World prematurity day

Dr Alison Earley

The statistics on premature birth remain of great concern:  12% of babies are born too soon in the poorest countries, compared with 9% in higher income countries.  One million babies die each year from complications of premature birth, and prematurity remains a leading cause of mortality globally.

Education for health care workers, enabling them to provide better care for pregnant women and new born babies, is vital if this situation is to improve.

Kola sent these pictures from Liberia this morning – a celebration of their babies born too early! Most of the nurses in these pictures have done the Neonatal Care Course with NICHE trainers.

Celebrating World Prematurity Day at CB Dumbar, Liberia
Kola and team of nurses and neonatal technicians in their Neonatal Nursery

bag-valve-mask questionnaire

Gathering the evidence for the work we do, both for funders and to inform our direction of travel as an organisation, is not at all easy! Alison has been working with Grace in Cameroon to collect information from health clinics about their use of bag-valve-masks which NICHE International provided them with a few months ago.

3 out of the 5 units who had the questionnaire responded which doesn’t give us statistically robust information but does give us a fascinating insight into the obstetric services at these centres, the numbers of deliveries, trained staff and how many babies were born in a bad enough condition to worry the newly trained personnel.

preliminary results from the BVM questionnaire

There are a couple of things to learn from here:

1.) The very positive free text comments at the bottom that all units feel that having the bag-valve-mask over the last 8 weeks has potentially saved lives.

2.) The disappointing comment from Bafoussam that people have been reluctant to use the BVM because they can’t attach it to the oxygen supply is a reminder of the need for on-going training and refresher courses. Babies born at 32 weeks gestation and above should be resuscitated in air. The new 2021 guidelines suggest that babies between 28 and 32 weeks can be resuscitated in air to 30% oxygen. Only the very small ones, most of which do not survive in resource poor areas of the world, should be resuscitated in 30% oxygen from the outset. It is recommended to increase to 100% oxygen in any situation if the baby requires cardiac compressions.

We are looking to return to Cameroon at the end of April 2022 to train more instructors and begin training some of the Cameroonian instructors to be instructor trainers themselves. Well done to Grace and team for keeping the Neonatal Care Course training going throughout the Covid pandemic and thanks to the Cameroon Baptist Convention for continuing to fund the programme.

Teaching again after the pandemic

It is great to be back teaching face-to-face again, albeit still only in the UK. UK NICHE instructors have to teach on a certain number of life support courses per year to maintain their instructor status. Julia was teaching the UK Resuscitation council Newborn Life Support (NLS) course this week in her home hospital in London.

Scenario teaching – unexpected preterm baby delivery

There are some differences when stabilising a preterm delivery at birth. The 2021 guidelines suggest that babies born under 32 weeks gestation should be put into a plastic bag at birth and placed under a radiant heater to stop them getting cold and dehydrated. Just their heads should be dried.

In most other respects, and if there is no radiant heater available, they should be stabilised the same way one would stabilise a term baby. Here the learners are demonstrating the 2-handed BVM technique with Julia checking that the chest is actually rising!

2-person technique of bag-valve-mask use at a simulated preterm delivery