstructive labor &amp; prolong 2nd stage of labor, etc were more likely to deliver asphyxiated baby, and analysis of maternal risk factors for birth asphyxia. Many pathological, biochemical &amp; metabolic changes occurs as a result of birth asphyxia. And the data were analyzed by slandered statistical test, namely, Z test, Chi square test, and uniovariate and ultivariate logistic regression analysis of risk factor.Conclusion: In our study it was observed that, Pregnancy related complication in rural &amp; urban population of Kishanganj district was mostly Eclampsia, pre-eclamptic toxaemia, Oligohydramnios, PROM(M24hr) etc. To prevent birth asphyxia trained personal and neonatal resuscitation equipment should be mandatory in all maternity home/hospital because prevention is the best and be only option to reduce the Pre natal &amp; birth asphyxia.Bangladesh Journal of Medical Science Vol.16(4) 2017 p.554-556

Survey of neonatal resuscitation equipment and training in NSW/ACT non‐tertiary birthing units

Survey of neonatal resuscitation equipment and training in NSW/ACT non‐tertiary birthing units

Survey of neonatal resuscitation practices showed post-training improvements but need to reinforce preterm management, monitoring and adrenaline use.

Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.

Neonatal resuscitation training and equipment in private health institutions in Kano metropolis

Background: Over 200,000 babies die yearly in Nigeria, of which about 26% is due to birth asphyxia. Effective neonatal resuscitation (NR) using basic equipment is capable of preventing up to 30% of deaths associated with perinatal asphyxia. However, NR is only effective where caregivers have sufficient knowledge and required skills. The frequent industrial actions by health workers in the public sector have brought to the fore the importance of private health facilities in healthcare delivery. Thus, there is a need to assess training of health workers and availability of basic equipment in private health institutions in Kano. Aim: To assess availability of trained providers on NR and resuscitation equipment in private health facilities in Kano. Materials and Methods: This is a cross sectional survey of 85 conveniently sampled private institutions that provide obstetric care as part of their services in Kano metropolis. A semi-structured self-administered questionnaire was used to collect data from each facility. Results: Seventy eight filled questionnaires were retrieved and analyzed. There were 25 specialist clinics, 44 general practice facilities, and nine maternity homes/primary healthcare (PHC). Only 29 (37.2%) of the facilities have caregivers trained on NR in attendance during normal deliveries. Thirty four (43.5%) facilities have written protocol on NR. Only two (22.2%) of the maternity homes/PHC have functional ambu bags; the corresponding figures for specialist and general practice clinics are 16 (64%) and 24 (54.5%) respectively. Conclusion: There is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis.