Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Identifying a Baby with Birth Asphyxia
The baby may have the following features:
• does not cry at birth
• is either not breathing or has very slow breathing (less than 20/minute) or is gasping
• is blue or pale
• is limp and not moving or not responding properly to stimulation
The Apgar score is used at hospitals to assess the status of the baby in relation to breathing,
heart rate, color, muscle tone, and reflex response to stimulation at 1, 5, and 10 minutes after
birth. Low scores at 5 and 10 minutes have also had some correlation with a poorer long-term
outcome, but this correlation is not always consistent. However, in most peripheral centers the
scoring is frequently carried out in a wrong/inappropriate manner. The score, in any case, is not
required and must not be used to make decisions to carry out resuscitation. Hence, the Apgar
score will not be covered in this training session.
STEPS IN NEWBORN RESUSCITATION
The initial actions for resuscitation are similar for all babies, irrespective of the status of the baby
and presence or absence of asphyxia. After each step, an evaluation of the condition must be
made to judge progress so that the appropriate next step can be implemented. Evaluation and
action constitute a cycle that has to be repeated in a timely manner until the baby recovers or a
decision is made to discontinue an unsuccessful resuscitation. Universal precautions for the
safety of the baby and the staff and steps for prevention of infection are also mandatory.
Preparation
Switch on the heating source before the delivery to warm the table top/mattress for the baby.
Place the linen for the baby on the table under the warmer so that it gets warmed up before the
delivery. Wash your hands and wear sterile gloves.
Immediate Care in the Case of Meconium in the Amniotic Fluid
If the amniotic fluid is stained by meconium, and especially in case of thick meconium:
• Suction the mouth and nose as soon as the head is delivered on the perineum and before
the delivery of the shoulders. Tell the mother not to push for a little while, giving time to
suction the mouth and nose of the baby. Based on research results, this preliminary
suction before full delivery is not carried out in centers in advanced countries; instead,
early suction, including endotracheal suction, is carried out immediately after delivery if the
baby is not crying. However, in low-resource settings, such as peripheral centers in
developing countries where intubation is not feasible, suctioning of the mouth and nose
before delivery of the shoulders is likely to decrease the risk of meconium inhalation into
the lungs that could cause additional problems.
• After full delivery of the baby, if no breathing is observed, suction the mouth and nostrils
before drying and stimulation. Do not suction a baby who is already crying.
Integrated maternal and newborn care
Basic skills course
99