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Neonatal resuscitation: EN-BIRTH multi-country validation study
BACKGROUND: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscita...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995695/ https://www.ncbi.nlm.nih.gov/pubmed/33765958 http://dx.doi.org/10.1186/s12884-020-03422-9 |
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author | KC, Ashish Peven, Kimberly Ameen, Shafiqul Msemo, Georgina Basnet, Omkar Ruysen, Harriet Zaman, Sojib Bin Mkony, Martha Sunny, Avinash K. Rahman, Qazi Sadeq-ur Shabani, Josephine Bastola, Ram Chandra Assenga, Evelyne KC, Naresh P. El Arifeen, Shams Kija, Edward Malla, Honey Kong, Stefanie Singhal, Nalini Niermeyer, Susan Lincetto, Ornella Day, Louise T. Lawn, Joy E. |
author_facet | KC, Ashish Peven, Kimberly Ameen, Shafiqul Msemo, Georgina Basnet, Omkar Ruysen, Harriet Zaman, Sojib Bin Mkony, Martha Sunny, Avinash K. Rahman, Qazi Sadeq-ur Shabani, Josephine Bastola, Ram Chandra Assenga, Evelyne KC, Naresh P. El Arifeen, Shams Kija, Edward Malla, Honey Kong, Stefanie Singhal, Nalini Niermeyer, Susan Lincetto, Ornella Day, Louise T. Lawn, Joy E. |
author_sort | KC, Ashish |
collection | PubMed |
description | BACKGROUND: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. METHODS: The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017–2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. RESULTS: Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV accuracy was higher (sensitivity 12.4–48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. CONCLUSIONS: Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-020-03422-9. |
format | Online Article Text |
id | pubmed-7995695 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-79956952021-03-26 Neonatal resuscitation: EN-BIRTH multi-country validation study KC, Ashish Peven, Kimberly Ameen, Shafiqul Msemo, Georgina Basnet, Omkar Ruysen, Harriet Zaman, Sojib Bin Mkony, Martha Sunny, Avinash K. Rahman, Qazi Sadeq-ur Shabani, Josephine Bastola, Ram Chandra Assenga, Evelyne KC, Naresh P. El Arifeen, Shams Kija, Edward Malla, Honey Kong, Stefanie Singhal, Nalini Niermeyer, Susan Lincetto, Ornella Day, Louise T. Lawn, Joy E. BMC Pregnancy Childbirth Research BACKGROUND: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. METHODS: The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017–2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. RESULTS: Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV accuracy was higher (sensitivity 12.4–48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. CONCLUSIONS: Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-020-03422-9. BioMed Central 2021-03-26 /pmc/articles/PMC7995695/ /pubmed/33765958 http://dx.doi.org/10.1186/s12884-020-03422-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research KC, Ashish Peven, Kimberly Ameen, Shafiqul Msemo, Georgina Basnet, Omkar Ruysen, Harriet Zaman, Sojib Bin Mkony, Martha Sunny, Avinash K. Rahman, Qazi Sadeq-ur Shabani, Josephine Bastola, Ram Chandra Assenga, Evelyne KC, Naresh P. El Arifeen, Shams Kija, Edward Malla, Honey Kong, Stefanie Singhal, Nalini Niermeyer, Susan Lincetto, Ornella Day, Louise T. Lawn, Joy E. Neonatal resuscitation: EN-BIRTH multi-country validation study |
title | Neonatal resuscitation: EN-BIRTH multi-country validation study |
title_full | Neonatal resuscitation: EN-BIRTH multi-country validation study |
title_fullStr | Neonatal resuscitation: EN-BIRTH multi-country validation study |
title_full_unstemmed | Neonatal resuscitation: EN-BIRTH multi-country validation study |
title_short | Neonatal resuscitation: EN-BIRTH multi-country validation study |
title_sort | neonatal resuscitation: en-birth multi-country validation study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995695/ https://www.ncbi.nlm.nih.gov/pubmed/33765958 http://dx.doi.org/10.1186/s12884-020-03422-9 |
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