Neonatal resuscitation: EN-BIRTH multi-country validation study

Abstract 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 r...

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Main Authors: Ashish KC, Kimberly Peven, Shafiqul Ameen, Georgina Msemo, Omkar Basnet, Harriet Ruysen, Sojib Bin Zaman, Martha Mkony, Avinash K. Sunny, Qazi Sadeq-ur Rahman, Josephine Shabani, Ram Chandra Bastola, Evelyne Assenga, Naresh P. KC, Shams El Arifeen, Edward Kija, Honey Malla, Stefanie Kong, Nalini Singhal, Susan Niermeyer, Ornella Lincetto, Louise T. Day, Joy E. Lawn, and EN-BIRTH Study Group
Format: Article
Language:English
Published: BMC 2021-03-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:https://doi.org/10.1186/s12884-020-03422-9
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author Ashish KC
Kimberly Peven
Shafiqul Ameen
Georgina Msemo
Omkar Basnet
Harriet Ruysen
Sojib Bin Zaman
Martha Mkony
Avinash K. Sunny
Qazi Sadeq-ur Rahman
Josephine Shabani
Ram Chandra Bastola
Evelyne Assenga
Naresh P. KC
Shams El Arifeen
Edward Kija
Honey Malla
Stefanie Kong
Nalini Singhal
Susan Niermeyer
Ornella Lincetto
Louise T. Day
Joy E. Lawn
and EN-BIRTH Study Group
author_facet Ashish KC
Kimberly Peven
Shafiqul Ameen
Georgina Msemo
Omkar Basnet
Harriet Ruysen
Sojib Bin Zaman
Martha Mkony
Avinash K. Sunny
Qazi Sadeq-ur Rahman
Josephine Shabani
Ram Chandra Bastola
Evelyne Assenga
Naresh P. KC
Shams El Arifeen
Edward Kija
Honey Malla
Stefanie Kong
Nalini Singhal
Susan Niermeyer
Ornella Lincetto
Louise T. Day
Joy E. Lawn
and EN-BIRTH Study Group
author_sort Ashish KC
collection DOAJ
description Abstract 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.
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spelling doaj.art-761a9b9bf21542908e327f1eb2615c602022-12-21T21:26:04ZengBMCBMC Pregnancy and Childbirth1471-23932021-03-0121S111910.1186/s12884-020-03422-9Neonatal resuscitation: EN-BIRTH multi-country validation studyAshish KC0Kimberly Peven1Shafiqul Ameen2Georgina Msemo3Omkar Basnet4Harriet Ruysen5Sojib Bin Zaman6Martha Mkony7Avinash K. Sunny8Qazi Sadeq-ur Rahman9Josephine Shabani10Ram Chandra Bastola11Evelyne Assenga12Naresh P. KC13Shams El Arifeen14Edward Kija15Honey Malla16Stefanie Kong17Nalini Singhal18Susan Niermeyer19Ornella Lincetto20Louise T. Day21Joy E. Lawn22and EN-BIRTH Study GroupInternational Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala UniversityMaternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical MedicineMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Department of Health Systems, Impact Evaluation and Policy, Ifakara Health InstituteResearch Division, Golden CommunityMaternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical MedicineMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Department of Health Systems, Impact Evaluation and Policy, Ifakara Health InstituteResearch Division, Golden CommunityMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Department of Health Systems, Impact Evaluation and Policy, Ifakara Health InstitutePokhara Academy of Health SciencesMuhimbili University of Health and Allied Sciences (MUHAS)Society of Public Health Physicians NepalMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Department of Health Systems, Impact Evaluation and Policy, Ifakara Health InstituteResearch Division, Golden CommunityMaternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical MedicineDepartment of Paediatrics, University of CalgaryUniversity of Colorado School of Medicine, Colorado School of Public HealthDepartment of Maternal, Newborn, Child and Adolescent Health and Ageing, WHOMaternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical MedicineMaternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical MedicineAbstract 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.https://doi.org/10.1186/s12884-020-03422-9BirthNeonatal resuscitationCoverageQualityMeasurementValidity
spellingShingle Ashish KC
Kimberly Peven
Shafiqul Ameen
Georgina Msemo
Omkar Basnet
Harriet Ruysen
Sojib Bin Zaman
Martha Mkony
Avinash K. Sunny
Qazi Sadeq-ur Rahman
Josephine Shabani
Ram Chandra Bastola
Evelyne Assenga
Naresh P. KC
Shams El Arifeen
Edward Kija
Honey Malla
Stefanie Kong
Nalini Singhal
Susan Niermeyer
Ornella Lincetto
Louise T. Day
Joy E. Lawn
and EN-BIRTH Study Group
Neonatal resuscitation: EN-BIRTH multi-country validation study
BMC Pregnancy and Childbirth
Birth
Neonatal resuscitation
Coverage
Quality
Measurement
Validity
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 Birth
Neonatal resuscitation
Coverage
Quality
Measurement
Validity
url https://doi.org/10.1186/s12884-020-03422-9
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