Increased perinatal survival and improved ventilation skills over a five-year period: An observational study

Ketil Størdal; Joar Eilevstjønn; Estomih Mduma; Kari Holte; Monica Thallinger; Jørgen Linde; Paschal Mdoe; Hussein Kidanto; Hege Langli Ersdal

doi:10.1371/journal.pone.0240520

Increased perinatal survival and improved ventilation skills over a five-year period: An observational study

PLoS One. 2020 Oct 12;15(10):e0240520. doi: 10.1371/journal.pone.0240520. eCollection 2020.

Authors

Ketil Størdal^{1

2}, Joar Eilevstjønn³, Estomih Mduma⁴, Kari Holte¹, Monica Thallinger⁵, Jørgen Linde⁶, Paschal Mdoe⁴, Hussein Kidanto⁷, Hege Langli Ersdal^{6

8}

Affiliations

¹ Ostfold Hospital Trust, Grålum, Norway.
² Norwegian Institute of Public Health, Oslo, Norway.
³ Laerdal Medical AS, Stavanger, Norway.
⁴ Haydom Lutheran Hospital, Manyara, Tanzania.
⁵ Vestre Viken HF, Gjettum, Norway.
⁶ Helse Stavanger HF, Stavanger, Norway.
⁷ Muhimbili National Hospital, Dar Es Salam, Tanzania.
⁸ SAFER, Stavanger, Norway.

Abstract

Background and aim: The Helping Babies Breathe program gave major reductions in perinatal mortality in Tanzania from 2009 to 2012. We aimed to study whether this effect was sustained, and whether resuscitation skills changed with continued frequent training.

Methods: We analysed prospective data covering all births (n = 19,571) at Haydom Lutheran Hospital in Tanzania from July 2013 -June 2018. Resuscitation training was continued during this period. All deliveries were monitored by an observer recording the timing of events and resuscitation interventions. Heart rate was recorded by dry-electrode ECG and bag-mask-ventilation by sensors attached to the resuscitator device. We analyzed changes over time in outcomes, use of resuscitation interventions and performance of resuscitation using binary regression models with the log-link function to obtain adjusted relative risks.

Results: With introduction of user fees for deliveries since 2014, the number of deliveries decreased by 30% from start to the end of the five-year period. An increase in low heart rate at birth and need for bag-mask-ventilation indicate a gradual selection of more vulnerable newborns delivered in the hospital over time. Despite this selection, newborn deaths <24 hours did not change significantly and was maintained at an average of 8.8/1000 live births. The annual reductions in relative risk for perinatal death adjusted for vulnerability factors was 0.84 (95%CI 0.76-0.94). During the five-year period, longer duration of bag-mask ventilation sequences without interruption was observed. Delivered tidal volumes were increased and mask leak was decreased during ventilation. The time to initiation or total duration of ventilation did not change significantly.

Conclusion: The reduction in 24-hour newborn mortality after introduction of Helping Babies Breathe was maintained, and a further decrease over the five-year period was evident when analyses were adjusted for vulnerability of the newborns. Perinatal survival and performance of ventilation were significantly improved.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Female
Health Plan Implementation*
Humans
Infant, Newborn
Male
Perinatal Care*
Perinatal Death / prevention & control*
Perinatal Mortality / trends*
Prospective Studies
Respiration, Artificial / methods
Respiration, Artificial / mortality*
Resuscitation / mortality*

Grants and funding

This work was supported by the Research Council of Norway and Laerdal Foundation for Acute Medicine to MT and JL. Laerdal Medicals provided support in the form of salary for Joar Eilevstjønn. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.