Helping Babies Breathe Implementation: Where are we? Joseph de Graft Johnson – MCHIP CORE Group Spring meeting Baltimore M...
OUTLINE  <ul><ul><li>Brief reminder of the components of essential newborn care </li></ul></ul><ul><ul><li>Brief descripti...
Essential Newborn Care <ul><li>World Health Organization divides essential newborn care into two categories:  </li></ul><u...
Essential Newborn Care-Components <ul><li>Cleanliness </li></ul><ul><li>Thermal protection </li></ul><ul><li>Early and exc...
Essential Newborn Care Course <ul><li>New layout </li></ul><ul><li>French version in print </li></ul>
Needs in Helping Babies Breathe at Birth Assessment at birth and routine care Drying, warmth, clearing the airway, stimula...
Initiation of Breathing <ul><li>Always dry the baby first and assess breathing </li></ul><ul><li>during the process (dryin...
Helping Babies Breathe (HBB)*   New Simplified Resuscitation Training: <ul><li>Simple color-coded algorithm (The Golden Mi...
” The Golden Minute”
HBB…. <ul><li>Designed to be used at all levels of health system   </li></ul><ul><ul><li>Targets community, 1 st  level fa...
Helping Babies Breathe  Learning/teaching - in pairs
Global Development Alliance  to  Reduce Newborn Mortality Helping Babies Breathe
<ul><li>Objective:   </li></ul><ul><ul><li>To  reduce  newborn mortality due to asphyxia </li></ul></ul><ul><li>Partners <...
Global Development Alliance <ul><li>Primary Roles: </li></ul><ul><ul><li>Laerdal:  Provide resuscitation devices and suppo...
GDA Achievements to Date -- 1 <ul><li>Conducted HBB training at various levels: </li></ul><ul><li>---Global </li></ul><ul>...
GDA Achievements to Date -- 2 <ul><li>Mobilized resources for conducting HBB performance and impact evaluations in selecte...
Potential role for PVOs/NGOs <ul><li>Advocacy for adaptation of the HBB initiative in countries where they work  </li></ul...
HBB Implementing Countries
HELPING BABIES BREATHE CONTACT INFORMATION <ul><li>Community of practice contact list: </li></ul><ul><li>Monika Gutestam, ...
<ul><li>HBB link: http://www.helpingbabiesbreathe.org/ </li></ul><ul><li>www.mchip.net </li></ul><ul><li>Follow us on: </l...
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Newborn Health_Graft-Johnson_5.12.11

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  • World Health Organization 17 May 2011 The WHO definition stemms from a WHO Working Group Meeting in 1994 in Trieste, Italy. ENC was defined as consisting of eight components: Cleanliness : clean delivery and clean cord care for the prevention of newborn infections Thermal protection : prevention and/or management of neonatal hypothermia and hyperthermia Early and exclusive breastfeeding : Breasfeeding should be started within an hour of birth. Feeding should be as frequent as the baby demands, without prelacteal feeds or other fluids and food. Knowledge about importance of breastfeedin should be disseminated among families and communities as well as health workers and managers (10 steps) Initiation of breathing, resuscitation : &amp;quot; Helping Babies Breathe &amp;quot; … These elements remain, even if some of these elements have slightly changed in content, sine. The concept of ENC was further divided into Basic Care and Special Care . Basic Care includes interventions for all infants to meet their physiological needs. Special Care is required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon or too small. This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems .
  • What can be done in the face of such a large burden of mortality and limitations of workforce? The answer lies in an understanding of the science of resuscitation. For 99% of babies simple interventions can be lifesaving. All babies need assessment and routine care at birth, and for most, such simple care is enough. For babies who do not breathe at birth, many will respond to the basic steps of drying and warmth, plus clearing the airway and specific stimulation to breathe. Only a small percentage of babies will require bag and mask ventilation, and less than 1% of babies require advanced methods of resuscitation, such as chest compressions and medications. By focusing on the timely delivery of the essential interventions of drying, warmth, clearing the airway, stimulation to breathe, and bag and mask ventilation, many babies can be saved.
  • The baby is the focus for learning in pairs, with an educational methodology that emphasizes facilitation of learning. Participants work together to help one another learn skills - recognizing that we all learn best when we are teaching. These participants in a workshop in Tanzania are providing feedback to one another on techniques for bag and mask ventilation. As one learner is providing ventilation, the other learner not only offers suggestions, but provides the response of the baby by squeezing the pneumatic bulbs of the simulator to create a cry, spontaneous breathing, or umbilical pulse.
  • Newborn Health_Graft-Johnson_5.12.11

    1. 1. Helping Babies Breathe Implementation: Where are we? Joseph de Graft Johnson – MCHIP CORE Group Spring meeting Baltimore May 12, 2011
    2. 2. OUTLINE <ul><ul><li>Brief reminder of the components of essential newborn care </li></ul></ul><ul><ul><li>Brief description of HBB Initiative </li></ul></ul><ul><ul><li>Share information on the HBB Global Development Alliance </li></ul></ul><ul><ul><li>Recommendations for PVO/NGO involvement in HBB implementation </li></ul></ul><ul><ul><li>Share HBB contact information </li></ul></ul>
    3. 3. Essential Newborn Care <ul><li>World Health Organization divides essential newborn care into two categories: </li></ul><ul><ul><li>Basic care (often equated to ENC) </li></ul></ul><ul><ul><li>Special care </li></ul></ul><ul><li>“ Basic care” that comprises “interventions for all infants to meet their physiological needs” at birth and later </li></ul><ul><li>Special care – comprises interventions for a small group of newborns with conditions that require extra care </li></ul>WHO 1996
    4. 4. Essential Newborn Care-Components <ul><li>Cleanliness </li></ul><ul><li>Thermal protection </li></ul><ul><li>Early and exclusive breastfeeding </li></ul><ul><li>Initiation of breathing, resuscitation </li></ul><ul><li>Eye care </li></ul><ul><li>Immunization </li></ul><ul><li>Management of newborn illness </li></ul><ul><li>Care of the preterm and/or low birth weight newborn </li></ul>
    5. 5. Essential Newborn Care Course <ul><li>New layout </li></ul><ul><li>French version in print </li></ul>
    6. 6. Needs in Helping Babies Breathe at Birth Assessment at birth and routine care Drying, warmth, clearing the airway, stimulation Bag and mask ventilation Chest compressions, medications 80-90% 8-10 % 3-6% < 1%
    7. 7. Initiation of Breathing <ul><li>Always dry the baby first and assess breathing </li></ul><ul><li>during the process (drying may stimulate </li></ul><ul><li>breathing in a non-crying baby) </li></ul><ul><li>If baby is crying or shows no signs of breathing difficulties - continue with essential newborn care </li></ul><ul><li>If baby is not crying or breathing or has breathing difficulties - need to help the baby breathe (HBB) </li></ul>
    8. 8. Helping Babies Breathe (HBB)* New Simplified Resuscitation Training: <ul><li>Simple color-coded algorithm (The Golden Minute ™ ) </li></ul><ul><ul><li>Drying and wrapping/skin-to-skin </li></ul></ul><ul><ul><li>(2) Assess breathing – if not breathing then, </li></ul></ul><ul><ul><li>(3) Clear airway and stimulate – if not breathing then, </li></ul></ul><ul><ul><li>(4) Ventilate until breathing (or no response after 10 – 15 min) </li></ul></ul><ul><li>* Developed by American Academy of Pediatrics in collaboration with Save the Children, USAID, ACCESS, NICHD, WHO, & UNICEF </li></ul>
    9. 9. ” The Golden Minute”
    10. 10. HBB…. <ul><li>Designed to be used at all levels of health system </li></ul><ul><ul><li>Targets community, 1 st level facilities, district hospitals -- typically where birth attendants are alone attending deliveries (frequently without a second person to assist in resuscitation) </li></ul></ul><ul><ul><li>Tertiary hospitals – especially midwives. (Does not replace current advanced resuscitation training- cardiac compressions, intubation, drugs – Pediatricians) </li></ul></ul><ul><li>Pictorial algorithm </li></ul><ul><li>Focuses on achieving and maintaining skills </li></ul>
    11. 11. Helping Babies Breathe Learning/teaching - in pairs
    12. 12. Global Development Alliance to Reduce Newborn Mortality Helping Babies Breathe
    13. 13. <ul><li>Objective: </li></ul><ul><ul><li>To reduce newborn mortality due to asphyxia </li></ul></ul><ul><li>Partners </li></ul><ul><ul><li>Founding members: USAID, Laerdal, American Academy of Pediatrics, NICHD, Save the Children, and USAID’s implementing partners - MCHIP, HCI, HealthTech, CORE, Africa 2010 </li></ul></ul><ul><ul><li>Growing partnership: UNICEF, WHO, Latter Day Saints Church, Earth Institute </li></ul></ul>Global Development Alliance Adopted from Lily Kak
    14. 14. Global Development Alliance <ul><li>Primary Roles: </li></ul><ul><ul><li>Laerdal: Provide resuscitation devices and support evaluation </li></ul></ul><ul><ul><li>AAP: Provide curriculum and build skills of health providers </li></ul></ul><ul><ul><li>NICHD: Evaluate </li></ul></ul><ul><ul><li>Save the Children: Provide technical leadership </li></ul></ul><ul><ul><li>USAID, MCHIP, HCI, HealthTech, CORE : Provide technical leadership and implement at scale </li></ul></ul><ul><li>Launched in June 2010; Introduced in over 25 countries to date with 16 receiving USAID support </li></ul>Adapted from Lily Kak
    15. 15. GDA Achievements to Date -- 1 <ul><li>Conducted HBB training at various levels: </li></ul><ul><li>---Global </li></ul><ul><li>---Regional (Africa and LAC) </li></ul><ul><li>---Country level </li></ul><ul><li>Translation of HBB materials into French and Spanish </li></ul><ul><li>Mobilized funds from other private partners such as Millennium Cities Initiative, Johnson & Johnson and General Electric </li></ul>
    16. 16. GDA Achievements to Date -- 2 <ul><li>Mobilized resources for conducting HBB performance and impact evaluations in selected countries: Malawi, Ethiopia, Bangladesh, Kenya and India </li></ul><ul><li>Purchase of HBB training materials at cost </li></ul><ul><li>Free license to translate/print HBB materials at country level </li></ul><ul><li>Establishment of community of practice </li></ul><ul><li>Developed HBB implementation guide </li></ul>
    17. 17. Potential role for PVOs/NGOs <ul><li>Advocacy for adaptation of the HBB initiative in countries where they work </li></ul><ul><li>Facilitate national level planning and coordination </li></ul><ul><li>Support adaptation of HBB materials and associated job aids including supervisory, monitoring and evaluation tools Support national/district implementation </li></ul><ul><li>Track and report on HBB-related activities </li></ul>
    18. 18. HBB Implementing Countries
    19. 19. HELPING BABIES BREATHE CONTACT INFORMATION <ul><li>Community of practice contact list: </li></ul><ul><li>Monika Gutestam, Save the Children ( [email_address] ) </li></ul><ul><li>Betsy Hendrickson, USAID ( [email_address] ) </li></ul><ul><li>Bonnie Koenig, American Academy of Pediatrics ( [email_address] ) </li></ul><ul><li>Lani Marquez, USAID Health Care Improvement Project/URC ( [email_address] ) </li></ul><ul><li>Charlene Reynolds, MCHIP ( [email_address] ) </li></ul>
    20. 20. <ul><li>HBB link: http://www.helpingbabiesbreathe.org/ </li></ul><ul><li>www.mchip.net </li></ul><ul><li>Follow us on: </li></ul>THANK YOU!

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