Project Details

Decreasing Neonatal Mortality with Interventions Initiated during Labor, at Birth, and the Golden Hour

Emily Ahn, MD

Summary

BACKGROUND: The World Health Organization has set a 2030 target of less than 12 neonatal deaths per 1000 live births. The neonatal mortality rate for Tanzania in 2021 was 20 per 1000 live births. To achieve a reduction in mortality, preventative strategies during labor, the golden minute immediately following delivery, and the initial golden hour must be prioritized. METHODS: This was a prospective observational study at Kilimanjaro Christian Medical Centre in Tanzania. As part of a larger five-year implementation study, a multi-modal resuscitation program was introduced for midwives and pediatric residents. The program combined individual bag mask ventilation training with multidisciplinary team training. The Thrasher Early Career Award supported a research assistant to observe clinical resuscitations post-training to evaluate program effectiveness. She additionally obtained heart rate and pulse oximeter tracings on a subset of patients in order to analyze cardiorespiratory transitioning in the first 15 minutes of life in neonates receiving varying levels of resuscitation. RESULTS: During the individual skill trainings of bag mask ventilation, midwives initially outperformed residents by more often achieving effective bag mask ventilation upon the first attempt. However, this was not sustained overtime with midwives more often demonstrating poor bag mask ventilation performance on repeat testing. Amongst both residents and midwives, low inflating pressures were a common cause of ineffective ventilation and likely represented a degree of mask leak. During clinical observations post team training in the delivery room, participants had close adherence to pre-delivery preparation steps and basic neonatal stabilization/resuscitation interventions. Importantly, bag mask ventilation appeared to be effective in most observed resuscitations. When analyzing ECG and pulse oximeter recordings, comfortably breathing neonates who did not receive resuscitation steps had both higher initial saturation values and heart rates compared to neonates receiving oxygen only or bag mask ventilation. Neonates receiving oxygen only without endexpiratory pressure were slower to reach the Neonatal Resuscitation Program’s saturation goals than neonates resuscitated with bag mask ventilation connected to oxygen. CONCLUSIONS: A multi-modal approach combining individual skills training with team training that focuses on preparation, communication, and immediate skill feedback may enhance neonatal resuscitation in low-resource settings. Physiologically, elevated early saturation values coupled with relatively higher initial heart rates in comfortably breathing neonates who did not receive resuscitation may be indicative of a rapid decrease in pulmonary vascular resistance and seamless cardiorespiratory adaptation. However, for neonates with labored breathing, oxygen alone without positive endexpiratory pressure may delay respiratory transitioning. This was evidenced by low oxygen saturations at five minutes and suggests the need for CPAP in the delivery room in this setting. This will

Publications:

Ahn E, Cypriane J, Peter N, Ngowi E, Shayo A, Mlay P, Perlman J. Individualized Skill-Based Manikin Training Coupled with a Team Approach May Enhance Delivery Room Neonatal Resuscitation in Low-Resource Settings. Children (Basel). 2026 May 15;13(5):679. doi: 10.3390/children13050679. PMID: 42194205; PMCID: PMC13204646.

Ahn E, Cypriane J, Ngowi E, Shayo A, Perlman J. Cardiorespiratory Transitioning at Birth during Varying Levels of Resuscitation and the Role of Dry-Electrode ECG (NeoBeat) and Pulse Oximetry in a Low Resource Setting. Neonatology. 2026 May 13:1-10. doi: 10.1159/000552554. PMID: 42126979; PMCID: PMC13368024.

Hartman C, Ngowi E, Ahn E, Shayo A, Peter N, Cypriane J, Mlay P, Tiwari P, Perlman J. Reducing Rates of Neonatal Hypothermia at Birth in Tanzania: A Quality Improvement Initiative. Journal of Perinatology. 2026 September.