Pre-Training Cognitive and Psychomotor Gaps in Healthcare Worker Neonatal Resuscitation Skills for Helping Babies Breathe – A Report from the eHBB/mHBS Study

Abstract

Intrapartum asphyxia accounts for the deaths of around 280,000 babies per year. Helping Babies Breathe® (HBB) is an evidence-based global neonatal resuscitation training program. HBB utilizes an in-person dissemination model with standardized pre- and post-evaluations using the bag and mask ventilation (BMV) skills checklist and a post-evaluation using the objective structured clinical exam (OSCE) format. Due to logistical challenges, HBB courses do not have pre-class preparation requirements and little is known about the pre-training cognitive gaps in neonatal resuscitation skills in healthcare workers in low and middle income countries. Aim: To identify common gaps in healthcare worker skills in neonatal resuscitation before in-person HBB training at eHBB/mHBS sites in Nigeria and Kenya, utilizing standardized BMV and OSCE A checklists and Neonatalie advanced manikin BMV performance. Methods: From December 2018-March 2019, in-service healthcare workers in Nigeria and Kenya who are participating in the eHBB/mHBS-DHIS2 study received pre-class assessments by trained research staff using the standard HBB BMV skills and OSCE A checklists. Data was collected in real-time by trained research assistants using the mobile Helping Babies Survive (mHBS) app and securely stored in a DHIS2 database. BMV performance was also assessed using the Neonatalie Advanced manikin (Laerdal Medical) using a bluetooth connected ipad application to record data on ventilation duration, pressures, and rate. The ipad application provided standardized performance-based feedback to the participant on one critical error after each session. Results: 90 healthcare workers participated. Healthcare workers were nearly all female (84, 93%), in-service labor/delivery (53, 59%) or newborn ward (35, 39%) nurses or midwives. Manikin data was available from 76 (84%) of pre-training sessions. The mean session time was 132+/-7s. The mean % ventilation time (first vent to spontaneous breathing) was 70+/-20% with a mean ventilation rate of 70+/-11 breaths per minute. The number of ventilations with insufficient pressure was low at 6% (range 0-45). The most common performance-based feedback from the Neonatalie Advanced manikin was on tilting the head to open the airway (48%), ventilation pressure (24%), and continuous ventilation without pauses (11%). Common gaps in pre-training BMV skills and "OSCE A" simulation performance checklists are shown in Figures 1 and 2. Conclusions: Standardized assessments, mobile data collection, and manikin BMV data identified common pre-training gaps in healthcare worker neonatal resuscitation skills. The results of this study may increase educational efficiencies, provide guidance for HBB instructors, and support pre-course preparation to enable the dissemination of HBB training in low and middle income countries. Acknowledgements: The eHBB/mHBS project is supported by the Bill & Melinda Gates Foundation. Figure