1. The Helping Babies Survive Programs: Educational Programs to Improve Neonatal Outcomes 2015 NRP® Current Issues Seminar

2. Faculty Disclosures Carl Bose, MD, FAAP & Nalini Singhal, MD, FAAP have no relevant disclosures

4. Global Neonatal Health Most of these deaths are preventable! 3.8 neonatal deaths (3.2 million stillbirths) ~ 3x deaths due to HIV/AIDs and malaria combined > 400 neonatal deaths each hour

5. Where do most neonatal deaths occur? Oestergaard et al. PLoS Med 2011

6. What Causes Neonatal Death?

8. What can be done? Improved resuscitation Preterm labor management KMC Alternate feeding techniques Cord care Improved hygiene Exclusive breastfeeding

9. EDUCATIONAL DESIGN SIMPLEHANDS ONCO-OPERATIVE LEARNING

10. EDUCATIONAL DESIGN PURPOSEFUL DEVELOPMENT OF EDUCATIONAL MODELS Bag and Mask Ventilation Expression breast milkNasogastric tube feeding

11. EDUCATIONAL DESIGN ONGOING PROFESSIONAL DEVELOPMENT: Suggestions for practice Ability to practice with partners as modeled in the course Low cost simulators for practice IMPLEMENTATION OF CHANGE: How to start What to monitor Possible options for change

12. Helping Babies Breathe (HBB) Action Plan

13. Facilitator Flip Chart Learner Workbook Neonatal Simulator Bag and Mask Suction Device Helping Babies Breathe Materials

14. Change in Skills but not Practice: Observations at Haydom Hospital, Tanzania Sept 2009Nov 2010 Scenario (video analysis) N= 39N=27 Routine care (% pass)4174* Bag-mask (% pass)1874^ Delivery room (observation) N=2745N=3116 Stimulation (%)17.714.1* BMV (%)8.47.5 Time to BMV (sec)76+5489+76* * p<0.05 ^ p<0.0001 Ersdal HL et al. Resuscitation 2013; 84:1422 April 2010 HBB training

15. Msemo G et al. Pediatrics 2013; 131:e353

16. Impact of Low-Dose, High-Frequency Practice: Haydom Hospital, Tanzania Sept 2009Nov 2010Feb 2010- Jan 2011 Feb 2011- Jan 2012 Clinical interventions Fresh stillbirth (per 1000 live births) 16.014.4* Death < 24 hours (per 1000 live births) 11.17.2* Delivery room (obs)N=2745N=3116N=4876N=4734 Stimulation (%)17.714.1*14.416.0 * BMV (%)8.47.57.25.7 + Time to BMV (%)76+5489+76*89+7297+74 * p < 0.05 + p =0.03Ersdal HL et al. Resuscitation 2013; 84:1422 April 2010 HBB trainingFebruary 2011 LDHF practice

18. Essential Care for Every Baby (ECEB) Action Plan

19. Facilitator Flipchart Provider Guide Parent Guide Essential Care for Every Baby Materials

20. Essential Care for Every Baby Parent Guide

21. Field Testing MCQ Pre 19.4/26 Post 25.2/26 Confidence Pre 3.2/5 Post 4.6/5

22. Essential Care for Small Babies (ECSB) Action Plan

23. Facilitator Flipchart Provider Guide Parent Guide Essential Care for Small Babies Materials

25. Expression of Breast Milk

26. Nasogastric Tube Feeding

27. Improved resuscitation Cord care Improved hygiene Exclusive breastfeeding The Helping Babies Survive Programs Preterm labor management KMC Alternate feeding techniques

28. The Formula for Survival Utopia 100% x 100% x 100% = 100% Ideal? 90% x 90% x 90% = 72% Actual? 80% x 50% x 50% = 20% Patient survival the result of three equally important factors Ref: Søreide et al. The formula for survival in resuscitation. Resuscitation 2013;84:1487-93 Medical Science Educational Efficiency Local Implementation Survival

30. Sample Page from the Provider Guide Monitor Key Indicators Quality Improvement Strategies

31. THANK YOU! Help babies breath if they do not cry at birth. Provide essential care to all babies. Keep small babies well and help them grow.