​Scientific Articles

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Helping Babies Survive, along with our implementing partners, continually strives to evaluate and communicate the impact of our progra​​ms – at conferences, meetings, and through peer-reviewed publications.

Help us measure our progress! We are proud to highlight and share the results of HBS-related research studies being conducted worldwide.  Please contact us at hbs@aap.org if you would like to submit a scientific publication for inclusion on the website.

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Featu​red Ar​ticles ​​

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe​ 
Pediatrics, June 2016​

Newborns are at the highest risk of dying around abstract the time of birth, ​​due to intrapartum-related complications… READ MORE 

Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training

Pediatrics, February 2013

The Helping Babies Breathe program was implemented in 8 hospitals in Tanzania in 2009… READ MORE

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All Scie​nt​ific Articles​

​​Global Gains After Helping Babies Breathe
Niermeyer, Susan. Acta Paediatrica, Oct 2017, 106(10), 1550-1551.​

Implementation of basic neonatal resuscitation in low- and middle-income settings consistently results in lives saved on the day of birth. Wrammert et al. explore the causes and timing of newborn deaths in a large maternity facility in Nepal before... READ MORE
​​​Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial

Ashish KC, Anna Bergström, Dipak Chaulagain, Olivia Brunell, Uwe Ewald, Abhishek Gurung, Leif Eriksson, Helena Litorp, Johan Wrammert, Erik Grönqvist, Per-Anders Edin, Claire Le Grange, Bikash Lamichhane, Parashuram Shrestha, Amrit Pokharel, Asha Pun, Chahana Singh, Mats Målqvist
BMJ Global Health, September 2017, DOI: 10.1136/bmjgh-2017-000497

Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using... READ MORE

​​Improvements in the delivery of resuscitation and n​ewborn care after Helping Babies Breathe training
BD Kamath-Rayne, S Josyula, ARL Rule, JC Vasquez
Journal of Perinatology, July 2017, 1-8; doi: 10.1038/jp.2017.110​

To evaluate changes in neonatal resuscitation an​d postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. READ MORE
Successful implementation of Helping Babies Survive and Helping Mothers Survive programs—An Utstein formula for newborn and maternal survival
Hege L. Ersdal, Nalini Singhal, Georgina Msemo, Ashish KC, Santorino Data, Nester T. Moyo, Cherrie L. Evans, Jeffrey Smith, Jeffrey M. Perlman, Susan Niermeyer
PLOS ONE, June 2017, 12(6): e0178073; https://doi.org/10.1371/journal.pone.0178073

This paper provides users of Helping Babies Survive and Helping Mothers Survive programs a 10-point list of key implementation steps to create sustained impact, leading to increased survival of mothers and babies. READ MORE

​​Using quality improvement to decrease birth asphyxia rates after ‘Helping Babies Breathe’ training in Kenya
Amy R.L. Rule, Esther Maina, David Cheruiyot, Priscilla Mueri, Jeffrey M. Simmons, Beena D. Kamath-Rayne
Acta Paediatrica, June 2017; doi: 10.1111/apa.13940

The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB. READ MORE

​​Implementation of "Helping Babies Breathe": A three-year experience in Tanzania
L Arlington, AK Kairuki, KG Isangula, RA Meda, E Thomas, A Temu, V Mponzi, D Bishanga, G Msemo, M Azayo, BD Nelson​​
Pediatrics, May 2017, 139(5); doi: 10.1542/peds.2016-2132​​​​

This first-ever country-level study assesses the implementation of the Helping Babies Breathe (HBB) program in 15 of Tanzania’s mainland regions by measuring coverage, adoption and retention of provider skills, acceptability among providers, and barriers and challenges to at-scale implementation. READ MORE

Helping Babies Breathe implementation in Zanzibar, Tanzania​
GM Wilson, AM Ame, MM Khatib​, EK Rende, AM Hartman, J Blood-Siegfried
International Journal of Nursing Practice, April 30, e12561; https://doi.org/10.1111/ijn.12561

Each year, there are approximately 3.6 million neonatal deaths in the world, with 98% of these deaths occurring in resource-limited environments. READ MORE​​

Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania
Sumona Chaudhury, Lauren Arlington, Shelby Brenan, Allan Kaijunga Kairuki, Amunga Robson Meda, Kahabi G. Isangula, Victor Mponzi, Dunstan Bishanga, Erica Thomas, Georgina Msemo, Mary Azayo, Alice Molin​ier, Brett D. Nelson
BMC Health Services Research, Dec 2016, 16: 681; doi: 10.1186/s12913-016-1924-2

The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. READ MORE

Newborn resuscitation training in resource-limited settings: A systematic literature review
Jonathan Reisman, Lauren Arlington, Lloyd Jensen, Henry Louis, Daniela Suarez-Rebling, Brett D. Nelson
Pediatrics, 2016 Aug;138(2).

This review examined acquisition and retention of NR knowledge and skills by birth attendants in LMICs and the effectiveness of interventions to improve them. READ MORE

​​Evaluating newborn care skills among trained birth attendants in a resource-limited setting
Megan E. Kassick, Margaret Amanua Chinbuah, Magdalena Serpa, Goldy Mazia, Alice M. Tang, Isabella Sagoe-Moses, Mira Taylor, Adoma Dwomo-Fokuo, Nihad Salifu, Daniel Kojo Arhinful, Cyril Engmann, Thomas F. Burke, Patience Cofie, Brett D. Nelson
International Journal of Gynecology and Obstetrics, 2016 Aug 20;S0020-7292(16)30313-7.

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[This article develops and tests a scalable OSCE for ECEB]  To validate a novel objective structured clinical examination (OSCE) tool for assessing neonatal care skills among delivery attendants trained as part of the Essential Care for Every Baby (ECEB) program and to assess ECEB training effectiveness. READ MORE

Validation of a novel tool for assessing newborn resuscitation skills among birth attendants trained by the 'Helping Babies Breathe' program

Jonathan Reisman, Narra Martineau, Allan Kairuki, Victor Mponzi, Amunga R. Meda, Kahabi G. Isangula, Erica Thomas,​ Marya Plotkin, Grace J. Chan, Leila Davids, Georgina Msemo, Mary Azayo, Brett D. Nelson
International Journal of Gynecology and Obstetrics, 2015 Nov;131(2):196-200.

To validate a simplified objective structured clinical examination (OSCE) tool for evaluating the competency of birth attendants in low-resource countries who have been trained in neonatal resuscitation by the Helping Babies Breathe (HBB) program. READ MORE

Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal

Ashish KC, Johan Wrammert, Viktoria Nelin, Robert Clark, Uwe Ewald, Stafan Swartling Peterson, Mats Målqvist
Uppsala University Publications, November 2015​


Each year 700,000 infants die due to intrapartum-related complications. Helping Babies Breathe (HBB) uses an algorithm to increase knowledge and improve skills on neonatal resuscitation. READ MORE

Educational Outcomes of Helping Babies Breathe Training at a Community Hospital in Honduras​

Teresa Seto, Meredith Tabangin, Srirama Josyula, Kathryn K. Taylor, Juan Carlos Vasquez, Beena D. Kamath-Rayne
Perspect Med Educ, Oct 2015, 4(5): 225-32; doi: 10.1007/s40037-015-0214-8

Helping Babies Breathe is an evidence-based curriculum designed to teach basic neonatal resuscitation in low-resource countries. The purpose of this study was to evaluate the acquisition of knowledge and skills following this training and correlation of learner characteristics to performance in a Spanish-speaking setting. READ MORE

Provider experiences with the large-scale ‘Helping Babies Breathe’ training programme in Tanzania

Kahabi Ganka Isangula, Megan E. Kassick, Allan Kaijunga Kairuki, Robson Amunga Meda, Erica Thomas, Akwila Temu, Georgina Msemo, Mary Azayo, Brett D. Nelson
Paediatrics and International Child Health, 29 Sep 2016:1-7.

Worldwide, there has been renewed emphasis on reducing neonatal mortality in low-resource countries. The Helping Babies Breathe (HBB) programme has been shown to reduce newborn deaths. READ MORE

​​Cost-Effectiveness of the "Helping Babies Breathe" Program in a Missionary Hospital in Rural Tanzania

Corinna Vossius, Editha Lotto, Sara Lyanga, Estomih Mduma, Georgina Msemo, Jeffrey Perlman, Hege L. Ersdal
PLoS ONE, July 2014, 9(7): e102080; doi: 10.1371/journal.pone.0102080

​The Helping Babies Breathe'' (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania. READ MORE

Beyond Newborn Survival: The Global Burden of Disease Due to Neonatal Morbidity

Joy E. Lawn, Parviz Minoo
Paediatric Research, Dec 2013, 74(S1), S1-S6; doi: 10.1038/pr.2013.202-208

​This supplement includes six research articles presenting the first systematic estimates of impairment after neonatal morbidity, bringing together the work of almost 50 authors representing 35 institutions from 12 countries, from more than a thousand different data inputs. READ MORE

Resuscitation in Resource-Limited Settings​

H.L. Ersdal, N. Singhal
Fetal & Neonatal Medicine, Dec 2013, 18(6), 373-378; doi: 10.1016/j.siny.2013.07.001.​ ​

Intrapartum-related hypoxia leading to deaths and disabilities continues to be a global challenge, especially in resource-limited settings. Primary prevention during labour is likely to have a significant impact, but secondary prevention with focus on immediate basic stabilization at birth can effectively reduce a large proportion of these adverse outcomes as demonstrated in the resource-rich settings. READ MORE

Helping Babies Breathe' Training in Sub-Saharan Africa: Educational Impact and Learner Impressions​

R Hoban, S Bucher, I Neuman, M Chen, N Tesfaye, JM Spector
Journal of Tropical Pediatrics, Jun 2013, 59(3), 180-6; doi: 10.1093/tropej/fms077

Poor resuscitation contributes significantly to neonatal deaths globally. Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation curriculum for low-resource settings. We sought to characterize knowledge changes after national-level HBB training in Ethiopia, factors correlated with successful training, resuscitation skills and trainees' perceptions. READ MORE

Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training​

Shivaprasad S. Goudar, Manjunath S. Somannavar, Robert Clark, Jocelyn M. Lockyer, Amit P. Revankar, Herta M. Fidler, Nancy L. Sloan, Susan Niermeyer, William J. Keenan, Nalini Singhal
Pediatrics, Feb 2013, 131(2), e344–e352; doi: 10.1542/peds.2012-2112

This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs.READ MORE

Addressing High Infant Mortality in the Developing World: A Glimmer of Hope​

John Kattwinkel
Pediatrics, Feb 2013, 131(2); doi: 10.1542/peds.2012-3171

Extraordinary progress has been made in reducing infant mortality in the developed world over the past 7 decades, with death rates during the first year of life falling by more than 90% since my own birth in 1941. However, infant mortality rates in the developing world are still nearly 10 times higher than in the United States. READ MORE

Appropriate Interventions to Reduce Perinatal Mortality and Morbidity in Low-Resourced Settings

HL Ersdal
PhD Thesis, Stavanger University Hospital, 2012

To meet the Millennium Developmental Goal (MDG) 4, a significant reduction in early neonatal mortality is required. It is necessary to definite appropriate and effective low-tech interventions that can be implemented with high coverage and low costs worldwide. READ MORE

Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB) - at a tertiary level hospital in Nepal for an increased perinatal survival​

Ashish KC, Mats Målqvist, Johan Wrammert, Sheela Verma, Dhan Raj Aryal, Robert Clark, Naresh P KC, Ravi Vitrakoti, Kedar Baral, Uwe Ewald
BMC Pediatrics, Oct 2012, 12(1), 1; doi: 10.1186/1471-2431-12-159

​Reducing neonatal death has been an emerging challenge in low and middle income countries in the past decade. The development of the low cost interventions and their effective delivery are needed to reduce deaths from birth asphyxia. READ MORE

Intermittent Detection of Fetal Heart Rate Abnormalities Identify Infants at Greatest Risk for Fresh Stillbirths, Birth Asphyxia, Neonatal Resuscitation, and Early Neonatal Deaths in a Limited-Resource Setting: A Prospective Descriptive Observational Study at Haydom Lutheran Hospital​

Hege Langli Ersdal, Estomih Mduma, Erling Svensen, Johanne Sundby, Jeffrey Perlman
Neonatology, Aug 2012, 102, 235-242; doi: 10.1159/000339481

Intermittent fetal heart rate (FHR) monitoring during labor using an acoustic stethoscope is the most frequent method for fetal assessment of well-being in low- and middle-income countries. READ MORE

An Introduction to​ Helping Babies Breathe: the "Golden Minute" is here for South African Newborn Babies​

C Van HeerdenProfessional Nursing To
day, Jun 2012, 16(3)

​It is estimated by the World Health Organization (WHO) that one million babies die each year due to birth asphyxia. REA​D MORE ​

Birth Asphyxia: A Major Cause of Early Neonatal Mortality in a Tanzanian Rural Hospital

Hege Langli Ersdal, Estomih Mduma, Erling Svensen and Jeffrey Perlman
Pediatrics, April 2012, 129(5), e1238–e1243; doi: 10.1542/peds.2011-3134

Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. The definition of birth asphyxia (BA) is imprecise, and reliable cause-specific mortality data are limited; thus the estimated proportion of BA-related deaths globally remains questionable. READ MORE

Helping Babies Breathe: Global neonatal resuscitation program development and formative educational evaluation

Nalini Singhal, Jocelyn Lockyer, Herta Fidler, William Keenan, George Little, Sherri Bucher, Maqbool Qadir, Susan Niermeyer
Resucitation, Jan 2012, 83(1), 90-6; doi: 10.1016/j.resuscitation.2011.07.010

To develop an educational program designed to train health care providers in resource limited settings to carry out neonatal resuscitation. We analyzed facilitator and learner perceptions about the course, examined skill performance, and assessed the quality of instruments used for learner evaluation as part of the formative evaluation of the educational program Helping Babies Breathe. READ MORE

​​​​​Early Initiation of Basic Resuscitation Interventions Including Face Mask Ventilation May Reduce Birth Asphyxia Related Mortality in Low-income Countries: A Prospective Descriptive Observational Study

Hege Langli Ersdal, Estomih Mduma, Erling Svensen, Jeffrey M. Perlman
Resuscitation, Dec 2011, 83(2012), 869-873; doi: 10.1016/j.resuscitation.2011.12.011

​Early initiation of basic resuscitation interventions within 60 s in apneic newborn infants is thought to be essential in preventing progression to circulatory collapse based on experimental cardiorespiratory responses to asphyxia. READ MORE

Neonatal Nursing and Helping Babies Breathe: An Effective Intervention to Decrease Global Neonatal Mortality
George A. Little, William J. Keenan, Susan Niermeyer, Nalini Singhal, and Joy E. Lawn
Newborn & Infant Nursing Reviews, Jun 2011, 11(2); doi: 10.1053/j.nainr.2011.04.007

Helping Babies Breathe (HBB) is an evidence-based medical educational curriculum designed to improve neonatal resuscitation and be taught in resource-limited circumstances. It has been field-tested for educational effectiveness and feasibility of wide implementation. READ MORE