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Letters to the Editor Indian Pediatrics 2001; 38: 1436 |
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Reply |
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The algorithm provided in the textbook states clearly the sequence "provide warmth, position, clear airway, dry, sTimulate, reposition, give oxygen (as necessary)"(1). Drying the baby and removal of wet towel always follows clearing of airways. One must use commonsense approach for analyzing these steps. This sequence is for babies who require initial steps under the warmer (often they are meconium stained or premature or depressed). Drying and stimulating them before clearing the airway may lead to onset of breathing resulting in aspiration of uncleared oral secretions. I quote the texbook section 2-11. Once the airway is clear, what should be done to stimulate breathing and further prevent heat loss? • Dry, stimulate to breathe, and reposition. Often, positioning the baby and suctioning secretions will provide stimulation. Drying the body and head will also help to prevent heat loss. If two people are present, the second person can be drying the baby while the first person is positioning and clearing the airway. On the other hand Drs. Kiran and Dutta are quoting steps from Basic Steps for Resuscitation as published in September 2000(2). The text in paragraph refers to babies who do not need initial steps and refers to routine management of babies with mother. This reads "whenever possible, deliver the infant in a warm, draft-free area. Placing the infant under a radiant warmer, rapidly drying the skin, removing wet linen immediately, and wrapping the infant in prewarmed blankets will reduce heat loss. Another strategy for reducing heat loss is placing the dried infant skin-to-skin on the mother’s chest or abdomen to use her body as a heat source". There are some conflicts in the latest textbook text and algorithm. We are sure that these will be suitably modified in the future editions.
A.K. Deorari, |
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