The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe...

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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

Transcript of The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe...

Page 1: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

The Helping Babies Breathe Program

George A. Little MD Geisel Medical School at Dartmouth

Hanover, NH USA

Wilson Center Washington

September 30, 2014

Page 2: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

An evidence-based neonatal resuscitation curriculum for

resource poor areas

Page 3: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Where do most neonatal deaths occur?

Oestergaard et al. PLoS Med 2011

Page 4: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Global causes of neonatal death

UNICEF 2007 Lee, Wall, Cousens et al. Int J Epidemiol

Page 5: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

What causes neonatal death?

Page 6: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson
Page 7: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

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

Page 8: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Annual Global Deaths

• 7.7 million children under 5 years • 3.1 million neonatal • 800,000 intrapartum asphyxia related

• 1.0 million stillbirths

Page 9: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

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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

Page 10: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Basic Strategy of HBB

• Evidence Based Medical Action Plan

• Educational curriculum and teaching

methodology

• Clinical and teaching equipment

Page 11: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Primary Concepts of the Science of Neonatal

Resuscitation

• Asphyxia (intrapartum hypoxia)

• Primary and secondary apnea

• Recovery

Page 12: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson
Page 13: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson
Page 14: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

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

Page 15: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Action Plan

Page 16: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Routine Care • Clearing the airway if

meconium present • Drying infant • Recognize crying • Keeping warm • Cutting the umbilical

cord • Encouraging

breastfeeding

Page 17: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

The Golden Minute ® • Recognizing infant

not crying • Positioning head • Clearing the airway • Stimulating • Recognizing

breathing • Initiating ventilation

by 1 minute

Page 18: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Basic Strategy of HBB

• Evidence Based Medical Action Plan

• Educational curriculum and teaching

methodology

• Clinical and teaching equipment

Page 19: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Educational curriculum and teaching methodology

• Targeted at all levels of care providers

• Based on teacher-learner pairs

• Knowledge and skill assessments

• TOT cascade implementation

Page 20: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Paired Learning/Teaching

Page 21: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Hands on Practice

Page 22: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Basic Strategy of HBB

• Evidence Based Medical Action Plan

• Educational curriculum and teaching

methodology

• Clinical and teaching equipment

Page 23: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Flipchart

Workbook

Simulator

Page 24: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson
Page 25: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Source: Helping Babies Breathe July 2012 progress report

Helping Babies Breathe is now in 48 countries

Page 26: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Implementation

Designed to be integrated into Essential Newborn Care (ENC) or equivalent

Intended to be an evidence-based focus

of excellence and change agent

Page 27: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Helping Babies Survive

Page 28: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Helping Babies Survive Essential Newborn Care on the First Day

Page 29: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Essential Care for Every Baby materials

Page 30: The Helping Babies Breathe Program - Wilson Center. George Little...The Helping Babies Breathe Program George A. Little MD Geisel Medical School at Dartmouth . Hanover, NH USA . Wilson

Present and Future Challenges

Program sustainability

Quality assessment and improvement