Clinical audit of neonatal care in Assiut Women's Health Hospital, Egypt

Walaa S. Shehata, Nafisa H. Refat, Ali El Saman, Mansour Y. Kandeel, Alaa M. Ismail, Ahmed M. Abbas


Background: The current study aims to auditing the current care of healthy full term newborns in the delivery room and identify the gap between the current practice and ideal practice in Assiut Women's Health Hospital, Egypt.

Methods: The current study was a clinical audit carried out in Assiut Woman Health Hospital, in the period from 1 September 2016 to 28 February 2017.The study included all newborns delivered in the delivery word of gestational age after 37 week. We excluded all Preterm babies, those with congenital anomalies, pregnant women with medical disorders and multiple pregnancies. In the present work all data was collected prospectively through direct personal patient contact, direct observation of care givers, patient interactions and attitudes, from the clinical records and then recording the data in special check sheet. All basic criteria of the study participants as age, parity, gestational age at delivery and type of delivery were obtained. The neonatal gender, weight, heart rate and respiratory rate were checked. Audit criteria were selected according to the WHO 2015 and AAP 2010-2015 guidelines.

Results: The study included 800 women; the mean age of the women was 26.52±5.70 years. The mean parity was 1.78±1.85. The mean gestational age at delivery was 38.81±0.96 weeks. As regard the type of delivery, 54.1% of women were delivered by cesarean section. Calling neonatologists occurred in 67.9% of deliveries. The mean birth weight was 3.17±0.39 kilograms. Nearly half of them (52%) were males.

Conclusions: Application of the guidelines of the neonatal handling is important for optimum care to the neonates. Re-audit the steps of the handling is important to discuss whether practice has improved or not in our tertiary hospital.


Clinical audit, Neonates, Resuscitation

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Excellence, NIfC 2002, Principles for best practice in clinical audit, Radcliffe Publishing;2002.

Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.

Perlman JM, Wyllie J, Atkins DL, Chameides L, Goldsmith JP, Guinsbirg R, et al. Part 15: Neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and Emergency cardiovascular care science with treatment Recommendations. Pediatrics. 2010;126(5):e1319-44.

Kiremitici S, Tuzun F, Yesilirmak DC, Kumral A, Duman N, Ozkan H. Is gastric aspiration needed for newborn management in delivery room? Resuscitation. 2011;82:40-4.

Acolet D. Quality of neonatal care and outcome. Arch Dis Child Fetal Neonatal Ed. 2008;93:F69-73.

Soll RF. Evaluation the medical evidence for quality improvement. Clin Perinatal. 2010;37:11-28.

Barber CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics. 2006;118(3):1028-34.

Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010;126:e1400-13.

Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S543-60.

Mitchell A, Niday P, Boulton J, Chance G, Dulberg C. A prospective clinical audit of neonatal resuscitation practices in Canada. Adv Neonatal Care. 2002;2,(6):316-26.

Save the Children: Surviving the first day: State of the World’s Mothers 2013. Westport, CT: Save the Children; 2013.

van den Broek N, Graham W. Quality of care for maternal and newborn health: the neglected agenda. BJOG. 2009;116(Suppl. 1):18-21.

Ajaari J, Masanja H, Weiner R, Abokyi SA, Owusu-Agyei S. Impact of place of delivery on neonatal mortality in rural Tanzania. Int J MCH AIDS. 2012;1(1):49-59.

Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2010;11:CD007754.

Wall SN, Lee AC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries: What works? Semin Perinatol. 2010;34(6):395-407.

Lee AC, Cousens S, Wall SN, Niermeyer S, Darmstadt GL. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: A systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health. 2011;11(Suppl 3):S12.

Galadanci H, Künzel W, Shittu O, Zinser R, Gruhl M, Adams S. Obstetric quality assurance to reduce maternal and fetal mortality in Kano and Kaduna State Hospitals in Nigeria. Int J Gynecol Obstet. 2011;114:23-28.