Implementation of the Helping Babies Breathe Training Program: A Systematic Review

Abstract

CONTEXT: Helping Babies Breathe (HBB) is a well-established neonatal resuscitation program designed to reduce newborn mortality in low-resource settings. OBJECTIVES: In this literature review, we aim to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming. DATA SOURCES: Databases used in the systematic search included Medline, POPLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, African Index Medicus, Cochrane, and Index Medicus. STUDY SELECTION: All articles related to HBB, in any language, were included. Article quality was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA EXTRACTION: Data were extracted if related to HBB, including its implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, or the impact on newborn outcomes. RESULTS: Ninety-four articles met inclusion criteria. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Researchers of several studies found HBB cost-effective. Posttraining decline in knowledge and skills can be prevented with low-dose high-frequency refresher trainings, on-the-job practice, or similar interventions. Impact of HBB training on provider clinical practices varies. Although not universal, researchers in multiple studies have shown a significant association of decreased perinatal mortality with HBB implementation. LIMITATIONS: In addition to not conducting a gray literature search, articles relating only to Essential Care for Every Baby or Essential Care for Small Babies were not included in this review. CONCLUSIONS: Key challenges and requirements for success associated with each stage of HBB programming were identified. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.

Optimizing Helping Babies Breathe implementation in a resource limited setting to improve perinatal outcome

“…Study II lasted for a long period (5 years), and a continuous improvement in perinatal survival, compared to baseline was observed. We speculate that the CQI FBOS HBB training program was also responsible for sustaining improved clinical practice, which has been reported to be among the main challenges in HBB training [194,195].…”

Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda

“…Study co-investigators collectively used their knowledge and experience with the HBB program, resuscitation education, and mobile app development to create foundational features of HBB Prompt v0. In particular, we sought to leverage strategies that have previously been shown to improve skills retention, including LDHF practice, use of simulation, refresher training, and supportive supervision [10,38,39]. This provided a framework for our two software developers to build features of the app that we anticipated HBB trainers and providers would request.…”

“…Much of HBB Prompt's design focus was to facilitate users' ability to practise HBB skills in short, directed ways, either alone or with peers. LDHF practice of specific skills such as bag-mask ventilation has been shown to be effective in enhancing skills retention after training [10,38,45,46]. For individuals who are unable practise skills with others, the Training mode videos serve as a guide, and the function of Simulation-alone mode provides a structure and framework whereby users can benchmark their skills and receive automated external prompts and feedback in order to retain their resuscitation skills.…”

“…The HBB curriculum, currently in its second edition (HBB 2.0), was designed to train frontline health providers in low-resource settings to provide life-saving interventions for newborns [9]. HBB has been taught in over 80 countries and has been shown to reduce neonatal mortality and morbidity [10]. HBB training materials are standardized with a flowchart that illustrates the steps in the HBB algorithm, accompanied by a facilitator flip chart that provides all the teaching prompts for HBB workshop delivery.…”

Improving Newborn Resuscitation by Making Every Birth a Learning Event

“…These programs use simulation to train providers in a program-specific resuscitation algorithm informed by evidence-based practices. Standard resuscitation training increases providers’ knowledge and skills and often, but not universally, results in fewer fresh stillbirths, one-day newborn mortality, and early newborn mortality; however, there is a less consistent decrease in late neonatal mortality [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, on-going gaps in bedside performance persist after one-time training.…”