• Jackie Patterson, Sara Berkelhamer, Daniel Ishoso, Pooja Iyer, Casey Lowman, Melissa Bauserman, Joar Eilevstjønn, Ingunn Haug, Adrien Lokangaka, Beena Kamath-Rayne, Eric Mafuta, Helge Myklebust, Tracy Nolen, Janna Patterson, Nalini Singhal, Antoinette Tshefu, and Carl Bose.
• Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA. Electronic address: jackie_patterson@med.unc.edu.
• Resuscitation. 2022 Feb 1; 171: 57-63.

AimTo evaluate the effect of resuscitation training and continuous electronic heart rate (HR) monitoring of non-breathing newborns on identification of stillbirth.MethodsWe conducted a pre-post interventional trial in three health facilities in the Democratic Republic of the Congo. We collected data on a retrospective control group of newborns that reflected usual resuscitation practice (Epoch 1). In the prospective, interventional group, skilled birth attendants received resuscitation training in Helping Babies Breathe and implemented continuous electronic HR monitoring of non-breathing newborns (Epoch 2). Our primary outcome was the incidence of stillbirth with secondary outcomes of fresh or macerated stillbirth, neonatal death before discharge and perinatal death. Among a subset, we conducted expert review of electronic HR data to estimate misclassification of stillbirth in Epoch 2. We used a generalized estimating equation, adjusted for variation within-facility, to compare risks between EPOCHs.ResultsThere was no change in total stillbirths following resuscitation training and continuous electronic HR monitoring of non-breathing newborns (aRR 1.15 [0.95, 1.39]). We observed an increased rate of macerated stillbirth (aRR 1.58 [1.24, 2.02]), death before discharge (aRR 3.31 [2.41, 4.54]), and perinatal death (aRR 1.61 [1.38, 1.89]) during the intervention period. In expert review, 20% of newborns with electronic HR data that were classified by SBAs as stillborn were liveborn.ConclusionResuscitation training and use of continuous electronic HR monitoring did not reduce stillbirths nor eliminate misclassification.Copyright © 2021 Elsevier B.V. All rights reserved.

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