Abstract:
Background: About three – quarters of all neonatal deaths occur during the first week of life, with over half of
these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal
mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to
birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy
referral hospital.
Methods: Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a
predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were
computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR
processes for the observed newborns. Logistic regression models assessed the relationship between the survival
status at 1 h versus the NR processes and newborn characteristics.
Results: Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations.
Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation.
However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask
ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance.
About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76),
keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96)
and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h.
Conclusions: Mentorship and regular cost – effective NR trainings with focus on maintaining the warm chain
during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs
providing NR.