JHPIEGO TrainerNews™ |
Simple Approaches Save Newborns in
Respiratory Distress in Burkina Faso and Indonesia
(September 2001)
Sometimes the simplest interventions and equipment work the best to save newborns in distress. Two recent Maternal and Neonatal Health (MNH) Program clinical training workshops in Burkina Faso and Indonesia demonstrated the value of using simple techniques to resuscitate babies after childbirth. When providers implemented the Program's protocol for newborn resuscitation, they were able to start the babies' breathing.
In June, at the main referral hospital in Bobo Dioulaso, Burkina Faso, MNH Program staff and training participants used a series of steps to revive a baby after a breech birth. After a 30-45 second intervention to stimulate the baby's respiratory system using very simple techniques and equipment, the baby was breathing on its own. Program staff reported that within a few minutes, the baby was alert and able to nurse.
The steps in the MNH Program protocol are those outlined in the "Managing Complications in Pregnancy and Childbirth" manual published by the World Health Organization in 2001 and endorsed by members of the global health community. The midwife or doctor uses a simple suction tube to suction the baby's nose and mouth to remove any material that may be blocking these vital airways. Then a small mask is placed over the baby's nose and mouth and air is squeezed from a small bag (called an ambu bag) through the mask and into the baby's lungs.
A similar incident occurred in August during an MNH Program clinical training workshop at Budi Kemuliaan Hospital in Jakarta, Indonesia. After the birth of a baby with a good heart rate but no respiratory effort, MNH Program staff and participants initiated the resuscitation following the MNH protocol. After 5 minutes, the baby was still not breathing normally, so nurses attempted to contact the physician on call. Meanwhile, the MNH Program providers continued to try to stimulate the baby's breathing using the newborn mask and bag. After 45 minutes, the baby was finally able to breathe on her own. Program staff reported that at the at the mother's postnatal check-up the following morning, the baby was crying and responsive and breastfeeding vigorously.
Newborn asphyxia (lack of breathing) is a sign of distress that may be caused by a variety of conditions, including premature or prolonged labor, an insufficient placenta, abnormal fetal position, an infection or bleeding in the mother and general anesthesia during a cesarean section. Asphyxia can sometimes be detected during labor, but often it is not discovered until a baby is born.
As part of their training in labor and childbirth, MNH Program clinical training participants learn to make a rapid assessment of the baby's condition at birth. The MNH Program recommends that, if a baby is crying and breathing normally, the provider should avoid any manipulation, such as routine suctioning, that may cause trauma or introduce infection. If a baby is distressed and needs resuscitation, the use of a simple suction tube and neonatal face mask and ambu bag can make a real difference in saving babies' lives.
The MNH Program promotes this approach to newborn resuscitation because it can be implemented safely and effectively in remote settings by all levels of providers and because the equipment needed is minimal and affordable. It reflects the Program's focus on introducing low-tech solutions that are effective and that can be sustained in areas with few resources.
For more information about the MNH Program, visit the MNH Website or contact Sandra Crump.
This article was made possible through support provided by the Office of Health and Nutrition, Center for Population, Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for International Development, under the terms of Award No. HRN-A?00-98-00043-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.