AHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of major changes and their application in Resource-Limited Settings
Arun Sasi1, Deepak Chawla2, Ashok.K. Deorari1
From the Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, NewDelhi1 and Department of Pediatrics, Government Medical College, Chandigarh2
The American Heart Association (AHA) and American Academy of Pediatrics (AAP) have recently published the neonatal resuscitation guidelines 2010 , as a part of the international consensus on cardiopulmonary resuscitation and emergency cardiovascular care. These neonatal resuscitation guidelines undoubtedly incorporate complete and most recent evidence on various aspects of resuscitation. The current guidelines have proposed paradigm changes with respect to the existing practices based on AHA/AAP 2005 recommendations like - use of room air for resuscitation, monitoring of oxygenation with pulse oximetry even in term babies, underplaying the role of assessment of color, endorsing delayed cord clamping and therapeutic hypothermia etc, which are enumerated below (Table 1).
Unfortunately the AHA and APA in their quest for evidence-based medicine have partly ignored the feasibility and scalability of these guidelines in resource-limited settings, which bear the maximum burden of intrapartum related neonatal deaths. The current guidelines, in its present form are tailor-made for guiding resuscitation in tertiary care centers, with limited practical applicability in resource(financial and manpower)-crunched low- and middle-income countries, primarily due to recommending use of costly equipments like pulse oximetry, blenders for graded increase in supplemental oxygen etc, thereby making the whole process complex and less user friendly. However there are positive welcome changes like use of room air for initiation of resuscitation and less vigorous push for tracheal suctioning in non- vigorous neonates born through meconium-stained amniotic fluid.
There is an urgent need for policy makers and stakeholders in resource-limited settings to generate simpler, less technology-driven recommendations for newborn resuscitation, keeping in mind the larger interests and needs of their countries. These recommendations should provide a middle path between the current AHA/AAP resuscitation guidelines and the Helping Babies Breathe resuscitationalgorithm5 for peripheral health workers.
(1) Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP et al. on behalf of the Neonatal Resuscitation Chapter Collaborators. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2010; 122(suppl 2):S516 –S538.
(2) Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation.2010; 122(suppl 3):S909-S919.
(3) The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: Neonatal Resuscitation. The International Liaison Committee on Resuscitation. Pediatrics 2006; 117; e978-e988.
(4) Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK et al. Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done. Int J GynecolObstet 2009; 107:S5-S19.
(5) Helping Babies Breathe: The Golden Minute. URL: www.helpingbabiesbreathe.org. Accessed October, 24, 2010.