Respiratory distress is a significant cause of newborn morbidity and mortality. Every year, over five million newborns and infants around the world die before 28 days of life. Many more babies do not die but are permanently disabled. Major causes of this death and disability are associated with respiratory insufficiency, such as prematurity, sepsis, pneumonia and asphyxia. Noninvasive ventilation via continuous positive airway pressure (CPAP) remarkably improves outcomes, however, high costs and reliance on electricity make it a very difficult option for use in low-income settings. A lower-cost alternative, bubble CPAP (bCPAP) exists, where pressured air is generated by bubbling air underwater. However, available bCPAP devices have significant limitations for two reasons. They either: 1) require electricity and are too expensive for scale or 2) are locally improvised and assembled without standardized or best-evidence training, and without adjustable oxygen concentration, placing the newborn at significant risk of oxygen-related harm. As a solution, addressing the limitations of currently available bCPAP, the Mass General Division of Global Health Innovation, with close partnership of the African Institute for Health Transformation (AIHT), has developed a highly innovative, ultra-low-cost best-evidence bundle of training, equipment, checklists, manuals, and wall charts called the “Every Second Matters for Mothers and Babies™ - Newborn Respiratory Bundle” (ESM-NRB).

ESM-NRB is currently being implemented in western Kenya and India with superb results of lives saved and improved. ESM-NRB is expected to reduce newborn and infant mortality by 50% among participating facilities.

The ESM-NRB bundle improves the quality, safety, and effectiveness of early diagnosis, treatment, and monitoring of newborn and infant respiratory conditions. The package includes an ultra-low-cost, preassembled bCPAP circuit with an innovative adjustable oxygen blender (that does not require power), as well as a low-cost pulse oximetry device with accompanying clinical checklists, wall charts, manuals, and focused training. In July of 2017, the Division, along with our partners from PATH, was awarded a validation grant from USAID Saving Lives at Birth (SLAB) for the ESM-NRB package.