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Helping Babies Breathe curriculum updated to reflect new science :

November 1, 2016

As a young doctor working in rural Ecuador, Beena Kamath-Rayne, M.D., M.P.H., FAAP, remembers how it felt to rely solely on basic resuscitation skills to save a baby’s life.

“I didn’t have a ventilator. I didn’t have people skilled to help me if the baby needed advanced resuscitation. I had to do the resuscitation,” she said. “Realizing that I was the person that had to care for this baby and do the right things because there was no other help nearby is one real reason I recognize the importance of being involved in (Helping Babies Breathe).”

A birth attendant demonstrates proper suctioning skills at a Helping Babies Breathe workshop in Sierra Leone. Photo courtesy of Carrie Jo Cain, World Hope Intl.A birth attendant demonstrates proper suctioning skills at a Helping Babies Breathe workshop in Sierra Leone. Photo courtesy of Carrie Jo Cain, World Hope Intl.

The life-saving training program, Helping Babies Breathe (HBB) has been updated to reflect changes in evidence-based science and supporting guidelines. The new curriculum provides a way to transition to the next steps in care. It also emphasizes the importance of quality improvement.

It is the first update since HBB launched in 2010. So far, more than 400,000 providers in 77 countries have been trained in HBB. The materials have been translated into 26 languages.

“This is literally becoming a movement. It’s really emphasizing the initial steps of resuscitation, the most important steps of resuscitation that will help a baby to breathe within the critical golden minute of life,” said Dr. Kamath-Rayne, a master trainer and member of the AAP HBB Planning Group.

The new curriculum provides steps toward reducing the newborn mortality rate to seven per 1,000 live births or less by 2035, a world health goal (

Some of the key scientific updates include:

  • a discussion of the hazards of prolonged suctioning;
  • de-emphasizing oropharyngeal suctioning, particularly when there is meconium in the amniotic fluid;
  • information on delaying cord clamping so that ventilation can be established before cutting the cord; and
  • better assessment of the chest moving to improve the effectiveness of bag mask ventilation, as well as an explanation on corrective steps to make improper ventilation effective.

Recent studies have shown that HBB improves early neonatal mortality and stillbirth rates. The updated curriculum focuses more on quality changes, including curriculum exercises to sensitize participants to the principles of quality improvement and empower those trained to become champions in their facilities and ensure that those trained are practicing to maintain their skills.

HBB now is asking users to consider how often they should refresh their skills. Those already trained in the first edition can update their training practices for the second edition by accessing the Helping Babies Survive (HBS) website (see resources).

More educational advice explains how master trainers and educators can teach HBB at facilities, implement programs and make sure local health leaders are included. New guidelines on equipment reprocessing and cleaning also have been added, and a quality workbook accompanies materials to provide greater emphasis on the fragile lives that HBB is designed to save.

Continuing the transition from the golden minute, HBB links to the Survive and Thrive suite of educational programs. Helping Babies Survive, which includes HBB, Essential Care for Every Baby and Essential Care for Small Babies, addresses the three major causes of newborn death: asphyxia, infections and preterm/low-birthweight complications. It also links to Helping Mothers Survive, a maternal care curriculum that uses similar educational methodology as HBS. HBB can be integrated into a country’s health infrastructure alongside other newborn care programs.

Unlike the Neonatal Resuscitation Program, HBB does not set requirements for how often individuals should refresh their skills. However, a recent study found that Sudanese village midwives trained in HBB were able to sustain their skills for at least one year (

“A lot of countries and health systems have to decide for themselves how often they’re going to have people repeat the skills in order to retain them,” said Dr. Kamath-Rayne, noting that the transition to the updated materials is anticipated to be gradual, but will make an impact.

“The rate at which neonatal mortality has improved is slower compared to overall childhood mortality,” she said. “We really have to focus on the newborn if we’re going to meet our goals for preventable child deaths.”

HBB is an initiative of the Academy, developed in collaboration with the World Health Organization, and supported by the U.S. Agency for International Development, Save the Children, Latter-day Saint Charities, Laerdal Global Health, Johnson & Johnson and a number of other global health organizations.

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