Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?

BACKGROUND

The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.

METHODS

We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training.

RESULTS

One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training).

CONCLUSIONS

HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01681017 ; 04 September 2012, retrospectively registered.

Physical activity as a clinical tool in the assessment of malnutrition

OBJECTIVE

To measure physical activity in children with wasting and to look for association between poor physical activity and wasting.

METHODS

Physical activity was measured in 56 children with wasting, using Childrens Activity Rating Scale, and compared with age- and sex-matched controls.

RESULTS

A significant association was found between poor physical activity and malnutrition as determined by weight-for-height Z Score <-2 (P=0.001) and mid-upper-arm circumference (P=0.002).

MAIN CONCLUSION

Physical activity can be used as clinical parameter to assess malnutrition.

Impact and feasibility of breast crawl in a tertiary care hospital

OBJECTIVE

To determine the impact of breast crawl on breast feeding and its feasibility and acceptability in a busy labor room.

STUDY DESIGN

A prospective, single blinded, randomized controlled clinical trial. Impact of breast crawl was studied in one group and the outcome was compared with the other group where breast crawl was not performed. Feasibility and acceptability was determined by analysis of questionnaire given to obstetricians and nurses. Descriptive statistics and χ(2)-analysis was applied to evaluate the questionnaire and to compare the outcome in the two groups.

RESULT

Breast crawl had a significant positive impact on the onset of lactation (P=0.0005) as well as extent of neonatal weight loss on day 3 (0.032).

CONCLUSION

Our study adds to the body of evidence that breast crawl results in positive short-term breast feeding outcome but acceptability of breast crawl as a routine in a busy labor room remains a major issue.

Is knowledge of medicolegal issues concordant with heightened risk among doctors?

Spurred by the wave of consumerism, patients do not hesitate to drag the doctor to the court. It has now become essential for doctors to educate themselves on the laws relevant to medical practice. This study addresses some of the issues. Doctors in private practice, belonging to different specialities, were given a self administered questionnaire which was then analysed by the percentage of responses to each question. Only 3% of the respondents faced medicolegal problems at the time of the study. All of them were fighting charges of negligence from their patients. Most (97%) did not keep records of patients seen in outpatient services, 63% used consent forms written in English only and 78% took blanket consent forms for procedures; 97% were not aware of any laws protecting them in their practice. This study highlights the gross ignorance of medicolegal issues among doctors and the need for compulsory certificate courses for them and changes in the curriculum for the postgraduates with respect to this important aspect of medical profession.

DOOR syndrome

DOOR syndrome is a rare multisystem genetic disorder, consisting of deafness (sensorineural), onychodystrophy, osteodystrophy, and mental retardation. Seizures reported frequently in this condition are often refractory to treatment.

Panayiotopoulos syndrome

Panayiotopoulos syndrome is a benign childhood epileptic illness characterized by episodic autonomic symptoms. We present a 9 year old boy with this condition, who presented with episodes of severe vomiting, fever, deviation of eyes and altered sensorium, characteristic EEG in the form of multiple occipital spikes and normal neuroradiologic and metabolic investigations.

Breastfeeding programme--right policy, wrong target?

To assess the knowledge of breastfeeding management among obstetriciansand the practices being followed in their hospital, 50 obstetricians in private practice in Nagpur, responded to questionnaires having 6 points covering the entire gamut of common issues regarding breastfeeding. All believed that breast milk is best for the baby. It was found that knowledge about various aspects of breastfeeding management is very poor. Unawareness about the adequacy of colostrum for a full term appropriate for date baby was almost universal. While the policy of promoting breastfeeding every year through public programmes is appropriate, the question is who should be the target? Prospective mothers or obstetricians? It is obvious from this study that obstetricians have significant educational needs in the area of breastfeeding management.