Susan Niermeyer, MD, FAAP

The efforts of the AAP to disseminate information on skilled neonatal resuscitation are bearing fruit around the world, as more babies are born with trained attendants present, and more communities and governments are working together to support maternal and child health.

This was the message of Susan Niermeyer, MD, FAAP, professor of pediatrics, University of Colorado, Denver School of Medicine, who delivered the 2009 Christopherson Lecture, "Helping Babies Breathe at Birth: Global Impact of the American Academy of Pediatrics." In her lecture at the October 20 plenary session, Dr Niermeyer discussed three separate programs: the Neonatal Resuscitation Program (NRP); the Neonatal ILCOR (International Liaison Committee on Resuscitation) guidelines; and Helping Babies Breathe (HBB).

"These programs are working in slightly different, but synergistic ways," she said. They are addressing the problem of 4 million neonatal deaths around the world, 98 percent of which occur in the least developed nations.

The NRP algorithm was developed in 1987, and has proved to be effective, said Dr Niermeyer professor of pediatrics at the University of Colorado Medical School.

"NRP is simple. One instructor can make a difference," she said. "It is also contagious. It leads to systematic changes in perinatal delivery systems."

The program has jumped the boundaries of the United States and is now used in more than 125 countries. In Brazil, for example, NRP began with two neonatologists and was supported by a university and the AAP, and grew further when it was supported by regional and national pediatric societies. It eventually became integrated into Brazilian health policy, and now a national network for research and quality improvement is disseminating best practices, Dr Niermeyer said.

On a global level, NRP has become a catalyst for partnerships and bringing important stakeholders together. It receives financial support from commercial sponsors, international organizations and governments.

Important changes in the international guidelines for neonatal resuscitation, developed by the Neonatal ILCOR, made resuscitation techniques more accessible for providers in locations with limited resources, Dr Niermeyer said. These guidelines also were disseminated globally via open access electronic publishing. Evidence-based evaluation and research identified areas in which knowledge gaps existed, such as management of meconium-stained fluid when intubation is not routinely available.

Helping Babies Breathe (HBB) grew out of the mission of the Neonatal Resuscitation Global Implementation Task Force to develop and implement an evidence-based curriculum that would be adaptable to clinical and training use.

"It is directed to the single birth attendant who is present at the birth of the baby," Dr Niermeyer said. "It features limited text, which means less translation is needed, and it's appropriate for areas with low literacy. It is also adaptable to traditional birth attendants."

The training materials also include a mannequin-simulator that can be shipped empty and filled with warm water for use. Boilable syringes and other materials are also included she said.

The educational framework of the HBB program is already in place in Kenya and Pakistan, and HBB is now implemented in Tanzania and India.