the helping babies breathe program - wilson center. george little...the helping babies breathe...
TRANSCRIPT
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The Helping Babies Breathe Program
George A. Little MD Geisel Medical School at Dartmouth
Hanover, NH USA
Wilson Center Washington
September 30, 2014
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An evidence-based neonatal resuscitation curriculum for
resource poor areas
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Where do most neonatal deaths occur?
Oestergaard et al. PLoS Med 2011
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Global causes of neonatal death
UNICEF 2007 Lee, Wall, Cousens et al. Int J Epidemiol
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What causes neonatal death?
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Stillbirths
• Lawn JE, Blencowe H, Pattinson R, Cousen S, Kumar R, et al (2011)
Stillbirths: Where, When, Why? How to make the data count. Lancet 377: 1448-1463
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Annual Global Deaths
• 7.7 million children under 5 years • 3.1 million neonatal • 800,000 intrapartum asphyxia related
• 1.0 million stillbirths
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1990 1995 2000 2005 2009 2015
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Under-five mortality rate (UN) Under-five mortality rate (IHME)
Neonatal mortality rate (UN) Neonatal mortality rate (IHME)
MDG 4
Ref: Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: U5MR (UN): www.childinfo.org / www.childmortality.org and NMR (UN): Oestergaard et al 2011 PLoS updated for 2010 3.1 million neonatal deaths, 40% of all under-five deaths
Global Progress to MDG 4 for child survival
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Basic Strategy of HBB
• Evidence Based Medical Action Plan
• Educational curriculum and teaching
methodology
• Clinical and teaching equipment
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Primary Concepts of the Science of Neonatal
Resuscitation
• Asphyxia (intrapartum hypoxia)
• Primary and secondary apnea
• Recovery
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Evidence Based Medical Action Plan
• Targeted at the most common neonatal intrapartum problems
• Linked to advanced neonatal care if available
• Designed for use in all places where babies are born
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Action Plan
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Routine Care • Clearing the airway if
meconium present • Drying infant • Recognize crying • Keeping warm • Cutting the umbilical
cord • Encouraging
breastfeeding
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The Golden Minute ® • Recognizing infant
not crying • Positioning head • Clearing the airway • Stimulating • Recognizing
breathing • Initiating ventilation
by 1 minute
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Basic Strategy of HBB
• Evidence Based Medical Action Plan
• Educational curriculum and teaching
methodology
• Clinical and teaching equipment
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Educational curriculum and teaching methodology
• Targeted at all levels of care providers
• Based on teacher-learner pairs
• Knowledge and skill assessments
• TOT cascade implementation
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Paired Learning/Teaching
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Hands on Practice
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Basic Strategy of HBB
• Evidence Based Medical Action Plan
• Educational curriculum and teaching
methodology
• Clinical and teaching equipment
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Flipchart
Workbook
Simulator
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Source: Helping Babies Breathe July 2012 progress report
Helping Babies Breathe is now in 48 countries
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Implementation
Designed to be integrated into Essential Newborn Care (ENC) or equivalent
Intended to be an evidence-based focus
of excellence and change agent
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Helping Babies Survive
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Helping Babies Survive Essential Newborn Care on the First Day
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Essential Care for Every Baby materials
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Present and Future Challenges
Program sustainability
Quality assessment and improvement