Stillbirth Clinical Trial
Official title:
Newborn Heart Rate as a Catalyst for Improved Survival (NeoBeat Study)
Verified date | March 2022 |
Source | American Academy of Pediatrics |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Heart rate (HR) is not routinely assessed during newborn resuscitations in low- and lower-middle income countries (LMICs). Many non-breathing newborns classified as fresh stillbirths have a heartbeat and are live born. The effect of a low-cost monitor for measuring HR on the problem of misclassification of stillbirths in LMICs is unknown. Knowledge of HR during newborn resuscitation might also result in timely administration of appropriate interventions, and improvement in outcomes. Helping Babies Breathe (HBB), a resuscitation algorithm developed by the American Academy of Pediatrics (AAP), is widely accepted as the standard of care for newborn resuscitation in low-resource settings. In keeping with the International Liaison Committee on Resuscitation (ILCOR) recommendations that HR be measured during newborn resuscitation, HBB calls for HR assessment after 1 minute of positive-pressure ventilation with good chest movement (or sooner if there is a helper who can palpate/auscultate heart rate). However, given the frequent reality of a single provider attending deliveries in LMICs, as well as the currently available methods for assessing HR (i.e. palpitation or auscultation), assessment of HR is challenging to perform without delaying or stopping the provision of other life-saving interventions such as bag and mask ventilation. The effect of low-cost, continuous HR monitoring to guide resuscitation in these settings is unknown. NeoBeat is a low-cost, battery-operated device designed by Laerdal Global Health for the measurement of newborn HR. The device can be placed rapidly on a newborn by a single provider, and within 5 seconds, displays HR digitally. A preliminary trial of NeoBeat in 349 non-breathing newborns in Tanzania detected a HR in 67% of newborns classified as stillbirths, suggesting up to two thirds of fresh stillbirths may be misclassified in similar settings. This trial will evaluate: 1) the effectiveness of HBB in combination with NeoBeat for vital status detection on reduction of reported stillbirths, and 2) the effectiveness of HR-guided HBB on effective breathing at 3 minutes. The primary hypothesis is that implementation of HBB with measurement of HR using NeoBeat will decrease the reported total stillbirth rate by 15% compared to standard care. The secondary hypothesis is that implementation of HR-guided HBB will increase the proportion of newborns not breathing well at birth who are effectively breathing at 3 minutes by 50% compared to HBB with NeoBeat.
Status | Completed |
Enrollment | 24034 |
Est. completion date | October 31, 2020 |
Est. primary completion date | July 30, 2020 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 28 Weeks to 45 Weeks |
Eligibility | Inclusion Criteria: all newborns delivered via vaginal, assisted or operative delivery at any of 3 participating maternity units in Kinshasa, Democratic Republic of Congo (DRC), during the study period will be enrolled. All newborns will be included, regardless of: - intrauterine fetal demise - birth weight - congenital anomalies - multiple gestation - any maternal complication Exclusion Criteria: - Newborns transferred to the maternity unit following delivery at a referral hospital or in the community - Miscarriages, or previable newborns, defined as gestational age <28 weeks (or if gestational age is unavailable, birth weight <1,000g) at the time of delivery |
Country | Name | City | State |
---|---|---|---|
Congo, The Democratic Republic of the | Binza-Delvaux Maternity Hospital | Kinshasa | |
Congo, The Democratic Republic of the | Centre Hospital Kingasani | Kinshasa | |
Congo, The Democratic Republic of the | Mother and Child Hospital Bumbu | Kinshasa |
Lead Sponsor | Collaborator |
---|---|
American Academy of Pediatrics | Kinshasa School of Public Health, Laerdal Global Health, RTI International, Saving Lives at Birth, Thrasher Research Fund, University of North Carolina, Chapel Hill |
Congo, The Democratic Republic of the,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Fresh Stillbirth Rate | Total number of non-breathing newborns without a HR at the time of birth, and without signs of maceration, as determined by the delivery attendant, per 1,000 births. | At delivery | |
Other | Macerated Stillbirth Rate | Total number of non-breathing newborns without a HR at the time of birth, with signs of maceration, as determined by the delivery attendant, per 1,000 births. | At delivery | |
Other | Neonatal Death Prior to Discharge | Death of a live born infant during the birth hospitalization, where death occurs prior to discharge or transfer from the facility of birth. | Up to 28 days of life | |
Other | Number of Providers Adhering to Resuscitation Algorithm | any number of provider actions to promote resuscitation of the non-breathing newborn such as suctioning, stimulation, bag and mask ventilation and corrective measures to improve bag and mask ventilation in response to newborn respiratory condition or HR as defined in the resuscitation algorithm. | At delivery | |
Primary | Reported Total Stillbirth Rate | The total number of stillborn infants (both fresh and macerated) at the facility per 1,000 births, with stillbirth as classified by the delivery attendant. | At delivery | |
Secondary | Effective, Spontaneous Breathing at 3 Minutes | Breathing without the assistance of stimulation or bag and mask ventilation at a respiratory rate = 40 breaths per minute with a HR = 100 beats per minute at 32 minutes of life. | At 3 minutes of life |
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