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

ABSTRACT 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.

[1]  J. Katz,et al.  2500-g Low Birth Weight Cutoff: History and Implications for Future Research and Policy , 2016, Maternal and Child Health Journal.

[2]  J. Wrammert,et al.  Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe , 2016, Pediatrics.

[3]  S. Niermeyer.  Ventilation Remains the Key to Neonatal Resuscitation. , 2016, The Journal of pediatrics.

[4]  C. Mathers,et al.  National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. , 2016, The Lancet. Global health.

[5]  Patrick Gerland,et al.  Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation , 2015, The Lancet.

[6]  M. Escobedo,et al.  Part 13: Neonatal Resuscitation , 2015, Pediatrics.

[7]  M. Escobedo,et al.  Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Reprint). , 2015, Pediatrics.

[8]  R. Khalak,et al.  Does Reading Advocacy Program in the NICU Impact Shared Reading after Discharge , 2015 .

[9]  Ashley K. Fernandes.  The Ethics, Limits, and Potential Harm of Naming Names , 2015, Pediatrics.

[10]  J. Katz,et al.  Risk factors and neonatal/infant mortality risk of small-for-gestational-age and preterm birth in rural Nepal , 2015, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[11]  Mathias W Pletz,et al.  Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring , 2015, Infection Control & Hospital Epidemiology.

[12]  T. Bailey,et al.  Elevated risk of stillbirth in males: systematic review and meta-analysis of more than 30 million births , 2014, BMC Medicine.

[13]  J. Wrammert,et al.  Poor adherence to neonatal resuscitation guidelines exposed; an observational study using camera surveillance at a tertiary hospital in Nepal , 2014, BMC Pediatrics.

[14]  Colin Mathers,et al.  Every Newborn: progress, priorities, and potential beyond survival , 2014, The Lancet.

[15]  Jai K Das,et al.  Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? , 2014, The Lancet.

[16]  T. Vos,et al.  Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990 , 2013, Pediatric Research.

[17]  Joy Lawn,et al.  Born Too Soon: The global epidemiology of 15 million preterm births , 2013, Reproductive Health.

[18]  J. Perlman,et al.  Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training , 2013, Pediatrics.

[19]  H. Fidler,et al.  Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training , 2013, Pediatrics.

[20]  J. Wrammert,et al.  Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival , 2012, BMC Pediatrics.

[21]  D. Bick.  Born too soon: the global issue of preterm birth. , 2012, Midwifery.

[22]  Ann-Beth Moller,et al.  National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications , 2012, The Lancet.

[23]  Gary L Darmstadt,et al.  Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect , 2011, BMC public health.

[24]  B. Gelbart,et al.  Assessment of neonatal resuscitation performance using video recording in a perinatal centre , 2010, Journal of paediatrics and child health.

[25]  J. Lawn,et al.  Two million intrapartum‐related stillbirths and neonatal deaths: Where, why, and what can be done? , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[26]  J. Lawn,et al.  Neonatal resuscitation in low‐resource settings: What, who, and how to overcome challenges to scale up? , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[27]  J. Kattwinkel,et al.  Neonatal resuscitation guidelines for ILCOR and NRP: evaluating the evidence and developing a consensus , 2008, Journal of Perinatology.

[28]  J. Spector,et al.  Preventing those so-called stillbirths. , 2008, Bulletin of the World Health Organization.

[29]  D. Rabi,et al.  Room air resuscitation of the depressed newborn: a systematic review and meta-analysis. , 2007, Resuscitation.

[30]  T. Wardlaw,et al.  Monitoring low birth weight: an evaluation of international estimates and an updated estimation procedure. , 2005, Bulletin of the World Health Organization.

[31]  O. Saugstad.  The role of oxygen in neonatal resuscitation. , 2004, Clinics in perinatology.

[32]  C. Callaway,et al.  Part 8: Post–Cardiac Arrest Care , 2017 .

[33]  Nalini Singhal,et al.  Helping Babies Breathe: global neonatal resuscitation program development and formative educational evaluation. , 2012, Resuscitation.

[34]  T. Wardlaw,et al.  Low birthweight: country regional and global estimates. , 2004 .

[35]  K. Airede.  Should we resuscitate? Ethical dilemmas. , 1991, Annals of tropical paediatrics.