Abstract
BackgroundStimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. To evaluate the occurrence, patterns and response to tactile stimulation at birth in a low-resource setting.MethodsWe reviewed 150 video recordings of neonatal resuscitation at Beira Central Hospital (Beira, Mozambique). Timing, method, duration and response to tactile stimulation were evaluated.ResultsOne hundred two out of 150 neonates (68.0%) received stimulation, while the remaining 48 (32.0%) received positive pressure ventilation and/or chest compressions directly. Overall, 546 stimulation episodes (median 4 episodes per subject, IQR 2–7) were performed. Median time to the first stimulation episode was 134 s (IQR 53–251); 29 neonates (28.4%) received stimulation within the first minute after birth. Multiple techniques of stimulation were administered in 66 neonates (64.7%), while recommended techniques (rubbing the back or flicking the soles of the feet) only in 9 (8.8%). Median duration of stimulation was 17 s (IQR 9–33). Only 9 neonates (8.8%) responded to stimulation.ConclusionsIn a low-resource setting, stimulation of newly born infants at birth is underperformed. Adherence to international guidelines is low, resulting in delayed initiation, inadequate technique, prolonged duration and low response to stimulation. Back rubs may provide some benefits, but large prospective studies comparing different methods of stimulation are required.
Highlights
Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step
In high-resource settings, approximately 85% of babies born at term initiate spontaneous respirations within 10 to 30 s after birth, 5– 10% respond to simple stimulation, 3–6% start breathing after basic resuscitation and less than 1% require advanced resuscitation [2]
Median time elapsed from birth to the first stimulation was 134 s (IQR 53– 251); 29 neonates (28.4%) received stimulation within the first minute after birth
Summary
Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. In high-resource settings, approximately 85% of babies born at term initiate spontaneous respirations within 10 to 30 s after birth, 5– 10% respond to simple stimulation, 3–6% start breathing after basic resuscitation (positive-pressure ventilation, PPV) and less than 1% require advanced resuscitation (intubation, chest compressions and drugs) [2]. The need for neonatal resuscitation is most urgent in low-resource settings, where access to intrapartum obstetric care is poor and long-term impairments from intrapartum-related events represent a heavy burden [4]. While babies requiring advanced resuscitation may not survive without ongoing ventilation and neonatal intensive care, neonatal mortality from intrapartum-related events in low- and middle-resource settings can be reduced by 30% with basic training in neonatal resuscitation [5]. Expert consensus estimates a 10% reduction in intrapartum-related deaths with immediate newborn assessment and stimulation alone [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
