Doug SimkissAssociate Professor of Child Health

Warwick Medical School

The principles of good neonatal care and why neonatal resuscitation is

important

Introduction• Principles of good

neonatal care• Why neonatal

resuscitation is important

Introduction - Reference texts• Malawi National Reproductive Health

Service Delivery Guidelines, 2007• Managing Complications in Pregnancy and

Childbirth: a guide for midwives and doctors; Integrated Management of Pregnancy and Childbirth, WHO, 2007

Introduction - Reference texts• Pregnancy, Childbirth, Postpartum and

Newborn Care: a guide for essential practice; Integrated Management of Pregnancy and Childbirth, WHO, 2009

Principles of good neonatal care• Most babies require only simple

supportive care at and after delivery– Dry the baby with a clean towel– Give the baby to mother as soon as

possible, for skin to skin contact on breast

– Cover the baby with clean towel to prevent heat loss

– Record time of birth– Clamp and cut the cord (K10)

Principles of good neonatal care– Assess infant using APGAR score– Encourage breast feeding within the

first half hour, after maternal HIV status and choice of feeding clarified

– Keep newborn warm (K9)– Perform eye care– Weigh and record weight– Undertake head to toe examination

of newborn– Maintain infection prevention and

control practices during care of baby

Principles of good neonatal care• APLS video clips

– Drying the baby– Kangaroo care

Ongoing care of normal newborn• Behaviour of baby (crying, feeding,

reactions to stimuli

• Colour (eye and skin)

• Respiration

• Cord (bleeding/infection)

• Elimination pattern

Ongoing care of normal newborn• Fontanelle (bulging/sunken)

• Vital signs (temperature)

• Immunisations (BCG, polio 0)

• Keep the baby safe

• (J2)

Breast feeding (J4, J9)

Breast feeding

Breast feeding

Introduction• Principles of good

neonatal care• Why neonatal

resuscitation is important

Neonatal resuscitation is important

‘each year approximately 10 million babies do not breathe immediately at birth, of which about 6 million require basic neonatal resuscitation…evidence from several observational studies shows that facility based basic neonatal resuscitation may avert 30% of intrapartum – related neonatal deaths’

Neonatal resuscitation is important

‘Very few babies require advanced neonatal resuscitation (endotracheal intubation and drugs) and these newborns may not survive without neonatal intensive care.

Neonatal resuscitation is important

‘Of the 60 million non-facility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum-related neonatal deaths (based on expert opinion)’ 1.

Neonatal resuscitation is important

‘Universal application of basic resuscitation may save hundreds of thousands of newborn lives currently lost each year and contribute significantly to progress toward Millennium Development Goal 4’ .

Neonatal resuscitation

S.N.Wall et al. International Journal of Obstetrics and Gynaecology 107 (2009) S47-S64

Neonatal resuscitation• For some babies, the need for resuscitation

can be anticipated– Mother has a chronic illness– Mother has a previous stillbirth or foetal death– Mother has pre-eclampsia– In multiple pregnancies– In preterm delivery– In abnormal presentation of the foetus

Neonatal resuscitation– With a prolapsed cord– Where there is prolonged labour or rupture of

membranes or meconium stained liquor• However for many babies the need for

resuscitation cannot be anticipated before delivery, therefore be prepared for resuscitation at every delivery

Neonatal resuscitation

‘Anticipate the need for resuscitation and have a plan to get assistance for every baby but especially if the mother has a history of eclampsia, bleeding, prolonged or obstructed labour, preterm birth or infection’

WHO guidelines 2007

Neonatal resuscitation

S.N.Wall et al. International Journal of Obstetrics and Gynaecology 107 (2009) S47-S64

Neonatal resuscitation• If these limited data were

generalised for Africa, <¼ of babies born in facilities would have access to resuscitation and because only about half of births are in facilities, only 1/8 of babies who require resuscitation may receive this intervention.

Neonatal resuscitation• We will look at

practical aspects of resuscitation in detail this afternoon including– Helping babies breathe– Bag and mask

ventilation

Neonatal resuscitation• APLS video clips

– Head position infant airway– Neonatal resuscitation by nurses

Conclusion• Principles of good

neonatal care• Why neonatal

resuscitation is important