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Immediate care of newborn babies in a low-income country (Bangladesh) – an observational study

Presented at the Neonatal Society 2018 Spring Meeting (programme).

Chowdhury T1, Karim T3, Chowdhury S3, Gupta N2, Ross O1

1 Anaesthetics and Critical Care, Faculty of Medicine, University of Southampton, UK
2 Neonatal Intensive Care Service, University Hospital Southampton, UK
3 Obstetrics and Gynaecology Department, Chittagong Medical College Hospital (CMCH), Bangladesh

Background: Immediate care of newborn after birth is important in reducing neonatal mortality rate (NMR). Since 1990, NMR has declined in Bangladesh due to introduction of national guidelines e.g. Helping Babies Breathe (HBB), addressing resuscitation measures. Aims: 1) a. Describe and assess the current enabling environment to support the immediate care for newborn in Chittagong Medical College Hospital (CMCH). b. Describe the demographics of in-born newborn admitted. 2) Assess newborn resuscitative measures currently used at CMCH.

Methods: Ethics approval was obtained from CMCH and University of Southampton through ERGO. Data was recorded in proformas created from NRP guidelines and WHO standards, over 3 weeks. Information on the enabling environment, mode of delivery and the staff present were collected via observation. Demographics were taken from patient notes. Resuscitation carried out in theatre/labour ward or in Special Care Newborn Unit (SCANU), was recorded from observation. Thermal control and deferred cord clamping (DCC) were focused on. All data collected in the hardcopy proformas was transferred to an excel spreadsheet at the end of each day.

Results: Over half the equipment recorded in the proforma was available in both the labour ward and operating theatre. The mean weight of the babies was 2.74kg which included 12.5% preterm. 70% of deliveries were caesarean section (CS). 74.1% of the newborn were resuscitated of which 3.4% required advanced resuscitation. HBB resuscitation was followed successfully in 66.3%. After resuscitation, 31.5% were referred to SCANU and 2.2% died immediately after. DCC was not practised in CMCH but 36 cases (30%) had contraindications for immediate cord clamping. All newborn received thermal care and were at least dried and wrapped in a blanket.

Conclusion: CMCH has adequate provision of equipment and staff to support basic and advanced resuscitation. HBB protocol was adhered to in almost all deliveries. CS rates have gradually increased in CMCH, now exceeding WHO recommended levels. Currently DCC is not practiced but could be considered for future implementation.

Corresponding author:

Acknowledgements: This project was generously funded by The Royal Society of Medicine- British Medical and Dental Student’s Trust, The Royal College of Obstetricians and Gynaecologists and The Neonatal Society.

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