Air To Breathe – Resuscitation Techniques for Newborns and Teaching Methods
Advances in medicine and access to professional care in the antenatal period and during labour mean that over the decades infant mortality rates have been decreasing steadily. However, 10% of babies still need some degree of intervention immediately after birth, and 25% of all newborn deaths are caused by breathing problems. Healthcare professionals have over the years followed various different methods and protocols for resuscitating newborns, with varying degrees of success. Bodies such as the World Health Organisation (WHO) pull together best practice from across the globe, and regularly update their guidance to ensure infant mortality rates continue on their downward trajectory.
Antenatal Prediction of Which Babies May Be Affected
Only about half the cases of babies who are born not breathing could have been predicted from the mother’s pregnancy or labour history. However, hospitals around the world are putting protocols into place to identify those women whose babies are most likely to require extra support with breathing and ensure that the correct staff and equipment is in the delivery room at the time of birth. Babies born by caesarean section are particularly at risk, but in vaginal deliveries there are other risk factors which have been identified. These include multiple births, births before 35 weeks gestation, a breech presentation, babies where medical issues have been diagnosed pre-birth and occasions when the mother has been given opiate based pain killers during labour.
Protocol When Problems Have Not Been Predicted
In the UK, it is the midwife who is likely the first to be confronted with a baby suffering from breathing difficulties are they are taught to follow the following steps. Firstly, getting the baby breathing is a time critical issue so any signs of distress or that the baby is struggling to breathe much be acted upon immediately. The first thing the midwife must do is to wrap the baby in a towel or blanket to dry and keep them warm, while simultaneously calling for help from other midwives or doctors. There is no rush to clamp the cord as the placenta will sustain the baby for a short period while the midwife assesses what is going on. Nearly all babies who are born and don’t breathe straight away will do so after three minutes if they are dried and kept warm.
Suctioning and Oxygen
Babies often fail to breathe or struggle to breathe because they have inhaled meconium filled amniotic fluid during the birth. Midwives are often aware before birth that this may be an issue as the mother’s waters will be stained when they break. In these cases, suction is used to clear any remaining fluid from around the baby’s nose and mouth, and when combined with keeping the baby warm, this is often enough to clear the baby’s airway and encourage them to breathe. For babies who have not breathed in meconium but who are still struggling to breathe or maintain a regular heart rate, oxygen is usually recommended. Doctors and midwives use their judgement and experience to adjust the flow of oxygen and air until the baby’s vital signs return to normal.
Chest Compressions and Ventilation
Only a very small number of babies will fail to respond to the above measures and will require further attempts to
resuscitate them at birth. Another small group of babies will initially breathe and then require resuscitation at a later time, either when the mother is still in hospital or once at home. Chest compressions and either bag and mask or manual ventilation will also be needed. Medics will undergo training on this life-saving procedure, but parents are generally unaware of the main differences between performing CPR on an adult and a baby. Firstly, when giving breaths to a baby, adults are advised to put their mouths right over the baby’s mouth and nose when blowing to inflate lungs rather than just the mouth. In hospital situations, staff will use a bag and a mask which seals over the baby’s nose and mouth instead. The chest compression technique is also different when it comes to newborns. Babies should be laid on their backs, with the adults hands encircling the body with the thumbs in the centre of the chest. The chest must be pushed down quickly and repeatedly, at a speed of 100 beats per minute. After 30 chest compressions, give the baby two breaths if doing this manually, then continue with compressions until the baby responds or qualified medical help arrives.
Further Medical Decisions
After a baby has been resuscitated, ongoing monitoring is recommended to ensure the baby continues to make progress. In a small percentage of cases a baby may need to be ventilated with a tube, in others drugs such as adrenaline may be required to stabilise the baby. Every case is different, and the medical staff will work as a team towards the best outcome possible. Although difficult in emergency situations, it is important to maintain communication with the parents wherever possible and let them know what is being done and why, especially when dealing with a baby who has just been born.
Important life saving information is easy to pass on when you have high-quality hands-on education tools in your teaching environment. Simple techniques performed correctly are skills that we can all master and last a life-time. What questions do you get asked most in your clinic about baby CPR?