xylander: who 2012 guidelines on basic newborn resuscitation

7/28/2019 Xylander: WHO 2012 Guidelines on Basic Newborn Resuscitation

1/16

Global Newborn Conference 2013, Johannesburg | 16 April 20131|

WHO 2012 Guidelines on

Basic Newborn Resuscitation

Severin von Xylander

WHO Department of Maternal, Newborn, Child and Adolescent Health (MCA)

The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this presentation andthey do not necessarily represent the decisions, policy or views of the World Health Organization.


2/16


Essential Newborn Care

1. Cleanliness

2. Thermal protection

3. Early and exclusivebreastfeeding

4. Initiation of breathing,resuscitation

5. Eye care

6. Immunization

7. Management of newborn illness

8. Care of the preterm and/or lowbirth weight newborn


3/16


1998 WHO Guidelines

(1996-1998)

Revolutionary:

First global guidelines for

resource-limited settings

Feasible for singleprovider (one SBA

model)

Focus on ventilation

Minimum equipment Use of room air


4/16


Newborn Resuscitation in WHO Documents

2003,

2006,

2009

2000,

2007

2000,2007

2005

2000,2007

2010


5/16


Skilled Care at Birth (latest since 2000)

Global: 69%

AFR: 48%

EMR & SEAR: 59%


6/16


BNR Guidelines Development Process

2009, January : initial meeting

15 priority questions

2010 January : ILCOR conference 6 priority questions

2011 February: ILCOR Guidelines Resuscitation Guidelines published

2009

2011 Systematic reviews of the evidence and summaries

2011 June: Technical Consultation: 13 Priority questions

2011 December: Conditional Approval by Guidelines Review

Committee (GRC)

2012 GRC Approval and Publication


7/16


What is different?

Emphasis on not clamping the cord too early

Reduced indications for suctioning: No routine suctioning even before ventilation

For babies born through meconium-stained amniotic fluid who do not start breathingon their own

Preference of bulb syringe in the absence of mechanical equipment

Recommendation to start PPV within one minute

Preference of self-inflating bag

Measurement of heart rate after 60 seconds

Recommendation to stop resuscitation after 10 min., if no detectable heartrate


8/16


Key Actions: Clamping the Cord

The cord should be clamped after 1 to 3minutes in all newly-born babies; the

cord should be clamped and cut before

one minute only if this is needed forresuscitation.


9/16


Key Actions: Ventilation

In newly-born babies who do not start breathing despite drying andadditional stimulation, positive pressure ventilation should be

started within one minute.

When positive-pressure ventilation is needed in babies, in most

cases it should be started with air and using a self-inflating bag andface-mask; in preterm babies born before 32 weeks of gestation, it

is preferable to start with 30% oxygen, if this is available.

Newly-born babies requiring ventilation should be assessed by

measuring heart rate after 60 seconds.

In newborn resuscitation providing adequate ventilation is more

important than chest compressions.


10/16


Key Actions: Suctioning

If newly-born babies start breathing on their own, suctioning of themouth and nose and/or trachea should not be performed, even if the

baby is born through meconium-stained amniotic fluid.

If the mouth of the non-breathing baby is full of secretions preventing

effective ventilation, the mouth and nose should be suctioned.

If the non-breathing baby is born through meconium-stained amniotic

fluid, the mouth and nose (and trachea if possible) should be suctioned

before initiating ventilation.

Where single use suction catheters are not available, use a bulb syringe

to suction the mouth and nose. Tracheal suctioning requires highlyskilled personnel and equipment often not available in low-resource

settings.


11/16


Key Actions: Stopping Resuscitation

Ventilation should be stopped if thebaby has no detectable heart beat after

10 minutes of effective ventilation, or

continues to have a heart rate below60/min and no spontaneous breathing

after 20 minutes.


12/16


Standards for Effective Resuscitation (1)

All women giving birth should be assisted by a personskilled in newborn resuscitation (SBA), with access to

the appropriate equipment.

SBAs should be competent in: Use of partograph and anticipate any risk

assessing the newborn and normal initiation of breathing

resuscitate and stabilize

correct use and maintenance of resuscitation equipment.


13/16



Minimum equipment and supplies (available, clean& functioning):

heat source or pre-warmed towels

a suction device

a self-inflating bag with 2 face masks of appropriate

size for normal and small babies

clock.


14/16



A functioning referral system tocomprehensive neonatal care for newborns.

Health records.

Post resuscitation care: closer monitoring for

breastfeeding difficulties or other problems.


15/16


Assessing Impact

Proposed Service Delivery Indicators: Proportion of health professionals attending births competent

and equipped in basic newborn resuscitation

Proportion of births attended by health personnel skilled and

equipped in basic newborn resuscitation

Proportion of newborns requiring resuscitation with outcomes

Perinatal death audits


16/16

Thank you