IMMEDIATE CARE AFTER BIRTH
1.
In newly-born term or preterm babies who do not require positive-pressure
ventilation, the cord should not be clamped earlier than one minute after
birth.
When
newly-born term or preterm babies require positive-pressure ventilation, the
cord should be clamped and cut to allow effective ventilation to be performed.
2.
Newly-born babies who do not breathe spontaneously after thorough drying should
be stimulated by rubbing the back 2-3 times before clamping the cord and
initiating positive-pressure ventilation.
3.
In neonates born through clear amniotic fluid who start breathing on their own
after birth, suctioning of the mouth and nose should not be performed.
In
neonates born through clear amniotic fluid who do not start breathing after
thorough drying and rubbing the back 2-3 times, suctioning of the mouth and
nose should not be done routinely before initiating positive pressure
ventilation. Suctioning should be done only if the mouth or nose is full of
secretions.
4.
In the presence of meconium-stained amniotic fluid, intrapartum suctioning of
the mouth and nose at the delivery of the head is not recommended.
5.
In neonates born through meconium-stained amniotic fluid who start breathing on
their own, tracheal suctioning should not be performed.
In
neonates born through meconium-stained amniotic fluid who start breathing on
their own, suctioning of the mouth or nose is not recommended.
In
neonates born through meconium-stained amniotic fluid who do not start
breathing on their own, tracheal suctioning should be done before initiating
positive pressure Ventilation.
In
neonates born through meconium-stained amniotic fluid who do not start
breathing on their own, suctioning of the mouth and nose should be done
before
initiating positive-pressure ventilation.
(in situations where endotracheal intubation
is possible)
6.
In settings where mechanical equipment to generate negative pressure for
suctioning is not available and a newly-born baby requires suctioning, a bulb
syringe (single-use or easy to clean) is preferable to a mucous extractor with
a trap in which the provider generates suction by aspiration.
POSITIVE-PRESSURE VENTILATION
7.
In newly-born babies who do not start breathing despite thorough drying and
additional stimulation, positive-pressure ventilation should be initiated
within
one
minute after birth.
8.
In newly-born term or preterm (>32 weeks gestation) babies requiring
positive-pressure ventilation, ventilation should be initiated with air.
9.
In newly-born babies requiring positive-pressure ventilation, ventilation
should be provided using a self inflating bag and mask.
10.
In newly-born babies requiring positive-pressure ventilation, ventilation
should be initiated using a facemask interface.
11.
In newly-born babies requiring positive-pressure ventilation, adequacy of
ventilation should be assessed by measurement of the heart rate after 60
seconds of ventilation with visible chest movements.
12.
In newly-born babies who do not start breathing within one minute after birth,
priority should be given to providing adequate ventilation rather than to chest
compressions.
STOPPING RESUSCITATION
13.
In newly-born babies with no detectable heart rate after 10 minutes of
effective ventilation, resuscitation should be stopped.
14.
In newly-born babies who continue to have a heart rate below 60/minute and no
spontaneous breathing after 20 minutes of resuscitation, resuscitation should
be stopped.
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