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Indian Pediatr 2021;58: 591 |
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The Initial Steps in Neonatal Resuscitation
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PMC Nair
Emeritus Professor, Department of Neonatology,
SAT Hospital, Medical College,
Trivandrum, Kerala.
Email: drpmc50@gmail.com
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We read with interest the randomized control
trial by Kumar, et al. [1] and would like to make some
observations. Neonatal Resuscitation program as per the
International Liaison Committee on Resuscitation (ILCOR)
guidelines had made it clear that the initial steps should
include, in order, positioning the baby under radiant warmer,
then suctioning if there is a lot of secretions, and after that
only drying and gentle stimulation, if needed. The process of
rubbing the baby’s back while drying, it-self is a good
stimulant for 90% of the babies to make a good cry and establish
respiration. Certain points require consideration:
1. The reason this RCT did not pick up
the difference is that the study was looking at composite
outcome of admission temperature in the NICU and respiratory
distress at 6 hours of age.
2. In the study only 5.2% in the first
group (suctioning before drying) died, while 11.7% died in
the second group (drying before suctioning) [RR (95% CI)
0.44 (0.14-0.38)]. This is an eye opener that depressed sick
babies require suctioning first and then only drying.
3. The babies were transported to NICU
without any additional source of heat which is not
acceptable. Even years back, we have the consensus that the
baby should be transported in a transport incubator, or a
warmer or phase exchange material like Embrace or at least
swaddling the baby well. Ideally babies temperature should
have been recorded in the delivery room itself.
To bring uniformity and consistency among
health professionals and to avoid confusion in implementation of
NRP guidelines, let us follow a scientific and common sense
approach which is in agreement with the standard guidelines. So
in the initial steps of resuscitation of a depressed neonate (apneic/gasping/
decreased tone) let us follow the standard guidelines of NRP
namely, positioning under the warmer, suctioning if needed,
drying and removing the wet linen, followed by gentle
stimulation or evaluation for respiration and heart rate [2].
REFERENCES
1. Kumar A, Yadav RP, Basu S, Singh TB.
Suctioning first or drying first during delivery room
resuscitation: A randomized controlled trial. Indian Pediatr.
2021:58:25-9.
2. Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal
Resuscitation: 2015 American Heart Association Guidelines Update
for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care. Circulation.2015;132: S543-60.
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