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

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.ISRCTN97846009The Millennium Development Goals 4 and 5, aimed respectively at reducing child mortality and improving maternal health, [1], are inextricably linked [2,3]. Improvements in maternal health will lead to reduction in intrapartum and newborn deaths. However, the progress towards reaching the goals by 2015 remains unsatisfactory since of the 68 Countdown countries only 19 are on track to achieve MDG 4 [4]. Though there has been significant progress in reducing the under-five mortality in the last decade, the rate of reduction in neonatal death has been relatively slow, with still more than 40% of child deaths occurring in the neonatal period [5,6]. One fourth of the death during the first four weeks of life is attributed to intrapartum-related hypoxia, “birth asphyxia”, also known as intrapartum related death [5,7,8].Nearly all (99%) intrapartum-related deaths occur in low and middle income countries with 60 million births each year outside health facilities and up to one-half without a skilled birth attendant [9,10]. Every year, approximately 904,000 intrapartum-related neonatal deaths and 1.02 million intrapartum stillbirths [11] occur globally, with intrapartum-related conditions making u