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.
More and more research is coming out of the datas collected at Haydom and Muhibili. There is a much interest in the study and the results, so 2015 has been a busy year for the researchers.This week at one of the largest medical conferences in the world the World Congress of Gynaecology and Obstetrics FIGO 2015 in Vancouver Canada, two of the Safer Births PhD Fellows are giving oral presentations on their recent findings.
The room was completely full yesterday 6th october when Dr. Paschal Mdoe presented the preliminary results from the Randomized controlled study comparing hand held doppler and Pinard Fetoscope for fetal heart rate monitoring in Tanzania.
It was fascinating to hear that the results from the rural hospital Haydom Lutheran Hospital and the Urban hospital Muhimbili National Hopital were different and it will be interesting to learn more about why in the final analysis and futur studies.
On Thursday morning 8th October Dr. Jørgen Linde will do a presentation called Heart Rate detection in “Fresh stillbirths” and Early Neonatal Deaths during Resuscitation – What is the true stillbirth rate?
This study is based on the data collected with the newborn resucitation monitor using dry electrodes on the abdomen of the newborn to detect the heart rate immediately after birth.
But this is not the first conference this year where the Safer Births Researchers have been active.
In March at the 9th Annual Global Health and Vaccination Research Conference (GLOBVAC) in Oslo the Safer Births group had five poster and one oral presentation. Then at the high-light of the year, The Pediatric Academic Society (PAS) in San Diego, there were also five poster presentations from the group
- Randomized controlled study comparing handheld Doppler and Pinard Fetoscope for fetal heart rate monitoring in Tanzania. Mdoe P, Mduma E, Ersdal H, Moshiro R, Perlman J, Kidanto H. Presented PAS 2015
- CUSUM statistical process control method can be used to continuously monitor the impact of health interventions and management on neonatal mortality rate. Mduma E, Ersdal H, Kvaløy J, Søreide E, Mdoe P, Perlman J, Kidanto H, Svensen E. Accepted PAS 2015 and Globvac 2015.
- Novel resuscitation bag and mask provide PEEP in a newborn manikin. Thallinger M, Ersdal H, Purington C, Gomo Ø, Eilevstjønn J, Morley C, Størdal K. Presented PAS 2015 and Globvac 2015.
- Novel newborn resuscitator gives significantly less mask leakage on a manikin model. Thallinger M, Ersdal H, Størdal K. Presented PAS 2015 and Globvac 2015.
- Neonatal heart rate in the first minutes of life measured with novel dry electrodes heart rate measurement technology. Linde JE, Eilevstjønn J, Francis F, Perlman J, Ersdal HL. Presented PAS and Globvac 2015.
- Quality of Partogram recordings and perinatal outcomes at Muhimbili National Hospital Tanzania. Mdoe P, Masawe S, Kidanto H, Mduma E, Ersdal H. Presented Globvac 2015
Not to mention that during the Norwegian Researchers Grand Prix, Huyen Vu and Dr. Monica Thallinger were participating and Dr. Thalling got all the way to the finals presenting her randomized study on the Upright Bag and Mask vs. Simplified Resuscitator.
How can newborn ventilation be improved? The Safer Births partnership, a collaboration of midwives, doctors, researchers and developers from Tanzania and Norway, believes the key to improvement is with frequent training. From March 18 to 20, 2015, key stakeholders gathered in Stavanger to discuss training concepts, real life experiences, equipment opportunities, and recent research, all related to newborn ventilation. Through workshops and case studies, it was concluded that the 4 key areas of improvement during newborn resuscitation are: prioritizing tasks, team work and collaboration, decision making, and skill training. Moving forwards, the group in Norway will follow up with providing sustainable training solutions that the group returning to Tanzania can effectively implement.
On Wednesday, 5 midwives and 1 researched produced a ventilation training instruction video which was filmed in the Laerdal film studio. The purpose was not to make a final instruction video for educational use, but to see if this would be embraced as a useful teaching tool. The video was presented on Thursday to all meeting participants, and general opinion was that this could be a very good tool in a ventilation training setting, especially because the content and quality of instructions would be standardized for all students, and independent of different instructor’s different skills.
Many different equipment and training combinations were evaluated by the midwives and doctors. Overall, they prioritized having training equipment that was adjustable for different levels of difficulty and that gave feedback to the user based on performance. It was also important that it could be used in a realistic scenario, including movement of the manikin from bedside at birth to the resuscitation table.