Integrated Maternal and Newborn Care Basic Skills Course ...

When to Discontinue Resuscitation
While it is essential to carry out the steps for resuscitation in a correct and timely manner, it is
equally important to know when the process should be terminated. Conventionally, if a newborn
does not breathe and does not cry for 20 minutes, resuscitation should be discontinued. A
newborn who is not breathing 20 minutes after appropriately managed resuscitation has already
suffered from significant hypoxia and merely continuing ventilation without ancillary support
carries the risk of further brain damage and long-term disability. Intensive care is appropriate at
this time. At a peripheral center, where it is not feasible to provide such care, a baby who is not
breathing should be managed as best as feasible locally, unless facilities exist to transport the
baby with effective ventilation to an appropriate higher referral center where intensive care is
available. Otherwise, the baby is likely to die on the way or reach the center in a state from
which it cannot be revived or that may be associated with severe disability.
Dangerous/Inefficient Resuscitation Practices
Avoid harmful practices such as:
• Vigorous aspiration of the mouth and nose of the baby. It may result in bradycardia or
cardiac arrest due to vagal stimulation.
• Postural drainage with head down.
• Slapping of the baby’s back.
• Compression of the chest to eliminate secretions. This is dangerous since it may lead to
rib fractures, pulmonary lesions, and even death.
• Strong stimulation of the newborn, such as slapping the buttock.
• Immersing the baby in cold water and then in hot water.
• Introducing a glass thermometer in the anus, as this may result in injury.
• Use of medication such as sodium bicarbonate administered without indication before
breathing is established or rapidly in high concentrations.
POST-RESUSCITATION CARE
After resuscitating the asphyxiated baby, the health care worker has to provide routine essential
care, monitor the infant for problems/complications, counsel the family, and document all events
and actions. All equipment needs to be decontaminated/cleaned/sterilized before it can be used
again (see chapter 1) and all disposable or consumable/single-use supplies need to be
replenished.
Care Following A Successful Resuscitation
• Prevent hypothermia; keep the baby warm and dry and if feasible in skin-to-skin contact
with the mother, covering his/her body and head over the mother’s chest, keeping the
face exposed.
• Examine the baby and evaluate the respiratory rate:
o If the infant has cyanosis, breathing problems such as rapid breathing with a rate of
more than 60/minute, intercostal retractions, and/or expiratory grunting, administer
supplemental oxygen as illustrated above. If these do not subside, refer the baby.
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Integrated maternal and newborn care
Basic skills course