The Impact of a Designated Resuscitation Team on Decreasing Admissions and Providing Appropriate Oxygen Support and Thermoregulation in Advanced Care Center NICUs in Sub-Saharan Africa

Trainee Mentoring Award

Mentee: Yvonne Yui, MD

Mentor: Leah Greenspan Hodor, MD 

Objectives: 

1. To design and implement a Designated Resuscitation Team (DRT) to attend all high-risk deliveries in referral centers in Africa
2. To train the DRT on the Neonatal Resuscitation Program (NRP) 7th edition in didactics, simulation, and delivery room mentoring
3. To transport newborns from the delivery setting to the NICU with a focus on thermoregulation and oxygen management to ensure a smooth transition through the “Golden Hour” when admission is necessary 
4. To reduce the number of NICU and Baby Unit admissions of late preterm to term infants and improve thermoregulation and oxygen saturation for all newborns admitted, this decreasing their length of stay and improving morbidity and mortality 

Project Summary: 

Globally, there are 2.6 million neonatal deaths annually with 99% of the disease burden coming from the developing world (WHO). Protocols and guidelines for resuscitation and stabilization during delivery, post resuscitation and transport are not standardized despite the increase in morbidity and mortality associated with poor resuscitation, neonatal hypothermia, and hypoxia. 

Though already established relationships with multi-site advanced care settings and NICUs in Sub-Saharan Africa, the team identified gaps in care enabling implementation of training and mentoring programs. In Uganda, preliminary data show that the pilot project resulted in a reduction of neonatal admissions by 20% after the first two months of training. We have expanded the scope of the program to include a multi-center site in order to prove concept and capacity of scale. The interventions include both skills training and health system strengthening through the development, training, and mentoring of a designated resuscitation team. The scope of their practice will include resuscitation, stabilization, and transport guidelines, use of t-piece resuscitation, thermoregulation (radiant warmers and a reusable warming mattress), and monitoring and evaluation tools.