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Herrick HM, Wild KT, Hill M. Video recording in neonatology: the need for objective measures and collaboration. Pediatr Res 2024; 96:295-296. [PMID: 38627590 DOI: 10.1038/s41390-024-03185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Heidi M Herrick
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Katherine T Wild
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Hill
- Division of Neonatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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2
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Heesters V, van Zanten HA, Heijstek V, Te Pas AB, Witlox RSGM. Record, reflect and refine: using video review as an initiative to improve neonatal care. Pediatr Res 2024; 96:299-308. [PMID: 38356026 DOI: 10.1038/s41390-024-03083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The goal of every medical team is to provide optimal care for their patients. We aimed to use video review (VR) sessions to identify and address areas for improvement in neonatal care. METHODS For nine months, neonatal procedures (stabilization at birth, intubations and sterile line insertions) were video recorded and reviewed with the neonatal care providers. Action research was used to identify and address areas for improvement which were categorized as (1) protocol/equipment adjustments, (2) input for research, (3) aspects of variety, or (4) development of educational material or training programs. RESULTS Eighteen VR sessions were organized with a mean(SD) of 17(5) staff members participating. In total, 120 areas for improvement were identified and addressed, of which 84/120 (70%) were categorized as aspects of variety, 20/120 (17%) as development of educational material or training programs, 10/120 (8%) as protocol/equipment adjustments, and 6/120 (5%) as input for research. The areas for improvement were grouped in themes per category, including sterility, technique, equipment, communication, teamwork, parents' perspective and ventilation. CONCLUSION Our study showed that regularly organized VR empowered healthcare providers to identify and address a large variety of areas for improvement, contributing to continuous learning and improvement processes. IMPACT Video review empowered healthcare providers to identify areas for improvement in neonatal care Video review gave providers the opportunity to address identified areas for improvement, either by enhancing the application of external evidence (i.e. guidelines), learning from individual clinical expertise or strengthening resilience and teamwork Embedding regularly organized video review sessions allowed for continuous monitoring of care by providers, which can be beneficial for creating ongoing learning and improvement processes The structured pathways, supporting implementation of changes that were proposed based on the video review sessions, could help other centers make use of the potential video review has to offer.
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Affiliation(s)
- Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
| | - Henriette A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Veerle Heijstek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Ruben S G M Witlox
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
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3
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Biniwale M. Neuromuscular components of Apgar score in predicting delivery room respiratory support. Pediatr Res 2024:10.1038/s41390-024-03281-6. [PMID: 38769404 DOI: 10.1038/s41390-024-03281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Manoj Biniwale
- Department of Pediatrics, Keck Medical School of USC, 1200 N State Street, Los Angeles, CA, 90033, USA.
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4
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Rüdiger M, Reichert J, Schmitt J, Birdir C. [Perinatal Networks: Ensuring Regional Care of Pregnant Woman and Newborns]. Z Geburtshilfe Neonatol 2024; 228:127-134. [PMID: 38365210 PMCID: PMC11014747 DOI: 10.1055/a-2211-7018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 02/18/2024]
Abstract
Health care of pregnant women and their newborns is facing major challenges due to the decline in birth rate and shortage of specialists. In the current discussion about future concepts, the centralization associated with minimum quantities and the necessary safeguarding of care in the area are often construed as conflicting goals. Instead, concepts are needed to guarantee that pregnant women and their children will continue to receive care close to home. The example of the saxony center for feto/neonatal health is used to show how partners in a region can jointly ensure care during pregnancy, birth and the neonatal period on a supra-local and cross-hospital basis. The close cooperation of maximum care providers with regional partners enables comprehensive health care. At the same time, this cooperation enables hospitals to remain attractive employers in structurally weak regions and to provide comprehensive care for young families in need of medical services related to pregnancy and birth through good family and social integration close to home and work. The overriding goals of the saxony center for feto/neonatal health are optimal, guideline-based, interdisciplinary and intersectoral care of pregnant women and premature or sick newborns in the region.
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Affiliation(s)
- Mario Rüdiger
- Klinik und Poliklinik für Kinder- und Jugendmedizin,
Medizinische Fakultät und Universitätsklinikum, Fachbereich
Neonatologie und Pädiatrische Intensivmedizin, TU Dresden, Dresden,
Germany
- Zentrum für feto/neonatale Gesundheit, Medizinische
Fakultät TU Dresden, Dresden, Germany
| | - Jörg Reichert
- Klinik und Poliklinik für Kinder- und Jugendmedizin,
Medizinische Fakultät und Universitätsklinikum, Fachbereich
Neonatologie und Pädiatrische Intensivmedizin, TU Dresden, Dresden,
Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung,
Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden,
Germany
| | - Cahit Birdir
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe,
Universitätsklinikum Carl Gustav Carus Dresden, Dresden,
Germany
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5
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Krammer T, Kessler L, Aspalter G, Kuster L, Fussenegger B, Aichner H, Simma B. Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study. Pediatr Crit Care Med 2023; 24:e1-e8. [PMID: 36226954 DOI: 10.1097/pcc.0000000000003080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Moving an ICU to a new location is a challenge. The objective of this study was to use in situ simulation to identify potential problems and solutions with the new environment before commencing patient care. DESIGN Planned, observational video-recorded simulation study using four scenarios: delivery room management of term-neonate; delivery room management of extremely low-birth-weight infant; management and transfer of an infant with respiratory syncytial virus bronchiolitis and apnea; and management and transfer of an adolescent with septic shock. SETTING Academic tertiary neonatal and combined neonatal ICU/PICU. PARTICIPANTS Sixteen volunteers (eight physicians, eight nurses). INTERVENTIONS Standardized briefing introduction, with before versus after survey of thoughts about each scenario, and after 8 weeks, debriefing at least 60 minutes and additional video recording. MEASUREMENTS AND MAIN RESULTS A total of 91 potential problem areas were identified and included issues related to technical aspects ( n = 29), infrastructure ( n = 27), administration ( n = 19), and structure ( n = 16). Fifty-three (58%) of these potential issues could be resolved before the move, including: 15 of 29 technical, 15 of 27 infrastructure, nine of 19 administration, and 14 of 16 structural. The video analysis revealed an additional 13 problem areas (six technical, three infrastructure, two administration, and two structural). Participants felt more confident 8 weeks after the simulations (χ 2 = 12.125; p < 0.002). All 16 participants confirmed the usefulness of the in situ simulation, the majority wanted further introductions to the new ward ( n = 13) and noted a positive impact of the changes on the new ward ( n = 12). CONCLUSIONS In situ simulation before moving into a new facility identifies numerousness potential problem areas. Survey shows that providers feel better prepared and are more confident. Video recording reveals additional difficulties not addressed in conventional verbal debriefing.
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Affiliation(s)
- Theresa Krammer
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Lisa Kessler
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gerhard Aspalter
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Lucas Kuster
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Barbara Fussenegger
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Heidi Aichner
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Heesters V, Witlox R, van Zanten HA, Jansen SJ, Visser R, Heijstek V, Te Pas AB. Video recording emergency care and video-reflection to improve patient care; a narrative review and case-study of a neonatal intensive care unit. Front Pediatr 2022; 10:931055. [PMID: 35989985 PMCID: PMC9385994 DOI: 10.3389/fped.2022.931055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams' management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.
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Affiliation(s)
- Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Ruben Witlox
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Henriette A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Sophie J Jansen
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Remco Visser
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Veerle Heijstek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
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Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB. Teamwork and Adherence to Guideline on Newborn Resuscitation-Video Review of Neonatal Interdisciplinary Teams. Front Pediatr 2022; 10:828297. [PMID: 35265565 PMCID: PMC8900704 DOI: 10.3389/fped.2022.828297] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. OBJECTIVE By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. METHODS Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1-5 (1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0-60, average 60-84, high 85-100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. RESULTS Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4-22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79-0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66-0.89). CONCLUSION Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Esberg
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Neil Finer
- Department of Neonatology, University of California, San Diego, San Diego, CA, United States
| | | | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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8
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Kaufmann M, Seipolt B, Rüdiger M, Mense L. Tactile stimulation in very preterm infants and their needs of non-invasive respiratory support. Front Pediatr 2022; 10:1041898. [PMID: 36467488 PMCID: PMC9715591 DOI: 10.3389/fped.2022.1041898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
AIM Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation. METHODS In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 320/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support. RESULTS All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support. CONCLUSION This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.
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Affiliation(s)
- Maxi Kaufmann
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Barbara Seipolt
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Mario Rüdiger
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Lars Mense
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany.,Saxony Center for Feto-Neonatal Health, TU Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
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9
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Olson L, Bui XA, Mpamize A, Vu H, Nankunda J, Truong TT, Byamugisha J, Dempsey T, Lubulwa C, Winroth A, Helldén D, Nguyen AD, Alfvén T, Pejovic N, Myrnerts Höök S. Neonatal resuscitation monitoring: A low-cost video recording setup for quality improvement in the delivery room at the resuscitation table. Front Pediatr 2022; 10:952489. [PMID: 36405840 PMCID: PMC9666784 DOI: 10.3389/fped.2022.952489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The quality of neonatal resuscitation after delivery needs to be improved to reach the Sustainable Development Goals 3.2 (reducing neonatal deaths to <12/1,000 live newborns) by the year 2030. Studies have emphasized the importance of correctly performing the basic steps of resuscitation including stimulation, heart rate assessment, ventilation, and thermal control. Recordings with video cameras have previously been shown to be one way to identify performance practices during neonatal resuscitation. METHODS A description of a low-cost delivery room set up for video recording of neonatal resuscitation. The technical setup includes rechargeable high-definition cameras with two-way audio, NeoBeat heart rate monitors, and the NeoTapAS data collection tools for iPad with direct data export of data for statistical analysis. The setup was field tested at Mulago National Referral Hospital, Kampala, Uganda, and Phu San Hanoi Hospital, Hanoi, Vietnam. RESULTS The setup provided highly detailed resuscitation video footage including data on procedures and team performance, heart rate monitoring, and clinical assessment of the neonate. The data were analyzed with the free-of-charge NeoTapAS for iPad, which allowed fast and accurate registration of all resuscitative events. All events were automatically registered and exported to R statistical software for further analysis. CONCLUSIONS Video analysis of neonatal resuscitation is an emerging quality assurance tool with the potential to improve neonatal resuscitation outcomes. Our methodology and technical setup are well adapted for low- and lower-middle-income countries settings where improving neonatal resuscitation outcomes is crucial. This delivery room video recording setup also included two-way audio communication that potentially could be implemented in day-to-day practice or used with remote teleconsultants.
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Affiliation(s)
- Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam.,Neonatal Department, Vietnam National Children's Hospital, Hanoi, Vietnam.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Xuan Anh Bui
- Department of Information Technology, Phu San Hanoi Hospital, Hanoi, Vietnam
| | | | - Hien Vu
- Social Department, Phu San Hanoi, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.,Department of International Collaboration, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Jolly Nankunda
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda.,Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampal, Uganda
| | - Tung Thanh Truong
- Social Department, Phu San Hanoi, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Makerere, Uganda
| | - Tina Dempsey
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Clare Lubulwa
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Axel Winroth
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Helldén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Anh Duy Nguyen
- Department of Hospital Administration, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nicolas Pejovic
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Susanna Myrnerts Höök
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Centre for International Health, University of Bergen, Bergen, Norway
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