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Neonatal resuscitation practices in Uganda: a video observational study
Daniel Helldén1, Susanna Myrnerts Höök1,2,3, Nicolas J Pejovic1,2,3
1Global Public Health, Karolinska Institute, Stockholm, Sweden.
BMJ Paediatrics Open
|October 1, 2021
Summary
Neonatal resuscitation in sub-Saharan Africa shows low adherence to guidelines, with minimal positive pressure ventilation (PPV) time and frequent interruptions. This highlights the need for improved training and resources to enhance infant survival rates.
Area of Science:
- Neonatal care
- Pediatric emergency medicine
- Global health
Background:
- Neonatal mortality remains high in sub-Saharan Africa, frequently linked to birth asphyxia.
- Established guidelines for neonatal resuscitation, emphasizing positive pressure ventilation (PPV), are implemented in low-resource settings.
- Actual clinical resuscitation practices in these settings are seldom examined.
Purpose of the Study:
- To prospectively observe and detail the time spent on ventilation during the initial minute of resuscitation for neonates requiring PPV.
- To assess adherence to resuscitation guidelines in a low-resource hospital setting.
Main Methods:
- Video recording of neonatal resuscitations using motion sensor cameras.
- Analysis of resuscitation practices using the NeoTapAS application.
- Comparison of practices between labor ward and theatre settings using statistical tests.
Main Results:
- Analysis included 99 out of 141 recorded resuscitations.
- Mean time to initiate PPV was 66 seconds, with minimal PPV delivered in the first minute (0-12 seconds).
- Interruptions during the first minute of PPV averaged 28 seconds, primarily due to stimulation, unknown reasons, and suction.
Conclusions:
- Observed resuscitation practices demonstrated low adherence to standard guidelines in 2015-2016.
- Continuous education, staff investment, and resource allocation are crucial for improving neonatal resuscitation quality in low-resource environments.
- Enhanced quality of care is essential to reduce neonatal mortality.
