621 - A 4.5-fold Increase in Newborns Ventilated Within the First Minute of Life following Continuous Quality Improvement in Tanzania

Intrapartum-related events leading to newborn deaths and fresh stillbirths (FSB) are major global concerns causing 1.5 million perinatal deaths annualy. Rapid initiation of skilled bag-mask ventilation within the “Golden Minute” (≤60 seconds from birth) is important for intact survival as adverse outcome increases by 16% for every 30-second delay. Early ventilation is reported to be challenging, especially in low/middle-income countries. Helping Babies Breathe (HBB) is a WHO endorsed simulation-based training program for newborn resuscitation. 

Objective: The objective of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes.

Design/Methods: Prospective observational study in a rural referral Tanzanian hospital, 01.10.2017-31.08.2021; 1^st year baseline, 2^nd year QI intervention, and two years post-intervention. Trained research assistants observed and recorded wide-ranging information from all births (n=12,938). The QI intervention included clinical debriefings, monthly feedback meetings, and clinical data guided HBB simulation training. Post-intervention, the QI effort was substantially scaled down, with less simulation trainings and no monthly QI meetings. 

Results:

During full QI intervention, 68.5% newborns were ventilated within the Golden Minute compared to 15.8% during baseline and 42.2% and 28.9% during the post-intervention years (p< 0.001) (Table 1). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds (p< 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds post-intervention (Figure 1). More non-breathing newborns were ventilated in the intervention period (12.9%) compared to baseline (8.5%) and the post-intervention years (10.6% and 9.4%) (p< 0.001) and FSB decreased from baseline to intervention (3.2% to 0.7%) (p=0.013) (Table 1).

Conclusion(s):

This study demonstrates a 4.5-fold increase in newborns being ventilated within the Golden Minute and a significant reduction in FSB after implementation of an HBB QI intervention. Earlier start of ventilation likely improved the outcome of the most severely asphyxiated newborns, assumed to be FSB. The improvements from baseline to the QI intervention period sustained two years after implementation. However, from intervention to post-intervention, there was a decline in newborns ventilated within the Golden Minute and increased median times from birth to ventilation. This highlights the need for continuous QI focus and research into QI efforts essential for sustainable changes.