నైరూప్య

Initial steps of delivery room resuscitation in depressed neonates-suctioning first or drying first!

Vijayakumar Biradar, Siddu Charki*, MM Patil, P Siri Chandna, P Mounica, SS Kalyanshettar, SV Patil

Background: Establishing adequate respiration at birth is necessary to start and maintain in extra uterine life; a phenomenon that proceeds smoothly in 90% of neonates but 10% of newborns fail to initiate effectual breathing. Most of these neonates start breathing after initial stimulation, about 3%-5% need basic resuscitation, but <1% requires advanced resuscitation. Objectives: To compare the effect of suctioning first or drying first on bradycardia outcomes during resuscitation and the need and duration of positive pressure ventilation, hypothermia at NICU admission or onset of respiratory distress at 6 hours of age, duration of NICU stay, and death. Methods: This study was conducted in the MCH unit of Shri BM Patil medical college hospital and research centre, Vijayapura. Design: Open-label, parallel grouped, randomized controlled trial. 200 depressed newborns requiring initial resuscitation steps at delivery were enrolled to receive either suctioning first or drying first during delivery room resuscitation. Results: Bradycardia during resuscitation and the need and duration of positive pressure ventilation was high in the suction first group (P-value=0.046). Incidence of hypothermia at NICU admission, onset of respiratory distress at 6 hours of age was also high in the suction first group. Duration of NICU stay was high in the suction first group (<0.001). Conclusion: At birth, in depressed newborns, the sequence of advocating initial resuscitation steps, drying first had a favorable effect compared to suctioning first on bradycardia outcomes during resuscitation and the need and duration of positive pressure ventilation and NICU stay.