492 - Discrepancies in Delivery Room Experience Between Midwives and Residents in Tanzania Highlights the Need for Team Training in the Low Resource Setting

Poster Number: 492
Publication Number: 492.263

Background: Birth asphyxia, defined by the World Health Organization as failure to establish breathing at birth, is a leading cause of global neonatal mortality. Prompt stimulation and bag mask ventilation (BMV) can often prevent progression to death or encephalopathy. For advanced resuscitations, best practices in high resource settings recommend repeat training and a team approach. Currently at Bugando Hospital and Kilimanjaro Christian Medical Centre, midwives are the primary resuscitation providers.

Objective: Assess resuscitation experience and teamwork of midwives and pediatric residents (PR) in a low resource setting to identify gaps in resuscitation training.

Design/Methods: PR and midwives at two hospitals in Tanzania were given a 14-question survey. Topics included delivery room attendance, BMV experience on manikins and newborns, team training experience, and whether physicians are called appropriately to resuscitations. Data analyzed with t-test and chi-squared.

Results: Twenty-four midwives and 29 PR at Hospital 1 and 16 midwives and 16 PR at Hospital 2 participated. PR at Hospital 1 had more recent delivery room resuscitation and BMV experience than midwives while midwives at Hospital 2 were more likely than PR to have delivered BMV in the past month (81% vs 38%, P=0.01, Table 1). The majority of Hospital 1 PR (83%) practice BMV vs 56% at Hospital 2 and ~half of midwives at both hospitals. Hospital 1 PR were more likely to have training around teamwork during a resuscitation than midwives (79% vs 50%, P=0.02); no differences were noted at Hospital 2. PR at Hospital 1 are under the assumption they are being called more frequently both prior to a delivery (P < 0.01, Fig 1) and when BMV ventilation is delivered (P=0.01, Fig 2) than midwives reported; no differences were noted at Hospital 2. PR as compared to midwives felt a physician should be called more often to resuscitations at both Hospital 1 (86% vs 63%, P=0.04) and Hospital 2 (81 vs 31%, P< 0.01).

Conclusion(s): Neonatal resuscitation with BMV requires a teamwork approach of skilled providers with resuscitation physiology knowledge. The data indicate that PR at Hospital 1 were significantly more likely to have attended a delivery, practiced BMV on a manikin, and have received teamwork training than midwives while minimal differences were seen at Hospital 2. At both hospitals PR as opposed to midwives wanted more involvement in delivery room resuscitations. Given these findings, resuscitation curriculum centered around team training is necessary to enhance collaboration. Implementation strategies may differ amongst hospitals.