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Pediatrics. 2016 Jun;137(6). pii: e20150117. doi: 10.1542/peds.2015-0117.

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe.

Author information

1
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; Health Section, UNICEF Nepal Country Office, UN House, Pulchowk, Lalitpur, Nepal; aaashis7@yahoo.com.
2
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;
3
Latter-Day Saints Charities, Salt Lake City, Utah; and.
4
Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.

Abstract

BACKGROUND AND OBJECTIVE:

Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal.

METHODS:

The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC.

RESULTS:

The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32-0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31-0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09-0.17) and 62% (OR 0.38, 95% CI 0.29-0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after.

CONCLUSIONS:

The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.

PMID:
27225317
DOI:
10.1542/peds.2015-0117
[Indexed for MEDLINE]
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