The first phase of our project to ‘Improve Neonatal Care in Armenia’ was successfully completed at the end of 2009.
In 2010 a second grant was received from Vivacell to continue the project, targeting some neonatal departments in the regions of Armenia. The project was presented at a press conference in October with Vivacell’s general manager, Ralph Yirikian. Some preliminary data from 2009 was also presented.

Seven neonatal departments in four regions were selected for 2010, chosen because of difficult access to Yerevan due to distance and terrain, particularly in winter.
Again we selected equipment and provided training specifically for managing sick and premature babies after birth, giving these departments the appropriate equipment to stabilise and manage such babies.
In addition, we provided one portable ultrasound machine for use in all the neonatal departments in Yerevan. A programme has been established, with the scanner based in one hospital and a neonatologist DrMazmanyan, travelling to the other hospitals to provide a service for cranial ultrasound scanning at the bedside for sick and premature babies. This is the first time bedside scanning has been possible on neonates in Armenia and from this experience protocols will be developed. This will be closely monitored and audited during the first year.

We held our second ‘INCA’ conference in May 2010 at the Congress Hotel in Yerevan.
Professor Neena Modi and Dr Frances Cowan from Imperial College in London, together with Dr Robert Carr from Guy’s & St Thomas’, were invited and gave presentations on Stabilisation at Birth, An Introduction to Cranial Ultrasound in Newborns and Neonatal Haematology.
A hundred neonatologists from Yerevan and the regional centres supported in this year’s project, attended the one day conference and had the opportunity to participate in case presentations.

Data from 2010 will be collected and presented in 2011, specifically looking at neonatal outcomes, mortality and morbidity since the start of the programme in Armenia.
After the first full year using Bubble CPAP, available for the first time in Armenia, data is currently being collected and will be presented at ‘INCA’ 2011.

Again we are indebted to Vivacell for their continuing support to BirthLink for this project. We also wish to mention Fisher & Paykel Healthcare in the UK, and specifically Nick Connolly, their general sales manager. Nick continues to travel with BirthLink to build Infant Warmers, maintain equipment and participate in training, as well as supporting our conferences.

BirthLink received a large grant to improve neonatal care in Armenia. Neonatal mortality is four times higher in Armenia than in Western Europe and the US.
Vivacell, the Armenian mobile phone company supported a new project to improve outcomes for newborn babies.
The first stage of the project over last year addressed the first 24 hours after birth. Through improving facilities, ongoing education and continuing support, ten maternity units and one neonatal department in one of the Children’s hospitals in the capital Yerevan, were included in the project.
With more than 40% of births taking place in Yerevan, these departments were targeted in 2009.
Our main objective, in line with the UN Millennium goal 4, was to reduce neonatal mortality. Equipment to support the sick and low birth-weight baby in the first 24 hours was installed, allowing the vulnerable baby to be stabilised. This included facilities for good resuscitation, thermal control, oxygen delivery, monitoring and delivery of appropriate nutrition.
In addition we supplied equipment for non-invasive respiratory support in through a bubble CPAP system. This was a new initiative for Armenia and essential for managing respiratory distress in the newborn period, where ventilation was not available.
Last September our first conference was held in Yerevan, with over 100 nurses, midwives and neonatologists attending, held at the Medical University. The programme included topics for management of the compromised baby in the first twenty four hours after birth, and practical sessions in the afternoon demonstrating safe use of all the equipment being distributed.
Mr Ralph Yirikian, general manager of Vivacell, our local donor, opened the day which included coverage on national television.
Practical training on all new equipment was undertaken and continuing support and monitoring is taking place on a regular basis. This has been supported by three neonatologists, Dr Hrant Kalenterian, Dr Pavel Masmanyan and Dr Arshak Djerdjerian, who work closely with BirthLink to ensure safe and appropriate use, and changes in practice continues to develop. Data will be collected annually to measure our outcomes.
A randomised controlled trial is in progress, comparing Bubble and Flow driver CPAP in preterm infants in a resource poor setting.
There are two principle devices currently available for the administration of continuous CPAP. The systems differ substantially in cost; however their efficacy has not been formally compared. CPAP is likely to be of particular benefit in resource-poor settings, particularly where other high-cost treatments for respiratory disease syndrome such as surfactant and mechanical ventilation may not be available. This study’s aim is to determine if bubble CPAP and flow driver CPAP are equally efficacious in the management of preterm infants requiring respiratory support.

In Yerevan, there are a number of neonatal departments, but the facilities and knowledgebase is limited, particularly for the nurses. There is no formal education programme for nurses working in neonatal care. Aid Armenia in London supported a nurse education programme which was provided over three visits. We were also able to supply two methods for delivering non-invasive CPAP to babies with respiratory disease.

Past reports on Birthlink’s visits to Armenia:

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