Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

Area of Science:

• Neonatal Resuscitation
• Quality Improvement in Healthcare
• Perinatal Mortality Reduction

Background:

• Intrapartum-related complications pose the highest risk to newborns.
• Improving adherence to the Helping Babies Breathe (HBB) protocol is crucial for reducing perinatal mortality.
• A tertiary hospital in Nepal was the setting for this quality improvement initiative.

Purpose of the Study:

• To enhance adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol.
• To decrease perinatal mortality rates through a quality improvement cycle (QIC).
• To evaluate the effectiveness of the HBB QIC in a tertiary hospital in Nepal.

Main Methods:

• Implementation of the HBB QIC using a multifaceted approach.
• Formation of quality improvement teams and setting clear goals and standards.
• Training, regular meetings, skill checks, self-evaluation, and refresher training for staff.
• Cohort design with a nested case-control study using video recordings for outcome and adherence measurement before and after intervention.

Main Results:

• Intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries.
• First-day neonatal mortality decreased from 5.2 to 1.9 per thousand live births.
• Significant reductions observed in intrapartum stillbirth (aOR 0.46) and first-day mortality (aOR 0.51).
• Inappropriate use of suction and stimulation decreased by 87% and 62%, respectively.
• Bag-and-mask ventilation within 1 minute increased from 0% to 83.9%.

Conclusions:

• The Helping Babies Breathe Quality Improvement Cycle (HBB QIC) effectively reduced intrapartum stillbirth and first-day neonatal mortality.
• The HBB QIC led to more frequent and appropriate use of suctioning and stimulation.
• Further testing of the HBB QIC is recommended in primary healthcare settings across Nepal.