Abstract 454 Clinical Research in Developing Countries Poster Symposium, Sunday, 5/2

Neonatal and Infant mortality in the newly independent states (NIS) of former Soviet Union are unacceptably high, 19-40/1000. To respond to critical needs of the newborns in NIS countries, a cost effective clinical approach with potential of saving many lives was initiated by American International Health Alliance (AIHA) funded by USAID. The program supports partnership between hospitals in USA & hospitals in NIS. Initial efforts of the partnership consisted of exchange of physicians, nurses, administrators, which resulted in reorganization of NIS hospitals. The major deficiencies found in the NIS were; 1) lack of a standardized protocol for neonatal resuscitation, 2) lack of proper resuscitative equipment, 3) lack of adequately trained personnel. In view of these deficiencies, the partnership task force adopted the NRP developed by AAP/AHA. A Neonatal Resuscitation Training Center (NRTC) to carry the mandate of training health care personnel in the country round the year was established with the financial support of AIHA and local ministry of health. The US partnership hospitals provided the professional support who conducted initial NRP for trainors. Since the first NRTC opened in 1992, there are now 10 centers; Ukraine (4), Russia, (4), Uzbekistan (2). Each center in NIS was provided the educational material, audiovisual supplies, a computer to maintain data base and fax machines to maintain communication with their corresponding partner. During the last 3 years, overall, 50 instructors and 2250 providers have been certified in three of NIS countries; The NRTC at Tashkent/the partnership program of UIC at Chicago trained over 450 professionals (physicians, nurses, midwives) from 40 different hospitals. More interestingly NRP has been adopted into the curriculum of undergraduate medical education. Over 200 medical students were also trained, NRTC has become a major focus of attention for Ministry of Health in Uzbekistan and is included in the National Program "Healthy Generation." The NRTC represents a very cost effective method of improving the care of the newborn in countries with high neonatal mortality. NRP is primarily designed to train systematic approach to neonatal resuscitation i.e. bagging, intubation, chest compression and use of appropriate medications, also emphasizes physiologic approach to neonatal care (understanding of fetal circulation, transitional circulation and extrauterine adaptation, physiology of asphyxia, and thermo regulation.) Thus the NRTC represents important approach to fostering collaborative relationships to facilitate changes in clinical practice. The neonatal resuscitation initiative and its activities have paved the way for long term change in neonatal care through the regions of NIS. There is emerging evidence of decreasing neonatal and infant mortality in participating institutions.