Safer Births Project has been chosen by SkatteFUNN, a Norwegian grant for tax reductions to companies working in research and development.
In realtion to this grant, the Norwegian Prime Minister Erna Solberg visted some of the Safer Births researchers to learn more about the innovations the project has released.
Se the video of the visit here – in Norwegian:
Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers.
Objective: This study aimed at exploring barriers and facilitators to effective bag mask
ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania.
Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis.
Results: Midwives reported the ability to monitor labour properly, preparing resuscitation
equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby’s condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed.
Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training.
Read more here.
Objective: To characterize, among non-breathing flaccid neonates at delivery, immediate heartrate and responses to ventilation in relation to the clinical diagnosis of fresh stillbirth (FSB) or early neonatal death (END) within 24 hours.
Methods: The present cross-sectional study included all deliveries at Haydom Hospital in rural Tanzania between July 1, 2013, and July 31, 2016. Ventilation parameters and heartrate were recorded by monitors with ventilation and dry-electrocardiography
sensors. Perinatal characteristics were recorded on data forms by trained research assistants.
Results: Among 12 789 neonates delivered, 915 were ventilated; among ventilated neonates, there were 53 (6%) FSBs and 64 (7%) ENDs. Electrocardiography was used in 46 FSBs and 55 ENDs, and these neonates were included in a subanalysis. Initial heartrate was detected in 27 (59%) of 46 FSBs and 52 (95%) of 55 ENDs, and was lower in FSBs (52 ± 19 vs 76 ± 37 bpm; P=0.003). More ENDs responded to ventilation (53% vs 9%; P<0.001), with heartrate increasing above 100 bpm. Heartrate at ventilation discontinuation was higher among ENDs (115 ± 49 vs 52 ± 33 bpm; P<0.001).
Conclusion: Progression to FSB or END after intrapartum hypoxia/anoxia is probably
part of the same circulatory end-process. Distinguishing FSB from severely asphyxiated
newborns is clinically difficult and probably influences estimated global perinatal
Read the full publication here.
Helping Babies Breathe (HBB) is a simulation-based educational program developed to help reduce perinatal mortality worldwide. A one-day HBB training course did not improve clinical management of neonates. The objective was to assess the impact of frequent brief (3–5 min weekly) onsite HBB simulation training on newborn resuscitation practices in the delivery room and the potential impact on 24-h neonatal mortality. The results showed that on-site, brief and frequent HBB simulation training appears to facilitate transfer of new
knowledge and skills into clinical practice and to be accompanied by a decrease in neonatal mortality. Read the full publication here.
Dr. Jørgen E. Linde, one of the Safer Births PhD fellows, presented his research project at the “Forsker Grand Prix,” the national championship competition for researchers in Norway.
Jørgen’s presentation “When life is a breath away” was nominated by the audience and the jury as the winner from the Stavanger Region, leading him to represent his work at the final competition in Bergen this fall. Linde’s presentation included his findings on how his study showed that giving higher volumes when ventilating than the guidelines recommend produces better outcomes. He also spoke about the importance of using heart rate as a form of feedback during ventilation and various techniques that can be used to optimize bag and mask ventilation. The judges gave Jørgen’s presentation the top score, and emphasized how important they felt his research was.
Haydom Hospital has recently begun a randomized control trial (RCT) comparing the Upright bag-mask with and without PEEP (positive end-expiratory pressure). PEEP is considered to benefit newborn and small infants by preventing repeated lung alveolar collapse, helping recruit lung volume more efficiently, clearing fluid from the lungs and reducing damage to the lung tissue during ventilation. The international Liaison Committee on Resuscitation (ILCOR) suggests using PEEP for preterm infants during delivery room resuscitation. However, ILCOR is unable to make any recommendation for term infants due to insufficient data. The RCT in Tanzania will be helpful in providing the data needed to support use of PEEP in order to improve newborn ventilation.
Dr. Monica Thallinger’s work using Upright with Newborn PEEP was recently published in the British Medical Journal. Positive end expiratory pressure (PEEP) is considered to be beneficial when ventilating preterm newborns. The aim of Thallinger’s study was to determine whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation. Her study showed that inexperienced participants were successfully able to generate PEEP with a novel silicone PEEP valve attached to an upright self-inflating bag, without an external gas source. Read the full publication here.
Twenty researchers from different parts of the world are now engaged in Safer Births. They represent disciplines like neonatology, obstetrics, nursing, mathematics, statistics, physics, human factor and engineering. Before Easter they gathered in Stavanger to present their projects and latest findings to the Safer Births group.
Dr. Monica Thallinger has recently published her research comparing Upright with a traditional bag-mask resuscitator.
The study compared ventilation properties and used preference between the new Upright Bag and Mask with a standard Laerdal Newborn Resuscitator.
Tanzanian nursing school students and Norwegian Medical students with no prior experience in Newborn resuscitation used the devices on a manikin with ventilation parameters monitored by the Laerdal Newborn Resuscitation Monitor.
The study showed that Upright had a lower mask leakage than the standard bag and that it was preferred by the study participants.
Not long after the CE-marking certificates were received, the first cartons of Moyos were sent off to Tanzania.
To make sure that the midwives were comfortable using the Moyo, selected midwives from Temeke, Muhimbili and Haydom were taken through a training of trainers course using the Moyo training package. Since then provider training have been conducted and Moyo have been introduced in the clinic.
During a recent visit to Haydom, some of the LGH engineers took these wonderful pictures from the Moyo being in use in the clinic. .
Photo: Midwife using the Moyo for a check up of a mother before admission.
Photo: Moyo being used in the second stage of labor.
Photo: The midwives are very happy with their new tool, allowing them to monitor fetal heart rate in a more effectively and insuring mobility of the mother when monitored.