Neonatal resuscitation: EN-BIRTH multi-country validation study

Abstract Background Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment training. However, there is no consistent tracking for coverage. Methods The EN-BIRTH study, five hospitals Bangladesh, Nepal, Tanzania (2017–2018), collected time-stamped data care around birth, including resuscitation. Researchers surveyed women extracted from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage survey-reported register-recorded coverage, using absolute difference, validity ratios, individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two numerators (stimulation, BMV) three denominators (live births fresh stillbirths, non-crying, non-breathing). also examined timeliness of BMV. Qualitative were health workers collectors regarding barriers enablers recording Results Among 22,752 births, 5330 (23.4%) babies did not cry 3860 (17.0%) breathe the first minute after birth. 16.2% ( n = 3688) stimulated 4.4% 998) received Survey-report underestimated Four registers captured numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV was higher 12.4–48.4%, > 93%), with small differences between recorded Accuracy vary by denominator option. < 1% initiated within 1 min Enablers register included training use while design, documentation burden, time pressure. Conclusions Population-based surveys are unlikely be useful measuring given low exit-survey report. Routine potential accurately capture as numerator. Measuring true clinical need complex; may if ineffectively or experiencing apnoea initial drying/stimulation subsequently any time. Further research required evaluate non-crying a alternative context respectful care. quality gaps, notably timely provision resuscitation, crucial programme improvement impact, but feasible systems, requiring audits special studies.