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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 and they do not necessarily represent the decisions, policy or views of the World Health Organization.

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Essential Newborn Care


1. Cleanliness 2. Thermal protection 3. Early and exclusive breastfeeding

4. Initiation of breathing, resuscitation


5. Eye care

6. Immunization
7. Management of newborn illness 8. Care of the preterm and/or low birth weight newborn

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1998 WHO Guidelines (1996-1998)


Revolutionary:

First global guidelines for resource-limited settings


Feasible for single provider (one SBA model) Focus on ventilation

Minimum equipment
Use of room air
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Newborn Resuscitation in WHO Documents

2003, 2006, 2009

2000, 2007

2000, 2007 2000, 2007

2005

2010

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Skilled Care at Birth (latest since 2000)

Global: 69% AFR: 48% EMR & SEAR: 59%

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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

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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 breathing on 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 heart rate

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Key Actions: Clamping the Cord

The cord should be clamped after 1 to 3 minutes in all newly-born babies; the cord should be clamped and cut before one minute only if this is needed for resuscitation.

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Key Actions: Ventilation


In newly-born babies who do not start breathing despite drying and additional 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 and face-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.
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Key Actions: Suctioning


If newly-born babies start breathing on their own, suctioning of the mouth 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 highly skilled personnel and equipment often not available in low-resource settings.
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Key Actions: Stopping Resuscitation

Ventilation should be stopped if the baby has no detectable heart beat after 10 minutes of effective ventilation, or continues to have a heart rate below 60/min and no spontaneous breathing after 20 minutes.

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Standards for Effective Resuscitation (1)


All women giving birth should be assisted by a person skilled 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.

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Standards for Effective Resuscitation (2)


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.

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Standards for Effective Resuscitation (3)


A functioning referral system to comprehensive neonatal care for newborns.
Health records. Post resuscitation care: closer monitoring for breastfeeding difficulties or other problems.

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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

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Thank you