Helping Babies Breathe

a global educational program in neonatal resuscitation *

Helping Babies Breathe

Target of Helping Babies BreatheLawn JE et al. IJGO 2009; 107:S51.02 million stillbirths due to asphyxia830,000 neonatal deaths due to asphyxia*

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

Need for help to breathe at birth*

Evidence base and Evaluation*Scientific evidence baseInternational consensus on science (ILCOR)Revision every 6 years

Harmonization with international health policyWHO technical expert reviewDelphi panel

World Health OrganizationBasic resuscitation guidelines (in revision)Hand washingBreastfeedingContext of ENCHelping Babies Breathe

Helping Babies Breathe*

Action PlanPlan*

Helping Babies Breathe

Preparation for Birth

Identifying a helper and reviewing the emergency planPreparing the are for deliveryHand washingPreparing and area for ventilation and checking equipment*

Helping Babies BreatheRoutine Care

Drying thoroughlyKeeping warmEvaluating cryingChecking breathingClamping or typing and cutting the cord

*

Helping Babies Breathe*The Golden Minute

Positioning the headClearing the AirwayProviding stimulation to breatheEvaluating breathingInitiating ventilationVentilating with bag and mask

Helping Babies BreatheContinued ventilation with normal or slow heart rate

Improving ventilationEvaluating heart rateActivating the emergency planSupport Family*

EvaluationFormative Evaluation

Content/Methodology/EducationalKenyaPakistan

Helping Babies Breathe

Training of Master TrainersTraining of a facilitator and learners

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

*Graphic linkage of Action Plan, flipchart, learner workbook

*Flipchart image for learner and instructional guide for facilitator

Peer learning/teaching*

Case scenarios conducted independently by learner pairs*

Helping Babies Breathe*Course assessmentAll HBB training participantMaster Trainers & Facilitators after teachingKnowledge assessmentMultiple Choice Questionnaire (pre- and post-training)Skills and Performance assessmentBag-and-mask skills assessment (pre and post)OSCE A (post only)OSCE B (post only)Qualitative assessmentFocus Group Discussions

Results

(Likerts scale) Facilitators

*Helping Babies Breathe

KenyaPakistanTraining to lead a course54.73Course materials4.84.3I can help baby breathe4.854.55Group will help babies breathe4.754.9

Helping Babies Breathe*Learners

KenyaPakistanCourse Content4.454.80I can use Action Plan4.434.64I can help babies breathe4.584.70

Knowledge Assessment*

PreKenyaPostKenyaPostPakistanT-testFacilitators20.5Pass: 75%22.3Pass: 95%20.2Pass: 82%P < .01Learners14.02%19.554%19.552%P < .001

Skills Assessment*

Bag-and-mask ventilation skillsMaster = 12/12 steps correctPreKenyaPostKenyaPostPakistanT-testFacilitators2.0Pass: 0%10.5Pass: 31%11.8Pass: 48%P < .00001

Learners.170&9.415%917%P < .00001

Item missed most frequently: ventilate at 40 breaths per minute watch for chest rise

Performance Assessment*

Objective Structured Clinical Evaluation (OSCE post-HBB training only)OSCE A (11 items) pass = 3 critical items and 80% overallOSCE B (22 items) pass = 9 critical items and 80% overall OSCE AKenyaOSCE APakistanOSCE BKenyaOSCE APakistanFacilitators8.950%8.36100%19.370%17.6445%Learners9.1Pass: 60%8.32Pass: 83%15.8Pass: 20%15.6Pass: 23%

Conclusions from Phase IHelping Babies BreatheIncreases 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.*

Helping Babies BreatheImplementation Field TestingIndiaTanzaniaKenyaBangladesh*

Results India*

Knowledge Assessment*HBB Trainers & Providers

Chart1

12.614.04

10.6813.33

9.3212.47

6.312

Pre Test

Post Test

Sheet1

Pre TestPost Test

Doctors - 12312.614.04

Nurses - 32110.6813.33

ANMs - 779.3212.47

TBAs - 36.312

To resize chart data range, drag lower right corner of range.

Helping Babies Breathe*

Pre-TrainingOct 2009 Mar 2010Post TrainingMar 2010 Oct 2010Deliveries41735427Live Births40465301Still Births124 (3%)123 (2.3%)Deaths at Birth33

*Helping Babies Breathe

Pre Trainingn(%)Post Trainingn(%)Body breathing at 1 minute118 (2.8)266 (4.9)Resuscitation Required1218 (29.2)645 (11.9)Stimulation666 (16)491 (9)Suction1113 (26.7)594 (10)Bag & Mask124 (3)219 (4)Bag & Mask started < 1 minute92 (2.2)144 (2.7)

Conclusions

Better recognition of babies not breathing at birthStill births decreasedNeonatal deaths remained unchangedNeed for specific resuscitation decreased*Helping Babies Breathe

Summary

Program well receivedImproves knowledgeImproves skillsClinical impact needs further study*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 learningHelping Babies Breathe*

Babies acknowledge the support ofAmerican Academy of Pediatrics (AAP)United States Agency for International Development (USAID)Laerdal MedicalLaerdal Foundation for Acute MedicineSaving Newborn Lives (SNL)Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)World Health Organization (WHO)Helping Babies Breathe*

Thank YouNalini Singhal, Calgary Canada

Millennium Development Goal 4 Reduce under-5 child deaths 2/3 from 1990 levels by 2015Lawn JE et al. Lancet 2005

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

The World of Physicians Workingwww.worldmapper.org 2002*

The World of Physicians Workingwww.worldmapper.org 2002*

Regional rates of neonatal mortalityUNICEF, State of the Worlds Children 2009

*A babys first cry is one of the most anticipated and welcome sounds in all the world. But in much of the world, when there is no cry hopes are dashed. Too many times there is no one with the knowledge or the skills or the equipment to helpand a baby dies. This baby in Lesotho was born in a such a center and did not survive. ****Most common items missed in OSCE A for both Facilitators and Learners = Evaluate breathing and Position and clear airway.

Mixed causes for failure of OSCE B by Facilitators; Most common items missed by Learners = Selects appropriate sized mask and Ventilates at 40 breaths/mins.****