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a global educational program in neonatal resuscitation. Helping Babies Breathe. 1. Hel p ing Babies Breathe. Target of Helping Babies Breathe. 1.02 million stillbirths due to asphyxia. 830,000 neonatal deaths due to asphyxia. Lawn JE et al. IJGO 2009; 107:S5. 3. Circumstances at Birth.
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a global educational program in neonatal resuscitation Helping Babies Breathe 1
Target of Helping Babies Breathe 1.02 million stillbirths due to asphyxia 830,000 neonatal deaths due to asphyxia Lawn JE et al. IJGO 2009; 107:S5 3
Circumstances at Birth Wall SN, et al. IJGO 2009; 107:S47 4
Assessment at birth and routine care Drying, warmth, clearing the airway, stimulation Bag and mask ventilation Chest compressions, medications Need for help to breathe at birth 80-90% 8-10% 3-6% < 1 5
Evidence base and Evaluation • Scientific evidence base • International consensus on science (ILCOR) • Revision every 6 years • Harmonization with international health policy • WHO technical expert review • Delphi panel 6
Helping Babies Breathe • World Health Organization • Basic resuscitation guidelines (in revision) • Hand washing • Breastfeeding • Context of ENC
Helping Babies Breathe Preparation for Birth Identifying a helper and reviewing the emergency plan Preparing the are for delivery Hand washing Preparing and area for ventilation and checking equipment 10
Helping Babies Breathe Routine Care Drying thoroughly Keeping warm Evaluating crying Checking breathing Clamping or typing and cutting the cord 11
Helping Babies Breathe The Golden Minute Positioning the head Clearing the Airway Providing stimulation to breathe Evaluating breathing Initiating ventilation Ventilating with bag and mask 12
Helping Babies Breathe Continued ventilation with normal or slow heart rate Improving ventilation Evaluating heart rate Activating the emergency plan Support Family 13
Evaluation Formative Evaluation Content/Methodology/Educational • Kenya • Pakistan
Helping Babies Breathe • Training of Master Trainers • Training of a facilitator and learners
Learner pair + neonatal simulator6:1 learner-to-facilitator ratio 16
Graphic linkage of Action Plan, flipchart, learner workbook 17
Flipchart image for learner and instructional guide for facilitator 18
Helping Babies Breathe • Course assessment • All HBB training participant • Master Trainers & Facilitators after teaching • Knowledge assessment • Multiple Choice Questionnaire (pre- and post-training) • Skills and Performance assessment • Bag-and-mask skills assessment (pre and post) • OSCE A (post only) • OSCE B (post only) • Qualitative assessment • Focus Group Discussions 21
Helping Babies Breathe (Likert’s scale) Facilitators 23
Helping Babies Breathe Learners 24
Conclusions from Phase I Helping Babies Breathe • Increases knowledge of immediate care at birth and interventions to help babies who do not breathe. • Improves bag-and-mask ventilation (BMV) skills. • Improves the ability of birth attendants in the resource-limited setting to manage both simple (OSCE A) and complicated (OSCE B) cases of newborns who do not breathe spontaneously. 28
Helping Babies Breathe Implementation Field Testing India Tanzania Kenya Bangladesh 29
Knowledge Assessment HBB Trainers & Providers 31
Helping Babies Breathe Conclusions • Better recognition of babies not breathing at birth • Still births decreased • Neonatal deaths remained unchanged • Need for specific resuscitation decreased 34
Helping Babies Breathe Summary • Program well received • Improves knowledge • Improves skills • Clinical impact needs further study 35
Helping Babies Breathe • Sustainability • Simple • Evidence based • Low-cost and effective • Easy to integrate • Hands on • Empowers the learner • Higher level of learning • Promotes life long learning 36
Helping Babies Breathe Babies acknowledge the support of • American Academy of Pediatrics (AAP) • United States Agency for International Development (USAID) • Laerdal Medical • Laerdal Foundation for Acute Medicine • Saving Newborn Lives (SNL) • Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) • World Health Organization (WHO) 37
Thank You Nalini Singhal, Calgary Canada
150 Under-5 mortality rate Early neonatal mortality Late neonatal mortality 100 Global mortality per 1000 births 50 Target for MDG-4 0 1960 1980 2000 2020 Year Millennium Development Goal 4 Lawn JE et al. Lancet 2005 Reduce under-5 child deaths 2/3 from 1990 levels by 2015
Global causes of neonatal death UNICEF 2007 Lee ACC, et al. Int J Epidemiol (inpress)
The World of Physicians Working www.worldmapper.org 2002 41
The World of Physicians Working www.worldmapper.org 2002 42
Regional rates of neonatal mortality UNICEF, State of the World’s Children 2009