The Helping Babies Survive Programs:Educational Programs to Improve Neonatal Outcomes

2015 NRP® Current Issues Seminar

The Helping Babies Survive Programs:Educational Programs to Improve Neonatal Outcomes

2015 NRP® Current Issues Seminar

Faculty Disclosures

Carl Bose, MD, FAAP & Nalini Singhal, MD, FAAP have no relevant disclosures

Global Neonatal Health

Most of these deaths are preventable!

• 3.8 neonatal deaths (3.2 million stillbirths)

•~ 3x deaths due to HIV/AIDs and malaria combined

•> 400 neonatal deaths each hour

Where do most neonatal deaths occur?

Oestergaard et al. PLoS Med 2011

What Causes Neonatal Death?

What Causes Neonatal Death?

What can be done?

Improved resuscitation

• Preterm labor management• KMC• Alternate feeding techniques

• Cord care• Improved hygiene• Exclusive breastfeeding

EDUCATIONAL DESIGN

SIMPLE HANDS ON CO-OPERATIVE LEARNING

EDUCATIONAL DESIGNPURPOSEFUL DEVELOPMENT OF EDUCATIONAL MODELS

Bag and Mask Ventilation Expression breast milk Nasogastric tube feeding

EDUCATIONAL DESIGN

• ONGOING PROFESSIONAL DEVELOPMENT: Suggestions for practice Ability to practice with partners as modeled in the course Low cost simulators for practice

• IMPLEMENTATION OF CHANGE: How to start What to monitor Possible options for change

Helping Babies Breathe (HBB)

Action Plan

• Action Plan • Facilitator Flip Chart• Learner Workbook

• Neonatal Simulator• Bag and Mask• Suction Device

Helping Babies Breathe Materials

Change in Skills but not Practice: Observations at Haydom Hospital, Tanzania

Sept 2009 Nov 2010

Scenario (video analysis)

N= 39 N=27

Routine care (% pass) 41 74*

Bag-mask (% pass) 18 74^

Delivery room(observation)

N=2745 N=3116

Stimulation (%) 17.7 14.1*

BMV (%) 8.4 7.5

Time to BMV (sec) 76+54 89+76*

* p<0.05^ p<0.0001 Ersdal HL et al. Resuscitation 2013; 84:1422

April 2010 HBB training

Msemo G et al. Pediatrics 2013; 131:e353

Impact of Low-Dose, High-Frequency Practice:Haydom Hospital, Tanzania

Sept 2009 Nov 2010 Feb 2010-Jan 2011

Feb 2011-Jan 2012

Clinical interventions

Fresh stillbirth (per 1000 live births)

16.0 14.4*

Death < 24 hours(per 1000 live births)

11.1 7.2*

Delivery room (obs) N=2745 N=3116 N=4876 N=4734

Stimulation (%) 17.7 14.1* 14.4 16.0 *

BMV (%) 8.4 7.5 7.2 5.7 +

Time to BMV (%) 76+54 89+76* 89+72 97+74

* p < 0.05 + p =0.03 Ersdal HL et al. Resuscitation 2013; 84:1422

April 2010 HBB training February 2011 LDHF practice

Essential Care for Every Baby (ECEB)

Action Plan

•Action Plan •Facilitator Flipchart•Provider Guide•Parent Guide

Essential Care for Every Baby Materials

Essential Care for

Every Baby

Parent Guide

Field Testing

MCQ Pre 19.4/26 Post 25.2/26

Confidence Pre 3.2/5 Post 4.6/5

Essential Care for Small Babies (ECSB)

Action Plan

•Action Plan •Facilitator Flipchart•Provider Guide•Parent Guide

Essential Care for Small BabiesMaterials

Expression of Breast Milk

Nasogastric Tube Feeding

Improved resuscitation

• Cord care• Improved hygiene• Exclusive breastfeeding

The Helping Babies Survive Programs

• Preterm labor management• KMC• Alternate feeding techniques

The Formula for Survival

Utopia 100% x 100% x 100% = 100%

Ideal? 90% x 90% x 90% = 72%

Actual? 80% x 50% x 50% = 20%

Patient survival the result of three equally important factors

Ref: Søreide et al. The formula for survival in resuscitation. Resuscitation 2013;84:1487-93

Medical Science

EducationalEfficiency

LocalImplementation

Survival

Sample Page from the Provider Guide

Monitor Key IndicatorsQuality Improvement Strategies

THANK YOU!

Help babies breath if they do not cry at birth.

Provide essential care to all

babies.Keep small

babies well and help them grow.