Menu
Menu
Menu
Menu
Background: The quality of neonatal resuscitation after delivery needs to be improved to reach the Sustainable Development Goals 3.2 (reducing neonatal deaths to <12/1,000 live newborns) by the year 2030. Studies have emphasized the importance of correctly performing the basic steps of resuscitation including stimulation, heart rate assessment, ventilation, and thermal control. Recordings with video cameras have previously been shown to be one way to identify performance practices during neonatal resuscitation. Methods: A description of a low-cost delivery room set up for video recording of neonatal resuscitation. The technical setup includes rechargeable high-definition cameras with two-way audio, NeoBeat heart rate monitors, and the NeoTapAS data collection tools for iPad with direct data export of data for statistical analysis. The setup was field tested at Mulago National Referral Hospital, Kampala, Uganda, and Phu San Hanoi Hospital, Hanoi, Vietnam. Results: The setup provided highly detailed resuscitation video footage including data on procedures and team performance, heart rate monitoring, and clinical assessment of the neonate. The data were analyzed with the free-of-charge NeoTapAS for iPad, which allowed fast and accurate registration of all resuscitative events. All events were automatically registered and exported to R statistical software for further analysis. Conclusions: Video analysis of neonatal resuscitation is an emerging quality assurance tool with the potential to improve neonatal resuscitation outcomes. Our methodology and technical setup are well adapted for low- and lower-middle-income countries settings where improving neonatal resuscitation outcomes is crucial. This delivery room video recording setup also included two-way audio communication that potentially could be implemented in day-to-day practice or used with remote teleconsultants.
We describe a low-cost monitoring setup for the resuscitation table in the delivery room. This method helps to identify the process and actions of staff procedures to improve the quality of care. The method has been used at Mulago National Referral Hospital, Uganda, and Phu San Hanoi Hospital, Vietnam. We reviewed existing procedures and equipment, the organization of the resuscitation team, and current guidelines. This included discussions with the administration and clinical staff of the hospitals about how to minimize interference of monitoring with current practices and information about the study and equipment aimed to be used. At both sites, ethical approval was sought from the local institutional review boards. The decision regarding the number of cameras and NeoBeat monitors needed for the studies was done according to where most neonatal resuscitations took place at the hospitals. The equipment was installed to identify potential technical problems before the training of the staff. Cameras were placed at each resuscitation table away from the high-temperature area of the heater to capture exact footage of the newborn and the hands of the providers, eliminating the risk of staff identification. Also, placement was optimized for easy SD card access needed for the data collection. Tables were adapted to fit the cameras within the recommended focus range, between 60 and 120 cm. Cables and NeoBeat chargers (24) were also placed on the resuscitation table to facilitate access and minimize interference in normal clinical practice. Midwives, doctors, nurses, and technical staff were introduced to the study setup and trained in equipment management. Hospital executives were informed about practice changes, and cleaning staff were trained to avoid tampering with the new setup. Video cameras HD 1080P Black Box AI-IP018 (Shenzhen Aishine Electronics) were installed at three out of four resuscitation tables at Mulago National Referral Hospital, Kampala, Uganda, and recorded data around the clock. The cameras were placed so that only the hands of the resuscitator and the neonates were recorded. The SD cards of each camera were swapped every day to ensure that all recordings were properly saved (Figure 1A). In case technical issues were noticed, the study coordinator or trial investigator was notified for corrective measures. NeoBeat heart rate meters were installed for a sub-study, and therefore only used for part of the newborns. It was placed directly around the neonates’ abdomen, providing a fast and accurate continuous display of heart rate visible on the videos during the review process (29). Inclusion criteria were neonates born in the hospital, estimated gestational age of at least 34 weeks, estimated birth weight of at least 2,000 g, and need of PPV at birth. Exclusion criteria were major malformations (incompatible with sustained life or affecting the airways) and stillbirths. All neonates fulfilling the eligibility criteria for each clinical study (please find the separate clinical criteria in references by Myrnerts Höök et al., Pejovic et al., and Larsson et al.) were filmed and enrolled (30, 31). Video camera process for Uganda (A) and Vietnam (B) from the insertion of SD card into camera to video recording and final cut ready for analysis. Each morning and afternoon, the camera data manager checked the cameras to ensure that they functioned well, including power control and the orientation of the camera. In case of problems, the study coordinator or trial investigator was notified for corrective measures. Power banks were used to keep the cameras running in case of a power shortage. The steps of retrieving and saving data are summarized in step six. After retrieving data, each resuscitation of the day was identified by the data managers and shown to one of the study doctors to ensure that it was a case of need of PPV and that the complete case was caught on video. Video cameras HD 1080P PIR Black Box Wi-Fi Security Camera AI-IP018 cameras (Shenzhen Aishine Electronics) (32) were installed above 7 out of 12 Phu San Hospital resuscitation tables, Hanoi, Vietnam, and recorded data around the clock. The cameras were placed so that only the hands of the resuscitator and the neonates were recorded (Figure 2). Inclusion criteria were born in a hospital, and need for PPV at birth. There were no exclusion criteria. The SD cards of each camera were swapped every second day (but the cards used could handle data up to 3.5 days) to ensure that all recordings were properly saved (Figures 1B). In case technical issues were noticed, the study coordinator or trial investigator was notified for corrective measures (Figure 3). NeoBeat heart rate meters were installed at each of the seven resuscitation tables (33), and used in the same way as above for the newborns with placement around the neonates’ abdomen, providing a fast and accurate continuous display of heart rate visible on the videos during the review process (33). A real capture from a video showing the situation at the resuscitation table with NeoBeat on the neonate's chest and only hands shown. The process from delivery to verified video captured resuscitation, Uganda, and Vietnam. Each camera’s footage was secured by swapping the SD card and checking that the camera was recording the correct angle. The SD card with the latest data was downloaded onto the first hard drive (4 TB, Western Digital My Passport Milpitas, CA, USA) and marked RAW, identifying the date, and camera. The data were stored in folders with formats as follows: The technical staff downloaded all video data including identified resuscitations. The time when the resuscitations took place was recorded by the attending midwife or doctor. The sections with important data were selected using Adobe Premiere 64-bit version and transferred to storage in a 4 TB hard drive. A final evaluation of the resuscitation recordings was performed by a study doctor, also checking for missing data. The videos were stored in folders with formats as follows: Data extracted from the video recordings as well as maternal and neonatal characteristics were collected using standardized hard-copy case report forms. Resuscitation data were collected by analysis of the videos, using the NeoTapAS (34) app for real-time data registration during neonatal procedures (25, 26). Recorded data were directly exported for statistical analysis. We used the free R statistical software [see previous papers (19, 33)]. The code documentation and scripts are available on request. Example scripts used to reproduce the figures have been published on GitHub were also the R package with functions and example data can be found. https://github.com/Global-child-health-SDGs-Team-KI/Neonatal-Resuscitation. At both study sites, all study-related information obtained was handled confidentially. All participant information, including case report forms, lists, logbooks, and any other listings linking participant ID numbers, was stored in locked file cabinets in areas with limited access. Research teams could only identify participants using a locally stored key file linked to the study numbers. Raw files were stored on a primary drive, cutout videos on a secondary drive, and backup copies were stored in a remote location (Figure 1). Videos were stored in a locked safe and hard drives were password protected. To help with the usage of the method, the collection types, variables used, and codes are available on request even if the real collected data due to ethical considerations cannot be shared. The protocol for the Ugandan study was approved by the Institutional Review Board of Mulago National Referral Hospital, Uganda (MHREC 1168), the Uganda National Council of Science and Technology; the Director-General from the Ministry of Health, Uganda (MREC 1168); and the Regional Committee for Medical and Health Research Ethics (REK South-East reference number 2017/989) in Norway. The protocol for the Vietnamese study was approved by the Institutional Review Board at Dinh Tien Hoang Institute of Medicine, the Ethical Review Board of Hanoi (No: IRB-2001 and IRB-2002), and the Swedish Ethical Review Authority (Dnr 2021-00064/2021-03-01). Video recording with ethical considerations is today the standard for data collection in neonatal resuscitation (21, 35–37). Only the neonate and the hands of the resuscitator were visible, and the video audio was muted. The identity of neonates and resuscitators were kept anonymous. Video recordings were not used for malpractice cases. Thus, no consent was required from the resuscitators. All staff involved at both sites in neonatal resuscitations got at least one information session prior to study commencement. If the parents of the neonate did not consent to participate in the study, the video recordings were deleted and safely discarded.
N/A
