Health
Ambu bag: How a simple, life-saving device can prevent newborn deaths
For many newborns, the first few seconds after birth, referred to as the ‘golden minute,’ determine whether they will live, suffer lifelong complications, or die.
While most babies take their first breath without assistance, thousands struggle to breathe because of birth asphyxia and other complications that deprive them of oxygen at the most critical moment of life.
Birth asphyxia, also known as perinatal asphyxia, is defined by the World Health Organisation as the failure to establish breathing at birth.
Sunday PUNCH learnt that during those crucial moments, a simple but often overlooked handheld medical device known as the Ambu bag can make the difference between life and death by delivering the oxygen needed to help a newborn breathe.
An Ambu bag, also known as a manual resuscitator or bag-valve mask, is a handheld medical device used to deliver positive-pressure ventilation to patients who are not breathing or are breathing inadequately.
The acronym AMBU stands for Artificial Manual Breathing Unit. It is a critical device in neonatal resuscitation and, in most cases, replaces the outdated practice of holding a newborn upside down in an attempt to stimulate breathing.
Invented in 1956 by German engineer Holger Hesse and Danish anaesthesiologist Henning Ruben to provide portable, manual artificial ventilation during medical emergencies, maternal and child health experts said the device should be available in all medical facilities, particularly low-resource primary healthcare centres, maternity homes and clinics, as well as tertiary hospitals.
According to the Wood Library Museum of Anesthesiology, Danish anaesthesiologist Henning Ruben, who was also a talented athlete, entertainer and inventor, developed the life-saving device during a period of oxygen scarcity in Danish hospitals.
In 1954, a shortage of oxygen supplies in Danish hospitals prompted Ruben to invent the world’s first self-inflating resuscitator, a breakthrough designed to save lives during medical emergencies.
However, the WHO estimates that perinatal asphyxia accounts for about 900,000 deaths annually and remains one of the leading causes of early neonatal mortality worldwide.
The WHO states that the most common cause of perinatal asphyxia is complications during childbirth, adding that neonatal resuscitation guidelines emphasise the importance of drying, stimulating and warming babies with birth asphyxia.
The global health body added that babies who still fail to breathe adequately require assistance with a bag-and-mask device or its equivalent, describing it as the most critical intervention in managing asphyxiated newborns.
According to the United Nations Children’s Fund, birth asphyxia accounts for roughly one-third of the estimated 250,000 to 280,000 newborn deaths recorded in Nigeria each year, translating into tens of thousands of preventable infant deaths annually.
“Out of roughly 700 to 800 total infant deaths recorded daily in the country, birth complications such as asphyxia, combined with prematurity and infections, are the primary drivers of neonatal mortality.
“Each of these deaths is a tragedy, especially because the majority could be prevented. More than 80 per cent of newborn deaths are due to asphyxia, prematurity, complications during birth, or infections such as pneumonia and sepsis,” UNICEF added.
A Consultant Gynaecologist and Surgeon at the Federal Medical Centre, Epe, Lagos, Dr Cynthia Okafor, explained that an Ambu bag is used to help a newborn breathe when the baby is not breathing, is gasping, or is breathing inadequately immediately after birth.
“It works by delivering gentle positive-pressure breaths into the baby’s lungs until the baby begins breathing effectively on their own.
“The Ambu bag is particularly effective because most newborns with birth asphyxia only need effective ventilation to survive, and it works well in resuscitating babies with breathing difficulties in the absence of advanced equipment,” she explained.
The expert added that this is why every delivery room, from tertiary hospitals to primary healthcare centres, should have a functional neonatal Ambu bag and healthcare workers trained in its proper use.
Sunday PUNCH learnt that in the absence of an Ambu bag, some birth attendants resort to outdated methods such as slapping babies to make them cry in an attempt to stimulate breathing. Others rely on gentle massage, while some combine different manual techniques.
According to the WHO’s neonatal resuscitation guidelines, prompt positive-pressure ventilation within the first minute after birth is the single most important intervention for babies who fail to breathe at birth.
UNICEF also identifies perinatal asphyxia as a major contributor to newborn mortality, accounting for a significant proportion of the more than 250,000 newborn and infant deaths recorded annually in Nigeria.
The agency noted that while it is difficult to isolate a precise national figure for deaths caused solely by birth asphyxia because of overlapping birth complications, historical and regional studies suggest that the condition accounts for about 29 per cent of newborn deaths in some clinical settings across the country.
Overlooked device
Despite its proven role in neonatal resuscitation, the Ambu bag remains one of the most overlooked tools in Nigeria’s healthcare system.
A cardiopulmonary specialist, Dr Tina Uneza, described the Ambu bag as a device used to provide respiratory support to patients in both emergency and non-emergency situations.
She explained that the device consists of a self-inflating bag, a mask or mouthpiece, and a valve that controls airflow, adding that the user manually squeezes the bag to deliver breaths through the mask or mouthpiece.
“The valve allows the user to control the flow of air and the amount of pressure applied. Ambu bags can be used on patients of all ages, from newborns to adults. There are several advantages to using an Ambu bag.
“One of the main benefits is that it is portable and easy to use, making it suitable for use in hospitals, ambulances, and emergency care settings. It is also an essential tool during emergencies because it can provide life-saving respiratory support until advanced medical care becomes available,” Uneza added.
Popular Nigerian medical doctor, activist and social media personality, Dr Nonso Egemba, urged hospitals, health centres and other healthcare facilities to invest in Ambu bags, describing them as life-saving devices that should be available in every delivery room.
Popularly known as Aproko Doctor, Egemba said, “I have been saying this, but many people will not listen. Get this device and keep it, especially in small hospitals and clinics. It will help save lives. It is a must-have for every medical facility.”
He noted that in many health facilities, particularly primary healthcare centres and rural clinics where skilled birth attendants and emergency equipment are often lacking, the absence of this low-cost device continues to contribute to preventable newborn deaths.
Egemba also noted that even where Ambu bags are available, inadequate training, poor maintenance, and inconsistent supply limit their life-saving potential, urging healthcare workers to receive proper training in their use.
As Nigeria battles one of the highest neonatal mortality rates in the world, the expert said greater investment in newborn resuscitation, wider availability of Ambu bags, and continuous training of frontline health workers could significantly improve newborn survival.
He stressed that ensuring every delivery room has a functional Ambu bag may be one of the simplest and most cost-effective ways of giving every Nigerian baby a fighting chance at life.
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