Review
From the Neonatal Resuscitation Program to Helping Babies Breathe: Global impact of educational programs in neonatal resuscitation

https://doi.org/10.1016/j.siny.2015.06.005Get rights and content

Summary

Two educational programs in neonatal resuscitation, the Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB) have found widespread acceptance globally as practical tools to improve newborn survival and reduce death from perinatal asphyxia. The programs share a common scientific evidence base and both employ adult education principles with an emphasis on building skills. However, they differ in their target audience and context, their core content, and the methods used for knowledge translation. This review describes how the design of NRP transported it outside the USA to countries around the globe and how the program has contributed to improvements in care at multiple levels from the bedside to guidelines and research. It examines the gaps in the reach of NRP that stimulated the development of HBB and helped shape a different approach to education of health care providers in resource-limited settings. Implementation of HBB is summarized to date, and evidence provided of its effectiveness in reducing neonatal death and stillbirth. Finally, consideration of how the programs function together suggests their future potential to strengthen health systems and maximize the impact on the health of newborns.

Introduction

The birth of a baby represents one of the most dramatic physiologic transitions in human life. Although this transition most often proceeds naturally and smoothly, the day of birth also carries high risk of death when the transition is disrupted. Neonatal resuscitation, broadly defined as support for successful transition at birth, thus has been a major focus in all efforts to improve neonatal survival. Even in technologically advanced settings, the now-accepted standard of having a person skilled in neonatal resuscitation at every birth took decades to become reality. In resource-limited settings this reality has not yet been achieved. Two educational programs for health care providers, the Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB), have played a central role in the evolution toward the global goal of having a skilled person present at the birth of every baby.

Section snippets

Elements promoting transportability

Development of NRP came in response to the emergence of neonatal intensive care in the 1970s. At that time, rates of neonatal mortality from asphyxia (intrapartum-related events) and prematurity were unacceptably high in the USA; there was increasing awareness that community hospitals needed to recognize and provide initial management of infants who required care in a neonatal intensive care unit. The National Institutes of Health funded five projects to provide education on the fundamentals of

Evolution of the approach to neonatal resuscitation: the origins of HBB

Nearly twenty years after the introduction of NRP, it became evident that a different approach was needed to address the global burden of neonatal mortality. In the year 2000 the United Nations General Assembly ratified the Millennium Development Goals (MDGs), aimed at reducing poverty globally. Among these, MDGs 4 and 5 dealt with reducing under-five child mortality and maternal mortality. MDG 4 focused the world's attention on just how large a proportion of under-five child deaths occurred in

Dissemination of HBB through the Global Development Alliance

Helping Babies Breathe was released in June 2010, simultaneous with the inauguration of the Helping Babies Breathe Global Development Alliance (GDA). In contrast with the spontaneous global dissemination of NRP, a public–private partnership among key organizations in the sphere of child health deliberately accelerated the dissemination of HBB in the face of the 2015 MDG 4 target. Founding partners of the GDA included the US Agency for International Development (USAID), the American Academy of

Role of NRP and HBB beyond the MDGs

The Neonatal Resuscitation Program and Helping Babies Breathe are educational programs that improve newborn survival in complementary ways. Both programs strive to translate global neonatal resuscitation guidelines into practice with simplicity and clarity, but at different levels of the health system. In first-level facilities HBB equips frontline providers with basic skills and brings the possibility of an attended birth to the furthest reaches of communities. When resources are available,

Conflict of interest statement

The author is editor of Helping Babies Breathe and a technical and editorial consultant for the American Academy of Pediatrics.

Funding sources

None.

References (38)

  • H.L. Ersdal et al.

    A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates

    Resuscitation

    (2013)
  • E. Mduma et al.

    Frequent brief on-site simulation training and reduction in 24-h neonatal mortality – an educational intervention study

    Resuscitation

    (2015)
  • American Academy of Pediatrics

    Neonatal Resuscitation Program (NRP) 20th Anniversary 1987–2007

    (2007)
  • J. Arnold

    The Neonatal Resuscitation Program comes of age

    J Pediatr

    (2011)
  • L.P. Halamek

    The genesis, adaptation, and evolution of the Neonatal Resuscitation Program

    NeoReviews

    (2008)
  • A.K. Deorari et al.

    Impact of education and training on neonatal resuscitation practices in 14 teaching hospitals in India

    Ann Trop Paediatr

    (2001)
  • X.Y. Zhu et al.

    The impact of the neonatal resuscitation program guidelines (NRPG) on the neonatal mortality in a hospital in Zhuhai, China

    Singapore Med J

    (1997)
  • N.Y. Boo

    Neonatal resuscitation programme in Malaysia: an eight-year experience

    Singapore Med J

    (2009)
  • M.M. Jabir et al.

    Knowledge and practical performance gained by Iraqi residents after participation to a neonatal resuscitation program course

    Acta Paediatr

    (2009)
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