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Data S, Nelson BD, Cedrone K, Mwebesa W, Engol S, Nsiimenta N, Olson KR. Real-Time Digital Feedback Device and Simulated Newborn Ventilation Quality. Pediatrics 2023; 152:e2022060599. [PMID: 37873596 DOI: 10.1542/peds.2022-060599] [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] [Accepted: 07/25/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES Effective bag-valve-mask ventilation is critical for reducing perinatal asphyxia-related neonatal deaths; however, providers often fail to achieve and maintain effective ventilation. The Augmented Infant Resuscitator (AIR) attaches to bag-valve-masks and provides visual feedback on air leaks, blocked airways, harsh breaths, and improper ventilatory rates. We evaluated the effect of this real-time-digital feedback on ventilation quality and the effective determination of airway integrity in a randomized controlled study in Uganda and the United States. METHODS Birth attendants trained in newborn resuscitation were randomized to receive either real-time AIR device feedback (intervention) or no feedback (control) during ventilation exercises. Intervention-arm participants received a 2-minute orientation on interpreting AIR feedback using a single-page iconography chart. All participants were randomly assigned to 3 blinded ventilation scenarios on identical-appearing manikins with airways that were either normal, significantly leaking air, or obstructed. RESULTS We enrolled 270 birth attendants: 77.8% from Uganda and 22.2% from the United States. Birth attendants receiving AIR feedback achieved effective ventilation 2.0 times faster: intervention mean 13.8s (95% confidence interval 10.6-17.1) versus 27.9s (21.6-34.3) for controls (P < .001). The duration of effective ventilation was 1.5 times longer: intervention mean 72.1s (66.7-77.5) versus 47.9s (41.6-54.2) for controls (P < .001). AIR feedback was associated with significantly more accurate and faster airway condition assessment (intervention mean 43.7s [40.5-47.0] versus 55.6s [51.6-59.6]). CONCLUSIONS Providers receiving real-time-digital AIR device feedback achieved effective ventilation significantly faster, maintained it longer, and determined airway condition faster and more accurately than providers in the control group.
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Affiliation(s)
- Santorino Data
- Department of Pediatrics and Child Health
- Consortium for Affordable Medical Technologies in Uganda, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brett D Nelson
- Department of Pediatrics
- Consortium for Affordable Medical Technologies and the Springboard Studio, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Naome Nsiimenta
- Consortium for Affordable Medical Technologies in Uganda, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kristian R Olson
- Department of Pediatrics
- Consortium for Affordable Medical Technologies and the Springboard Studio, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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2
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Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
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Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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3
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Patterson J, North K, Dempsey E, Ishoso D, Trevisanuto D, Lee AC, Kamath-Rayne BD. Optimizing initial neonatal resuscitation to reduce neonatal encephalopathy around the world. Semin Fetal Neonatal Med 2021; 26:101262. [PMID: 34193380 DOI: 10.1016/j.siny.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One million two hundred thousand neonatal lives are lost each year due to intrapartum-related events; 99% of these deaths occur in low- and lower middle-income countries. Neonates exposed to intrapartum-related events present with failure to breathe at birth. Quick and effective delivery room management of these neonates is critical in the prevention of brain injury. Given the prominent role of lung aeration in the cardiopulmonary transition at birth, the mainstay of neonatal resuscitation is effective ventilation. Basic neonatal resuscitation focuses on simple stimulation, airway positioning and clearing, and bag-mask ventilation. Although principles for basic neonatal resuscitation remain the same for high- and low-resource settings, guidelines may differ based on available human and material resources. Formal training in basic resuscitation reduces intrapartum-related neonatal mortality in low-resource settings. However, there remain opportunities to improve provider performance for increased impact with other strategies such as regular practice and continuous quality improvement.
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Affiliation(s)
- Jackie Patterson
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Krysten North
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Research Centre, University College Cork, Wilton, Cork, Ireland.
| | - Daniel Ishoso
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, PO Box 11850, Kinshasa, Democratic Republic of the Congo.
| | - Daniele Trevisanuto
- Department of Women's and Child Health, University of Padova, Via Giustiniani, 3, Padova, Italy.
| | - Anne Cc Lee
- Harvard Medical School; Director of Global AIM Lab, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA.
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Patterson JK, Girnary S, North K, Data S, Ishoso D, Eilevstjønn J, Bose CL. Innovations in Cardiorespiratory Monitoring to Improve Resuscitation With Helping Babies Breathe. Pediatrics 2020; 146:S155-S164. [PMID: 33004638 DOI: 10.1542/peds.2020-016915h] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Ninety percent of intrapartum-related neonatal deaths are attributable to respiratory depression, with the vast majority of these deaths occurring in low- and lower-middle-income countries. Neonatal resuscitation training with Helping Babies Breathe (HBB) decreases mortality from respiratory depression. Cardiorespiratory monitoring in conjunction with HBB can provide valuable resuscitation feedback for both training and bedside purposes. In this article, we discuss 3 innovations that couple cardiorespiratory monitoring with HBB: NeoNatalie Live, the Augmented Infant Resuscitator, and NeoBeat. NeoNatalie Live is a high-fidelity manikin that facilitates bag mask ventilation training through case scenarios of varying difficulty. The Augmented Infant Resuscitator is added in-line between a face mask and ventilation bag during bag mask ventilation training to provide users with real-time feedback on ventilation quality. NeoBeat is a battery-operated heart rate meter that digitally displays the newborn heart rate during bedside resuscitations. For each innovation, we review details of the device, implementation in the field, and areas for further research. Using early experience implementing these devices, we suggest building blocks for effective translation of training into improved care. We also highlight general challenges in implementation of devices in facilities in low- and lower-middle-income countries including considerations for training, adaptations to existing workflow, and integration into the ecosystem. Although the devices highlighted in this article hold promise, more data are needed to understand their impact on newborn outcomes.
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Affiliation(s)
- Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Krysten North
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda; and
| | - Daniel Ishoso
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Carl L Bose
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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5
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Singhal N, McMillan DD, Savich R, Matovelo D, Santorino D, Kamath-Rayne BD. Development and Impact of Helping Babies Breathe Educational Methodology. Pediatrics 2020; 146:S123-S133. [PMID: 33004635 DOI: 10.1542/peds.2020-016915e] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The educational pedagogy surrounding Helping Babies Breathe (HBB) has been transformative in going beyond a curriculum focused only on basic neonatal resuscitation; indeed, it created the framework for an educational program that has served as a model for replication for other impactful programs, such as the Helping Mothers Survive and other Helping Babies Survive curricula. The tenets of HBB include incorporation of innovative learning strategies such as small group discussion, skills-based learning, simulation and debriefing, and peer-to-peer learning, all of which begin the hard work of changing behaviors that may eventually affect health care systems. Allowing for adaptation for local resources and culture, HBB has catalyzed innovation in the development of simplified, pictorial educational materials, in addition to low-tech yet realistic simulators and adjunct devices that have played an important role in empowering health care professionals in their care of newborns, thereby improving outcomes. In this review, we describe the development of HBB as an educational program, the importance of field testing and input from multiple stakeholders including frontline workers, the strategies behind the components of educational materials, and the impact of its pedagogy on learning.
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Affiliation(s)
- Nalini Singhal
- Department of Pediatrics University of Calgary, Calgary, Canada;
| | - Douglas D McMillan
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Renate Savich
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Data Santorino
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda; and
| | - Beena D Kamath-Rayne
- Global Health and Life Support and American Academy of Pediatrics, Itasca, Illinois
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6
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Ali A, Nudel J, Heberle CR, Santorino D, Olson KR, Hur C. Cost effectiveness of a novel device for improving resuscitation of apneic newborns. BMC Pediatr 2020; 20:46. [PMID: 32000740 PMCID: PMC6993372 DOI: 10.1186/s12887-020-1925-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Intrapartum-related hypoxic events are a major cause of morbidity and mortality in low resource countries. Neonates who receive proper resuscitation may go on to live otherwise healthy lives. However, even when a birth attendant is present, these babies frequently receive suboptimal ventilation with poor outcomes. The Augmented Infant Resuscitator (AIR) is a low-cost, reusable device designed to provide birth attendants real-time objective feedback on measures of ventilation quality during resuscitations and is intended for use in training and at the point of care. The goal of our study was to determine the impact and cost-effectiveness of AIR deployment in conjunction with existing resuscitation training programs in low resource settings. Methods We developed a simulation model of the natural history of intrapartum-related neonatal hypoxia and resuscitation deriving parameters from published literature and model calibration. Simulations estimated the number of disability-adjusted life years (DALYs) averted with use of the AIR by birth attendants if deployed at the point of care. Potential decreases in neonatal mortality and long-term subsequent morbidity from disability were modeled over a lifetime horizon. The primary outcome for the analysis was the cost per DALY averted. Model parameters were specific to the Mbeya region of Tanzania. Results Implementation of the AIR strategy resulted in an additional cost of $24.44 (4.80, 73.62) per DALY averted on top of the cost of existing, validated resuscitation programs. Per hospital, this adds an extra $656 to initial training costs and averts approximately 26.84 years of disability in the cohort of children born in the first year, when projected over a lifetime. The findings were robust to sensitivity analyses. Total roll-out costs for AIR are estimated at $422,688 for the Mbeya region, averting approximately 9018 DALYs on top of existing resuscitation programs, which are estimated to cost $202,240 without AIR. Conclusion Our modeling analysis finds that use of the AIR device may be both an effective and cost-effective tool when used as a supplement to existing resuscitation training programs. Implementation of this strategy in multiple settings will provide data to improve our model parameters and potentially confirm our findings.
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Affiliation(s)
- Ayman Ali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, USA.,Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA.,Tulane University School of Medicine, New Orleans, USA
| | - Jacob Nudel
- Department of General Surgery, Boston University, Boston, USA.,Institute for Health System Innovation and Policy, Boston University, Boston, USA
| | - Curtis R Heberle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, USA.,Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA
| | - Data Santorino
- Mbarara University of Science and Technology, Mbarara, Uganda.,Consortium for Affordable Medical Technologies, Mbarara, Uganda
| | - Kristian R Olson
- Consortium for Affordable Medical Technologies, Massachusetts General Hospital, Center for Global Health, Boston, USA.,Harvard Medical School, Boston, USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, USA. .,Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA. .,Harvard Medical School, Boston, USA. .,Health Innovations Research and Evaluation (HIRE), Columbia University Medical Center, 630 W 168th Street, PH9 105, New York, NY, 10032, USA.
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7
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Groothuis E, Van Genderen K. Helping Babies Breathe: Improving Neonatal Resuscitation and Global Neonatal Mortality. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Merali HS, Chan NHM, Mistry N, Kealey R, Campbell D, Morris SK, Data S. Designing and evaluating a novel mobile application for Helping Babies Breathe skills retention in Uganda: comparative study protocol. BMJ Paediatr Open 2019; 3:e000561. [PMID: 31549001 PMCID: PMC6733314 DOI: 10.1136/bmjpo-2019-000561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Over 600 000 newborns die each year of intrapartum-related events, many of which are preventable in the presence of skilled birth attendants. Helping Babies Breathe (HBB) is a neonatal resuscitation training programme designed for low-resource settings that can reduce both early neonatal mortality and stillbirths. However, as in other similar educational programmes, knowledge and skill retention deteriorate over time. This trend may be counteracted by strategies such as regular simulated exercises. In this study, a mobile application (app) 'HBB Prompt' will be developed to assist providers in retaining HBB knowledge and skills. METHODS AND ANALYSIS This is a comparative study in Uganda with two phases: an app development phase and an assessment phase. In the first phase, HBB trainers and providers will explore barriers and facilitators to enhance learning and maintenance of HBB skills and knowledge through focus group discussions (FGDs). The FGDs are designed with a human factors perspective, enabling collection of relevant data for the prototype version of HBB Prompt. The app will then undergo usability and feasibility testing through FGDs and simulations. In the second phase, a minimum of 10 healthcare workers from two district hospitals will receive HBB training. Only the intervention hospital will have access to HBB Prompt. All participants will be asked to practise HBB skills every shift and record this in a logbook. In the intervention site, app usage data will also be collected. The primary outcome will be comparing skills retention 12 months after training, as determined by Objective Structured Clinical Examination B scores. ETHICS AND DISSEMINATION This study received ethics approval from The Hospital for Sick Children and Mbarara University of Science and Technology. The authors plan to publish all relevant findings from this study in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03577054.
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Affiliation(s)
- Hasan Shamsh Merali
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natalie Hoi-Man Chan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neonatalogy, University of California Davis Children's Hospital, Sacramento, California, USA
| | - Niraj Mistry
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neonatology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
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9
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Yamada NK, Kamlin COF, Halamek LP. Optimal human and system performance during neonatal resuscitation. Semin Fetal Neonatal Med 2018; 23:306-311. [PMID: 29571705 DOI: 10.1016/j.siny.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Performance in the delivery of care to sick neonates in need of resuscitation has long been defined primarily in terms of the extent of the knowledge possessed and hands-on skill demonstrated by physicians and other healthcare professionals. This definition of performance in neonatal resuscitation is limited by its focus solely on the human beings delivering care and a perceived set of the requisite skills to do so. This manuscript will expand the definition of performance to include all of the skill sets that humans must use to resuscitate newborns as well as the often complex systems in which those humans operate while delivering that care. It will also highlight how the principles of human factors and ergonomics can be used to enhance human and system performance during patient care. Finally, it will describe the role of simulation and debriefing in the assessment of human and system performance.
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Affiliation(s)
- N K Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Palo Alto, CA, USA.
| | - C O F Kamlin
- Royal Women's Hospital and Newborn Research, Parkville, Victoria, Australia
| | - L P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Palo Alto, CA, USA
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