FREEDOM OF BREATH, FOUNDATION OF LIFE
Authors: Ye Hongmao , Yu Renjie 
Published: January 2008

Perinatal asphyxia is the leading cause of neonatal mortality, cerebral palsy, and mental retardation worldwide and accounts for ∼1 million of the 4 million neonatal deaths that occur each year (World Health Organization, 2005). According to China's national maternal and children's health surveillance in 2005, neonatal mortality was 19 per 1000 live births. In China, the first top 3 causes of infant mortality are preterm birth and low birth weight, birth asphyxia, and pneumonia. In 2005 asphyxia accounted for 20.5% of deaths in children under the age of 5 years. On the basis of a national sample survey from China Disabled Persons' Foundation in 2003, there are 199 000 disabled children between 0 and 6 years old each year, 54.2% of whom are mentally disabled, primarily related to birth asphyxia.

The Neonatal Resuscitation Program (NRP) was introduced to China in the 1990s to reduce mortality and morbidity caused by asphyxia. NRP training was held in cities such as Beijing and Shanghai, which helped to build the foundation of the NRP in China. To disseminate the NRP throughout China, a multidisciplinary partnership was established among the Chinese Ministry of Health, Chinese Perinatal Society, Chinese Nursing Association, American Academy of Pediatrics, and Johnson and Johnson Pediatric Institute. In July 2003, a task force that consists of representatives from all partners made a 5-year commitment to set up “Freedom of Breath, Foundation of Life: China Neonatal Resuscitation Program.” The objective was to ensure the presence of at least 1 trained health care professional at every delivery. It has been 3 years since the program launched, and many key accomplishments have been made: The Chinese version of the fourth and fifth editions of the NRP manual (created by American Academy of Pediatrics and American Heart Association) was published.Chinese NRP editions were made with Chinese cultural considerations to guide neonatal resuscitation practices in China.Since July 2004, many training sessions have been organized, including a national instructors training, provincial instructors training(s) in 30 provinces (there are a total of 30 provinces in China), and cascading trainings in cities, counties, and townships. To date, 18 240 health care professionals have been trained, among them obstetricians, pediatricians, nurses/midwives, and anesthetists. By the end of 2006, NRP training had covered 99.1% of health care institutions in cities and 59.8% in 20 target provinces.On September 20–23, 2006, the NRP Science Updates and Experience Sharing conference was held in Xian, capital city of Shaanxi in the northwest part of China. One hundred fifty health care professionals from 20 target provinces attended to learn of scientific updates from Drs Keenan and Niemeyer. Each province presented their training reports and summaries; a few of them were rewarded for their excellence of performance.Since the launch of the NRP, many provincial health bureaus included neonatal resuscitation skills into midwifery service licensing. By the end of 2007, it will become a nationwide regulation in midwifery service licensing. Starting in 2007, the Chinese NRP expanded its program elements to add neonatal mortality and morbidity evaluation. We believe the data collected from this evaluation would be valuable, not only to the Chinese NRP but also to the international NRP.