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