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 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. We are committed to supporting the expansion of effective neonatal care, agree that HBB is highly suitable for that purpose, and promote the statement that “the time to act on behalf of every newborn infant is now” (Little G, Niermeyer S, Singhal N, Lawn J, Keenan W, Neonatal Resuscitation: A Global Challenge, Pediatrics, 2010;126(5):e1259-e1260). We also note that a program is only as effective as its systematic implementation and that neonatal nursing must serve an essential role in standard setting, education, and implementation of any bedside change in care of the newly born infant. Keywords: Neonatal nursing; Helping Babies Breathe; Global neonatal mortality; Neonatal resuscitation The neonate has only recently attained its rightful status as a full and equal partner in the spectrum of maternal, newborn and child health (MNCH) care, research, and policy initiatives. The United Nations Millennium Development Goals (MDGs) of the international development initiative for improving the social and economic conditions of the world's poor adopted 8 goals in 2000 that have a 2015 date for attainment. Significantly, 2 of the 8 goals are directed at MNCH: MDG 4 for child health including neonatal survival and MDG 5 for maternal health. 1 Neonatal deaths (deaths in the first 28 days of life) are a major portion of child deaths, are often graphically depicted and monitored with under-5 mortality, and serve as a sentinel indicator of reproductive health. Most neonatal deaths occur within hours after birth. The Global Neonatal Death Problem There are about an equal number of neonatal deaths (3.6 million) and stillbirths (3.3 million) in the world each year with a remarkable 98% occurring in the less-resourced and developing world. 2 Authorities agree that in most resource poor areas—those places with inadequate facilities, equipment, and trained providers—reliable data and information that distinguishes between stillbirth and neonatal death are not generally available and that clinical and research efforts should be directed at both. 3,4 Although the stillbirth population in the resource-limited perinatal population is inadequately studied, it is apparent that a portion of stillbirths occur in late labor and delivery, are related to hypoxia, and may in fact not be stillbirths at all but babies who would respond to resuscitation efforts if recognized as such and survive if they received clinical intervention by providers skilled in resuscitation and subse- quent care. 5 Neonatal resuscitation is recognized as an intervention for which there is evidence of effectiveness. 6-8 Of the many babies who die who would benefit from neonatal resuscitation, there are 2 large groupings: intrapartum-related deaths, often and previously described by the term birth asphyxia, are estimated to occur at an annual rate of approximately 814 000 globally. There is an obvious relationship between this group of babies and the late pregnancy stillbirths discussed in the previous paragraph. Complications of preterm birth are estimated to be associated with a million (1,033,000) deaths globally per year. In addition to resuscitation at birth, there are other in- terventions for which there is considered to be reasonable evidence of effectiveness in reducing risk of neonatal death of preterm infants, including thermal support such as skin-to-skin (kangaroo) care, early breastfeeding, and prevention/treatment of infection. 9 Monitoring of MDG 4 progress has revealed that although both the under-5 mortality rate and the neonatal mortality rate are slowly decreasing, an increasing proportion of under-5 deaths occur in the neonatal period or the first 28 days after From the Department of Pediatrics, Dartmouth Medical School, Hanover, NH; Department of Pediatrics, St Louis University, St Louis, MO; Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO; Department of Pediatrics, University of Calgary, Calgary, Alberta; and Saving Newborn Lives/Save the Children, Cape Town, South Africa. Address correspondence to George A. Little, Department of Pediatrics, Dartmouth Medical School, Hanover, NH. E-mail: george.a.little@ dartmouth.edu. © 2011 Elsevier Inc. All rights reserved. 1527-3369/1102-0407$36.00/0 doi:10.1053/j.nainr.2011.04.007