September Is National Infant Mortality Awareness Month

With September right around the corner, I can't help but realize that it is also National Infant Mortality Awareness Month. The most fragile period of a child's life is in the first 28 days, known as the neonatal period. In these first days, newborns can succumb to birth asphyxia (the inability to breathe at birth), as well as other issues related to preterm birth or infection. As a neonatologist, I have a strong interest in reducing infant mortality, particularly neonatal mortality, through research, teaching, and clinical practice.

A few weeks ago, I had the privilege of joining the China Neonatal Resuscitation Task Force, a partnership of several Chinese organizations including the Chinese Ministry of Health, Chinese National Center for Women and Children's Health, Society of Perinatal Medicine, and Chinese Nursing Association, along with the American Academy of Pediatrics (AAP) and Johnson & Johnson. The Task Force is committed to reducing neonatal mortality in China by addressing birth asphyxia. Babies who have difficulty breathing at birth need help from healthcare providers who are skilled in neonatal resuscitation. In order to accomplish the goal of reducing neonatal mortality, it will be necessary to have at least one trained and skilled health provider at every facility birth in China -- a country with over 17 million births per year.

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The World Health Organization (WHO) estimates that 1 million babies die every year from birth asphyxia. Since the launch of the Chinese Neonatal Resuscitation Program (NRP) in 2005, more than 150,000 Chinese healthcare providers have been trained to save these fragile babies' lives by using neonatal resuscitation techniques.

I was excited to be continuing in this effort with colleagues from the NRP Steering Committee, Jane McGowan and Linda McCarney. We spent a week in Beijing, first training the National Instructors - of which there are 20 - and helping them to train the provincial instructors that will subsequently train healthcare providers in 31 provinces across the country. One of the main goals was to help them learn about simulation as a method of training.

The health care professionals came from a variety of backgrounds -- neonatologists, obstetricians, midwives, and pediatricians. As healthcare professionals are accustomed to a traditional lecture top-down approach to learning, there was initially some hesitation on their part to adopt the new style of "simulation training." Simulation training is being increasingly recognized as an optimal way to improve teamwork and communication in healthcare. The Chinese NRP Task Force is always interested in new techniques and had expressed an interest in incorporating simulation training into their curriculum.

Simulation training has several aspects that may not be familiar in the hierarchical nature of Chinese culture, including instructors, who are healthcare professionals, having to admit mistakes and receive suggestions. However, as they observed and began to practice with one another, they gained confidence and saw the value in this new method of learning, from the youngest trainers to the most distinguished professors who were in their 70's. A midwife in the training commented that the new style of training will be beneficial. She had observed that healthcare providers who have learned skills from lectures and books without practice often have a hard time translating what they have learned into a clinical setting.

I felt very privileged to have a small part in this partnership, being impressed in particular by the enthusiasm, dedication and knowledge of the Chinese instructors, many who were national leaders in their fields. If we continue to work together and learn from one another, through these various training methods, we can have a huge impact in the number of newborns lives that we touch and save. I am excited to see the impact of these China NRP instructors on newborn survival in the years to come.

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