title: Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?
abstract: The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.
  
  
  
  We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training.
  
  
  
  One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training).
  
  
  
  HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.
  
  
  
  ClinicalTrials.gov Identifier: NCT01681017 ; 04 September 2012, retrospectively registered.
authors.affiliation: Mahatma Gandhi Institute of Medical Sciences, Sewagram, India.
authors.forename: Akash
authors.initials: A
authors.lastname: Bang
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Bellad
authors.affiliation: Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Gisore
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Sreelatha
authors.initials: S
authors.lastname: Meleth
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Goco
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Niermeyer
authors.affiliation: St. Louis University, St Louis, MO, USA.
authors.forename: William
authors.initials: W
authors.lastname: Keenan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Beena D
authors.initials: BD
authors.lastname: Kamath-Rayne
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Little
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Clarke
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Flanagan
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Bucher
authors.affiliation: Mahatma Gandhi Institute of Medical Sciences, Sewagram, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Jain
authors.affiliation: NKP Salve Institute of Medical Sciences, Nagpur, India.
authors.forename: Nilofer
authors.initials: N
authors.lastname: Mujawar
authors.affiliation: Daga Memorial Government Women's Hospital, Nagpur, India.
authors.forename: Vinita
authors.initials: V
authors.lastname: Jain
authors.affiliation: Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya.
authors.forename: Janet
authors.initials: J
authors.lastname: Rukunga
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Niranjana
authors.initials: N
authors.lastname: Mahantshetti
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Sangappa
authors.initials: S
authors.lastname: Dhaded
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bhandankar
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA. lindawright.md@gmail.com.|George Washington University, 5800 Nicholson Lane, #1206, Rockville, MD, 20852, USA. lindawright.md@gmail.com.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D001238:Asphyxia Neonatorum / Q000401:mortality / Q000628:therapy; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003479:Curriculum; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007630:Kenya; D008880:Midwifery / Q000193:education*; D011247:Pregnancy; D011446:Prospective Studies; D012042:Registries; D012151:Resuscitation / Q000193:education*; D000066908:Simulation Training / Q000379:methods*; D013997:Time Factors
keywords: Asphyxia; Bag and mask ventilation; Helping Babies Breathe; Perinatal mortality; Resuscitation; Stillbirth; Training