The purpose of this presentation is to discuss experiences with low birth weight newborns. WHO estimates that almost half of newborn mortality is associated with preterm or low birth weight babies (Child Health Research Project and Maternal and Neonatal Health Program 1999). Note: In this presentation, the term “newborn” refers to a baby between birth and one month old.
03/30/10 Alternative devices in place of self-inflating bag are now being developed that are safe and effective. Milner A et al. 1990. A device for domiciliary neonate resuscitation. Lancet 335: 273-275.
03/30/10 The most crucial aspects of essential newborn care are warmth and breathing. Placing the newborn on a warm surface and drying the newborn helps maintain body temperature and prevent hypothermia.
03/30/10 Warmth is essential for newborns, to help maintain body temperature. The best source of warmth is the mother’s skin. To avoid heat loss, the newborn must also be dry.
Avoid bathing too early (within 24 hours) to prevent heat loss (except in areas with high HIV prevalence, where bathing may help reduce maternal-fetal transmission.
The most important vital sign to assess is respiration. Do not hesitate to begin resuscitation is needed.
03/30/10 Objective measures are most useful in determining whether a newborn needs to be resuscitated. Of these measures, breathing is the most important. If a newborn does not start or keep breathing, resuscitation should be started immediately. Do not delay to assess muscular tone, skin color, etc.
03/30/10 The steps in resuscitation are to: Open the airway: Slightly extend the head and clear the airway Begin ventilation: Use a size 0 (small newborn) or 1 (normal newborn) mask. Ensure a good seal around the nose and mouth so that the airways are properly getting air. Continually assess the newborn’s progress.
If ventilation does not work, it may be due to a technical problem. Reposition the newborn’s head and mask first, then try increasing the pressure with which air is ventilated. Also, repeat suctioning to clear the airway.
03/30/10 These practices may be dangerous, but also delay the initiation of effective resuscitative measures. Slapping or flicking the soles of the feet is only useful for mildly depressed newborns, and only results in delaying effective resuscitative efforts in newborns who are asphyxiated. Using postural drainage or slapping the newborn’s back may cause trauma, as can squeezing the chest. Aspiration of the nose, mouth and stomach can cause brachycardia. Study by Takroni et al 1998 suggests heavy meconium should be aspirated on the perineum, but intubation only called for if signs of asphyxia are present. Vigorous newborns do not need intubation to prevent MAS. Bulb aspiration vs Delee equally effective. Locus et al 1990.
03/30/10 These practices may be dangerous, but also delay the initiation of effective resuscitative measures. Sprinkling cold water on the newborn can result in hypothermia. Intubation by unskilled personnel can injure the respiratory or alimentary tract.
03/30/10 Infection prevention is very important.
Low birth weight newborns have low body mass and more body surface area, and therefore have a greater tendency to lose heat. Thermal protection is, therefore, even more important.
Included Small for gestational age/low birth weight No gestational age limits No oxygen or IV fluids needed, partly able to feed No visible malformations
Managing Low Birth Weight and Sick Newborns Advances in Maternal and Neonatal Health
Select appropriate mask size to cover chin, mouth and nose with a good seal
Squeeze bag with two fingers or whole hand, look for chest to rise
If chest not rising:
Reposition head and mask
Evaluate After ventilating for about 1 minute, stop and look for spontaneous breathing If no breathing, breathing is slow (< 30 breaths/ min.) or is weak with severe indrawing If newborn starts crying/breathing spontaneously Continue ventilating until spontaneous cry/ breathing begins
Do not leave newborn
Put newborn skin-to-skin with mother and cover them both
Harmful and Ineffective Resuscitation Practices
Practices to be avoided include:
Routine aspiration of the newborn’s mouth and nose as soon as the head is born
Routine aspiration of the newborn’s stomach at birth
Stimulation of the newborn by slapping or flicking the soles of her/his feet: only enough stimulation for mildly depressed-delays resuscitation
Postural drainage and slapping the back: dangerous