534 - Clinical Pilot of a Mobile Health Application to Improve Newborn Resuscitation through Real-Time Guidance and Debriefing in the Democratic Republic of Congo

Poster Number: 534
Publication Number: 534.409

Kourtney Bettinger, University of Kansas School of Medicine, Prairie Village, KS, 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); Helge Myklebust, Laerdal Medical, STAVANGER, Rogaland, Norway; Carl Bose, University of North Carolina at Chapel Hill School of Medicine, Pittsboro, NC, United States; Benjamin H.. Chi, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Patricia Gomez, Johns Hopkins University, LACEY, WA, United States; Ingunn Anda. Haug, Laerdal Medical, Sandnes, Rogaland, Norway; Jackie Patterson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: One third of neonatal deaths are caused by intrapartum-related events, resulting in failure to breathe at birth. Training in basic resuscitation reduces these deaths, but gaps in quality persist due to the challenge of translating knowledge into practice during emergency care. Bedside learning strategies such as real-time guidance and debriefing can enhance knowledge translation; however, they can be difficult to implement in low-resource settings. We developed a mobile health application for newborn resuscitation called LIVEBORN that provides real-time guidance and supports debriefing.

Objective: To develop and evaluate the feasibility of a strategy to incorporate LIVEBORN into clinical practice in a low resource setting

Design/Methods: Beginning in January 2022, we partnered with two health facilities in the Democratic Republic of the Congo to develop an integrated 6-element strategy for LIVEBORN using a participatory research methodology called trials of improved practices (TIPS; Figure 1). One facility implemented real-time guidance and the other debriefing (with a focus on debriefing bag-mask ventilation [BMV] cases). We completed iterative cycles of strategy development, small-scale testing, and rapid analysis until a feasible strategy was developed; then midwives implemented the final strategy in a feasibility study. We evaluated usability and feasibility through validated surveys and LIVEBORN use according to a priori thresholds.

Results:

We identified a feasible strategy for elements 3-6 (Figure 1) during the first round of TIPS. Subsequent rounds focused on adaptations to selected observers (element 1) and observed births (element 2), with the goal of maximizing the number of LIVEBORN observations (Table 1). LIVEBORN met the usability threshold overall but scored below the threshold in the debriefing facility (Table 2). LIVEBORN observation and real-time guidance met the feasibility threshold. Use of LIVEBORN debriefing for BMV cases was below the threshold; 6 cases without BMV were also debriefed, with a time to first breath ranging from 49-163 seconds after birth.

Conclusion(s): We developed feasible, context-specific strategies to observe births using LIVEBORN. Although more than half of BMV cases were not debriefed, midwives debriefed on additional cases of newborns who failed to breathe at birth that did not receive BMV. Given the underuse of BMV in non-breathing newborns, cases for debriefing may be better selected based on time to breathing rather than receipt of BMV. Beginning Spring 2023, we will evaluate the effectiveness of LIVEBORN in a hybrid, randomized trial.