Newborn resuscitation: defining best practice for low-income settings

Trans R Soc Trop Med Hyg. 2006 Oct;100(10):899-908. doi: 10.1016/j.trstmh.2006.02.012. Epub 2006 Jun 6.

Abstract

Current resuscitation practices are often poor in low-income settings. The purpose of this review was to summarise recent evidence, relevant to developing countries, on best practice in the provision of newborn resuscitation. Potential studies for inclusion were identified using structured searches of MEDLINE via PubMed. Two reviewers independently evaluated retrieved studies for inclusion. The methodological quality of the selected articles was assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence, whilst the Scottish Intercollegiate Guidelines Network (SIGN) grading system was used for subsequent recommendations. Based on available evidence, where there is meconium-stained liquor, routine perineal suction of all babies and endotracheal suction of active babies do not prevent meconium aspiration syndrome and have potential risks. Adequate ventilation is possible with a bag-valve-mask device and room air is just as efficient as oxygen for initial resuscitation. This review supports the view that effective resuscitation is possible with basic equipment and minimal skills. Thus, where resources are limited, it should be possible to improve neonatal outcomes through promotion of the effective use of a bag-valve-mask alone, without access to more sophisticated and expensive technologies. Basic, effective resuscitation should therefore be available at all health facilities and potentially in the community.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-Agonists / therapeutic use
  • Developing Countries*
  • Epinephrine / therapeutic use
  • Glucose / therapeutic use
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / therapy*
  • Intubation, Intratracheal / standards
  • Perinatal Care / standards*
  • Practice Guidelines as Topic
  • Respiration, Artificial / methods
  • Resuscitation / methods
  • Resuscitation / standards*
  • Sodium Bicarbonate / therapeutic use
  • Suction

Substances

  • Adrenergic alpha-Agonists
  • Sodium Bicarbonate
  • Glucose
  • Epinephrine