The principles of good neonatal care
and why neonatal resuscitation is
important
Doug Simkiss
Associate Professor of Child Health
Warwick Medical School
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 intrapartumrelated 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