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Chile a model for countries seeking to develop national NRP :

July 26, 2018

When he was a neonatology fellow in Santiago, Chile, Jorge Fabres, M.D., M.S.P.H., learned about a simple way to boost newborn survival — the AAP Neonatal Resuscitation Program (NRP). With persistence and time, he and colleagues have helped Chile build a national neonatal resuscitation program based on the AAP NRP.

It was a big goal: to have a trained person at every delivery in case a baby needed resuscitation care.

Dr. Fabres first learned of the AAP program when NRP instructor Waldemar Carlo, M.D., FAAP, visited Chile in 1994. But the health care providers who attended Dr. Carlo’s course faced many obstacles to fueling national interest.

“The people that came had the job of going back to the services and teach around the country,” said Dr. Fabres. “Some were very active, but many didn’t have the support they needed.”

Dr. Fabres knew they had to fan the flames. He became an NRP instructor while completing a fellowship at the University of Alabama at Birmingham. Returning home re-inspired, Dr. Fabres approached the Pediatric Society of Chile, which created a Neonatal Resuscitation Committee in 2010 to help train NRP instructors.

A poster presentation about the success of Chile’s neonatal resuscitation program by Miriam Faunes, R.N., M.H.A. (left), and Jorge Fabres, M.D., M.S.P.H., at this year’s Pediatric Academic Societies meeting drew interest from pediatricians around the world who want to launch their own national programs.

“That was the spark for the Ministry of Health to get the challenge and say they would give more support for the rest of the country,” he said.

With the Ministry of Health on board, the national program grew: 221 instructors have been trained and 272 provider courses offered between 2010 and 2017.

Preliminary data are promising, as Dr. Fabres and Miriam Faunes, R.N., M.H.A., representing the Neonatal Resuscitation Committee, noted during their poster presentation “Developing a National Neonatal Resuscitation Program in Chile: First International Report”at the 2018 Pediatric Academic Societies meeting.

“This was the largest program started with the government,” Dr. Fabres said.

Next goals are building communications and online offerings such as videos.

But the continuing conundrum is one that all pediatricians know well, whether they live in the United States, Chile or other countries that have started a national NRP like Hong Kong and Brazil.

“The society has the infrastructure, but we need the money for each service to organize courses, buy materials and buy mannequins,” Dr. Fabres said. “That’s the main challenge: to maintain the support from the government.”

The shared objective is to have a trained person at every one of the 250,000 births per year. The program’s continued success hinges on its impact on Chile’s 7% neonatal mortality rate. Asphyxia-associated mortality is 4% of neonatal mortality, with a high rate of hospital deliveries (98%).

“Everybody is very happy that the AAP is interested in the program (in Chile). I understand that it is important for you to see what is happening around the world with this,” Dr. Fabres said. “It’s a win-win situation.”


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