Basic Newborn Resuscitation.

A short summary of the guideline

The practical guideline “Basic newborn resuscitation: a practical guide” was published by World Health Organization in 1998. The indications and principles of newborn resuscitation are reviewed here. The main and basic idea of this guideline is to give recommendations to all health care providers who are involved in the delivery of newborns. Newborn resuscitation skills are essential for all birth attendants.

This guide focuses on management of baby with birth asphyxia. Birth asphyxia occurs when a baby doesn’t receive enough oxygen before, during or just after birth. Prompt treatment is important to minimize the damage effects of decreased oxygen to the baby and to prevent permanent brain damage. It has been estimated that birth asphyxia accounts for 19 % of newborn deaths, suggesting that the outcome might be improved through implementation of simple and safe resuscitative techniques.

Resuscitation of newborn presents a different set of challenges than resuscitation of the adult or even the older infant or child. The transition from dependence on placental gas exchange in a liquid-filled intrauterine environment to spontaneous breathing of air presents dramatic physiologic challenges to the infant within the first minutes to hours after birth. Approximately 5% to 10% of newborns require some assistance to begin breathing at birth. Approximately 1% require extensive resuscitative measures.

This practical guide very clearly carried out the steps of basic resuscitation (A- airway, Bbreathing, C-circulation) with concentration mainly on the method of resuscitation. It is applicable even in conditions with lack of equipment or where one birth attendant present at the birth. According to this guideline the initial steps of basic resuscitation are: thermal management, positioning, suctioning and tactile stimulation. Critical for the success of resuscitation are anticipation, adequate preparation, timely recognition and quick and correct action. 1Advanced resuscitation includes: endotracheal intubation, oxygen, chest compressions and drugs. 2,3Care after successful resuscitation includes put newborn skin-to-skin with mother, encourage breastfeeding within one hour of birth and observe suckling.

The document covers some ethical questions like when to start or to stop resuscitation. 4Answers of these questions are left to the person caring for the newborn and depend on conditions of health organization needed for adequate care of malformed or very preterm newborns. Sometimes, decision-making is based on concept “cost-effectiveness” to critical-care. 5Thanks to the modern technology, very preterm infants, malformed newborns and newborns with very low birth weight have more chance for surviving. 6Care of infants like these is an exclusive domain of specialized units in hospitals. But, even there it is still hard to make a decision. 7My opinion is that in situations like these parents must be included.

This guideline is based on the consensus of assembled international experts and studies. Implementation of this guideline contributes in decreasing perinatal deaths which are over 6.3 million every year according to WHO estimates. 8Also, it is a basis for developing national standards and protocols for improving health care during pregnancy, delivery and after birth.

Republic of Macedonia is low-income country successful in reducing perinatal mortality rate through the period of last ten years according to data from State Statistics. But, compared to other European countries, it still remains high. Reduction of perinatal mortality rate is result of government efforts through past period and training and education of neonatologists abroad 4 (Royal Prince Hospital, Australia, 2001). Our general hospitals which provide secondary level of newborn care don’t have units for intensive care. Newborns from risk pregnancy are transported in-utero to tertiary level of health care (University Clinic for Gynecology and Obstetrics) or short after births to Unit for Intensive Care at University Children’s Hospital.

As our hospitals became Baby Friendly Hospitals with rooming-in, we applied all suggestions by this guideline for newborn care after birth or after resuscitation.

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