P0721 - Designated Neonatal Resuscitation and Transport Team Implementation Improves Neonatal Outcomes in Low Resource Settings

Background: The World Health Organization’s Sustainable Development Goals (SDGs) aim to reduce neonatal mortality to 12 or less per 1000 by 2030. However, neonatal mortality remains high in developing nations. According to UNICEF, Uganda and Ghana have neonatal mortality rates of 20 deaths per 1000 live and 24 per 1000 live births, respectively. Previous studies have shown that training in neonatal resuscitation can reduce mortality in infants with asphyxia by 30%.Temperature instability, hypoxemia and hypoglycemia resulting from poor transport methods significantly increase the neonatal morbidity and mortality rates. Advanced resuscitation, transport of sick neonates, and capacity building for providers in advanced care centers is essential to shift the pendulum.

Objective: Our aim is to show that the train the trainer program, i.e., a Designated Resuscitation and Transport Team (DRT) training program, providing highly skilled care to at-risk newborns during delivery and transport in resource limited countries, was sustainable over a 1-3 year period.

Method: Our DRT team model, first piloted in Uganda and subsequently trialed in Ghana at a similar tertiary care facility, included a team lead and midwives all of whom were trained and mentored by a US-based NICU team in multiple 2-4 week on–site sessions interspersed over 3 years in Uganda and 1 year in Ghana. The training consisted of didactics, procedural skills stations, scenarios, pre and post knowledge checks and OSCES based on the Neonatal Resuscitation Program 7th edition (NRP) as well as direct mentoring in the delivery room and on transport. A T-piece resuscitator (Neopuff (c)) and a reusable thermal mattress designed for low resource settings (Warmilu (c)) were implemented. In 2019, the DRT model, including the Ugandan team lead, was extended to Ghana for proof of concept and to demonstrate scalability and sustainability.

Results: The implementation of a dedicated DRT with attention to oxygen support and thermoregulation has improved the outcomes of high-risk neonates in both resource-limited settings. In 2020, 3 years after the initial pilot in Uganda, the program continues to be in place in both institutions and has been the backbone of larger grants to scale up the concept countrywide.

Conclusions: Implementation of a Designated Resuscitation Team in tertiary neonatal care centers in low resource settings can be initiated and sustained through high quality training, mentoring and refresher courses as demonstrated at sites in two developing countries, thereby improving the pathway to WHO 2030 SDG targets.