Patterson Jackie, Berkelhamer Sara, Ishoso Daniel, Iyer Pooja, Lowman Casey, Bauserman Melissa, Eilevstjønn Joar, Haug Ingunn, Lokangaka Adrien, Kamath-Rayne Beena, Mafuta Eric, Myklebust Helge, Nolen Tracy, Patterson Janna, Singhal Nalini, Tshefu Antoinette, Bose Carl
Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA.
Department of Pediatrics, University of Washington, Seattle, WA 98105, USA.
Resuscitation. 2022 Feb;171:57-63. doi: 10.1016/j.resuscitation.2021.12.020. Epub 2021 Dec 26.
To evaluate the effect of resuscitation training and continuous electronic heart rate (HR) monitoring of non-breathing newborns on identification of stillbirth.
We conducted a pre-post interventional trial in three health facilities in the Democratic Republic of the Congo. We collected data on a retrospective control group of newborns that reflected usual resuscitation practice (Epoch 1). In the prospective, interventional group, skilled birth attendants received resuscitation training in Helping Babies Breathe and implemented continuous electronic HR monitoring of non-breathing newborns (Epoch 2). Our primary outcome was the incidence of stillbirth with secondary outcomes of fresh or macerated stillbirth, neonatal death before discharge and perinatal death. Among a subset, we conducted expert review of electronic HR data to estimate misclassification of stillbirth in Epoch 2. We used a generalized estimating equation, adjusted for variation within-facility, to compare risks between EPOCHs.
There was no change in total stillbirths following resuscitation training and continuous electronic HR monitoring of non-breathing newborns (aRR 1.15 [0.95, 1.39]). We observed an increased rate of macerated stillbirth (aRR 1.58 [1.24, 2.02]), death before discharge (aRR 3.31 [2.41, 4.54]), and perinatal death (aRR 1.61 [1.38, 1.89]) during the intervention period. In expert review, 20% of newborns with electronic HR data that were classified by SBAs as stillborn were liveborn.
Resuscitation training and use of continuous electronic HR monitoring did not reduce stillbirths nor eliminate misclassification.
评估对无呼吸新生儿进行复苏培训及持续电子心率（HR）监测对死产识别的影响。
我们在刚果民主共和国的三个卫生机构开展了一项前后对照干预试验。我们收集了反映常规复苏做法的新生儿回顾性对照组数据（第1阶段）。在前瞻性干预组中，熟练的助产人员接受了“帮助婴儿呼吸”培训，并对无呼吸新生儿实施持续电子HR监测（第2阶段）。我们的主要结局是死产发生率，次要结局包括新鲜或浸软死产、出院前新生儿死亡及围产期死亡。在一个子集里，我们对电子HR数据进行专家审查，以估计第2阶段死产的误分类情况。我们使用广义估计方程，并对机构内部的变异进行校正，以比较各阶段之间的风险。
对无呼吸新生儿进行复苏培训及持续电子HR监测后，总死产数没有变化（调整后风险比[aRR]为1.15[0.95，1.39]）。我们观察到干预期间浸软死产率（aRR为1.58[1.24，2.02]）、出院前死亡率（aRR为3.31[2.41，4.54]）和围产期死亡率（aRR为1.61[1.38，1.89]）有所增加。在专家审查中，被助产人员根据电子HR数据分类为死产的新生儿中有20%是活产。
复苏培训及持续电子HR监测的使用既未降低死产率，也未消除误分类。
