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.

Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training, Pediatrics, 2013 Feb.

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  1. David Hutchon says:

    I agree that this is a very important program but as well as teaching the skill of ventilating a baby the teaching needs to ensure that the carers understand the importance of the placental circulation after birth and do not clamp the cord soon after the baby is born. If the baby does need resuscitation and ventilation it can nearly always be done right by the mother with the cord intact as explained by Patrick van Rheenen in the BMJ editorial almost two years ago.

    • Thomas D says:

      Thanks for your comment, and what you mention is certainly an important low resource intervention as well. There are many simple interventions like that available, and I think the beauty of the research done alongside implementing the Helping Babies Breathe program is that it documents the effect in hard endpoints, and over time.

      It is important to document impact like this, both for future funding and spread of these programs, but also as a reminder for us in high resource/high tech settings of how powerful simple interventions can be.

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