Effect of Remote Essential Newborn Care Training Paired With In‐Person Quality Improvement on Optimizing Immediate and Resuscitative Care Practices

AIM: This study evaluated the effect of combining remote training (RT) with quality improvement (QI) processes on immediate and resuscitative care practices in a hospital in Nepal. METHODS: This prospective, before-after-design study included 5034 newborns, with 1836 newborns independently observed for immediate and resuscitation care practice. Essential Newborn Care (ENC) training was delivered remotely via zoom to healthcare providers (HCPs) followed by six bi-monthly facilitated QI interventions through Plan-Do-Study-Act (PDSA) meeting. Generalized linear models were used to estimate the multivariable adjusted risk ratios (aRRs) between the periods as well as incidence risk ratio (IRR) change for key HCP performance on a weekly basis during PDSA interventions. RESULTS: The proportion of deliveries for which resuscitation equipment was prepared by HCP increased from 9.6% to 43.7% between the observation periods (aRR = 1.44). Initiation of ventilation within the first minutes of birth improved significantly (0% vs. 18%, aRR = 1.49) with IRR increase by 17% with each additional week (IRR = 1.17; 95% CI; 1.08, 1.26). The proportion of infants who received repeat suctioning decreased non-significantly (88.6% vs. 63.2%, aRR = 1.22). CONCLUSION: Pairing RT with facilitated QI led to improvements in immediate newborn and resuscitation care practice, recommending pairing of remote training and facilitating QI for future resuscitation program.