Newborn resuscitation: defining best practice for low-income settings.
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.
Newton
Opiyo
O
Kenya Medical Research Institute/Wellcome Trust Collaborative Programme, P.O. Box 43640, 00100 GPO, Nairobi, Kenya. nopiyo@wtnairobi.mimcom.net
English
Mike
M
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D003906:Developing Countries; D004837:Epinephrine / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000592:standards; D018743:Perinatal Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013396:Suction
D000316:Adrenergic alpha-Agonists; D017693:Sodium Bicarbonate; D005947:Glucose; D004837:Epinephrine