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 rate for Tanzania in 2021 was 20 per 1000 live births. To achieve this goal, preventative strategies must be prioritized. GAP: Preventative strategies are needed during labor, the Golden Minute immediately following delivery, and the initial Golden Hour. We postulate that unexplored human and/or systemic factors may impact the effectiveness of these strategies. HYPOTHESIS: We hypothesize (1) that a care bundle for preterm infants comprised of antenatal steroid administration, teamwork in the delivery room, early bag mask ventilation, and avoidance of hypothermia, coupled with Golden Hour interventions of continuous positive airway pressure and early antibiotics will reduce neonatal mortality of infants < 1500g by 50% and (2) that a care bundle for term infants comprised of continuous fetal heart rate monitoring plus partograph use in high-risk mothers and early bag mask ventilation of the non-breathing infant, will reduce neonatal encephalopathy by 20% and fresh stillbirths by 30%. METHODS: This is a prospective observational study at Kilimanjaro Christian Medical Centre in Tanzania. Care bundles will include educational curriculum, case reviews, skills training, team training, and introduction of essential equipment. A research assistant will explore potential human and system factors that may impact bundle implementation. RESULTS: Pending. IMPACT: The key to success is to implement evidenced based targeted interventions during labor, the Golden Minute, and the Golden Hour. The positive/negative contribution of human and/or systemic factors must be explored, identified, and corrected as necessary. If successful, findings will be disseminated so other hospitals can utilize the bundle template and correct as identified systemic and human factors.