Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden.
Golden Community, Lalitpur, Nepal.
BMC Health Serv Res. 2021 Apr 19;21(1):362. doi: 10.1186/s12913-021-06366-8.
High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal.
A prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions.
Out of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13-0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03-1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04-1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline.
QI intervention package improved health workers' performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.
在出生后立即对不哭的婴儿进行高质量的复苏可以降低分娩相关的死亡和发病。“帮助婴儿呼吸”项目旨在提高资源有限环境下新生儿复苏护理的表现。质量改进（QI）干预措施可以维持模拟新生儿复苏知识和技能以及临床表现。本研究旨在评估扩大 QI 干预包对尼泊尔公立医院中卫生工作者对不哭婴儿基本新生儿复苏护理表现的影响。
在尼泊尔的四家公立医院应用了前瞻性观察队列设计。在引入 QI 干预措施之前和之后，分析卫生工作者对基本新生儿护理的表现。
在研究期间观察到的总共 32524 例分娩中，有 3031 例新生儿出生时不哭。与对照组相比，干预组接受额外刺激的非哭泣婴儿比例较低（aOR 0.18；95%CI 0.13-0.26）。在引入 QI 干预措施后，非哭泣婴儿气道通畅的比例增加（aOR 1.23；95%CI 1.03-1.46）。与对照组相比，在干预期间开始使用 BMV 的非哭泣婴儿比例更高（aOR 1.28，95%CI 1.04-1.57）。与基线相比，干预期间开始通气的累积中位数时间减少了 39.46 秒。
QI 干预包改善了卫生工作者开始使用 BMV 和清理气道的表现。实施该方案后，首次通气的平均时间减少。QI 包可以在尼泊尔的其他公立医院和其他类似环境中扩大规模。
