Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, and Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Glob Health Sci Pract. 2018 Oct 4;6(3):538-551. doi: 10.9745/GHSP-D-18-00147. Print 2018 Oct 3.
Helping Babies Breathe (HBB), a skills-based program in neonatal resuscitation for birth attendants in resource-limited settings, has been implemented in over 80 countries since 2010. Implementation studies of HBB incorporating low-dose high-frequency practice and quality improvement show substantial reductions in fresh stillbirth and first-day neonatal mortality. Revision of the program aimed to further augment provider and facilitator skills and address gaps in implementation with the goal of improving neonatal survival.
The Utstein Formula for Survival-Medical Science X Educational Efficiency X Local Implementation = Survival-provided a framework for the revisions. The 2015 Neonatal Resuscitation Consensus on Science and Treatment Recommendations by the International Liaison Committee on Resuscitation informed scientific updates, which were harmonized with the 2012 World Health Organization Basic Newborn Resuscitation Guidelines. Published literature and program reports, consensus guidelines on reprocessing equipment, systematic collection of suggestions from frontline users, and responses to a semistructured online questionnaire informed educational/implementation revisions. Links to maternal care were added. Draft materials underwent Delphi review and field testing in India and Sierra Leone. An Utstein-style meeting of stakeholders identified key actions for successful implementation.
Scientific revisions included expectant management of infants with meconium-stained amniotic fluid, limitation of suctioning, and initiating and continuing effective ventilation until spontaneous respirations. Frontline users (N=102) suggested augmented simulation methods to build confidence and competence and additional guidance for facilitators on implementation. Users identified a need for sufficient practice during the workshop, systematized ongoing practice, and enough simulators for participants. Field trials refined approaches to self-reflection, feedback and debriefing, and quality improvement. Utstein meeting stakeholders validated the importance of quality improvement and use of data to improve outcomes.
The second edition of HBB provides a newer paradigm of learning for providers that incorporates workshop practice, self-reflection, and feedback and debriefing to reinforce learning as well as the promotion of mentorship and development of facilitators, systems for low-dose high-frequency practice in facilities, and quality improvement related to neonatal resuscitation.
自 2010 年以来，“帮助婴儿呼吸”（HBB）项目已在 80 多个国家实施，该项目是一项针对资源有限环境中分娩人员的新生儿复苏技能培训项目。实施 HBB 的研究表明，低剂量高频实践和质量改进可显著降低新鲜死产和新生儿第一天死亡率。修订该项目旨在进一步提高提供者和促进者的技能，并解决实施过程中的差距，从而提高新生儿的存活率。
“生存-医学科学 X 教育效率 X 当地实施-生存”的厄斯泰因公式为修订提供了框架。2015 年国际复苏联络委员会制定的新生儿复苏共识中的科学更新，以及 2012 年世界卫生组织基本新生儿复苏指南，为科学更新提供了依据。出版文献和项目报告、设备再处理共识指南、从一线用户系统收集的建议、以及对半结构化在线问卷的回应，为教育/实施修订提供了信息。增加了与母婴护理的联系。草案材料在印度和塞拉利昂进行了德尔菲审查和现场测试。利益攸关方的厄斯泰因式会议确定了成功实施的关键行动。
科学修订包括期待管理羊水有胎粪污染的婴儿、限制抽吸、以及开始并持续有效的通气，直到自主呼吸。一线用户（N=102）建议增加模拟方法来建立信心和能力，并为促进者提供更多实施方面的指导。用户发现需要在讲习班期间进行足够的练习、系统地进行持续练习以及为参与者提供足够的模拟人。现场试验改进了自我反思、反馈和讨论的方法，以及质量改进。厄斯泰因会议的利益攸关方验证了质量改进和使用数据来改善结果的重要性。
第二版 HBB 为提供者提供了一种更新的学习模式，该模式包含了讲习班实践、自我反思、反馈和讨论，以加强学习，并促进导师制和促进者的发展、在机构中进行低剂量高频实践的系统以及与新生儿复苏相关的质量改进。
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