Things you need to know about neonatal resuscitation
By Dr.KrutikaKumaresan MPT
Before we go ahead with the actual discussion about neonatal resuscitation,I would like to share a few heartfelt points with you. I too gave birth to a pre-term infant who was low in birth weight and required resuscitation, but things turned out positive and she is a very healthy and hearty baby now. So, if you are reading this article with a confused and heavy heart of parent, be brave everything will turn out just fine, trust your Birth Practitioners.
What is neonatal resuscitation?
Neonatal resuscitation is an interventionto aid the baby’s breathing and heart-beatduring the time after its birth. This happens in instances where the baby doesn’t start breathing on its own and is at a risk of vital organ damage owing to hypoxia caused by lack of oxygen. When in the womb the placenta is responsible for the oxygen supply of the baby but once out the baby takes its first breathe starting the lung function. Newborn resuscitation comes under emergency care and is given only if required.
Whatexactly happens during neonatal resuscitation?
Normalising breathing and maintaining body temperature are the two main goals of the paediatrician (or midwife or obstetrician) during neonatal resuscitation. For this they keep your baby on the resuscitation cot which has done heater on the top to maintain the warmth and body temperature. Oxygen aid is given using a mask placed over the nose (or rarely a tube inserted through the nose into the lungs). These enable the doctor/midwife/nurse to push the oxygen gently to the lungs which indirectly helps oxygen transport to brain and other organs.
Some of the more common causes that can lead on to the need for Neonatal Resus:
- being born too early (preterm birth of a premature baby with immature lungs)
- getting an infection during birth (such as from very prolonged rupture of membranes)
- problems with placental anomalies (usually picked up on ultrasound scans)
- having a very long or very quick labour (baby a little in shock)
- the mother having a health condition such as high blood pressure or diabetes (adding general complications to her pregnancy and labor)
- unexpected problems during labour (e.g. abnormal bleeding or changes in baby’s heart rate before birth showing fetal distress)
- abnormalities inthe lung development (rare)
- Sometimes there is no obvious reason.
Senior Midwife and best-selling birth/babies/motherhood Author Kathy Fray from www.MothersWise.com explains it succinctly “Around 10% of full-term newborns require some level of Resus immediately after birth, so it is extremely common and generally nothing to be overly concerned about, especially if the baby is moving, pinkish in colour, and making sounds or attempts to inhale. Many babies are born with their lungs still quite wet from being in the amniotic waters, and so it can often take a few minutes of some mild Respiratory Distress for their lungs to ‘dry out’. During that time as Midwives we will assist the baby with some CPAP for a few minutes, until their grunting, nasal-flaring and diaphragm in-drawing settles down. If the Respiratory Distress symptoms and assistance with CPAP continues on past about 10-15 minutes, then often the baby will be transferred to SCBU/NICU for potentially a few more hours of CPAP and monitoring their Blood Sugar levels to ensure they don’t become hypoglycaemic from the extra exertion their breathing is temporarily necessitating.
What happens after neonatal resuscitation?
Depending on the reason for the procedure the health care provider will take a decision whether as to admit the baby to the NICU or to let the baby stay with you in the ward. If your baby stays in the NICU the staff will have complete vigilance over your baby’s breathing heart, heart rate, body temperature etc, Even when the doctors decides to let the baby stay with you in the wards the staff will have a close watch over the baby’s activities and well-being. If your baby is unable to suckle, a feeding tube may be inserted through its nose to help with the feed.
Things to remember if your midwife/obstetrician informs you of your baby’s need for neonatal resuscitation:
- They have taken this decision keeping your baby’s best in mind. So do not panic and trust your doctor, they are the experts under such scenario.
- If you have a fear or doubt whether your baby might require neonatal resuscitation after being bought home, discuss with your doctor about it. He would definitely clear your doubts about your baby’s state during discharge. Only in extremely rare cases the baby requires resuscitation and NICU stay again.
- Depending on how unwell your baby is he might require appropriate extra. Suckling might be weak, so you may need to feed the baby by handafter you express the milk. The midwife or nurse will help you with it.
- Mother and baby bond is very important for fast recovery, Kangaroo Mother Care (especially for very premature babies) is a technique by which the baby is held on an adult’s chest—usually the mother—with skin-to-skin contact, for extended periods of time.
Fray continues “Fetal lung maturation completes at around 36-weeks’ gestation, so any Babies born before 37-weeks are likely to need some level of resus assistance. However, it is very rare for full-term neonates to require intubation after a natural labour and normal birth. In my experience the most common reasons they dois after experiencingfetal distress during labour, leading to dramatic traumatic Obstetric instrumental/surgical deliveries, such as ventouse, forceps or C-Sections – which most typically occurs after labours prolonged by the use of Epidural anaesthesia, and the consequential need for Oxytocin augmentation.”
And at last, just remember your baby is alive and breathing because of the doctor and the advancement in science to save the child. Be thankful and positive rest will all be good.