HelpingHelpingBabiesBabiesBreatheBreathe

Susan Niermeyer, MD, MPH, FAAPSusan Niermeyer, MD, MPH, FAAPUniversity of Colorado Denver University of Colorado Denver School of MedicineSchool of MedicineAurora, Colorado, USAAurora, Colorado, USA

The worldThe world

www.worldmapper.org 2002

The world of early neonatal deaths

www.worldmapper.org 2002

Regional rates of neonatal mortality

UNICEF, State of the World’s Children 2009

The world of physicians working of physicians working

www.worldmapper.org 2002

Inverted pyramid of neonatal resuscitation

MedicationsMedications

Chest CompressionsChest Compressions

Positive-Pressure VentilationPositive-Pressure Ventilation

Initial Steps: Drying, Warmth, Clearing Initial Steps: Drying, Warmth, Clearing the Airway, Stimulationthe Airway, Stimulation

Assessment at Birth and Simple Newborn CareAssessment at Birth and Simple Newborn CareAll infantsAll infants

Some infantsSome infants

Few infantsFew infants

Wall, Lee, Niermeyer et al. IJGO 2009

136 million babies born

Approx 10 million babies

Approx 6 million babies

< 1.4 million babies

Global Implementation Task ForceCollaborators

• World Health Organization (WHO)• Eunice Kennedy Shriver National

Institute of Child Health and Human Development (NICHD)

• United States Agency for International Development (USAID, MCHIP)

• Save the Children U.S. - Saving Newborn Lives (SNL)

Helping Babies Breatheevidence base

• International Liaison Committee on Resuscitation (ILCOR)– Neonatal Resuscitation: Consensus on Science

and Treatment Recommendations http://circ.ahajournals.org/cgi/content/full/ 112/22_suppl/III-91

• World Health Organization– Basic resuscitation guidelines (in revision)– Post-partum hemorrhage– Handwashing– Breast feeding

Action Plan

Helping Babies Breatheflipchart/simulator/learner workbook

Helping Babies Breathefacilitator flipchart

Flipchart image for learner and Flipchart image for learner and instructional guide for facilitatorinstructional guide for facilitator

Helping Babies Breathelearner workbook

Helping Babies Breathelearner workbook - exercises

Peer learning/teachingPeer learning/teaching

Extension to the clinical setting

• Clinical supervision

• Case audit

• Perinatal quality improvement

Bookman L et al. PAS 2009 2505.7

Singhal N, McMillan DD, Cristobal FL, et al. Health Care for Women Intl 2001; 22:569

Educational field trials

• Learner evaluation– Written/verbal knowledge check (MCQs)

– Bag and mask ventilation skill check– Case scenarios (OSCEs) – The Golden Minute

• Educational evaluation– Learner and facilitator questionnaires

• Materials – content, presentation, function• Satisfaction, self-efficacy

– Focus group discussions

Educational field trials - resultsEducational field trials - results• Learner evaluationLearner evaluation

– Gains in knowledge, skills, performance– Significant revisions of evaluation tools

• Educational evaluationEducational evaluation– High satisfaction, feasibility, self-efficacy– Strengths: Neonatal simulator

The Golden Minute Pictorial Action Plan and Flip Chart Check yourself questions

– Suggestions: More time for practice Simultaneous distribution of equipment/training Involvement of men in advocacy activities

Implementation field trialseducational outcomes

• Master trainer/facilitator/provider cascade followed by scale-up

• Learner evaluations of knowledge, skills, performance, competence (delivery room observation)

• Learner questionnaires and focus group discussions– Satisfaction, self-efficacy among different cadres

of providers

• Retention of knowledge, skills

Implementation field trialsclinical outcomes

• Time to spontaneous breathing• Intervention (routine, initial steps, PPV)

• Apgar score• Provider

• Skin-to-skin positioning• Breastfeeding in first 30 minutes• Need for special care/length of stay• Outcome: stillborn, neonatal death,

seizures, normal

Helping Babies BreatheHelping Babies Breathe