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