Open Access Highly Accessed Study protocol

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival

Ashish KC12*, Mats Målqvist1, Johan Wrammert1, Sheela Verma3, Dhan Raj Aryal3, Robert Clark4, Naresh P KC5, Ravi Vitrakoti3, Kedar Baral6 and Uwe Ewald1

Author Affiliations

1 International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

2 Population Service International, Kathmandu, Nepal

3 Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal

4 Latter Day Saints Charity, Salt Lake City, USA

5 Ministry of Health and Population, Kathmandu, Nepal

6 Patan Academy of Health Sciences, Patan, Nepal

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BMC Pediatrics 2012, 12:159  doi:10.1186/1471-2431-12-159

Published: 5 October 2012



Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.


The study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention.


Along with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.

Trial registration