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Letters to the Editor Indian Pediatrics 2001; 38: 1435 |
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Newer Guidelines for Neonatal Resuscitation – How my Practice Needs to Change |
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We read the above article(1), which is based on American Academy of Pediatrics (AAP) neonatal resuscitation program (NRP) provider course(2). Both, according to this article(1) and according to the algorithm for resuscitation in the recently published international guidelines for neonatal resuscitation(3), the initial basic steps for resuscitation are described in a particular sequence, namely, "provide warmth, position, clear airway, dry, stimulate, reposition, give oxygen (as necessary)". A problem arises from the fact that the same guidelines(3), in the text, describe a somewhat different sequence of steps. The text states clearly that warmth can be provided, after delivering the infant in a warm, draft free area by either of two strategies. The first of the two strategies is as follows: Placing the infant under the radiant warmer, rapidly drying the skin, removing wet linen immediately and wrapping the infant in prewarmed blankets to reduce heat loss. This strategy suggests that "drying, and removing wet linen" are a part of giving warmth. Thus, if one were to follow this strategy mentioned in the text, then the recommended sequence of resuscitation become "place under radiant warmer, dry, remove wet linen, position, suction, stimulate, reposition, give oxygen (as necessary)". This sequance is similar to the pre-revision neonatal resuscitation guidlelines and is different from what is mentioned in the algorithm and what the author has stated in the article(1). We would like the author to clarify whether "drying and removal of wet linen" should come in the later part of the sequence of resuscitation, only after clearing the airway, or should it precede the clearing of airway? We believe that the critical factor in newborn who needs resuscitation is prevention of heat loss and is best accomplished by placing the infant under a radiant warmer and quickly drying him or her of amniotic fluid. The above two steps are appropriate for all infants, require only a few seconds and drying has the additional benefit of gentle stimulation which may initiative or help maintain respirations(4). Moreover, the newer guidelines fail to provide a superior level of evidence for reversing the steps of ‘drying and removal of wet linen’ and ‘positioning and clearing airway’. Hence, we find reason to adhere to the newer guidelines in this aspect.
P.S. Sandesh Kiran,
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