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Helping Babies Breathe

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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Helping Babies Breathe

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  1. a global educational program in neonatal resuscitation Helping Babies Breathe 1

  2. Helping Babies Breathe

  3. 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

  4. Circumstances at Birth Wall SN, et al. IJGO 2009; 107:S47 4

  5. 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

  6. 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

  7. Helping Babies Breathe • World Health Organization • Basic resuscitation guidelines (in revision) • Hand washing • Breastfeeding • Context of ENC

  8. Helping Babies Breathe 8

  9. Action PlanPlan 9

  10. 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

  11. Helping Babies Breathe Routine Care Drying thoroughly Keeping warm Evaluating crying Checking breathing Clamping or typing and cutting the cord 11

  12. 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

  13. Helping Babies Breathe Continued ventilation with normal or slow heart rate Improving ventilation Evaluating heart rate Activating the emergency plan Support Family 13

  14. Evaluation Formative Evaluation Content/Methodology/Educational • Kenya • Pakistan

  15. Helping Babies Breathe • Training of Master Trainers • Training of a facilitator and learners

  16. Learner pair + neonatal simulator6:1 learner-to-facilitator ratio 16

  17. Graphic linkage of Action Plan, flipchart, learner workbook 17

  18. Flipchart image for learner and instructional guide for facilitator 18

  19. Peer learning/teaching 19

  20. Case scenarios conducted independently by learner pairs 20

  21. 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

  22. Results

  23. Helping Babies Breathe (Likert’s scale) Facilitators 23

  24. Helping Babies Breathe Learners 24

  25. Knowledge Assessment 25

  26. Skills Assessment 26

  27. Performance Assessment 27

  28. 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

  29. Helping Babies Breathe Implementation Field Testing India Tanzania Kenya Bangladesh 29

  30. Results India 30

  31. Knowledge Assessment HBB Trainers & Providers 31

  32. Helping Babies Breathe 32

  33. Helping Babies Breathe 33

  34. 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

  35. Helping Babies Breathe Summary • Program well received • Improves knowledge • Improves skills • Clinical impact needs further study 35

  36. 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

  37. 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

  38. Thank You Nalini Singhal, Calgary Canada

  39. 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

  40. Global causes of neonatal death UNICEF 2007 Lee ACC, et al. Int J Epidemiol (inpress)

  41. The World of Physicians Working www.worldmapper.org 2002 41

  42. The World of Physicians Working www.worldmapper.org 2002 42

  43. Regional rates of neonatal mortality UNICEF, State of the World’s Children 2009

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