Presentation is loading. Please wait.

Presentation is loading. Please wait.

Postnatal Home Visits Meeting | 8 - 10 February 2012 1 |1 | WHO Guidelines on Basic Newborn Resuscitation Bernadette Daelmans, Coordinator Policy, Planning.

Similar presentations


Presentation on theme: "Postnatal Home Visits Meeting | 8 - 10 February 2012 1 |1 | WHO Guidelines on Basic Newborn Resuscitation Bernadette Daelmans, Coordinator Policy, Planning."— Presentation transcript:

1 Postnatal Home Visits Meeting | February |1 | WHO Guidelines on Basic Newborn Resuscitation Bernadette Daelmans, Coordinator Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health (MCA)

2 Postnatal Home Visits Meeting | February |2 | Guidelines development: principles Systematically developed, based on all available evidence Clear, unambiguous recommendations, but stating the quality of evidence on which they are based Strength of recommendation based on the balance of benefits and risks, values and preferences, and costs Should take into account the range of circumstances in which they will be used

3 Postnatal Home Visits Meeting | February |3 | 2. Scoping the guidelines: key questions and critical outcomes 1. Establishing WHO Steering Group and independent Guidelines Development Group 3. Systematic reviews and synthesis of evidence 4. Grading quality of evidence using GRADE 7. Field testing, implementation and evaluation 6. Peer-review and finalization 5. Formulation of recommendations by GDG: Benefits, Harms, values and preferences, costs Process of guideline development

4 Postnatal Home Visits Meeting | February |4 | Declaration of Interests Research Support Investment Interests Intellectual Property Public Statements and Positions Additional Information

5 Postnatal Home Visits Meeting | February |5 | Essential Newborn Care guidance 1.Cleanliness 2.Thermal protection 3.Early and exclusive breastfeeding 4.Initiation of breathing, resuscitation 5.Eye care 6.Immunization 7.Management of newborn illness 8.Care of the preterm and/or low birth weight newborn

6 Postnatal Home Visits Meeting | February |6 | Newborn Resuscitation in WHO Documents 2003, 2006, ,

7 Postnatal Home Visits Meeting | February |7 | Newborn Resuscitation in WHO Training Module 1 – Care of the newborn baby at the time of birth Module 2 – Examination of the newborn baby Module 3 – Care of the newborn baby until discharge –S8 Resuscitation of the newborn baby Module 4 – Special situations: –Breastfeeding difficulties / alternative feeding –The small baby Module 5 – Optional sessions –Injection safety –Kangarooh Mother Care –Prevention of Mother-to-Child Transmission

8 Postnatal Home Visits Meeting | February |8 | Guidelines Development Process 2009 January: initial meeting – 15 priority questions 2010 January: ILCOR conference – 6 priority questions 2011 February: ILCOR Resuscitation Guidelines published 2009 – 2011: Systematic reviews of the evidence and summaries 2011 June: Technical Consultation addressing 13 priority questions 2011 December: Conditional Approval by Guidelines Review Committee 2012 June: Finalization

9 Postnatal Home Visits Meeting | February |9 | Examples of PICO questions In normal or depressed newly-born babies (P), does late cord clamping (I) compared with standard management (C) improve outcome (O)? In neonates not breathing spontaneously after birth (P), does additional stimulation (I) compared with thorough drying (C) reduce the need for positive pressure ventilation (O)?

10 Postnatal Home Visits Meeting | February | Grading the quality of evidence Level of evidenceRationale HighFurther research is very unlikely to change confidence in the estimate of effect ModerateFurther research is likely to have an important impact on confidence in the effect LowFurther research is very likely to have an important impact on estimate of effect and is likely to change the estimate Very lowAny estimate of effect is very uncertain Criteria: Study design, Limitations in methods, Consistency, Precision, Directness

11 Postnatal Home Visits Meeting | February | Assessment criteria for the strength of recommendations Strength of recommendationRationale StrongThe GDG is confident that the desirable effects of adherence to the recommendation outweigh the undesirable effects WeakThe GDG concludes that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects. However, the recommendations is only applicable to a specific group, population or setting OR where new evidence may result in changing the balance of risk or benefit OR where the benefits may not warrant the cost or resource requirements in all settings No recommendationFurther research is required before any recommendation can be made

12 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. IMMEDIATE CARE AFTER BIRTH High to moderate Guidelines Development Group (GDG) consensus in absence of published evidence Strong Weak In a 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. 1. GDG consensus in absence of published evidence WeakNewly-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 2. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendations 1-2

13 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. IMMEDIATE CARE AFTER BIRTH High GDG consensus in absence of published evidence Strong Weak 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. 3. LowStrongIn the presence of meconium-stained amniotic fluid, intrapartum suction of mouth and nose at the delivery of the head is not recommended. 4. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendations 3-4

14 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. IMMEDIATE CARE AFTER BIRTH Moderate to low GDG consensus in absence of published evidence Very low GDG consensus in absence of published evidence Strong Weak Weak (if … ) Weak 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, suction of 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. 5. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendation 5

15 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. IMMEDIATE CARE AFTER BIRTH Very lowWeakIn settings where a mechanical equipment to generate negative pressure for suction is not available and a newly born baby requires suction, 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. 6. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendations 6

16 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. POSITIVE-PRESSURE VENTILATION Very lowStrongIn 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. 7. ModerateStrongIn newly-born term or preterm (>32 weeks gestation) babies requiring positive-pressure ventilation, ventilation should be initiated with air.. 8. Very lowWeakIn newly-born babies requiring positive-pressure ventilation, ventilation should be provided using a self- inflating bag and mask. 9. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendations 7-9

17 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. POSITIVE-PRESSURE VENTILATION Based on limited availability and lack of experience with nasal cannulae, despite low quality evidence for benefits StrongIn newly-born babies requiring positive-pressure ventilation, ventilation should be initiated using a face mask interface. 10. Very lowStrongIn newly-born babies requiring positive-pressure ventilation, adequacy of ventilation should be assessed by measurement of heart rate after 60 seconds of ventilation with visible chest movements Very lowStrongIn newly-born babies who do not start breathing within one minute after birth, priority should be given to providing adequate ventilation than to chest compressions. 12. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendations 10-12

18 Postnatal Home Visits Meeting | February | Quality of evidenceStrength of recommendation Recommendation * No. STOPPING RESUSCITATION Low Very low Strong Weak (in resource- limited settings) In newly-born babaies with no detectable heart rate after 10 minutes of effective ventilation, resuscitation should be stopped. In newly-born babies who continue to have a heart rate below 60/min and no spontaneous breathing after 20 minutes of resuscitation, resuscitation should be stopped. 13. [1] [1] "Not earlier than one minute" should be understood as lower limit supported by published evidence. WHO recommendations for the Prevention of Postpartum Haemorrhage (2007) recommend that the cord should not be clamped earlier than is necessary for applying cord traction, which the guidelines development group clarified would normally take around 3 minutes. Recommendation 13

19 Postnatal Home Visits Meeting | February | What is different? Emphasis on not clamping the cord too early Reduced indications for suctioning: –No routine suctioning even before ventilation –Only for babies born through meconium-stained amniotic fluid who do not start breathing on their own Preference of bulb syringe in the absence of mechanical equipment Recommendation to start PPV within one minute Preference of self-inflating bag Measurement of heart rate after 60 seconds Recommendation to stop resuscitation after 10 min., if no detectable heart rate

20 Postnatal Home Visits Meeting | February | Products  A guidelines document providing the background, summarizing the process, the evidence and recommendations including references To be developed:  A flow chart on basic newborn resuscitation  A standards document on initiation of breathing and resuscitation  Updated guidance in existing IMPAC, IMCI and child health documents and training materials  Updated ENC training materials !

21 Postnatal Home Visits Meeting | February | WHO Newborn guidelines Care of the newborn immediately after birth Newborn resuscitation Newborn immunization Postnatal care Care of the preterm and low birth weight baby Management of neonatal sepsis Management of neonatal seizures Management of neonatal jaundice Management of necrotizing enterocolitis Care of the HIV-exposed newborn

22 Postnatal Home Visits Meeting | February | Thank you


Download ppt "Postnatal Home Visits Meeting | 8 - 10 February 2012 1 |1 | WHO Guidelines on Basic Newborn Resuscitation Bernadette Daelmans, Coordinator Policy, Planning."

Similar presentations


Ads by Google