A14 The World
Course teaches people in poor countries how to help newborns breathe
by David Brown It’s been called the most dan-
gerous minute of the most dan- gerous day of a person’s life. For 829,000 babies each year, it’s the beginning of the end. In the first minute after birth,
S
KLMNO International campaign tries to reduce infant deaths
an infant must inhale, pop open millions of microscopic air sacs and take the first of numberless breaths that will sustain life for decades. For the majority of new- borns, this happens naturally. Some, however, require help and in too many places around the world, they’re not getting it. The Helping Babies Breathe campaign, an international effort to prevent “birth asphyxia” was rolled out in Washington last week with the goal of teaching
midwives and traditional birth at- tendants in poor countries how to gently nudge newborns into the world of respiration. The tools include a dry towel, a
suction bulb and a hand-operated bag-and-mask resuscitator. A big part of the campaign is expected to be a newborn mannequin, made by a Norwegian medical de- vice company and soon to be dis- tributed by the thousands to vil- lage clinics.
But the most important part is
convincing practitioners — many of whom went no further than el- ementary school and don’t un- dergo regular retraining — that there is something they can do in the blood-chilling moment when a delivery goes awry. A key concept in the Helping Babies Breathe campaign is that simple actions can save a dusky and limp baby, but they must be done quickly. “We use the idea of the ‘golden minute,’ ” said Susan Niermeyer, a
neonatologist at the University of Colorado School of Medicine, who helped write the curriculum. “It conveys a sense of urgency. It pushes the idea that prompt ac- tion predisposes to a positive re- sult.” Little equipment (and no elec-
tricity) is required for newborn resuscitation. More than 80 per- cent of newborns will breathe spontaneously immediately after birth. About 10 percent will need the stimulation of being dried off and having their nose and mouth gently suctioned. Five percent will need “positive pressure venti- lation,” either by mask or mouth.
SUNDAY, JUNE 20, 2010
Less than one percent need the full CPR procedure. About 7.7 million children will die this year before age 5, accord- ing to an estimate published this month in the Lancet, a medical journal. Birth asphyxia will ac- count for nine percent of the deaths; it accounts for one-quar- ter of deaths in the first month of life. It kills more children than malaria, and nearly five times more than AIDS. Experts say better instruction
in newborn resuscitation could reduce deaths from birth asphyx- ia by about 30 percent and deaths attributed to premature birth by up to 10percent. They say 500,000 lives a year might be saved. Helping Babies Breathe is an
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initiative of the American Acad- emy of Pediatrics, the U.S. Agency for International Development, the National Institute of Child Health and Human Development, and Save the Children. The cur- riculum is being offered immedi- ately to health ministries in about 10 countries in Africa, Asia and Latin America where USAID has maternal and newborn health programs. Save the Children is implementing it in 18 countries. The curriculum may eventually be used in most of the 68 coun- tries where 90 percent of mother or newborn deaths occur (and where 46 percent of births lack a medically trained attendant). Trainers use flip-chart books with little text and emphasize practicing the maneuvers. The training kit for six students in- cludes a washable, brown plastic mannequin filled with about two quarts of water, which gives it the weight and floppiness of a non- breathing newborn. The person running the simulation has three squeeze bulbs connected by tubes to the mannequin. One produces a cry and another a pulse in the umbilical cord. The third makes the chest rise (as does air blown into the mouth). Previous newborn mannequins cost about $400, said Joy Lawn, a physician at Save the Children. Laerdal Medical, a device-maker in Stavanger, Norway, developed the new mannequin and is pro- viding it at cost (about $50). The company is also selling bag-and- mask sets at cost (about $13) and has made a clear, boilable suction syringe to replace opaque bulb sy- ringes that are reused without sterilization in many places. Pilot projects have been run in Bangladesh, India, Pakistan, Ken- ya and Tanzania. About a hundred people from around the world be- came “master trainers” in the re- suscitation techniques last week at the 37th Annual International Conference on Global Health in Washington. They will teach the curriculum in their home coun- tries. “Where are the maximum gains? It is in the less-trained at- tendants,” Shivaprasad S. Goudar, a physician who piloted the Help- ing Babies Breathe curriculum in the southern India state of Karna- taka, told a gathering at the Glob- al Health Council. “But there is a group ready to learn, ready to soak up the skills.” Whether it will make a differ- ence to newborns is another ques- tion. The neonatal mortality rate went down only a small amount in the Karnataka pilot study. In an unrelated clinical trial reported in the New England Journal of Med- icine last winter, rural birth atten- dants in six countries who had been taught resuscitation tech- niques also saw no significant de- cline in newborn deaths. How- ever, there were fewer stillbirths, which the researchers believe might be attributable to the suc- cessful resuscitation of babies who once would have been con- sidered born dead.
browndm@washpost.com
U.S. lawyer charged in Rwanda departs
Associated Press
nairobi — An American lawyer accused of minimizing Rwanda’s 1994 genocide arrived in Nairobi late Saturday after Rwanda grant- ed him bail on medical grounds. Reached by phone, Peter Erlin- der declined to comment on his case but said he would hold a news conference Sunday. Later he sent a text message to the AP say- ing he was happy to be in Nairobi. Erlinder, 62, a professor at Wil-
liam Mitchell College of Law in St. Paul, Minn., was arrested May 28 while in Rwanda to help with an opposition leader’s legal defense. A lawyer representing Erlinder,
SERVING ARMY MARINE CORPS NAVY AIR FORCE DoD
Kennedy Ogeto, said security guards at the airport in Kigali, the Rwandan capital, checked his and Erlinder’s travel bags twice before allowing them into the gate area to depart. Erlinder’s brother, Scott, said
he expected him to fly from Kenya to Tanzania and Amsterdam be- fore arriving in New York.
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