title: Frequent brief on-site simulation training and reduction in 24-h neonatal mortality--an educational intervention study.
abstract: OBJECTIVE
  "Helping Babies Breathe" (HBB) is a simulation-based educational program developed to help reduce perinatal mortality worldwide. A one-day HBB training course did not improve clinical management of neonates. The objective was to assess the impact of frequent brief (3-5 min weekly) on-site HBB simulation training on newborn resuscitation practices in the delivery room and the potential impact on 24-h neonatal mortality.
  
  
  METHODS
  Before/after educational intervention study in a rural referral hospital in Northern Tanzania. Baseline data was collected from 01.02.2010 to 31.01.2011 and post-intervention data from 01.02.2011 to 31.01.2012. All deliveries were observed by research assistants who recorded information about labor, newborn delivery room management, perinatal characteristics, and neonatal outcomes. A newborn simulator was placed in the labor ward and frequent brief HBB simulation training was implemented on-site; 3-min of weekly paired practice, assisted by local-trainers. Local-trainers also facilitated 40-min monthly re-trainings. Outcome measures were; delivery room management of newborns and 24-h neonatal outcomes (normal, admitted to a neonatal area, death, or stillbirths).
  
  
  RESULTS
  There were 4894 deliveries pre and 4814 post-implementation of frequent brief simulation training. The number of stimulated neonates increased from 712(14.5%) to 785(16.3%) (p = 0.016), those suctioned increased from 634(13.0%) to 762(15.8%) (p ≤ 0.0005). Neonates receiving bag mask ventilation decreased from 357(7.3%) to 283(5.9%) (p = 0.005). Mortality at 24-h decreased from 11.1/1000 to 7.2/1000 (p = 0.040).
  
  
  CONCLUSIONS
  On-site, brief and frequent HBB simulation training appears to facilitate transfer of new knowledge and skills into clinical practice and to be accompanied by a decrease in neonatal mortality.
authors.affiliation: Research Centre, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania; Department of Research, Stavanger University Hospital, Stavanger, Norway. Electronic address: estomduma@gmail.com.
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.affiliation: SAFER (Stavanger Acute medicine Foundation for Education and Research), Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Hege
authors.initials: H
authors.lastname: Ersdal
authors.affiliation: Center for International Health, University of Bergen, Bergen, Norway.
authors.forename: Erling
authors.initials: E
authors.lastname: Svensen
authors.affiliation: Department of Obstetrics and Gynaecology, Muhimbili National Hospital/MUHAS, Dar Es Salaam, Tanzania.
authors.forename: Hussein
authors.initials: H
authors.lastname: Kidanto
authors.affiliation: Department of Research, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Auestad
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
mesh_terms: D001238:Asphyxia Neonatorum / Q000401:mortality / Q000628:therapy; D003479:Curriculum; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D012151:Resuscitation / Q000193:education* / Q000379:methods; D000066908:Simulation Training / Q000379:methods*; D013192:Staff Development / Q000379:methods; D013636:Tanzania / Q000453:epidemiology
keywords: Frequent brief on-site simulation training; Helping Babies Breathe; Implementation; Neonatal mortality; Resuscitation