Babies Breathe Research Articles

Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial.

Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.

Effect of Training Healthcare Providers in Helping Babies Breathe Program on Neonatal Mortality Rates.

BackgroundTraining in the Helping Babies Breathe (HBB) Program has been associated with a reduction in early neonatal mortality rate (ENMR), the neonatal mortality rate (NMR), and fresh stillbirth rate (FSBR) in low- and middle-income countries (LMICs). This program was implemented in five different healthcare facilities in the Oliver Reginald Tambo (ORT) District, South Africa from September 2015 to December 2020.ObjectiveTo determine and compare the FSBR, ENMR, and NMR between 2015 before initiation of the program (baseline) and subsequent years up to 2020 following the implementation of facility-based training of HBB in five hospitals in ORT District.MethodsRecords of perinatal statistics from January 2015 to December 2020 were reviewed to calculate FSBR, ENMR, and NMR. Data were collected from the five healthcare facilities which included two district hospitals (Hospital A&B), two regional hospitals (Hospital C&D), and one tertiary hospital (Hospital E). Comparisons were made between pre- (2015) and post- (2016–2020) HBB implementation periods. Differences in changes over time were also assessed using linear regression analysis.ResultsThere were 19,275 births in 2015, increasing to 22,192 in 2020 with the majority (55.3%) of births occurring in regional hospitals. There were significant reductions in ENMR (OR−0.78, 95% CI 0.70–0.87) and NMR (OR−0.81, 95% CI 0.73–0.90), but not in FSBR, in the five hospitals combined when comparing the two time periods. Significant reduction was also noted in trends over time in ENMR (r2 = 0.45, p = 0.001) and NMR (r2 = 0.23, p = 0.026), but not in FSBR (r2 = 0.0, p = 0.984) with all hospitals combined. In looking at individual hospitals, Hospital A (r2 = 0.61, p < 0.001) and Hospital E (r2 = 0.19, p = 0.048) showed a significant reduction in ENMR over time, but there were no significant changes in all mortality rates for Hospitals B, C, and D, and for the district or regional hospitals combined.ConclusionThere was an overall reduction of 22% and 19% in ENMR and NMR, respectively, from pre- to post-HBB implementation periods, although there were variations from year to year over the 5-year period and, across hospitals. These differences suggest that there were other factors that affected the perinatal/neonatal outcomes in the hospital sites in addition to the implementation of training in HBB.

Assessing Implementation of Helping Babies Breathe Program Through Observing Immediate Care of Neonates at Time of Delivery

BackgroundTraining in neonatal resuscitation has been shown to reduce deaths related to intrapartum asphyxia. Helping Babies Breathe (HBB) is a simulation-based program focusing on training healthcare providers (HCPs) in immediate neonatal care including stimulation, initiating bag mask ventilation (BMV) in the absence of breathing by 1 min of life, and delayed (30–60 s after birth) umbilical cord clamping (DCC). Data on implementation of HBB posttraining are limited.ObjectiveTo determine time from birth to spontaneous breathing, cord clamping, and initiation of BMV in a setting where the majority of HCPs are HBB trained.MethodsTwo research nurses observed deliveries conducted in two referral hospitals. Timing included the onset of breathing, cord clamping, and initiation of BMV. Deliveries were grouped according to the mode of delivery.ResultsIn total, 496 neonates were observed; 410 (82.7%) neonates cried or had spontaneous breathing (median time 17 s) soon after birth, 25/86 (29%) of neonates not breathing responded to stimulation, 61 (12.3%) neonates required BMV, and 2 (0.4%) neonates required chest compression and/or adrenalin. Neonates delivered by cesarean section (CS) took longer to initiate first breath than those delivered vaginally (median time 19 vs. 14 s; p = 0.009). Complete data were available in 58/61 (95%) neonates receiving BMV, which was initiated in 54/58 (93%) cases within 60 s of life (the “Golden Minute”). Median time to cord clamping was 74 s, with 414 (83.5%) and 313 (63.0%) having cord clamped at ≥ 30 and ≥ 60 s, respectively. Factors associated with BMV were CS delivery [odds ratio (OR) 29.9; 95% CI 3.37–229], low birth weight (LBW) (birthweight < 2,500 g) (OR 2.47; 95% CI 1.93–5.91), and 1 min Apgar score < 7 (OR 149; 95% CI 49.3–5,021). DCC (≥ 60 s) was less likely following CS delivery (OR 0.14; 95% CI 0.02–0.99) and being LBW (OR 0.43; 95% CI 0.24–0.77).ConclusionApproximately 83% of neonates initiated spontaneous breathing soon after birth and 29% of neonates not breathing responded to physical stimulation. BMV was initiated within the Golden Minute in most neonates, but under two-thirds had DCC (≥60 s). HBB implementation followed guidelines, suggesting that knowledge and skills taught from HBB are retained and applied by HCP.

Opioid-Free Labor Analgesia: Dexmedetomidine as an Adjuvant Combined with Ropivacaine.

Background Side effects of the use of opioid analgesics during painless delivery are the main factors that affect rapid postpartum recovery. Opioid use can result in dangerous respiratory depression in the patient. Opioids can also disrupt the baby's breathing and heart rate. The nonopioid analgesic dexmedetomidine, a new a2-adrenergic agonist, possesses higher selectivity, greater analgesic effects, and fewer side effects. Moreover, epidural administration of dexmedetomidine also reduces local anesthetic consumption. Objective Our study aims to compare the analgesic effects as well as the side effects of ropivacaine with dexmedetomidine against sufentanyl as an epidural labor analgesia. Methods This study is a randomized, double-blinded, controlled trial (registration no. ChiCTR2200055360) involving 120 primiparous (a woman who has given birth once), singleton pregnancy women who are greater than 38 weeks into gestation and have requested epidural labor analgesia. The participants were randomized to receive 0.1% ropivacaine with sufentanyl (0.4 μg/ml) or dexmedetomidine (0.4 μg/ml). The primary outcomes included Visual Analogue Score (VAS), duration of first epidural infusions, the requirement of additional PCEA bolus, and adverse reactions during labor analgesia. Results Of the 120 subjects who consented, 91 parturient women (women in the condition of labor) had complete data for analysis. Demographics and VAS, as well as maternal and fetal outcomes, were similar between the groups. The duration of first epidural infusions in dexmedetomidine was significantly longer than sufentanyl (median value: 115 vs 68 min, P < 0.01); the parturient women who received dexmedetomidine and who required additional PCEA bolus were fewer in comparison to those who received sufentanyl (27.5% vs 49.0%, P < 0.05). Furthermore, the incidence of pruritus in the dexmedetomidine group was lower in comparison to the sufentanyl group (0% vs 11.8%, P < 0.05). Conclusions Dexmedetomidine, a nonopioid, is superior to the opioid analgesic sufentanyl in providing a prolonged analgesic effect as an epidural during labor. It also reduces local anesthetic consumption and has fewer side effects. The trial is registered with ChiCTR2200055360.

Newborn Resuscitation Scale Up and Retention Program Associated with Improved Neonatal Outcomes in Western Nepal

The adoption of the Helping Babies Breath (HBB) tool has improved the outcomes of neonatal resuscitation following intrapartum events. Perinatal asphyxia however remains a leading cause of neonatal morbidity and mortality in Nepal. HBB training has proven effective, but a major challenge is maintaining resuscitation skills over time.

Gypsophila (baby's breath)

Gypsophila (baby's breath)

Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study

BackgroundMonitoring of peripheral capillary oxygen saturation (SpO2) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO2 and heart...

Experiences of community midwives receiving helping baby breathe training through the low dose high-frequency approach in Gujrat, Pakistan

BackgroundPakistan's neonatal mortality rate has the highest proportion in the South Asian region and it is higher in the rural areas as compared to the urban areas. Poor resuscitation techniques and lack of basic newborn resuscitation skills in birth attendants are contributing factors towards neonatal deaths. Based on the significant outcomes of the Helping Baby Breath (HBB) training, similar training was implemented for Community Midwives (CMWs) in a low-resource setting in Gujrat, Pakistan, to improve their knowledge and skills. The training evaluation was conducted and participant feedback was obtained through both qualitative and quantitative methods. The findings of the quantitative assessment of the training evaluation will be published elsewhere. This paper presents the qualitative evaluation of the training. ObjectiveThe objective of the study was, to determine the perceptions of HBB trained CMWs about the effectiveness of the HBB training, and the challenges faced in the implementation of HBB skills for newborn resuscitation, at their work settings. MethodologyThe qualitative descriptive design was used in this study. The purposive sampling technique was chosen to recruit midwives and key informants as participants of the training. Interviews were conducted by using a semi-structured interview guide. The study included a total of five interviews: two focus group interviews for CMWs (10 in each group), and three individual interviews of key informants. FindingsThe content analysis of the qualitative data yielded three themes: the effectiveness of training, challenges, and suggestions. The findings revealed that the HBB training was effective for the CMWs in terms of its usability, regarding improvement in newborn resuscitation knowledge and skills. Moreover, it enhanced confidence and satisfaction in CMWs. However, less volume of patients was a challenge for a few CMWs with regard to practicing their skills. ConclusionDue to the inadequate number of patients and fewer opportunities of practice for several CMWs, they required such training frequently, in order to maintain their competency. The CMWs also recommended that HBB training should be part of the Midwifery program curriculum. Moreover, similar training was also recommended for other healthcare providers working in low-resource settings, including doctors and nurses.

Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

BackgroundBirth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan.MethodA pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran’s Q tests were applied for data analysis. Participants’ feedback was also obtained at the end of each training, which was analyzed through descriptive statistics.ResultsData from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected.ConclusionThe study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Evaluation of SIMESON, a training program to improve access to quality health care for pregnant women and newborn in different healthcare facilities of northern Bangladesh.

AimThe study aims to explore the current knowledge and skills of healthcare providers already trained by SIMESON (simulation for essential skills for obstetrical and neonatal care), in reviewing perinatal health situations including current status of healthcare facilities and cost estimation.DesignIt was an observational study.MethodsCost estimation following both quantitative and qualitative approaches was also attempted.ResultKnowledge and skills of 88 healthcare providers about the provision of normal delivery and immediate postpartum care, management of postpartum haemorrhage (PPH), retained placenta and use of bag and mask ventilation to help a baby breathe were found to be considerably strengthened following SIMESON training. During the 6 months after training, there were 477 PPH cases managed successfully with only one death; neonatal deaths observed were 6.6/1,000 live births; twice the number of facility deliveries; and 80% use rate of Ambu bag for helping baby breathe. The estimated cost per trainee was 395.68 USD, and 5.85 USD per beneficiary.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Extending "Helping Babies Breathe" to an Academic Setting in Fiji: A Project Involving American Nursing Faculty and Graduate and Undergraduate Nursing Students.

Approximately 2.5 million neonates died worldwide in 2018. Over one quarter of neonatal deaths are caused by birth asphyxia. Helping Babies Breathe (HBB) was created to teach basic neonatal resuscitation steps in limited-resource settings. Fifteen Fijian faculty members attended a master teacher class. Nine undergraduate nursing students from the western United States assisted in teaching two HBB classes for Fijian nursing students. Fijian faculty and student knowledge increased significantly posteducation. Educational settings provide ideal locations for future nurses to learn and practice evidence-based neonatal resuscitation skills. Implementing HBB in an academic setting, though novel, may ensure educators are familiar with current guidelines.

Morphological characteristics of the baby’s breath (Gypsophila Paniculata L.) submitted to different organic compounds

The baby's breath (Gypsophila paniculata L.) is a plant used to compose floral arrangements. The objective of this work was to evaluate the efficiency of the use of Humoativo and Bovine Manure in the morphological characterization of the baby's breath. The experiment was carried out in the vegetation house at the Federal Institute of Education, Science and Technology of Bahia - IFBA - Campus of Vitória da Conquista, Bahia. Different proportions of Bovine Manure - BM and Humoativo - HA were used, constituting the following treatments: T1: 0% BM and 0% HA; T2: 25% BM and 75% HA; T3: 50% BM and 50% BM; T4: 75% BM and 25% HA; T5: 100% BM and 0% HA; T6: 0% BM and 100% HA. The design was completely randomized (DCR), with four replications, totaling 24 experimental units. After transplanting, Plant Height, Number of Flower Stems, Height of Flower Stem, Number of Primary Branches of the Flower Stem, and Flower Diameter were evaluated. The fresh and dry weight of the plant was also checked. Data were subjected to analysis of variance (ANOVA) followed by the mean test (Tukey 5%) using the statistical program SAEG - Statistical Analysis System (GOMES, 1992). The use of BM and HA favored the accumulation of fresh weight of the flower, stem, root, and total fresh weight. The same occurs for dry weight. All analyzed variables increased with the doses of EB and HA.

Comparison of the Neonatal Resuscitation Education (Helping Babies Breathe) and Resource Needs Between Selected Health Care Facilities in Bangladesh, Pakistan, and Yemen

Comparison of the Neonatal Resuscitation Education (Helping Babies Breathe) and Resource Needs Between Selected Health Care Facilities in Bangladesh, Pakistan, and Yemen

P0286 / #1094: EVALUATION OF RESUSCITATION SKILLS FOLLOWING IMPLEMENTATION OF HELPING BABIES BREATHE IN A RESOURCE-LIMITED SETTING

Aims & Objectives: Philippines has a persistently high neonatal mortality rate (14 per 1,000 live births). Helping Babies Breathe (HBB) simulation training has led to reductions in early neonatal mortality. However, data is lacking in application of skills taught in HBB such as bag valve mask (BMV) in clinical practice. In our study, HBB trainings were held for local nurses and midwives in the Philippines. Follow-up of HBB skills both at refresher training and at live deliveries in local hospitals was used to assess skill retention and application post-training. Methods: HBB trainings were held for local nurses and midwives in the Philippines over two days in August 2018. Follow-up of HBB skills was assessed in two settings: in refresher classes 12 months post-training (n=11) and at live deliveries in local hospitals 6 to 12 months post-training (n=14). Adherence to HBB skills was assesed using the validated HBB OSCE B. Results: At 12-month follow-up, passing rate for HBB OSCE B was 81%. Time to initiate BMV worsened from an average of 90.0 seconds to 135.9 seconds, with only 2 providers achieving successful BMV within the “Golden Minute” compared to 6 immediately post-training. In clinical practice, 93% of birth attendants followed HBB protocol for normal newborn care, though zero of 3 newborns received BMV when indicated. Conclusions: Some essential skills have been adopted by trainees that persist after HBB training. Future training sessions should focus on skill retention and initiation of adequate BMV within the “Golden Minute” after birth, as this skill was not observed in clinical practice.

A Systematic Review of The Helping Babies Breathe Training Program: From Implementation To Impact

A Systematic Review of The Helping Babies Breathe Training Program: From Implementation To Impact

What happens after helping babies breathe training is complete? A prospective cohort study of Nigerian health care workers

Background: Neonatal mortality remains disturbingly high in Nigeria. Helping Babies Breathe (HBB) is an evidence- based neonatal resuscitation (NR) educational program designed to teach NR in resourcelimited areas. There is no information in Nigeria on what happens after health careworkers (HCWs) complete HBB training.Aim: To determine if HCWs who received HBB training utilized the acquired knowledge and skills (K&amp;S) and engaged in any ongoing peer training. In addition, we studied HCW turnover one year after HBB training completion.Subjects and Methods: Seventy-two HCWs were trained in HBB, and surveyed 1 year later using a 10-item questionnaire. Data analysis used measures of central tendency and t testing.Results: Most HCWs reported the use of HBB daily. The commonest NR method used was suctioning (89.5 %), followed by drying and positioning (86%), however there was 0% reported use of bagmask- ventilation. Most HCWs (98%) reported sharing K&amp;S with colleagues. Following training,100% HBB trainers remained at original employment but 53% HBB providers moved to new employment and did not utilize their HBB K&amp;S at their new employment site.Conclusion: Frequent, brief, refresher practice sessions and implementation of a system for training new hires may improve HCW readiness for NR and their peer mentoring capabilities. Ensuring adequate equipment availability is critical for HCW to utilize acquired K&amp;S. Significant HCW turnover occurred within a year of training. Trained HCW who left to new employment subsequently had limited impact at their new place of employment.

Adapting Helping Babies Breathe into a Virtual Curriculum: Methods, Results, and Lessons Learned.

Introduction. The Helping Babies Breathe (HBB) curriculum is an established, effective method to combat neonatal mortality. The COVID-19 pandemic has disrupted in-person HBB training sessions worldwide, portending deficits in the dissemination of this important intervention. Methods. A pilot study to compare in-person versus virtual HBB training among US-based pediatric and family medicine residents. Two HBB master trainers condensed the curriculum into an abbreviated course that was offered to 14 learners in-person (n = 6) and virtually via Zoom (n = 8). A standardized 10-item survey was administered before and after the session to measure reported self-efficacy of critical elements of HBB. Difference of difference analysis was performed to detect differences in post vs pre-training results among the 2 groups using STATA MP 15. Results. All learners showed improvement in preparedness, assessment, and skills subcomponents of self-efficacy with no notable differences based on the type of learning medium. At baseline, in-person learners had a 7-point higher self-efficacy score (69.7) in comparison to virtual learners (62.8; P = .26). After training, the confidence score improved significantly; by 14.3 units for in-person learners (P = .01) and 12.9 for virtual learners (P = .04). There was no statistically significant difference in improvement between the 2 groups (P = .67). Furthermore, all learners passed the post-training knowledge assessment. Discussion. Virtual learning of HBB may be an alternative option in the setting of resource and travel limitations. Future work needs to assess possible differences in attainment of assessment skills and retention of the HBB curriculum among virtual learners.

Investigation of low baby's breath (Gypsophila muralis) herb: anatomical structure and chemical composition

Investigation of low baby's breath (Gypsophila muralis) herb: anatomical structure and chemical composition

Prayer for baby breath

prayer for baby breath