Xylander: WHO 2012 Guidelines on Basic Newborn Resuscitation
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Transcript of Xylander: WHO 2012 Guidelines on Basic Newborn Resuscitation
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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.
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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
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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
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Newborn Resuscitation in WHO Documents
2003,
2006,
2009
2000,
2007
2000,2007
2005
2000,2007
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 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
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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.
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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.
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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.
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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.
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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.
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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 tocomprehensive 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