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Patterson JK, Ishoso D, Eilevstjønn J, Bauserman M, Haug I, Iyer P, Kamath-Rayne BD, Lokangaka A, Lowman C, Mafuta E, Myklebust H, Nolen T, Patterson J, Tshefu A, Bose C, Berkelhamer S. Delayed and Interrupted Ventilation with Excess Suctioning after Helping Babies Breathe with Congolese Birth Attendants. CHILDREN 2023; 10:children10040652. [PMID: 37189901 DOI: 10.3390/children10040652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
There is a substantial gap in our understanding of resuscitation practices following Helping Babies Breathe (HBB) training. We sought to address this gap through an analysis of observed resuscitations following HBB 2nd edition training in the Democratic Republic of the Congo. This is a secondary analysis of a clinical trial evaluating the effect of resuscitation training and electronic heart rate monitoring on stillbirths. We included in-born, liveborn neonates ≥28 weeks gestation whose resuscitation care was directly observed and documented. For the 2592 births observed, providers dried/stimulated before suctioning in 97% of cases and suctioned before ventilating in 100%. Only 19.7% of newborns not breathing well by 60 s (s) after birth ever received ventilation. Providers initiated ventilation at a median 347 s (>five minutes) after birth; no cases were initiated within the Golden Minute. During 81 resuscitations involving ventilation, stimulation and suction both delayed and interrupted ventilation with a median 132 s spent drying/stimulating and 98 s suctioning. This study demonstrates that HBB-trained providers followed the correct order of resuscitation steps. Providers frequently failed to initiate ventilation. When ventilation was initiated, it was delayed and interrupted by stimulation and suctioning. Innovative strategies targeting early and continuous ventilation are needed to maximize the impact of HBB.
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Nantume A, Oketch BA, Otiangala D, Shah S, Cauvel T, Nyumbile B, Olayo B. Feasibility, performance and acceptability of an innovative vital signs monitor for sick newborns in Western Kenya: A mixed-methods study. Digit Health 2023; 9:20552076231182799. [PMID: 37434726 PMCID: PMC10331074 DOI: 10.1177/20552076231182799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Low- and middle-income countries (LMICs) account for 99% of the global neonatal mortality. Limited access to advanced technology, such as bedside patient monitors contributes to disproportionately poor outcomes for critically ill newborns in LMICs. We designed a study to assess the feasibility, performance, and acceptability of a low-cost wireless wearable technology for continuous monitoring of sick newborns in resource-limited settings. Methods This was a mixed-methods implementation study conducted between March and April 2021 at two health facilities in Western Kenya. Inclusion criteria for newborns monitored included: age 0 to 28 days, birthweight ≥2.0 kg, low-to-moderate severity of illness at admission and the guardian's willingness to provide informed consent. Medical staff who participated in monitoring the newborns were surveyed about their experience with the technology. We used descriptive statistics to summarize our quantitative findings and qualitative data was coded and analyzed as an iterative process to summarize quotes on user acceptability. Results The results of the study demonstrated that adoption of neoGuard was feasible and acceptable in this setting. Medical staff described the technology as safe, user-friendly and efficient, after successfully monitoring 134 newborns. Despite the positive user experience, we did observe some notable technology performance issues such as a high percentage of missing vital signs data. Conclusion The results of this study were critical in informing the iterative process of refining and validating an innovative vital signs monitor for patients in resource-limited settings. Further research and development are underway to optimize neoGuard's performance and to examine its clinical impact and cost effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Bernard Olayo
- Center for Public Health and Development, Nairobi, Kenya
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Costa BFCD, Carneiro BD, Ramalho A, Freitas A. Characterization of Innovation to Fight Child Mortality: A Systematic Scoping Review. Int J Public Health 2022; 67:1604815. [PMID: 36046259 PMCID: PMC9421644 DOI: 10.3389/ijph.2022.1604815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to summarize how child mortality—a Sustainable Development Goal stated by the United Nations—has been explicitly addressed in the context of innovations. Methods: A scoping review following the PRISMA-ScR Statement was performed analysing indexed and non-indexed literature. Results: Empirical and non-disruptive innovation in the context of process targeting under-five mortality rate was the main subset of literature included in this article. The increment of literature on innovation in the context of SDGs over the last years denotes its growing importance and even though innovation aiming to reduce child mortality is currently being done, a significant part of it is not published in indexed databases but as grey literature. Conclusion: Empirical, disruptive innovation under a structural approach and empirical, non-disruptive innovation under a project point of view are the main types of innovation addressed in the literature and would be of utmost potential to reduce child mortality rate. A systematic review of the methods used for the measures of evaluation of applied innovations, their quality and results would be of great importance in the future.
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Affiliation(s)
| | | | - André Ramalho
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Twist E, Salverda HH, Pas ABT. Comparing pulse rate measurement in newborns using conventional and dry-electrode ECG monitors. Acta Paediatr 2022; 111:1137-1143. [PMID: 34981852 PMCID: PMC9303717 DOI: 10.1111/apa.16242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
Aim Heart rate (HR) is the most important parameter to evaluate newborns’ clinical condition and to guide intervention during resuscitation at birth. The present study aims to compare the accuracy of NeoBeat dry‐electrode ECG for HR measurement with conventional ECG and pulse oximetry (PO). Methods Newborns with a gestational age ≥32 weeks and/or birth weight ≥1.5 kg were included when HR evaluation was needed. HR was simultaneously measured for 10 min with NeoBeat, PO and conventional ECG. Results A total of 18 infants were included (median (IQR) gestational age 39 (36–39) weeks and birth weight 3 150 (2 288–3 859) grams). Mean (SD) duration until NeoBeat obtained a reliable signal was 2.5 (9.0) s versus 58.5 (171.0) s for PO. Mean difference between NeoBeat and ECG was 1.74 bpm (LoA −4.987–8.459 and correlation coefficient 0.98). Paired HR measurements over 30‐s intervals revealed no significant difference between NeoBeat and ECG. The positive predictive value of a detected HR <100 bpm by NeoBeat compared with ECG was 54.84%, negative predictive value 99.99%, sensitivity 94.44%, specificity 99.99% and accuracy 99.85%. Conclusions HR measurement with NeoBeat dry‐electrode ECG at birth is reliable and accurate.
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Affiliation(s)
- Eris Twist
- Pediatric Intensive Care Unit Department of Pediatrics and Pediatric Surgery Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam the Netherlands
| | - Hylke H. Salverda
- Department of Paediatrics Division of Neonatology Willem‐Alexander Children’s Hospital Leiden University Medical Center the Netherlands
| | - Arjan B. te Pas
- Department of Paediatrics Division of Neonatology Willem‐Alexander Children’s Hospital Leiden University Medical Center the Netherlands
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Use of a Novel Manikin for Neonatal Resuscitation Ventilation Training. CHILDREN 2022; 9:children9030364. [PMID: 35327735 PMCID: PMC8947467 DOI: 10.3390/children9030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
All providers who attend deliveries independently should be well versed in the performance of effective ventilation, assessment of the quality of ventilation/interventions supplied and able to troubleshoot in situations where these may be ineffective. A novel manikin serves as a unique ventilation-focused training tool to practice these clinical skills and decision-making. The data generated by the manikin, with the aid of a facilitator, may be used for formative and summative feedback on an individual level or curricular development on a larger level. This communication describes the importance of focused ventilation training for front-line providers and illustrates how this manikin can be incorporated into an individualized ventilation training program.
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Thornton M, Ishoso D, Lokangaka A, Berkelhamer S, Bauserman M, Eilevstjønn J, Iyer P, Kamath-Rayne BD, Mafuta E, Myklebust H, Patterson J, Tshefu A, Bose C, Patterson JK. Perceptions and experiences of Congolese midwives implementing a low-cost battery-operated heart rate meter during newborn resuscitation. Front Pediatr 2022; 10:943496. [PMID: 36245737 PMCID: PMC9557145 DOI: 10.3389/fped.2022.943496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND 900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries. Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate's status to inform resuscitation care, but is infrequently used in low-resource settings. In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives' perceptions of NeoBeat including its utility and barriers and facilitators to use. METHODS After a 20-month intervention in which midwives from three facilities used NeoBeat during resuscitations, we surveyed midwives and conducted focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. FGDs were conducted in Lingala, the native language, then transcribed and translated from Lingala to French to English. We analyzed data by: (1) coding of transcripts using Nvivo, (2) comparison of codes to identify patterns in the data, and (3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus. RESULTS Each midwife from Facility A used NeoBeat on an estimated 373 newborns, while each midwife at facilities B and C used NeoBeat an average 24 and 47 times, respectively. From FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: (1) Providers' initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, (2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, (3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, (4) Challenges of use of NeoBeat included cleaning, charging, and insufficient quantity of devices, and (5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities. CONCLUSION Midwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up.
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Affiliation(s)
- Madeline Thornton
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adrien Lokangaka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Sara Berkelhamer
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joar Eilevstjønn
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | - Pooja Iyer
- RTI International, Durham, NC, United States
| | | | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Helge Myklebust
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | | | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jackie K Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Effect of resuscitation training and implementation of continuous electronic heart rate monitoring on identification of stillbirth. Resuscitation 2021; 171:57-63. [PMID: 34965451 DOI: 10.1016/j.resuscitation.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the effect of resuscitation training and continuous electronic heart rate (HR) monitoring of non-breathing newborns on identification of stillbirth. METHODS We conducted a pre-post interventional trial in three health facilities in the Democratic Republic of the Congo. We collected data on a retrospective control group of newborns that reflected usual resuscitation practice (Epoch 1). In the prospective, interventional group, skilled birth attendants received resuscitation training in Helping Babies Breathe and implemented continuous electronic HR monitoring of non-breathing newborns (Epoch 2). Our primary outcome was the incidence of stillbirth with secondary outcomes of fresh or macerated stillbirth, neonatal death before discharge and perinatal death. Among a subset, we conducted expert review of electronic HR data to estimate misclassification of stillbirth in Epoch 2. We used a generalized estimating equation, adjusted for variation within-facility, to compare risks between EPOCHs. RESULTS There was no change in total stillbirths following resuscitation training and continuous electronic HR monitoring of non-breathing newborns (aRR 1.15 [0.95, 1.39]). We observed an increased rate of macerated stillbirth (aRR 1.58 [1.24, 2.02]), death before discharge (aRR 3.31 [2.41, 4.54]), and perinatal death (aRR 1.61 [1.38, 1.89]) during the intervention period. In expert review, 20% of newborns with electronic HR data that were classified by SBAs as stillborn were liveborn. CONCLUSION Resuscitation training and use of continuous electronic HR monitoring did not reduce stillbirths nor eliminate misclassification.
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Umoren R, Bucher S, Hippe DS, Ezenwa BN, Fajolu IB, Okwako FM, Feltner J, Nafula M, Musale A, Olawuyi OA, Adeboboye CO, Asangansi I, Paton C, Purkayastha S, Ezeaka CV, Esamai F. eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings. BMJ Open 2021; 11:e048506. [PMID: 34433598 PMCID: PMC8390148 DOI: 10.1136/bmjopen-2020-048506] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. DESIGN Randomised controlled trial with 6-month follow-up (2018-2020). SETTING Secondary and tertiary healthcare facilities. PARTICIPANTS 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. INTERVENTIONS eHBB VR simulation or neonatal resuscitation video. MAIN OUTCOMES Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. RESULTS Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. CONCLUSION eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.
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Affiliation(s)
- Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sherri Bucher
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | | | | | - John Feltner
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | | | - Olubukola A Olawuyi
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria
| | | | | | - Chris Paton
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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