Newborn resuscitation

Newborn resuscitation

Nearly one million babies die each year because they do not breathe normally at birth. Urgent management is necessary when the baby does not breathe. Therefore for many babies, newborn resuscitation can be life saving measure. Oxygen is very important to every part of human body.

During pregnancy, the placenta manages oxygen, and after birth, the baby obtains oxygen through the lungs by breathing. Most babies breathing happens without any problem. But some babies need assistance to initiate or maintain breathing, and healthcare providers refer to this assistance as neonatal resuscitation.

The important steps for resuscitation

1. Prevention of heat loss,
2. Opening the airway and
3. Positive pressure ventilation that starts within the first minute of life.

• Always place the baby on a warm, flat, firm, and clean surface.
• Initial stabilization and evaluation

 This consists of :

• drying, positioning the neonate under radiant warmer to minimize heat loss and suctioning of mouth and nose (Tracheal suctioning if meconium present).

Drying

Provides sufficient stimulation of breathing in mildly depressed newborns and no further stimulation is appropriate. The second step (within 20-30 seconds of birth)is assessment of neonatal respiration

If the newborn is crying and breathing normally, there is no need for resuscitation. If there is no cry assess for breathing.

• If the chest is rising symmetrically at a frequency >30 breath/minute, there is no immediate action required.
• If the newborn is not breathing or gasping immediately start resuscitation. Occasionally gasps are not considered for breathing.

·Open the airway-Put the baby on its back. Position the head slightly extended.

Positive pressure ventilation- the most important aspect of newborn resuscitation for ensuring adequate ventilation of the lungs, oxygenation of vital organs, and initiation of spontaneous breathing. Healthcare providers can typically initiate ventilation by using a bag and mask with room air. When equipment is not available, they should administer mouth-to-mouth and nose breathing.

They assess the sufficiency of ventilation by observing chest movements.

For ventilation

• Reposition the newborn and ensure the neck is slightly extended.
• Select the appropriate mask. Place the mask on the newborn’s face, so that it covers the chin, mouth and nose. Form a seal between the mask and the infant’s face. Squeeze the bag with two fingers only or with the whole hand, depending on the size of the bag.
• Ventilate the baby for two puffs only to see the baby’s chest is on rise and fall
• If chest is correctly rising & falling then start  for bag & mask ventilation
• After effectively ventilating for about 1 minute, stop briefly but do not remove the mask and bag and look for spontaneous breathing (or assess the baby in each minute).

If there is none or it is weak, continue ventilating until spontaneous cry/breathing begins

If the newborn starts crying: stop ventilating but do not leave the newborn

If breathing is slow (frequency of breathing is <30), or if there is severe chest indrawing, continue ventilating and ask for arrangement for referral if possible.

If there is no gasping or breathing at all after 20 minutes of ventilation: Stop ventilation. Explain the condition to patient & visitor.

If request for referral, send with continuous bagging with maintaining warmth of the baby.

Helping Babies Breathe

Creating a global educational program in neonatal resuscitation to help babies breathe is a commendable initiative. This endeavor can significantly contribute to improving infant survival rates worldwide. Neonatal resuscitation is a critical skill that healthcare professionals and caregivers need to ensure the well-being of newborns who have difficulty breathing at birth. Helping Babies Breathe (HBB) is an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited areas.

It is an initiative of the American Academy of Pediatrics (AAP) in collaboration with the World Health Organization (WHO), US Agency for International Development (USAID), Save the Children’s Saving Newborn Lives program, the National Institute of Child Health and Development (NICHD), and a number of other global health stakeholders.

Preparation for Birth

• Identifying a helper and reviewing the emergency plan
• Preparing the area for delivery
• Hand washing
• Preparing and area for ventilation and checking equipment
• Assemble all supplies and equipment
• Check the bag and mask for ventilation.

Routine Care

• If meconium, clear airway
• Dry thoroughly
• Keep warm
• Recognize crying
• Checking breathing
• Clamp or tie and cut the umbilical cord
• Place on mother’s chest to encourage breastfeeding

The Golden Minute

Keep warm: place the baby skin to skin on the mother’s chest/abdomen

Position the head: position baby with the neck slightly extended to help keep the airway open

Clear the airway: clear the mouth and then the nose with a clean suction device or wipe

Stimulate breathing: gently rub the back once or twice. Do not delay or stimulate longer. Move quickly to assess breathing and determine if ventilation is required. Drying clearing airways and stimulating breathing should take less than 1 minute.

Evaluate breathing : is the baby breathing well? If not breathing (gasping or not breathing)

Initiate ventilation: bag and mask.

Improving ventilation steps (MRSOP)

• M−Mask reposition
• R− Repositoning baby,
• S−Suction
• O−Open the baby’s mouth
• P−Pressure on the ambu-bag

1. Evaluating hearth rate
2. Activating the emergency plan
3. Support  Family

Evaluating heart rate.

1. .If the baby breathes spontaneously and  his heart rate is >100, stop resuscitation. Continue to give supportive care.
2. If the baby is not breathing or is in gasping, heart rate is <100continue to ventilate 20-30times in 30 sec  and then re evaluate (through observation and cord pulsation)
3. If the baby is not breathing regularly after 20mins of ventilation. Continue ventilation with oxygen and transfer and refer to baby to the tertiary care center (if possible)
4. If there is no gasping or breathing at all after 20 mins of ventilation without heart beat, stop ventilation and provide emotional support to mother and family.

Care after successful resuscitation

• Do not separate the mother and the newborn.
• Leave the newborn skin-to-skin with the mother
• Encourage breast-feeding within one hour of birth.
• Assess the baby in every 15 mins for few hours then according to the condition
• The newborn that needs resuscitation is at higher risk of developing hypoglycemia.
• Observe suckling Good suckling is a sign of good recovery.

Record the resuscitation

1. Date & time of birth
2. The condition of baby at birth(color, breathing, heart rate or APGAR score)
3. Resuscitation

• −Time resuscitation started
• −Steps used (stimulation, ventilation)
• −Time breathed normally or resuscitation stopped
• −Result of the resuscitation(successful, needed referral, baby died)

4. Care after resuscitation( every 15mins compulsorily for few hours then according to situation)

Healthcare providers must recognize the need for resuscitation before the end of the first minute of life, which is when they take the first Apgar score.

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