1. Helping Babies Breathe Implementation: Where are we? Joseph de Graft Johnson – MCHIP CORE Group Spring meeting Baltimore May 12, 2011
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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%
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 : &quot; Helping Babies Breathe &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.
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