Dol Justine, Campbell-Yeo Marsha, Murphy Gail Tomblin, Aston Megan, McMillan Douglas, Richardson Brianna
Department of Health, Faculty of Health, Dalhousie University, Halifax, Canada.
Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada.
JBI Database System Rev Implement Rep. 2018 Mar;16(3):701-737. doi: 10.11124/JBISRIR-2017-003535.
The objective of this review was to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills.
The Helping Babies Survive program consists of three modules: Helping Babies Breathe, Essential Care for Every Baby, and Essential Care for Small Babies. It was developed to reduce preventable newborn deaths through skill-based learning using simulation, learning exercises, and peer-to-peer training of healthcare providers in low-resource areas. Despite the widespread increase in healthcare provider training through Helping Babies Survive and the growing number of studies that have been conducted, there has been no systematic review of the Helping Babies Survive program to date.
The review included studies on healthcare providers and/or birth attendants providing essential neonatal care during and post birth. Types of interventions were any Helping Babies Survive module (Helping Babies Breathe, Essential Care for Every Baby, Essential Care for Small Babies). Studies including experimental study designs with the following outcomes were considered: neonatal outcomes and/or healthcare provider knowledge and skills obtained, maintained, and used over time.
PubMed, Embase, Web of Science, ProQuest Databases, Scopus and CINAHL were searched for published studies in English between January 2010 to December 2016. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Conflicts were solved through consensus with a third reviewer. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. Conflicts were solved through consensus with a third reviewer. Quantitative data was, where possible, pooled in statistical meta-analysis using RevMan (Copenhagen: The Nordic Cochrane Centre, Cochrane). Where statistical pooling was not possible the findings have been reported narratively.
A total of 17 studies were identified - 15 on Helping Babies Breathe (n = 172,685 infants and n = 2,261 healthcare providers) and two on Essential Care for Every Baby (n = 206 healthcare providers). No studies reported on Essential Care for Small Babies. Helping Babies Survive was found to significantly reduce fresh stillbirth rates and first day mortality rates, but was not found to influence stillbirth rates or mortality rates, measured at seven or 28 days post birth. Short-term improvements were significant in knowledge and skills scores but not significant in sustainability over time. Additionally, implementation of resuscitations skills in clinical practice related to the Helping Babies Breathe module including drying/stimulation, suction, and bag and mask ventilation did not show a significant increase after training even though the number of fresh stillbirth and first-day mortality rate decreased.
Helping Babies Survive has a significant positive impact on early neonatal outcomes, including fresh stillbirth and first-day mortality primarily through Helping Babies Breathe, but limited conclusions can be drawn about its impact on other neonatal outcomes. While Helping Babies Survive was found to improve immediate knowledge and skill acquisition, there is some evidence that one-time training may not be sufficient for sustained knowledge or the incorporation of key skills related to resuscitation into clinical practice. Continued research on the sustained knowledge and skills is needed to evaluate the long-term impact of the Helping Babies Survive program.
本综述的目的是评估“帮助婴儿存活”项目对新生儿结局以及医疗服务提供者知识和技能的影响。
“帮助婴儿存活”项目由三个模块组成：“帮助婴儿呼吸”“每个婴儿的基本护理”以及“小婴儿的基本护理”。该项目旨在通过在资源匮乏地区对医疗服务提供者进行基于技能的学习，利用模拟、学习练习和 peer-to-peer 培训，减少可预防的新生儿死亡。尽管通过“帮助婴儿存活”项目进行的医疗服务提供者培训广泛增加，且开展的研究数量不断增多，但迄今为止，尚未对“帮助婴儿存活”项目进行系统综述。
本综述纳入了关于在分娩期间及产后提供基本新生儿护理的医疗服务提供者和/或助产人员的研究。干预类型为任何“帮助婴儿存活”模块（“帮助婴儿呼吸”“每个婴儿的基本护理”“小婴儿的基本护理”）。纳入的研究包括具有以下结局的实验性研究设计：随时间推移获得、维持和使用的新生儿结局和/或医疗服务提供者知识和技能。
检索了 PubMed、Embase、Web of Science、ProQuest 数据库、Scopus 和 CINAHL，以查找 2010 年 1 月至 2016 年 12 月期间发表的英文研究。由两名独立评审员使用乔安娜·布里格斯研究所（JBI）的标准化批判性评价工具进行批判性评价。通过与第三位评审员达成共识解决冲突。两名评审员使用 JBI 的标准化数据提取工具从纳入研究中独立提取定量数据。通过与第三位评审员达成共识解决冲突。在可能的情况下，使用 RevMan（哥本哈根：北欧 Cochrane 中心，Cochrane）对定量数据进行统计荟萃分析合并。若无法进行统计合并，则对研究结果进行叙述性报告。
共识别出 17 项研究——15 项关于“帮助婴儿呼吸”（涉及 172,685 名婴儿和 2,261 名医疗服务提供者），两项关于“每个婴儿的基本护理”（涉及 206 名医疗服务提供者）。未发现关于“小婴儿的基本护理”的研究。发现“帮助婴儿存活”项目可显著降低新鲜死产率和首日死亡率，但未发现其对出生后 7 天或 28 天测量的死产率或死亡率有影响。知识和技能得分在短期内有显著改善，但随着时间推移在可持续性方面不显著。此外，尽管新鲜死产和首日死亡率有所下降，但与“帮助婴儿呼吸”模块相关的临床实践中复苏技能（包括擦干/刺激、吸引以及面罩通气）的实施在培训后并未显示出显著增加。
“帮助婴儿存活”项目对早期新生儿结局，包括新鲜死产和首日死亡率有显著的积极影响，主要通过“帮助婴儿呼吸”模块实现，但关于其对其他新生儿结局的影响只能得出有限的结论。虽然发现“帮助婴儿存活”项目可改善即时知识和技能获取，但有证据表明一次性培训可能不足以维持知识或使与复苏相关的关键技能融入临床实践。需要对知识和技能的持续性进行持续研究，以评估“帮助婴儿存活”项目的长期影响。
