Neonatal Nursing and Helping Babies Breathe: An Effective Intervention to Decrease Global Neonatal Mortality

Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal

To reduce neonatal mortality attributable to intrapartum hypoxic events, Latter-days Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a neonatal resuscitation training, scale-up, and skill retention program. This article reports on the LDSC/SSN dissemination program and newborn outcomes associated with its implementation. To evaluate the program, we used a prospective cohort design to compare outcomes of birth cohorts in 87 health facilities preimplementation and postimplementation of the facility-based training. A paired T-test was used to determine whether baseline and endline values were significantly different. Resuscitation training began with trainers from 191 facilities attending Helping Babies Breathe (HBB) training-of-trainer (ToT) courses. Thereafter, 87 facilities from five provinces received active mentoring, scale-up assistance (6389 providers trained), and skill retention support. The LDSC/SSN program was associated with decreases in the number of intrapartum stillbirths in all provinces except Bagmati. Neonatal deaths within 24 hours of birth decreased significantly in Lumbini, Madhesh, and Karnali provinces. Morbidity associations, as defined by sick newborn transfers, decreased significantly in Lumbini, Gandaki, and Madhesh provinces. The LDSC/SSN model of neonatal resuscitation training, scale-up, and skill retention has the potential to significantly improve perinatal outcomes. It could potentially guide future programs in Nepal and other resource-limited settings.

Bridging the gap in neonatal resuscitation in Zambia

Neonatal resuscitation has been poorly instituted in many parts of Africa and most neonatal resuscitation algorithms are adapted from environments with abundant resources. Helping Babies Breathe (HBB) is an algorithm designed for resource-limited situations and most other algorithms are designed for resource-rich countries. However, there are neonatal referral centers in resource-limited countries who may provide more advanced resuscitation. Thus, we developed a neonatal resuscitation algorithm for a resource-limited country (Zambia) which considers more advanced interventions in situations where they can be provided. The algorithm described in this paper is based on the Newborn Life Support algorithm from the UK as well as the HBB algorithm and accounts for all situations in a resource-limited country. Most importantly, it focuses on non-invasive ventilation but includes advice on more advanced resuscitation including intravenous access, fluid management, chest compressions and adrenaline for resuscitation. Although intubation skills are included in neonatal training workshops, it is not the main focus of the algorithm as respiratory support equipment is scarce or lacking in most health facilities in Zambia. A home-grown neonatal resuscitation algorithm for a resource-limited country such as Zambia is likely to bridge the gap between limited situations requiring only bag and mask ventilation and better equipped institutions where more advanced resuscitation is possible. This algorithm will be rolled out in all training institutions and delivery facilities across Zambia over the next months.

Assessing the effectiveness of newborn resuscitation training and skill retention program on neonatal outcomes in Madhesh Province, Nepal

Intrapartum events leading to asphyxia at birth are among the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation competencies. The effectiveness of HBB trainings has been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from Latter-day Saint Charities (LDS Charities) designed an initiative for scaling up newborn resuscitation training and skills maintenance over time. This paper reports on the implementation of the SSN model of newborn resuscitation trainings and skill retention, and the changes in perinatal outcomes that occurred after the program. The program built capacity among facility-based trainers for the scale up and maintenance of resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external Mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. Data was gathered on the neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in neonatal deaths under 24 hours of life (p<0.001), intrapartum stillbirths (p<0.001), and the number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported ongoing skill retention. The SSN model for newborn resuscitation training and skills retention is a low-cost, evidence-based program focusing on facility-based trainers who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.

Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

Background

Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan.

Method

A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran’s Q tests were applied for data analysis. Participants’ feedback was also obtained at the end of each training, which was analyzed through descriptive statistics.

Results

Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected.

Conclusion

The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Achieving Country-Wide Scale for Helping Babies Breathe and Helping Babies Survive

Helping Babies Breathe (HBB) was piloted in 2009 as a program targeted to reduce neonatal mortality (NM). The program has morphed into a suite of programs termed Helping Babies Survive that includes Essential Care for Every Baby. Since 2010, the HBB and Helping Babies Survive training programs have been taught to >850 000 providers in 80 countries. Initial HBB training is associated with a significant improvement in knowledge and skills. However, at refresher training, there is a knowledge-skill gap evident, with a falloff in skills. Accumulating evidence supports the role for frequent refresher resuscitation training in facilitating skills retention. Beyond skill acquisition, HBB has been associated with a significant reduction in early NM (<24 hours) and fresh stillbirth rates. To evaluate the large-scale impact of the growth of skilled birth attendants, we analyzed NM rates in sub-Saharan Africa (n = 11) and Nepal (as areas of growing HBB implementation). All have revealed a consistent reduction in NM at 28 days between 2009 and 2018; a mean reduction of 5.34%. The number of skilled birth attendants, an indirect measure of HBB sustained rollout, reveals significant correlation with NM, fresh stillbirth, and perinatal mortality rates, highlighting HBB's success and the need for continued efforts to train frontline providers. A novel live newborn resuscitation trainer as well as a novel app (HBB Prompt) have been developed, increasing knowledge and skills while providing simulation-based repeated practice. Ongoing challenges in sustaining resources (financial and other) for newborn programming emphasize the need for innovative implementation strategies and training tools.

Implementation of the Helping Babies Breathe Training Program: A Systematic Review

CONTEXT

Helping Babies Breathe (HBB) is a well-established neonatal resuscitation program designed to reduce newborn mortality in low-resource settings.

OBJECTIVES

In this literature review, we aim to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming.

DATA SOURCES

Databases used in the systematic search included Medline, POPLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, African Index Medicus, Cochrane, and Index Medicus.

STUDY SELECTION

All articles related to HBB, in any language, were included. Article quality was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation framework.

DATA EXTRACTION

Data were extracted if related to HBB, including its implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, or the impact on newborn outcomes.

RESULTS

Ninety-four articles met inclusion criteria. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Researchers of several studies found HBB cost-effective. Posttraining decline in knowledge and skills can be prevented with low-dose high-frequency refresher trainings, on-the-job practice, or similar interventions. Impact of HBB training on provider clinical practices varies. Although not universal, researchers in multiple studies have shown a significant association of decreased perinatal mortality with HBB implementation.

LIMITATIONS

In addition to not conducting a gray literature search, articles relating only to Essential Care for Every Baby or Essential Care for Small Babies were not included in this review.

CONCLUSIONS

Key challenges and requirements for success associated with each stage of HBB programming were identified. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.

Influence of Neonatal Resuscitation Training on Practice of Community Health Extension Workers in Managing Asphyxiated Newborns in Rural Nigeria: A Qualitative Study

Birth asphyxia is a global health burden, and effective neonatal resuscitation could reduce the burden of deaths. Providing a suitable newborn resuscitation care will depend on the availability of an effective skilled health worker, who is competent in neonatal resuscitation. The study explores and assesses the effect of neonatal resuscitation training and retention of knowledge and skills in the management of asphyxiated newborns in rural Nigeria. This study used a narrative analysis technique to analyze data from a semistructured, individual interview. Data were analyzed using ATLAS.ti 8 qualitative software and applying the principle of thematic analysis. There was a considerable retention of knowledge and ability to practice the procedure even though some equipment was not available. Proficiency in neonatal resuscitation is an essential intervention for the survival of newborns and infants. Therefore, execution of neonatal resuscitation training program in rural communities can further improve knowledge and skills of community birth attendants in Nigeria.

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

Background

Birth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia.

Method

We used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge.

Results

The finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09–3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate.

Conclusion

Only half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment’s. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review

OBJECTIVE

The objective of this review was to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills.

INTRODUCTION

The Helping Babies Survive program consists of three modules: Helping Babies Breathe, Essential Care for Every Baby, and Essential Care for Small Babies. It was developed to reduce preventable newborn deaths through skill-based learning using simulation, learning exercises, and peer-to-peer training of healthcare providers in low-resource areas. Despite the widespread increase in healthcare provider training through Helping Babies Survive and the growing number of studies that have been conducted, there has been no systematic review of the Helping Babies Survive program to date.

INCLUSION CRITERIA

The review included studies on healthcare providers and/or birth attendants providing essential neonatal care during and post birth. Types of interventions were any Helping Babies Survive module (Helping Babies Breathe, Essential Care for Every Baby, Essential Care for Small Babies). Studies including experimental study designs with the following outcomes were considered: neonatal outcomes and/or healthcare provider knowledge and skills obtained, maintained, and used over time.

METHODS

PubMed, Embase, Web of Science, ProQuest Databases, Scopus and CINAHL were searched for published studies in English between January 2010 to December 2016. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Conflicts were solved through consensus with a third reviewer. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. Conflicts were solved through consensus with a third reviewer. Quantitative data was, where possible, pooled in statistical meta-analysis using RevMan (Copenhagen: The Nordic Cochrane Centre, Cochrane). Where statistical pooling was not possible the findings have been reported narratively.

RESULTS

A total of 17 studies were identified - 15 on Helping Babies Breathe (n = 172,685 infants and n = 2,261 healthcare providers) and two on Essential Care for Every Baby (n = 206 healthcare providers). No studies reported on Essential Care for Small Babies. Helping Babies Survive was found to significantly reduce fresh stillbirth rates and first day mortality rates, but was not found to influence stillbirth rates or mortality rates, measured at seven or 28 days post birth. Short-term improvements were significant in knowledge and skills scores but not significant in sustainability over time. Additionally, implementation of resuscitations skills in clinical practice related to the Helping Babies Breathe module including drying/stimulation, suction, and bag and mask ventilation did not show a significant increase after training even though the number of fresh stillbirth and first-day mortality rate decreased.

CONCLUSIONS

Helping Babies Survive has a significant positive impact on early neonatal outcomes, including fresh stillbirth and first-day mortality primarily through Helping Babies Breathe, but limited conclusions can be drawn about its impact on other neonatal outcomes. While Helping Babies Survive was found to improve immediate knowledge and skill acquisition, there is some evidence that one-time training may not be sufficient for sustained knowledge or the incorporation of key skills related to resuscitation into clinical practice. Continued research on the sustained knowledge and skills is needed to evaluate the long-term impact of the Helping Babies Survive program.

Baby-directed umbilical cord clamping: A feasibility study

INTRODUCTION

Over five percent of infants born worldwide will need help breathing after birth. Delayed cord clamping (DCC) has become the standard of care for vigorous infants. DCC in non-vigorous infants is uncommon because of logistical difficulties in providing effective resuscitation during DCC. In Baby-Directed Umbilical Cord Clamping (Baby-DUCC), the umbilical cord remains patent until the infant's lungs are exchanging gases. We conducted a feasibility study of the Baby-DUCC technique.

METHODS

We obtained antenatal consent from pregnant women to enroll infants born at ≥32 weeks. Vigorous infants received ≥2 min of DCC. If the infant received respiratory support, the umbilical cord was clamped ≥60 s after the colorimetric carbon dioxide detector turned yellow. Maternal uterotonic medication was administered after umbilical cord clamping. A paediatrician and researcher entered the sterile field to provide respiratory support during a cesarean birth. Maternal and infant outcomes in the delivery room and prior to hospital discharge were analysed.

RESULTS

Forty-four infants were enrolled, 23 delivered via cesarean section (8 unplanned) and 15 delivered vaginally (6 via instrumentation). Twelve infants were non-vigorous. ECG was the preferred method for recording HR. Two infants had a HR < 100 BPM. All HR values were >100 BPM by 80 s after birth. Median time to umbilical cord clamping was 150 and 138 s in vigorous and non-vigorous infants, respectively. Median maternal blood loss was 300 ml.

CONCLUSIONS

It is feasible to provide resuscitation to term and near-term infants during DCC, after both vaginal and cesarean births, clamping the umbilical cord only when the infant is physiologically ready.

Respiratory changes in term infants immediately after birth

INTRODUCTION

Over 5% of infants worldwide receive breathing support immediately after birth. Our goal was to define references ranges for exhaled carbon dioxide (ECO₂), exhaled tidal volume (VTe), and respiratory rate (RR) immediately after birth in spontaneously breathing, healthy infants born at 36 weeks' gestational age or older.

METHODS

This was a single-centre, observational study at the Royal Women's Hospital in Melbourne, Australia, a busy perinatal referral centre. Immediately after the infant's head was delivered, we used a face mask to measure ECO₂, VTe, and RR through the first ten minutes after birth. Respiratory measurements were repeated at one hour.

RESULTS

We analysed 14,731 breaths in 101 spontaneously breathing infants, 51 born via planned caesarean section and 50 born vaginally with a median (IQR) gestational age of 39^1/7 weeks (38^3/7-39^5/7). It took a median of 7 (4-10) breaths until ECO₂ was detected. ECO₂ quickly increased to peak value of 48 mmHg (43-53) at 143 s (76-258) after birth, and decreased to post-transitional values, 31 mmHg (28-24), by 7 min. VTe increased after birth, reaching a plateau of 5.3 ml/kg (2.5-8.4) by 130 s for the remainder of the study period. Maximum VTe was 19 ml/kg (16-22) at 257 s (82-360). RR values increased slightly over time, being higher from minute five to ten as compared to the first two minutes after birth.

CONCLUSIONS

This study provides reference ranges of exhaled carbon dioxide, exhaled tidal volumes, and respiratory rate for the first ten minutes after birth in term infants who transition without resuscitation.

Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study

Background

About three – quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital.

Methods

Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics.

Results

Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h.

Conclusions

Mentorship and regular cost – effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR.

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1127-6) contains supplementary material, which is available to authorized users.

The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review protocol

REVIEW OBJECTIVE/QUESTION

The objective of this review is to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills. This quantitative review will aim to answer the following question: What is the impact of the Helping Babies Survive modules (Helping Babies Breathe, Essential Care for Every Baby and Essential Care for Small Babies) on neonatal outcomes and health provider knowledge and skills?

Quality of Care during Neonatal Resuscitation in Kakamega County General Hospital, Kenya: A Direct Observation Study

Background

Birth asphyxia is the leading cause of neonatal mortality in Kenya. Quality care during neonatal resuscitation (NR) can contribute to a reduction in neonatal mortality related to birth asphyxia by 30 percent. This study assessed the quality of care (QoC) during NR for newborns with birth asphyxia.

Methods

Direct observations of 138 newborn resuscitations were done in labor ward and maternity theatre. Twenty-eight healthcare providers were observed 3–5 times using a structured checklist. Descriptive and inferential statistics were calculated and quality of care scores computed. Ordered logistic regression model identified HCPs characteristics associated with the QoC scores during NR.

Results

Overall QoC scores were good for airway clearance (83%). Suctioning in meconium presence (40%) was poorly performed. Years of experience working in maternity were associated with good drying/stimulation (β = 1.86, P = 0.003, CI = 0.626–3.093) and airway maintenance (β = 1.887, P = 0.009, CI = 0.469–3.305); nurses were poor compared to doctors during initial bag and mask ventilation (β = −2.338, P = 0.05, CI = −4.732–0.056).

Conclusion

Key steps in NR are poorly performed during drying and warmth, airway maintenance in meconium presence, and ventilation. Mentorship with periodic refresher training can improve the care provided during NR.

Helping Babies Breathe implementation in Zanzibar, Tanzania

AIM

To assess the efficacy and feasibility of implementing Helping Babies Breathe, a neonatal resuscitation programme for resource-limited environments.

BACKGROUND

This quality improvement project focused on training midwives on Helping Babies Breathe to address high rates of neonatal mortality secondary to birth asphyxia.

METHODS

The convenience sample was 33 midwives in Zanzibar, Tanzania. The train-the-trainer strategy with repeated measures design was used to assess knowledge and skills at 3 time points. Observations were completed during "real-time" deliveries, and a focused interview generated feedback regarding satisfaction and sustainability.

RESULTS

Knowledge scores and resuscitation skills significantly improved and were sustained, P < .05. Of the 62 birth observations, 19% needed intervention. All were appropriately resuscitated and survived.

CONCLUSION

Results indicate that participants retained knowledge and skills and used them in clinical practice. Observations demonstrated that participants took appropriate actions when presented with a baby who was not breathing.

Neonatal resuscitation training for midwives in Uganda: Strengthening skill and knowledge retention

The objective of this project was to improve birth outcomes for babies in a regional referral hospital in Uganda by strengthening factors that influence the retention and application of neonatal resuscitation skills. Initial training in neonatal resuscitation is not enough on its own. In order to better understand the gap between training and effective practice, an evaluation of a neonatal resuscitation program was carried out. This included practical skill testing of local midwives using a neonatal resuscitation doll pre- and post-training, as well as follow up testing at 1 month and 12 months, followed by focus groups and interviews. Test scores revealed that participants' knowledge grew significantly immediately following the workshop, and remained high after 1 month, but fell by 12 months post-training. Interviews with hospital staff revealed a number of facilitators and barriers to practice, namely knowledge retention and skill application. The most important barrier identified is the lack of refresher training post-workshop. Importantly, the findings demonstrated a need not for refresher training alone, but for improved organizational and administrative support for the newly assigned trainers.

Helping babies breathe around the world

Helping Babies Breathe (HBB) is an educational curriculum using the train-the-trainer model to teach neonatal resuscitation in resource limited areas. The purpose of this evidence-based program is to reduce global neonatal mortality by educating birth attendants to provide basic neonatal resuscitation. This program directly addresses the Millennium Developmental Goal #4 of reducing child mortality.

Addressing the challenge of neonatal mortality

Reducing neonatal mortality remains a challenge with an estimated 3.0 million neonatal deaths in 2011, three-quarters of these in sub-Saharan Africa and Southern Asia. The leading causes of neonatal death globally are complications of preterm birth, intrapartum-related causes and infections. While post-neonatal, under-5 deaths fell by 47% between 1990 and 2011, neonatal deaths only fell by 32% and they now account for 43% of all under-5 child deaths. This article reviews the progress in reducing neonatal deaths in high-burden countries and presents an overview of known effective interventions to reduce neonatal mortality and the challenges faced in implementing these in high-burden settings. Effective action is possible to reduce neonatal mortality, but innovative approaches to implementation will be required if these preventable deaths are to be avoided.

2013 Amendments to International Confederation of Midwive’s Essential Compentencies and Education Standards Core Documents: Clarification and Rationale

The International Confederation of Midwives (ICM) Council of Delegates approved the revision of the Essential Competencies for Basic Midwifery Practice and endorsed the newly crafted Global Standards for Midwifery Education with Companion Guidelines in June 2011. ICM views each of their documents as “living” documents, subject to change based on emerging evidence from science, implementation, and practice. This article informs the users of these two core documents about revisions and amendments that were made over the 3-year period from 2011 to 2013 in response to changing evidence, end-user questions, and concerns. The evidence that underpins the revisions made to the basic knowledge and/or skills statements in the Essential Competencies document is presented. The rationale for amendment to the format of the education standards and expansion of the guidelines document is offered. These changes were accepted by the ICM Board in 2013 and will be presented for endorsement by ICM Council of Delegates at the triennial meeting in Prague, Czech Republic, in June 2014.

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival

Background

Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. This study will assess the impact of a simplified neonatal resuscitation protocol provided by Helping Babies Breathe (HBB) at a tertiary hospital in Nepal. Perinatal outcomes and performance of skilled birth attendants on management of intrapartum-related neonatal hypoxia will be the main measurements.

Methods/Design

The study will be carried out at a tertiary level maternity hospital in Nepal. A prospective cohort-study will include a six-month baseline a six month intervention period and a three-month post intervention period. A quality improvement process cycle will introduce the neonatal resuscitation protocol. A surveillance system, including CCD cameras and pulse oximeters, will be set up to evaluate the intervention.

Discussion

Along with a technique to improve health workers performance on the protocol, the study will generate evidence on the research gap on the effectiveness of the simplified neonatal resuscitation protocol on intrapartum outcome and early neonatal survival. This will generate a global interest and inform policymaking in relation to delivery care in all income settings.

Trial registration

ISRCTN97846009