622 - Making Every Newborn Resuscitation A Learning Event: Establishing a Newborn Resuscitation Registry in the Democratic Republic of the Congo
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 622 Publication Number: 622.315
Amy Mackay, University of North Carolina at Chapel Hill School of Medicine, Durham, NC, United States; Daniel Ishoso, Kinshasa School of Public Health, Kinshasa, Kinshasa, Congo, (Congo – Kinshasa); Eric Musalu. Mafuta, Ecole de Santé Publique de Kinshasa, Kinshasa, Kinshasa, Congo, (Congo – Kinshasa); Melissa Bauserman, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Carl Bose, University of North Carolina at Chapel Hill School of Medicine, Pittsboro, NC, United States; Sara Brunner, Laerdal Medical AS, Stavanger, Rogaland, Norway; Joar Eilevstjønn, Laerdal Medical, Sandnes, Rogaland, Norway; Helge Myklebust, Laerdal Medical, STAVANGER, Rogaland, Norway; Jackie Patterson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
Neonatal-Perinatal Fellow The University of North Carolina at Chapel Hill Durham, North Carolina, United States
Background: Each year, one million newborns die in the first 24hours after birth. Most of these deaths occur in low- and middle-income countries (LMICs). Neonatal deaths in the first 24 hours are predominately caused by intrapartum events,resulting in failure to breathe at birth.One third of these intrapartum-related deaths could be averted withbasic resuscitation. To improve basic resuscitation, a detailed record of provider actions during resuscitation is essential. However, obtaining these data is challenging in most LMICs because medical records do not typically provide sufficient granularity. Objective: To establish a detailed newborn resuscitation registry in the Democratic Republic of the Congo (DRC). Design/Methods: We established a resuscitation registry at two health facilities in Kinshasa, DRC. Study nurses abstractclinical dataof all in-born neonates from the delivery register using KoboToolbox, with a focus on known risk factors for failure to breathe at birth including lowbirth weight and prematurity,and vital status at discharge.In a convenient sample of ≥50% of deliveries, a cadre of trained observers (study nurses, midwives, and environmental health services staff)documentprovider actionsand the newborn’s respiratory status during resuscitation using a mobile health application, LIVEBORN (Figure 1). In thesubset of observed non-vigorous newborns (defined as not breathing by 30 seconds after birth), we stream continuous heart rate data to LIVEBORNusing a heart rate meter, NeoBeat (Figure 1).LIVEBORN data (linked withNeoBeat data when applicable)are stored in a cloud-based server and analyzed with Matlab. Results: From 9/1/22 to 12/1/22, we enrolled1421newborns. Weabstracted medical recorddata on100%; clinical data were reliably recorded in the medical record, except for meconium-stained fluid (94.9% unknown) and gestational age (2.2% unknown; Table 1); vital status at discharge was missing for 0.8% (Table 2).We observed836 newborns with LIVEBORN(58.8%). Among the 109 observed non-vigorous newborns, we integratedNeoBeatheart rate data on 17.
Conclusion(s): Establishing a newborn resuscitation registry using medical record abstraction, a mobile health application,and an electronicheart rate meter is feasible in a low-resource setting.Integration of heart rate data could be improved with more consistent use of NeoBeat by providers. In January 2023, we will add videorecording of resuscitation care to our registry using the LIVEBORN station (Figure 1). This resuscitation registry isan essential first step to evaluatestrategies for improvingresuscitation care.
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