Every once in a while there’s a different research project, something that actually makes a difference. This is one of them. A great example of how simple interventions can lead to significant results in low resource settings. The “Helping Babies Breathe” program focuses on stimulation and, if needed, ventilation of flaccid, unresponsive newborns. This almost halved the newborn 24hr mortality rate!
Helping babies breathe
This PhD project by Norwegian anaesthetist Erdal consists of three publiations, the first two document the incidence of birth asphyxia and newborn mortality, and how basic resuscitation can save many of these babies. The last one in her PhD study documents the outcome of the “Helping Babies Breathe” program on 10.000 babies in Tanzania.
The Helping Babies Breathe program was instituted in major centers in Tanzania, teaching birth attendants to listen for fetal heart rate, stimulate newborns, and ventilate if necessary. They started out with a newborn 24hr mortality of 13.4 per 1000 live births, and cut it to 7.1 per 1000 live births with these simple interventions. Fresh still births were also reduced by 25% by these interventions, from 19 per 1000 births to 14 per 1000, likely because some babies previously diagnosed as fresh still births were now stimulated (and ventilated) back to life.
The impressive part is that all this was achived by teaching awareness, stimulation and ventilation. And the ventilation was done over a face mask without supplemental oxygen and without intubation or any chest compressions. Just simple ventilations. And the project documents that these improved outcomes were sustained over a two year observation period.
Breathing helps babies
In addition to helping low resource communities save lives and get Tanzania and other African countries on track for the Millenium Development Goal 4, Erdal has also shown the efficiacy of ventilations on lifeless newborns. We all ‘know’ this, but here’s pretty good proof of concept. According to Ersdal’s study, the risk of morbidity and mortality increases with 16% for every 30 seconds a newborn baby isn’t breathing or being ventilated.
The ventilations in newborns are the compressions in adult arrest. So focus on open airways and breathing when you get called to an unresponsive baby.