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May 08, 2011

Emergency Birth Training Curbs Infant Mortality

by Jessica Berman

Helping newborns breathe in first moments of life is critical to survival

Responding immediately when newborns fail to breathe in the critical moments after birth could dramatically cut the number of infant deaths worldwide. That’s the focus of a new training program for maternal healthcare workers.

An estimated one million newborns die each year of birth asphyxia, the failure to start or sustain breathing in the first moments after delivery.

To bring those numbers down, medical educators at the American Academy of Pediatrics designed a training program they call Helping Babies Breathe. Developed with input from the World Health Organization, the curriculum teaches healthcare workers simple techniques for initiating breathing in the newborn. These include rubbing the baby dry, keeping the baby warm and suctioning the baby’s mouth within the first minute of life.

If the newborn still does not begin breathing on their own, birth attendants are taught how to place a face mask on the baby’s face to initiate respiration.

Jeffrey Perlman, professor of pediatrics at Weill-Cornell Medical College in New York, says the protocol, carried out during the first minute of life, can reduce the newborn mortality rate by 50 percent.

Perlman says it also reduces the number of deaths from stillbirth, which is often simply a case of birth asphyxia.

"When a baby is born not breathing, it is often assumed that that is a stillbirth but that may not be the case," he says. "It may just be that the baby’s not breathing but has a low heart rate. And we know that if you can effectively breathe for the baby, and it doesn’t take too many assisted breaths, they will start breathing on their own."

Researchers conducting a 2009 pilot project with Helping Babies Breathe in Tanzania taught nurse-midwives, doctors and other medical personnel what immediate steps they should take if a baby is born not breathing, including how to use bulb suction and bag-mask ventilation devices.

Data collected at four hospitals, for three months before and three months after initiation of the program, showed the death rate dropped from 13 deaths per 1,000 births to just over six deaths per 1,000 deliveries.

Perlman is excited by the results. "If we can sustain that reduction, it will represent for the first time a reversal of asphyxia-related birth mortality."

Perlman says the simple strategies to initiate breathing during the first minute of delivery - which he calls "the golden minute" - could go a long way toward helping developing countries meet the United Nations’ Millennium Development goal of slashing infant mortality by two-thirds by 2015.

"It’s beautiful to actually see the nurse midwives and others taking possession and understanding why it’s so important to initiate the breathing within the Golden Minute. They’ve seen tangible results."