Dhaka, Bangladesh, April 8, 2015

Helping Babies Survive

What Causes Neonatal Death?

We can Reduce the Main Causes of Neonatal Death

Preterm birth

1. Preterm labor management*

2. Care including Kangaroo mother care (Essential care for small and every baby)
3. Feeding (Essential care for small baby)

Birth complications (and intrapartum stillbirths)

1. Prevention with obstetric care*

2. Essential Newborn Care, (Essential Care for Every baby)
3. Resuscitation* ( Helping Babies Breathe)

Neonatal infections

1. Prevention, (essential care for small and every baby), breastfeeding,

Chlorhexidine*
2. Case management of neonatal sepsis *
* Prioritized by the UN Commission on Life Saving Commodities for Women and Children

EDUCATIONAL DESIGN
SIMPLE

HANDS ON

CO-OPERATIVE LEARNING

EDUCATIONAL DESIGN
PURPOSEFUL 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

Helping Babies Breathe Materials

Action Plan
Facilitator Flip Chart
Learner Workbook
Neonatal Simulator
Bag and Mask
Suction Device

Change in Skills but not Practice:

Observations at Haydom Hospital, Tanzania
April 2010 HBB training

* p<0.05
^ p<0.0001

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*
Ersdal HL et al. Resuscitation 2013; 84:1422

Msemo G et al. Pediatrics 2013; 131:e353

Impact of Low-Dose, High-Frequency Practice:

Haydom Hospital, Tanzania
April 2010 HBB training
Sept 2009

Nov 2010

February 2011 LDHF practice

Feb 2010Jan 2011

Feb 2011Jan 2012

Fresh stillbirth
(per 1000 live births)

16.0

14.4*

Death < 24 hours

(per 1000 live births)

11.1

7.2*

Clinical interventions

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

Essential Care for Every Baby

Action Plan

Essential Care for Every Baby

materials

Essential Care for Every Baby

Parent Guide

Essential Care for Every Baby

Provider Guide Review and Quality Improvement

Field Testing
MCQ

Pre 19.4/26

Confidence Pre 3.2/5

Post 25.2/26
Post 4.6/5

Nasogastric Tube
Feeding

Expression of Breast Milk

Help babies
breath if they do
not cry at birth.
Provide essential
care to all
babies.
Keep small
babies well and
help them grow

THANK
YOU!