PRACTICES AND OUTCOMES OF NEONATAL RESUSCITATION FOR NEWBORNS WITH BIRTH ASPHYXIA IN TERTIARY CARE HOSPITALS IN LAHORE, PAKISTAN

Abstract

Background:Neonatal resuscitation (NR) is a critical intervention to reduce neonatal morbidity and mortality associated with birth asphyxia. The effectiveness of NR practices by healthcare professionals (HCPs) significantly influences newborn outcomes. However, gaps in NR training and adherence to standardized resuscitation protocols may impact survival and long-term health. Evaluating NR practices and their association with neonatal outcomes can help identify areas for improvement and optimize neonatal care. Objective: To observe the NR practices of HCPs and their outcomes and to determine the associations between practices and outcomes. Study Design: Observational Cross-sectional study. Setting: The study was conducted in the neonatal resuscitation unit of a tertiary care hospital. Duration of Study: March 2024 to August 2024. Methods: One thousand six hundred and forty neonates were followed, and out of them, a total of 138 newborn resuscitations were observed by 46 HCPs using a predetermined adopted checklist. Newborns with birth asphyxia by the WHO criteria, as well as criteria defined by the American Academy of Pediatrics, were included in the study. The complete bio-data of health care professionals was documented with their way of resuscitation. The observer was present in the resuscitation area every time a delivery was being conducted. Data was analyzed using the SPSS software. The chi-square test was used to determine the association between NR practices and outcomes at one hour. Result: 45.7% of the HCPs were within the age group of 26-30 years, with 55.2% as females. The majority of them are doctors, followed by nurses. 50.7% HCPs prepared the area for resuscitation, and only 18.8% identified a helper. 95.7% dried the baby, and 76.8% removed the wet cloth. 96.4% HCPs cleared the baby's airway. Meconium was present in 42% of neonates. Only 27.9% HCPs started BMV within the Golden minute (60s), 75% used the correct mask size and 96.9% observed chest movement. According to the level of practices by HCPs, good scores were as follows: 74.6% in Drying/Stimulating, 89.7% for Support Ventilation, 39.9% in Open Airway, 27.9 % for BMV, and in ABMW, 44.8% of HCPs demonstrated good practices. 16.7% neonates recovered well, 47.1% needed oxygen therapy, 29% required intensive care, and 7.2% died after 01 hour. Suctioning before the baby breathes (p-value .001), placing the baby's head in a neutral position (p-value = .013), initiation of BMV (p-value <.05), and checking the baby's heart rate after 1 minute (p-value = .022) were associated with newborn outcomes at 1 hour. Conclusion: The Majority of the HCPs were inadequately trained for NR practices. However, a significant association among HCPs' NR practices (airway management and advanced resuscitation practices) and outcomes was observed. Structured and ongoing NR training for HCPs can improve practices and contribute to reduced newborn morbidity and mortality rates. Consequently, it will be helpful for lowering healthcare costs for families and the healthcare system and will contribute to the national economy..