Doug Simkiss

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The principles of good neonatal care and why
neonatal resuscitation is important

• Doug Simkiss
• Associate Professor of Child Health
• Warwick Medical School

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Introduction

• Principles of good neonatal care
• Why neonatal resuscitation is important

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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

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Introduction - Reference texts

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

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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)

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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

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Principles of good neonatal care

• APLS video clips
• Drying the baby
• Kangaroo care

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Ongoing care of normal newborn

• Behaviour of baby (crying, feeding, reactions to
  stimuli
• Colour (eye and skin)
• Respiration
• Cord (bleeding/infection)
• Elimination pattern

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Ongoing care of normal newborn

• Fontanelle (bulging/sunken)
• Vital signs (temperature)
• Immunisations (BCG, polio 0)
• Keep the baby safe
• (J2)

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Breast feeding (J4, J9)
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Breast feeding
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Breast feeding
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Introduction

• Principles of good neonatal care
• Why neonatal resuscitation is important

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Neonatal resuscitation is important

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

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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.

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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.

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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 .

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Neonatal resuscitation
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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

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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

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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
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Neonatal resuscitation
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Neonatal resuscitation

• If these limited data were generalised for
  Africa, lt¼ 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.

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Neonatal resuscitation

• We will look at practical aspects of
  resuscitation in detail this afternoon including
• Helping babies breathe
• Bag and mask ventilation

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Neonatal resuscitation

• APLS video clips
• Head position infant airway
• Neonatal resuscitation by nurses

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Conclusion

• Principles of good neonatal care
• Why neonatal resuscitation is important