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Member Research and Reports

Member Research and Reports

Colorado Investigator Reflects on Helping Babies Breathe: Lessons Learned from Five Years and 80 Countries

Dr. Susan Niermeyer, senior investigator at the Colorado School of Public Health’s Center for Global Health is one of the chief architects of Helping Babies Survive (HBS), a set of comprehensive trainings designed to improve neonatal survival by combining evidence-based resuscitation practices with adult education and implementation science. HBS, an initiative of the American Academy of Pediatrics, is composed of three distinct one- to two-day trainings, Helping Babies Breathe, Essential Care for Every Baby, and Essential Care for Small Babies. Helping Babies Breathe (HBB) was the first to be developed because it focuses on risks present at the moment of birth.

Five years of implementation activities in 80 countries have generated an abundance of new information and data along the way. Teaching experiences in the field, feedback from local partners, and meetings with ministries of health and in-country leadership have all inspired changes in the HBB curriculum. These influences, along with new clinical guidelines from ILCOR (International Liaison Committee on Resuscitation), resulted in the development of Helping Babies Breathe, Second Edition. In addition to incorporating feedback, the second edition of HBB is informed by three distinct scientific disciplines.

“There are three bodies of research and evidence that we used in creating and updating this program,” Dr. Niermeyer explains. “One is resuscitation science, and what you need to do to take care of newborns to prevent them from dying. There is a truly global body of scientists working on this. Then, there is a body of educational research that is really about active learning, adult learning, and the value of hands-on simulation, feedback, and debriefing. The third big area is implementation science. What happens after the workshop? The whole HBS suite is a tool for quality improvement teams to apply what they have learned to address specific gaps in their facilities.”  

This focus on quality improvement teaches HBB learners how to implement changes in their hospitals and clinics and track results after changes have been made. The idea is to get learners to think critically about the standard procedures in their facility by asking questions like, “If a suction device is used [to clear a baby’s airway], is it disinfected before being used again?” For the facilitators teaching the course, there is also expanded educational advice and teaching tips to emphasize key points and reinforce specific skills.

Dr. Niermeyer and colleagues created a detailed guide to describe each of the changes made to the training, and where these changes are reflected in the printed materials.

To encourage awareness and dissemination of the program, all course materials are available online. Similarly, there is an opportunity for in-country health authorities to work with the American Academy of Pediatrics to translate and adapt materials to fit local contexts. Adaptations may include exchanging pictures in the flip charts for ones that are more culturally appropriate, or adjusting certain recommendations to align with national newborn care strategies issued by the ministry of health. Mentorship of in-country champions like program managers, HBB master trainers, and academicians allows the HBB program to assimilate with clinical practices across several systems. Strong emphasis is placed on conducting HBS trainings to complement and support national policies, service standards, and training programs.

The next five-year implementation cycle will bring new challenges and lessons. Dr. Niermeyer plans to explore the use of mobile platforms like cell phone and tablet-based systems that facilitate knowledge maintenance, and encourage data collection to enhance quality improvement efforts. Another objective is to increase coverage and sustainability by working with the in-country professional associations and academic institutions to include HBB in midwifery, nursing, and medical school curricula.

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