P0245 - A systematic review of the Helping Babies Breathe training program: From implementation to impact

Introduction: Developed and introduced in 2010, Helping Babies Breathe (HBB) has found great success globally as an easily-implementable neonatal resuscitation training program for healthcare providers working in resource-limited settings. As HBB approaches a decade of in-field use in over 80 countries, this systematic literature review aimed to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming.

Methods: A systematic literature review was conducted on studies related to HBB implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, and the impact on newborn outcomes. Databases utilized in the search included Medline, POPLINE, CINHAL, LILACS, African Index Medicus, Cochrane, and Index Medicus. All articles related to HBB, in any language, were included. Article quality was assessed using the GRADE framework.

Results: A search for “helping babies breathe” returned 247 unique articles. After full screening, the review included 94 articles that assessed HBB impact, implementation, knowledge acquisition, and skills retention: 50 monitoring and evaluation studies, 3 systematic literature reviews, 3 cost analyses, 15 editorials, 3 guidelines and consensus statements, 5 study protocols, 3 randomized controlled trials, and 12 reviews. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Several studies found HBB to be cost-effective. Post-training 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, multiple studies have shown a significant association between reduction in perinatal mortality and HBB implementation.

Conclusion: Studies have shown that HBB training programs have had significant impact on provider-level knowledge and skills, and effective retention strategies have been identified. This review identified remaining challenges and key requirements for success associated with each stage of HBB programming. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.