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WHO Guidelines on Basic Newborn Resuscitation

WHO Guidelines on Basic Newborn Resuscitation. Bernadette Daelmans, Coordinator Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health (MCA). Guidelines development: principles.

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WHO Guidelines on Basic Newborn Resuscitation

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  1. WHO Guidelines on Basic Newborn Resuscitation Bernadette Daelmans, Coordinator Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health (MCA)

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

  4. 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

  5. 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)?

  6. Grading the quality of evidence Criteria: Study design, Limitations in methods, Consistency, Precision, Directness

  7. Assessment criteria for the strength of recommendations

  8. Recommendations 1-2 [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.

  9. Recommendations 3-4 [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.

  10. Recommendation 5 [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.

  11. Recommendations 6 [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.

  12. Recommendations 7-9 [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.

  13. Recommendations 10-12 [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.

  14. Recommendation 13 [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.

  15. 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

  16. 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 !

  17. WHO Newborn guidelines 2009 -2012 • 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

  18. Thank you

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