​Helping Babies Breathe 2nd Edition FAQs

HBB 2^nd 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 2^nd Edition materials.  

We have developed a number of resources to help promote widespread awareness of the changes associated with HBB 2^nd 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 2^nd Edition materials – Action Plan, Facilitator Flip Chart, and Provider Guide –  clearly delineates the changes between HBB 1^st Edition and HBB 2^nd Edition.
• HBB 2nd Edi​tion Update Guide​:  a tool offering guidance on incorporating HBB 2^nd Edition content changes into future trainings to ensure a seamless transition from HBB 1^st Edition to HBB 2^nd Edition.
• HBB 2^nd Edition Webinar:  an on-demand presentation providing an overview of HBB 2^nd Edition features and changes, as well as answer anticipated questions and provide general guidance for transitioning to HBB 2^nd Edition. 

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

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 2^nd Edition resources listed below.  

• HBB 2nd Edition Summary of Changes
• HBB 2nd Edition Update​ Guide​​
• HBB 2^nd Edition Webinar
  
  

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

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 1^st 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 2^nd 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 2^nd Edition updates.  Based on valuable feedback from the global HBB community, the 2^nd 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 1^st 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 2^nd 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. 

ILCOR's neonatal resuscitation guidelines serve as the foundation for both the HBB program and WHO 2012 guidelines.  As was the case with HBB 1^st Edition, HBB 2^nd Edition remains highly coordinated with WHO.  Several examples of 2^nd 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 2^nd 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

The neonatal resuscitation and newborn care practices taught in HBB 1^st 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 2^nd 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.  

We encourage all trainers to use the updated HBB 2^nd 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 2^nd 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 2^nd Edition. 

• HBB 2nd Edition Summary of Changes​
• HBB 2nd Editio​n Update Guide​
• HBB 2^nd Edition Webinar (coming soon)
• HBB 2^nd Edition materials available for free download at http://internationalresources.aap.org/ 

Countries may need to make minor content modifications to HBB 2^nd 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.  

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. 

​It is recommended that you transition to the HBB 2^nd 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 http://hbs.aap.org. ​

If you are not currently able to transition to the new materials, please continue to use HBB 1^st 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 1^st Edition and incorporate new HBB 2^nd Edition content into future courses.  

We recognize the importance of having HBB 2^nd 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 2^nd Edition into a specific language.  In the meantime, it is fine to continue using translations of HBB 1^st 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 2^nd Edition – scientific updates, strengthened educational advice, new implementation guidance – into future trainings, even if you continue using HBB 1^st 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. 

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.