The Challenge
The magnitude of the challenge is clear. Globally, there are 136 million births per year including 3.3 million stillbirths. Although some newborns are at higher risk for asphyxia, it is unpredictable when a newborn will be born who is not breathing and does not respond to stimulation alone or to both stimulation and suctioning. There is evidence that newborn resuscitation can save hundreds of thousands of newborn lives. Therefore, every birth should be attended by someone trained and equipped to perform newborn resuscitation. Although the bag and mask is recommended by WHO for performing basic newborn resuscitation, for the 60 million births home, the equipment is not available. For the 76 million births in facilities in developing countries, although the situation is improving thanks to programs such as HBB, at the majority of facility births the equipment is not available. Even in facilities that are equipped with newborn bag and masks, the numbers may not be sufficient for the number of births, and the equipment may be dirty, broken, or unavailable (in another unit or locked up) when it is needed. The lack of newborn resuscitaion equipment is much more frequent in the developing world, but even in the developed world, newborn resuscitation equipment may not be available, may malfunction, or may be contaminated from prior use. What is a birth attendant to do when the newborn does not breathe and there is no newborn resuscitation equipment available?