{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:55:59Z","timestamp":1785412559947,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation","doi-asserted-by":"publisher","award":["2023-0277"],"award-info":[{"award-number":["2023-0277"]}],"id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2023-0277"],"award-info":[{"award-number":["2023-0277"]}],"id":[{"id":"https:\/\/ror.org\/01vacm368","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Birth asphyxia is a leading cause of neonatal mortality. More than half of these deaths are due to low-quality care. Objectives: To describe the frequency, sequence, timing, and duration of interventions after birth and newborn outcomes. Methods: This prospective observational study in rural Tanzania included newborns \u226528 weeks gestation. Trained research assistants observed and recorded all deliveries and resuscitations 24 h a day, 7 days a week, logging interventions in real time using the Liveborn Observation app. Results: Of 2564 newborns born, 2431 (94.9%) were enrolled in the study. Macerated stillbirth (n = 52), newborns with no parental consent (n = 67) or incomplete Liveborn data (n = 14) were excluded. Additionally, 2193\/2431 (90.2%) newborns did not receive bag-mask ventilation (BMV), and 1755\/2431 (72.2%) started breathing before 30 s from birth at median (quartiles) 6 (3, 13) s, 438\/2431 (18.0%) started breathing beyond 30 s at 49 (38, 67) s. Moreover, 238\/2431 (9.8%) received BMV at 82 (54, 120) s after birth, 1\/3 within the first min. Finally, 159\/238 (66.8%) were suctioned for 26 (17, 40) s. The first suction sequence was initiated at 44 (24, 78) s after birth. In 24\/238 (10.1%) newborns, BMV continued for more than 10 min, with an increased risk of dying within 24 h (RR = 4.26, 95% CI; 1.3\u201310.0, p = 0.016) and seven days (RR = 8.14, 95% CI; 3.5\u201317.6, p &lt; 0.001) compared to those ventilated for less than 10 min. Conclusions: Almost 10% of newborns received BMV at birth, but only one-third were ventilated within the first recommended minute. Excessive use of suctioning likely delayed the start of BMV, and prolonged ventilation beyond 10 min was associated with higher mortality.<\/jats:p>","DOI":"10.3390\/children13050614","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:34:42Z","timestamp":1777458882000},"page":"614","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Newborn Resuscitation Practices and Outcomes in Rural Tanzania\u2014A Real-Time Observational and Video Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Anita Yeconia","family":"Bukhay","sequence":"first","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania"},{"name":"Faculty of Health Sciences, Stavanger University, 4036 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9458-8991","authenticated-orcid":false,"given":"Hanne","family":"Pike","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Stavanger University, 4036 Stavanger, Norway"},{"name":"Department of Pediatrics, Stavanger University Hospital, 4011 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-2689","authenticated-orcid":false,"given":"Joar","family":"Eilevstj\u00f8nn","sequence":"additional","affiliation":[{"name":"Laerdal Medical, 4002 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Mduma","sequence":"additional","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladislaus","family":"Blacy","sequence":"additional","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estomih","family":"Mduma","sequence":"additional","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Moshiro","sequence":"additional","affiliation":[{"name":"Muhimbili National Hospital, Dar Es Salam 11103, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3330-7872","authenticated-orcid":false,"given":"Jackie K.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, 101 Manning Drive, 4th Floor, CB #7596, Chapel Hill, NC 27599-7596, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4305-141X","authenticated-orcid":false,"given":"Siren","family":"Rettedal","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Stavanger University, 4036 Stavanger, Norway"},{"name":"Department of Simulation-Based Learning, Stavanger University Hospital, 4011 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-8564","authenticated-orcid":false,"given":"Hege","family":"Ersdal","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Stavanger University, 4036 Stavanger, Norway"},{"name":"Department of Simulation-Based Learning, Stavanger University Hospital, 4011 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","unstructured":"WHO, UNICEF, and UNFPA (2026, February 24). Progress Report 2023. Improving Maternal and Newborn Health and Survival and Reducing Stillbirth. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240073678."},{"key":"ref_2","unstructured":"UNICEF (2026, February 24). Report 2024. Levels and Trends in Child Mortality. Available online: https:\/\/data.unicef.org\/resources\/levels-and-trends-in-child-mortality-2024\/."},{"key":"ref_3","unstructured":"WHO (2025). Essential Newborn Care Course, World Health Organization. [2nd ed.]. Available online: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/4e9c281f-3968-4ff0-95d0-f9ed47086109\/content."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kune, G., Oljira, H., Wakgari, N., Zerihun, E., and Aboma, M. (2021). Determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, Central Ethiopia: A case-control study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248504"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1377\/hlthaff.2018.05397","article-title":"In Low-And Middle-Income Countries, Is Delivery in High-Quality Obstetric Facilities Geographically Feasible?","volume":"38","author":"Gage","year":"2019","journal-title":"Health Aff."},{"key":"ref_6","unstructured":"(2026, February 26). Helping Babies Breathe. American Academy of Pediatrics. Available online: https:\/\/www.aap.org\/en\/aap-global\/helping-babies-survive\/our-programs\/helping-babies-breathe\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1542\/peds.2012-1795","article-title":"Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training","volume":"131","author":"Msemo","year":"2013","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e20162132","DOI":"10.1542\/peds.2016-2132","article-title":"Implementation of \u201cHelping Babies Breathe\u201d: A 3-year experience in Tanzania","volume":"139","author":"Arlington","year":"2017","journal-title":"Pediatrics"},{"key":"ref_9","unstructured":"WHO (2012). Guidelines on Basic Newborn Resuscitation, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241503693."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Brogaard, L., Hvidman, L., Esberg, A., Finer, N., Hjorth-Hansen, K.R., Manser, T., Kierkegaard, O., Uldbjerg, N., and Henriksen, T.B. (2022). Teamwork and Adherence to Guideline on Newborn Resuscitation\u2014Video Review of Neonatal Interdisciplinary Teams. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.828297"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.resuscitation.2017.03.035","article-title":"Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital","volume":"115","author":"Niles","year":"2017","journal-title":"Resuscitation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1159\/000431075","article-title":"Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway","volume":"108","author":"Steen","year":"2015","journal-title":"Neonatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110156","DOI":"10.1016\/j.resuscitation.2024.110156","article-title":"Newborn resuscitation timelines: Accurately capturing treatment in the delivery room","volume":"179","author":"Pike","year":"2024","journal-title":"Resuscitation"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lindb\u00e4ck, C., Kc, A., Wrammert, J., Vitrakoti, R., Ewald, U., and M\u00e5lqvist, M. (2014). Poor adherence to neonatal resuscitation guidelines exposed; an observational study using camera surveillance at a tertiary hospital in Nepal. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-233"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Helld\u00e9n, D., H\u00f6\u00f6k, S.M., Pejovic, N.J., Mclellan, D., Lubulwa, C., Tyllesk\u00e4r, T., and Alfven, T. (2021). Neonatal resuscitation practices in Uganda: A video observational study. BMC Pediatr., 14.","DOI":"10.1136\/bmjpo-2021-001092"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Patterson, J.K., Ishoso, D., Eilevstj\u00f8nn, J., Bauserman, M., Haug, I., Iyer, P., Kamath-Rayne, B.D., Lokangaka, A., Lowman, C., and Mafuta, E. (2023). Delayed and Interrupted Ventilation with Excess Suctioning after Helping Babies Breathe with Congolese Birth Attendants. Children, 10.","DOI":"10.3390\/children10040652"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.resuscitation.2011.12.011","article-title":"Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries","volume":"83","author":"Ersdal","year":"2012","journal-title":"Resuscitation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e000183","DOI":"10.1136\/bmjpo-2017-000183","article-title":"Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: A systematic review and meta-analysis","volume":"16","author":"Patel","year":"2017","journal-title":"BMJ Paediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151623","DOI":"10.1016\/j.semperi.2022.151623","article-title":"Positive pressure ventilation at birth","volume":"46","author":"Foglia","year":"2022","journal-title":"Semin. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"F485","DOI":"10.1136\/archdischild-2014-306261","article-title":"Auditing documentation on delivery room management using video and physiological recordings","volume":"99","author":"Schilleman","year":"2014","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Root, L., van Zanten, H.A., den Boer, M.C., Foglia, E.E., Witlox, R., and Te Pas, A.B. (2019). Improving guideline compliance and documentation through auditing neonatal resuscitation. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00294"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/ijgo.12430","article-title":"Fresh Stillbirths and Severely Asphyxiated Neonates Represent a Common Hypoxic-ischemic Pathway","volume":"141","author":"Ersdal","year":"2018","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100298","DOI":"10.1016\/j.resplu.2022.100298","article-title":"Suctioning of clear amniotic fluid at birth: A systematic review","volume":"12","author":"Fawke","year":"2022","journal-title":"Resusc. Plus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"110816","DOI":"10.1016\/j.resuscitation.2025.110816","article-title":"Neonatal Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations","volume":"215","author":"Liley","year":"2025","journal-title":"Resuscitation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1136\/bmj.38629.587639.7C","article-title":"Classification of stillbirths by relevant condition at death (ReCoDe): Population based cohort study","volume":"331","author":"Gardosia","year":"2005","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Peven, K., Day, L.T., Ruysen, H., Tahsina, T., Kc, A., Shabani, J., Kong, S., Ameen, S., Basnet, O., and Haider, R. (2021). EN-BIRTH Study Group. Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study. 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