Infant resuscitation guide: how to provide breath support

After the baby is born, normally the baby will breathe immediately with air. However, quoting from the Newborn WHO Collaborating Center, 1 in 20 babies need breathing assistance at birth. This assistance is known as infant resuscitation. What is that?

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What is infant resuscitation?

Resuscitation is assistance given after the baby is born so that he can breathe, usually done after the umbilical cord has been cut.

After birth, babies who cannot breathe will experience a lack of oxygen and lead to infant death.

The goals of newborn resuscitation also include preventing infant mortality and morbidity related to brain, heart and kidney injuries.

Resuscitation is included in the examination of the newborn which helps the baby breathe normally and strengthens the heartbeat.

Basically, the baby also takes oxygen while in the womb. However, it is not inhaled directly, but is drawn from the mother's bloodstream through the placenta.

However, after the baby is born, the placenta will be cut so that the supply of oxygen to the baby will stop.

Then the baby will take oxygen from the air to breathe.

Some babies may need help breathing normally.

Not all babies may spontaneously take their breaths of air after birth.

At this time, resuscitation of the newborn is required.

Conditions that make babies need resuscitation

There are no signs to indicate which babies need resuscitation after birth and which do not.

This makes resuscitation still have to be prepared at every birth of your little one.

Quoted from Hospital Care for Children, there are conditions that make babies need resuscitation, namely:

• Babies are born prematurely
• The mother has preeclampsia
• Premature rupture of membranes (PROM)
• Amniotic fluid is not clear.
• Born after a long labor
• Born to mothers who received sedatives during the later stages of labor.

According to the journal from the American Academy of Pediatrics (AAP), newborns who need resuscitation are generally assessed for the following four conditions:

• Is the baby born at full term?
• Is the amniotic fluid clear of meconium and signs of infection?
• Is the baby breathing or crying shortly after birth?
• Does the baby have good muscle work?

If the answer to these four questions is'not', babies need resuscitation.

How to do baby resuscitation?

Resuscitation is carried out by health workers according to your little one's condition. There are four consecutive actions that can be performed during infant resuscitation.

The baby may only need to receive one or more of these four actions.

The decision to go ahead with each resuscitation procedure is determined by an assessment of three vital signs, namely the baby's breathing, heart rate, and skin color.

The following are the steps for baby resuscitation by doctors:

Initial step

As a first step, there are several things that doctors do, namely:

• Provide warmth to the baby.
• Position the baby well face up.
• Position the baby's head slightly upward to help open the airway.
• Place the folds of fabric under the baby's shoulders to maintain this position.
• Clean the baby's airway if needed.

This includes applying suction in the mouth and then on the nose to remove meconium (swallowed baby feces).

This procedure is performed using a suction tube to alternate in the mouth and nose.

The next step is to stimulate the baby to breathe.

This can be done by flicking or patting the soles of the baby's feet, and gently rubbing the baby's back, feet and hands.

The doctor will assess the baby's breathing, heart rate, and muscle movements after each procedure.

If the baby is not breathing, the doctor will take further action.

Ventilation

This is a resuscitation procedure that aims to get air into the baby's lungs.

Ventilation measures are carried out by attaching a mask (oxygen mask) to the size of the baby's face to cover the baby's chin, mouth and nose.

The doctor will keep the baby's head in position and squeeze the bag that is on the lid. This air enters the baby's lungs so that the chest rises slightly.

If the baby's chest rises after 2-3 ventilation, it means that the ventilation pressure may be sufficient to be applied to the baby.

The doctor will continue to give ventilation 40 times per minute until the baby cries or breathes.

However, if the baby's chest does not rise, there may be problems, such as:

• Blocked airway of the baby
• Incorrect lid installation
• The pressure is not strong enough
• The baby's position is not correct

The doctor will continue to the next step if there is no improvement in the baby's condition.

Put pressure on the baby's chest

This is done temporarily to improve circulation and oxygen delivery to the baby's vital organs.

Chest pressure or heart massage is given accompanied by ventilation, to ensure that the blood circulating in the baby's body gets enough oxygen.

After 30-45 seconds of chest compressions, the doctor will assess the baby's heart rate.

If the baby's heart rate is less than 60 beats per minute, chest compressions should be continued (after the epinephrine injection).

Epinephrine administration

Epinephrine is administered when ventilation and chest compressions are not working properly.

The measure is when ventilation and chest compressions for more than 45 seconds do not get a response from the baby.

This condition is also characterized by the baby's heart rate remaining less than 60 beats per minute and no increase.

Not all babies need resuscitation. Everything depends on the health condition of your little one at birth.