Mayer Martha, Xhinti Nomvuyo, Dyavuza Vuyiswa, Bobotyana Luzuko, Perlman Jeffrey, Velaphi Sithembiso
Department of Paediatrics, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa.
Helping Babies Breathe Programme, Resuscitation Council of Southern Africa, Johannesburg, South Africa.
Front Pediatr. 2022 Apr 25;10:864431. doi: 10.3389/fped.2022.864431. eCollection 2022.
Training in neonatal resuscitation has been shown to reduce deaths related to intrapartum asphyxia. Helping Babies Breathe (HBB) is a simulation-based program focusing on training healthcare providers (HCPs) in immediate neonatal care including stimulation, initiating bag mask ventilation (BMV) in the absence of breathing by 1 min of life, and delayed (30-60 s after birth) umbilical cord clamping (DCC). Data on implementation of HBB posttraining are limited.
To determine time from birth to spontaneous breathing, cord clamping, and initiation of BMV in a setting where the majority of HCPs are HBB trained.
Two research nurses observed deliveries conducted in two referral hospitals. Timing included the onset of breathing, cord clamping, and initiation of BMV. Deliveries were grouped according to the mode of delivery.
In total, 496 neonates were observed; 410 (82.7%) neonates cried or had spontaneous breathing (median time 17 s) soon after birth, 25/86 (29%) of neonates not breathing responded to stimulation, 61 (12.3%) neonates required BMV, and 2 (0.4%) neonates required chest compression and/or adrenalin. Neonates delivered by cesarean section (CS) took longer to initiate first breath than those delivered vaginally (median time 19 vs. 14 s; = 0.009). Complete data were available in 58/61 (95%) neonates receiving BMV, which was initiated in 54/58 (93%) cases within 60 s of life (the "Golden Minute"). Median time to cord clamping was 74 s, with 414 (83.5%) and 313 (63.0%) having cord clamped at ≥ 30 and ≥ 60 s, respectively. Factors associated with BMV were CS delivery [odds ratio (OR) 29.9; 95% CI 3.37-229], low birth weight (LBW) (birthweight < 2,500 g) (OR 2.47; 95% CI 1.93-5.91), and 1 min Apgar score < 7 (OR 149; 95% CI 49.3-5,021). DCC (≥ 60 s) was less likely following CS delivery (OR 0.14; 95% CI 0.02-0.99) and being LBW (OR 0.43; 95% CI 0.24-0.77).
Approximately 83% of neonates initiated spontaneous breathing soon after birth and 29% of neonates not breathing responded to physical stimulation. BMV was initiated within the Golden Minute in most neonates, but under two-thirds had DCC (≥60 s). HBB implementation followed guidelines, suggesting that knowledge and skills taught from HBB are retained and applied by HCP.
新生儿复苏培训已被证明可减少与产时窒息相关的死亡。“帮助宝宝呼吸”（HBB）是一个基于模拟的项目，专注于培训医疗保健提供者（HCP）进行即时新生儿护理，包括刺激、在出生后1分钟内无呼吸时启动面罩气囊通气（BMV）以及延迟（出生后30 - 60秒）脐带结扎（DCC）。关于HBB培训后实施情况的数据有限。
确定在大多数HCP接受HBB培训的环境中，从出生到自主呼吸、脐带结扎和启动BMV的时间。
两名研究护士观察了两家转诊医院的分娩情况。记录时间包括呼吸开始、脐带结扎和BMV启动时间。分娩根据分娩方式分组。
总共观察了496例新生儿；410例（82.7%）新生儿出生后很快啼哭或自主呼吸（中位时间17秒），86例无呼吸的新生儿中有25例（29%）对刺激有反应，61例（12.3%）新生儿需要BMV，2例（0.4%）新生儿需要胸外按压和/或肾上腺素。剖宫产（CS）分娩的新生儿开始第一次呼吸的时间比阴道分娩的新生儿长（中位时间19秒对14秒；P = 0.009）。在接受BMV的61例新生儿中有58例（95%）获得了完整数据，其中54例（93%）在出生后60秒内（“黄金一分钟”）启动了BMV。脐带结扎的中位时间为74秒，分别有414例（83.5%）和313例（63.0%）在出生后≥30秒和≥60秒进行了脐带结扎。与BMV相关的因素有CS分娩[比值比（OR）29.9；95%置信区间3.37 - 229]、低出生体重（LBW）（出生体重<2500克）（OR 2.47；95%置信区间1.93 - 5.91）以及1分钟阿氏评分<7（OR 149；95%置信区间49.3 - 5021）。CS分娩（OR 0.14；95%置信区间0.02 - 0.99）和LBW（OR 0.43；95%置信区间0.24 - 0.77）后进行DCC（≥60秒）的可能性较小。
约83%的新生儿出生后很快开始自主呼吸，29%无呼吸的新生儿对物理刺激有反应。大多数新生儿在黄金一分钟内启动了BMV，但不到三分之二的新生儿进行了DCC（≥60秒）。HBB的实施遵循了指南，表明HCP保留并应用了HBB教授的知识和技能。
