- Copyright © 2010 by the American Academy of Pediatrics
Seizing the “golden minute” after birth can mean the difference between life and death for infants. A new program called Helping Babies Breathe is setting out to improve birth rates in developing countries, focusing on what happens during those first 60 seconds of life when a newborn is not breathing.
Every year, 940,000 die of intrapartum-related neonatal deaths, 99% in developing countries without medical assistance, according to the World Health Organization (WHO). Helping Babies Breathe is working to change that statistic and achieve a WHO goal to reduce child mortality worldwide by two-thirds by 2015.
The program, which launched during the International Conference on Global Health June13 in Washington, D.C., is a collaboration of the Academy, the U.S. Agency for International Development, the Saving Newborn Lives initiative of Save the Children, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), with materials provided by Laerdal Medical AS. These organizations have committed to reducing the newborn mortality rate across the globe by training birth attendants in developing countries in the essential skills of newborn resuscitation.
“There’s a high level of enthusiasm because (Helping Babies Breathe) fills a gap in education and a gap in services provided to newborn babies,” said William Keenan, M.D., FAAP, co-chair of the Helping Babies Breathe Global Implementation Task Force and AAP medical director, International Affairs.
Jeffrey M. Perlman, M.B., Ch.B., FAAP (left), Helping Babies Breathe Global Implementation Task Force member, and A. Udaya Thomas of Jhpiego – Innovating to Save Lives, Baltimore, observe as Arthur Munfungwa Ngoy, of St. Joseph Hospital, Dominican Republic of the Congo, applies a mask and delivers room air to the newborn simulator during the Master Trainer program in Washington, D.C.
Helping Babies Breathe trains birth attendants to use just a few simple tools and techniques to assess a newborn in the first golden minute of life to determine if the baby is breathing well or must be ventilated with a bag and mask. The aim of the program is to have at least one person skilled in neonatal resuscitation at the birth of every baby.
A durable, easy-to-use training simulator was developed by Laerdal to complement educational materials, and it will be provided at a very low cost to developing countries.
Growth of a program
Successful pilot testing was completed in Bangladesh, India, Kenya, Pakistan and Tanzania. The next goal is to roll out the program to between 15 and 20 countries globally, by using established links with a core planning team in each of the governments, ministries of health and other contacts in developing countries.
Master trainers designated in each country will train others, oversee data collection and act as a liaison between the country and the core planning team. New facilitators (birth attendants trained to train others) teach the program to other birth attendants in the community.
“Helping Babies Breathe is a natural outgrowth of the highly successful Neonatal Resuscitation Program that has saved so many children around the world. The AAP is continuing its great tradition in intervening in a major problem that claims the lives of between 1 and 2 million infants a year,” said AAP President Judith S. Palfrey, M.D., FAAP, who was among the 100 people from around the world who completed the Master Trainer program in Washington, D.C.
The evidence-based curriculum is adaptable to clinical and training use wherever babies are born and is based on the 2005 International Liaison Committee on Resuscitation Consensus on Science and Treatment Recommendations.
“There is a major emphasis on scaling up the program to benefit as many people and support policy and program development on a lasting and sustainable basis,” said Steve Wall, M.D., FAAP, senior adviser of Saving Newborn Lives at Save the Children, which assisted in technical review of the educational materials.
Back to basics
What makes the teaching materials unique is their ease of use. Birth attendants can follow a pictorial action plan algorithm step by step. Previous programs were too complex and required a high level of advanced skills, Dr. Wall said.
“Physicians attend very few deliveries and are not the major provider in low resource settings in countries where there’s high neonatal mortality,” he said.
Experts working in low resource countries have adapted the Neonatal Resuscitation Program materials with varying levels of success, said Dr. Keenan. “We had the opportunity to take all of that expertise and (those) international experiences to make a program tailored to the resource limited parts of the world,” he said.
Helping Babies Breathe will be one of the first well-monitored worldwide interventions, according to Linda Wright, M.D., FAAP, deputy director, Center for Research for Mothers and Children and director, Global Network for Women’s and Children’s Health Research at NICHD. NICHD is developing a framework to track outcomes and monitor quality of the program.
“It is very cutting edge because we are using new materials, we’re resuscitating with room air — which has increasingly gotten favorable reviews from neonatologists in the United States — and we’re primarily using stimulation first,” said Dr. Wright.
What’s being applied overseas also can help educators in the United States, said Dr. Wright. “We’ve taken a practice that’s worked and improved it more so by simplifying it. We should all be really proud as pediatricians that we have made this possible.”
Accolades
Helping Babies Breathe was recognized as an “outstanding program which has resulted in significant benefit to American society” and selected for the 2010 Award of Excellence from the ASAE and the Center for Association Leadership.
ASAE and the Center for Association Leadership is a joint organization for association professionals.
Friends of the section
Know of a pediatrician living abroad who, for economic reasons, cannot join the Academy as an AAP International member?
The AAP Section on International Child Health (SOICH) has an opportunity for those pediatricians living in countries classified as lower-middle and low-income categories by the World Bank to connect and interact with SOICH members. Friends of the Section can participate in the AAP international listserv and receive the SOICH newsletter electronically.
For details, visit www.aap.org/sections/ich/default.cfm or e-mail alule{at}aap.org.
Resource
For more information about Helping Babies Breathe and to access materials and the pictorial algorithm, visit www.helpingbabiesbreathe.org.
