Helping Babies Breathe 2nd Edition FAQs

​Helping Babies Breathe 2nd Edition FAQs


​​Please click here to view and download a printable version of the HBB 2nd Edition FAQs. ​​​

    What has been changed in the 2nd Edition? Where can I find a clear list of the changes?

    HBB 2nd Edition features a number of important updates and improvements.  It includes scientific updates that harmonize with 2015 ILCOR Consensus on Science with Treatment Recommendations, and 2012 WHO Guidelines on Basic Newborn Resuscitation. It also contains strengthened educational advice and new guidance on program implementation and quality improvement.  Please review the HBB 2nd Edition Summary of Changes​ for a more detailed overview of the updates to the 2nd Edition materials.  ​​

    What resources are available for facilitators and in-country health authorities to communicate the HBB 2nd Edition updates?

    We have developed a number of resources to help promote widespread awareness of the changes associated with HBB 2nd Edition, as well as provide learners, facilitators and in-country stakeholders with the information necessary to ensure a seamless transition to the new content and materials.  Please browse the resources on the HBS website.  

    • HBB 2nd Edition Summary of Changes​:  an overview of updates made to each of the HBB 2nd Edition materials – Action Plan, Facilitator Flip Chart, and Provider Guide –  clearly delineates the changes between HBB 1st Edition and HBB 2nd Edition.
    • HBB 2nd Edi​tion Update Guide​:  a tool offering guidance on incorporating HBB 2nd Edition content changes into future trainings to ensure a seamless transition from HBB 1st Edition to HBB 2nd Edition.
    • HBB 2nd Edition Webinar (coming soon):  an on-demand presentation providing an overview of HBB 2nd Edition features and changes, as well as answer anticipated questions and provide general guidance for transitioning to HBB 2nd Edition.  

    How do we phase in HBB 2nd Edition changes?

    The HBB 2nd Edition Update Guide​​​ offers information and guidance for incorporating HBB 2nd Edition content into existing HBB training programs.  Additionally, all HBB 2nd Edition materials – Action Plan, Facilitator Flip Chart, Provider Guide – are available for free download on the AAP’s International Resources site.  ​

    Do I need to retake the HBB Master Trainer or Facilitator course over again to be current on the content of HBB 2nd Edition?

    ​​​No, those who have previously completed an HBB Master Trainer or Facilitator course do not need to re-take the course.  However, this is a great opportunity to refresh and update your knowledge.  You should conduct a comprehensive review of the HBB 2nd Edition resources listed below.  

    These resources were designed to update existing HBB facilitators on the new elements included in HBB 2nd Edition to ensure a seamless, successful and accurate transition.  

    Why did the information and scientific recommendations change? Was what we have been teaching wrong?

    ​Since its launch in 2010, HBB has provided more than 400,000 health workers in 80 countries with the knowledge and skills necessary to save the lives of babies who need help to breathe at birth.  While the skills and learning concepts taught in the 1st Edition are still critically important and have been successful in reducing neonatal mortality rates in low-resource areas, it is essential that HBB continuously improve in order to provide trainers and newborn care providers around the world with the best program possible.  As such, changes to the HBB 2nd Edition were not made lightly – they are the result of an ongoing, systematic quality improvement effort focused on strengthening the performance of the HBB program.  ​

    In order to identify areas for improvement, a large volume of qualitative and quantitative data were collected throughout the 5 years HBB has been in use, and these data informed the 2nd Edition updates.  Based on valuable feedback from the global HBB community, the 2nd Edition now features expanded educational advice for trainers, strengthened program implementation guidance, and added resources on quality improvement. These new learning elements were added in an effort to build upon the success of the 1st Edition by providing further support to HBB trainers and health professionals working to implement sustainable newborn care programs in low-resource settings.

    Though the scientific changes between editions are few, it was also important that the HBB curriculum be revised in order to remain consistent with the latest evidence.  The 2nd Edition reflects updates to harmonize with 2015 ILCOR Consensus on Science with Treatment Recommendations (CoSTR) and 2012 WHO Guidelines on Basic Newborn Resuscitation.  The neonatal resuscitation guidelines reflected in the CoSTR are based on a rigorous, 5-year topic review by ILCOR, and represent thousands of hours of preparation and analysis.  Similarily WHO's original basic newborn resuscitation guidelines were developed in 1999; as this document was over a decade old, the recommendations were updated in 2012 using a meticulous, evidence-based assessment process.  

    How does HBB 2nd Edition coordinate with WHO and their recommendations?

    ​ILCOR's neonatal resuscitation guidelines serve as the foundation for both the HBB program and WHO 2012 guidelines.  As was the case with HBB 1st Edition, HBB 2nd Edition remains highly coordinated with WHO.  Several examples of 2nd Edition updates are provided below, demonstrating the alignment between the HBB and WHO neonatal resuscitation recommendations. 

    WHO Recommendation:  in neonates born through meconium-stained amniotic fluid who start breathing on their own: (1) tracheal suctioning should not be performed; (2) suctioning of the mouth or nose is not recommended

    • New HBB 2nd Edition guidance:  clear de-emphasis of suctioning, specifically:
      • removal of recommendation for suctioning before thorough drying if meconium in amniotic fluid
      • articulation of positioning and suctioning as two elements of clearing the airway
      • emphasis on hazards of prolonged or overly vigorous suctioning​

    WHO Recommendation: in neonates born through meconium-stained amniotic fluid who do not start breathing on their town, tracheal suctioning and/or suctioning of the mouth and nose should be done before initiating positive-pressure ventilation

    • New HBB 2nd Edition guidance:
      • ​Suction if needed – when airway obstructed or if meconium in amniotic fluid and baby is not crying after thorough drying
    What if HBB has already been integrated into national programs?

    The neonatal resuscitation and newborn care practices taught in HBB 1st Edition remain critically important and highly effective.  The goal of HBB is to have at least one person present at every birth who is skilled and equipped to provide neonatal resuscitation.  If HBB has been integrated at the national level, then health care providers and the newborns they serve are already benefiting from this high-impact, life-saving program.

    However, the launch of HBB 2nd Edition is a perfect opportunity for countries to conduct a review of their national program efforts to update practices.  Additionally, the review process can generate useful information about program outcomes, achievements, barriers to implementation and areas for quality improvement.  ​

    Countries and program managers should keep in mind that HBB educational materials will be revised on a five-year cycle following the cycle of revision of neonatal resuscitation guidelines by ILCOR.  Planning and budgets at the national, regional and local level should incorporate time and funds for training updates.  Materials will always be available for free access and download via the AAP's International Resources site.  This continual revision and quality improvement process guarantee that the latest scientific evidence in neonatal resuscitation can rapidly reach birth attendants in all parts of the world.  

    The health authority in my country does not wish to adopt the changes made in HBB 2nd Edition. Can I still use the new materials?

    ​We encourage all trainers to use the updated HBB 2nd Edition materials.  However, to build sustainable programs that have the potential to operate at scale, it is ideal to work in coordination with the MOH and national stakeholders whenever possible. 

    You may want to communicate with the health authority in your country to learn why they do not wish to adopt the HBB 2nd Edition changes.  There may be concern about the cost or the need to distribute new learning materials.

    This may also be an ideal opportunity to confirm that your health authority is aware of the scientific updates and improved educational content featured in the new edition, as well as share the resources listed below that were developed to help users transition to HBB 2nd Edition. 

    Countries may need to make minor content modifications to HBB 2nd Edition materials so they align with national guidelines for newborn care.  Please ensure the health authority in your country is aware of the process the AAP has in place to facilitate adaptions and modifications, as described on the HBS website.   

    I just purchased a large amount of HBB 1st Edition printed materials. Can I exchange them for the 2nd Edition materials?

    ​Unfortunately, we are not able to facilitate exchanges.  However, all HBB 2nd Edition materials are available for free access and download on the AAP's International Resources site. Once downloaded, the Action Plan, Flip Chart, Provider Guide and Reprocessing Job Aid can be printed based on your preferred size and color specifications. ​

    HBB's de-emphasis on suctioning does not match the guidelines of my country's health authority, what should I do?

    When national guidelines do not yet align with evidence-based practices featured in the HBB curriculum, health authorities and/or local stakeholders should consider conducting a careful review of the guidelines with respect to neonatal resuscitation and immediate newborn care.  This is a good opportunity to assess how practice, experience and the scientific recommendations line up.  Results from the review can then be used to update national guidelines and further strengthen essential newborn care.

    The development and updating of national guidelines is an in-depth process.  Depending on the expertise and/or resources available, the national health authority may: (1) accept recommendations of outside authorities such as HBB or WHO; or (2) develop a domestic source of expertise from in-country academic and/or professional organizations.  Regardless of the process, it is important for in-country health leaders to know that HBB can be adapted to fit country needs of the curricula within existing ENC, EmONC, IMNCI or other training programs.  ​

    The full ILCOR CoSTR and guidelines and the WHO Guidelines on Basic Newborn Resuscitation can be viewed online. ​

    Can I still use HBB 1st Edition materials?

    ​It is recommended that you transition to the HBB 2nd Edition materials, as they reflect scientific updates, strengthened educational advice, as well as n​ew implementation and quality improvement guidance.  These can be downloaded for free and printed via the AAP's International Resources site, or hard copies of the materials can be ordered online at ​

    If you are not currently able to transition to the new materials, please continue to use HBB 1st Edition materials and adapt them as you see fit.  The HBB 2nd Edition U​pdate Module​​ offers useful information on how best to adapt the HBB 1st Edition and incorporate new HBB 2nd Edition content into future courses.  

    We have just completed our translation of the first edition. Can we no longer use it? What about translations of HBB 2nd Edition into other languages?

    We recognize the importance of having HBB 2nd Edition materials available in a variety of languages, and we will be working with others to facilitate translations as quickly as possible.  Please visit the Translation and Adaption page of our website if you are interested in translating HBB 2nd Edition into a specific language.  In the meantime, it is fine to continue using translations of HBB 1st Edition materials – the information and learning concepts of this edition are still of critical importance, as studies show the program is associated with dramatic improvements in neonatal mortality rates and stillbirth rates.  We do encourage you to incorporate the changes featured in HBB 2nd Edition – scientific updates, strengthened educational advice, new implementation guidance – into future trainings, even if you continue using HBB 1st Edition materials.  To support this process, we created the HBB 2​nd Edition Update Module​​, which provides trainers with detailed guidance on how best to adapt materials and integrate content updates into their courses.  ​​

    Will Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) also undergo revisions every five years? When are those updates expected to be released?

    Yes, in order to ensure that the programs remain consistent with the latest science and evidence-based educational practices, ECEB​ and ECSB​ will also undergo revisions every five year and are anticipated for release in 2019/2020.