Need for timely resuscitation in a preterm infant

I would like you to note that, In India every year upto 15% of newborns are born preterm. Preterm population contributes to almost 35% of all neonatal deaths. This is a huge burden indeed. One of the important causes of preterm morbidity and mortality is asphyxia. Skilled timely interventions in the delivery room can help improve short term and long term outcomes.
It is well known that prematurity is a risk factor for resuscitation at birth, Compared to term newborns, preterm newborns have a higher chance of requiring resuscitation in the delivery room, The need for equipment and skills for preterm resuscitation differs from term newborns, Hence we need to have skills to manage preterm asphyxia appropriately
There are multiple problems a preterm may develop in the delivery room in addition to asphyxia. These include or hypothermia, respiratory distress, hypovolemia and hypoglycemia which may further complicate asphyxia. One needs to anticipate and take appropriate steps to care for these multiple problems in preterms at birth.
Let us understand why a preterm is at risk for multiple problems at birth. Preterms are at high risk to develop asphyxia because of poor respiratory drive, poor muscle tone, and immature brain functioning. Hypothermia is more likely in preterm newborns because of lesser body fat, large body surface area and limited thermal responses, Breathing difficulty may be due to immature lungs, weak muscles or immature respiratory drive, Smaller blood volume loss may increase the risk of hypovolemia predisposing to shock in preterm newborns, To anticipate is to be prepared and act appropriately
To manage a preterm at birth is a challange. We need to be prompt and act in timely fashionin a stepwise manner to assess support and maintain, temperature, airway, breathing and circulation. Appropriate actions help improve short and long term outcomes
Having understood the All newborns need assessment for need for resuscitation at birth. Provision of warmth is a must for all newborns. Majority of newborns would respond to initial steps and or bag and mask resuscitation. Very rarely one may need advanced resuscitation steps like chest compression and or intubation
Timely, skilled resuscitation by simple easy to practice steps can help improve short term and long term outcomes
  • Introduction...
  • 1. Learning object...
  • 2. Overview...
  • 3. FACT...
  • 4. Concerns of pre...
  • 5. Why preterm are...
  • 6. What can be don...
  • 7. Need for assess...
  • 8. Conclusion...
 

Introduction

DR. RHISHIKESH THAKRE
MD, DM (Neonatology)

Consultant
Neo Clinic & Hospital
Aurangabad

1. Learning objective

â–º To understand the need of timely resuscitation of a preterm
    newborn

2. Overview

â–º India has upto 15% preterm births

â–º Upto 35% of neonatal deaths are due to prematurity

â–º Preterm babies are at high risk for asphyxia

â–º Timely interventions improve outcomes

3. FACT

â–º Prematurity is a risk factor for resuscitation

â–º Preterm babies have higher chances of requiring resuscitation
    compared to term

â–º Equipments & expertise needed for preterm resuscitation/
    stabilization differs from term babies

4. Concerns of preterm in delivery room

â–º Asphyxia

â–º Hypothermia

â–º Breathing difficulty

â–º Hypoglycemia

â–º Hypovolemia

5. Why preterm are at “high risk”?

6. What can be done?

â–º The first minutes of life are decisive

â–º Follow a systematic stepwise approach

â–º Place emphasis on
      ♦ Temperature, Airway, Breathing, Circulation

â–º Actions during these minutes will have an influence later
    on outcome

7. Need for assessment

8. Conclusion

â–º Simple, effective, easy to practice steps can help and save
    preterm lives

â–º These steps can help improve short term and long term
    outcome