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Background

  1. Top of page
  2. Background
  3. Maternal risk factors
  4. Fetal risk factors
  5. Intrapartum risk factors
  6. References

All those who may need to provide resuscitation of the newborn should undertake training that specifically includes the necessary individual and teamwork skills. Simulation is a methodology in resuscitation education that allows multiple participants to practice and be assessed in these skills without risk to vulnerable patients. Use of simulation as an adjunct to traditional education methodologies may enhance performance of healthcare professions in actual clinical settings [LOE II1; LOE III-22]. The most effective interventions and evaluation methodologies for training remain to be defined.3

Training requires regular reinforcement in clinical practice, and/or refresher courses, which should be undertaken at least annually [Class A, expert consensus opinion]. Briefings and debriefings during learning activities while caring for simulated patients, and during clinical activities may also be helpful in improving individual and team skills.

A person trained in neonatal resuscitation should be available for normal, low-risk births and someone trained in advanced resuscitation should attend all births considered at high risk for neonatal resuscitation [Class A, expert consensus opinion]. If it is anticipated that the infant is at high risk of requiring advanced resuscitation more than one experienced person should be present at the birth [Class A, expert consensus opinion]. Local guidelines should be developed specifying who should attend which births.

The list below contains examples of maternal, fetal, and intrapartum circumstances that place the newborn infant at risk of needing resuscitation. The list is not exhaustive, and the magnitudes of these risks vary considerably, but the list is included to encourage planning. The need for an advanced resuscitation expert at the birth will depend on the number and severity of problems.

Whenever the need for resuscitation is anticipated, there should be a consistent and coordinated approach from the obstetric and neonatal teams in applying these guidelines and in communicating with the parents to develop a management plan when possible [Class A, expert consensus opinion].

Maternal risk factors

  1. Top of page
  2. Background
  3. Maternal risk factors
  4. Fetal risk factors
  5. Intrapartum risk factors
  6. References
  • • 
    Prolonged rupture of membranes (>18 hours)
  • • 
    Bleeding in second or third trimester
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    Pregnancy-induced hypertension
  • • 
    Chronic hypertension
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    Substance abuse
  • • 
    Drug therapy (e.g. lithium, magnesium, adrenergic blocking agents, narcotics)
  • • 
    Diabetes mellitus
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    Chronic illness (e.g. anaemia, cyanotic congenital heart disease)
  • • 
    Maternal pyrexia
  • • 
    Maternal infection
  • • 
    Chorioamnionitis
  • • 
    Heavy sedation
  • • 
    Previous fetal or neonatal death
  • • 
    No antenatal care

Fetal risk factors

  1. Top of page
  2. Background
  3. Maternal risk factors
  4. Fetal risk factors
  5. Intrapartum risk factors
  6. References
  • • 
    Multiple gestation (e.g. twins, triplets, etc.)
  • • 
    Preterm gestation (especially <35 weeks)
  • • 
    Post-term gestation (>41 weeks)
  • • 
    Large for dates
  • • 
    Fetal growth restriction
  • • 
    Alloimmune haemolytic disease (e.g. anti-D, anti-Kell, especially if fetal anaemia or hydrops fetalis is present)
  • • 
    Polyhydramnios, oligohydramnios
  • • 
    Reduced fetal movement before onset of labour
  • • 
    Congenital abnormalities which may affect breathing, cardiovascular function or other aspects of perinatal transition
  • • 
    Intrauterine infection
  • • 
    Hydrops fetalis

Intrapartum risk factors

  1. Top of page
  2. Background
  3. Maternal risk factors
  4. Fetal risk factors
  5. Intrapartum risk factors
  6. References
  • • 
    Non-reassuring fetal heart rate patterns on CTG
  • • 
    Abnormal presentation
  • • 
    Prolapsed cord
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    Prolonged labour (or prolonged second stage of labour)
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    Precipitate labour
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    Antepartum haemorrhage (abruption, placenta praevia, vasa praevia)
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    Meconium in the amniotic fluid
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    Narcotic administration to mother within 4 hours of delivery
  • • 
    Forceps delivery
  • • 
    Vacuum-assisted (Ventouse) delivery
  • • 
    Maternal general anaesthesia

References

  1. Top of page
  2. Background
  3. Maternal risk factors
  4. Fetal risk factors
  5. Intrapartum risk factors
  6. References
  • 1
    Knudson MM, Khaw L, Bullard MK, et al. Trauma training in simulation: translating skills from SIM time to real time. J Trauma 2008; 64: 25563; discussion 63–4.
  • 2
    Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 2008; 133: 5661.
  • 3
    Perlman JM, Wyllie J, Kattwinkel J, et al. Special Report–Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics 2010; 126: e131944.