Project to treat infant asphyxia in lower income countries

Scientists in a federally sponsored global research network will undertake a new project that will train midwives and traditional birth attendants in resource poor countries on how to treat newborn asphyxia, a major cause of infant death. The treatment, developed in the United States, is the standard of care provided to infants born in this country.

Newborn asphyxia—an infant's failure to begin or sustain breathing—is a serious problem in resource poor countries where births do not occur in a health care facility and where birth attendants are not trained in newborn resuscitation. In the United States and more developed regions of the world, trained health care professionals can rapidly take steps to treat asphyxia.

The project will be undertaken by the Global Network for Women's and Children's Health Research, which is sponsored by the National Institute of Child Health and Human Development of the National Institutes of Health, in partnership with the Bill and Melinda Gates Foundation.

The new project seeks to determine if training midwives and other traditional birth attendants in standard infant resuscitation practices commonly used in the United States can reduce the death and disability from newborn asphyxia in resource poor settings.

The Network project was announced on World Health Day April 7, 2005.

Newborn asphyxia claims the lives of 1 million infants each year, according to the World Health Organization. One estimate holds that newborn asphyxia afflicts from 6 to 10 percent of all births.

"The theme for this year's World Health Day is 'Making every mother and child count,'" said NICHD Director Duane Alexander, M.D. "In keeping with that sentiment, the Global Network's new project will seek to reduce the death and disability resulting when newborn asphyxia occurs in the developing world."

Newborns may stop breathing for a variety of reasons. For example, the placenta may tear free from the uterine wall during the birth process. Newborn asphyxia may also result when the umbilical cord is compressed between the baby's body and the uterine wall, or when the umbilical cord becomes knotted. Other causes of newborn asphyxia remain unknown, but are thought to involve abnormalities of the brain or heart.

When newborn asphyxia occurs, the chances that an infant will survive without brain damage are greatest if the infant can be resuscitated early—within the first 2 minutes after delivery.

The First Breath initiative will be implemented at seven Global Network sites located in South Asia, Africa, and Latin America. Nearly 80 communities will participate in this study to determine whether a standard newborn resuscitation program taught to birth attendants in the United States (the Birth Resuscitation Program of the American Academy of Pediatrics) can reduce the newborn death rate as well as other complications from newborn asphyxia. The program provides instruction in newborn resuscitation techniques for birth attendants who first come in contact with newborns.

Midwives and birth attendants who participate in the Global Network program will be taught such basic techniques as checking an infant's throat for obstructions, monitoring heart rate, and using mechanical ventilation to induce an infant to breathe. The Global Network study will involve 40,000 births per year over the two-year study period.

The Global Network for Women's and Children's Health Research supports partnerships at 10 sites in Asia, Africa and Latin America. The Network is dedicated to improving the health of women and infants in developing regions. The Network seeks to develop local scientific capacity to solve public health problems and works to convey its findings to improve health at a local level.

"International health research benefits people in all countries," said Danuta Krotoski, Ph.D., NICHD's Acting Associate Director for Prevention Research and International Programs. "Studies conducted abroad contribute to the health of populations living in those countries as well as to the health of people around the world."

Dr. Krotoski noted that the NICHD has funded numerous studies abroad that contributed important information for the U.S. health population. For example, she said, studies conducted in England and Tasmania were instrumental in the establishment of the Back to Sleep campaign. The campaign seeks to reduce infants' risk of dying from Sudden Infant Death syndrome, the sudden, unexplained death of an infant less than one year of age. Since the campaign began in 1994, the rate of Sudden Infant Death syndrome in the United States declined by more than 50 percent.