Nearly one quarter of newborn deaths result from babies failing to draw their first breath after birth. Yet, researchers estimate that newborn resuscitation could save 30 percent of the 814,000 babies lost to this condition each year. The process requires equipment and training that many low-resource birthing settings lack, however, greatly limiting the number of babies around the world with access to this life-saving--or life-giving--practice.
Neonatal resuscitation has been labeled one of fifteen focal points by the UN Commission on Life-Saving Commodities (we’ve written about the work of the Commission before). Last spring, Every Woman Every Child released a case study on the plight of neonates requiring resuscitation, which enumerates in detail the barriers of the problems and some possible solutions (find the full report here).
The problem with babies failing to breathe at birth, as is so often the case with maternal and newborn ailments in low-resource settings, is not a question of technology but of access. It is difficult to convince some nations to prioritize newborn resuscitation equipment, making the complications that already exist in delivering the devices and training seem insurmountable. Nevertheless, key studies in India and Indonesia have made the point that training village health workers in community based resuscitation does reduce asphyxia. The barriers to access include: high manufacturing and shipping costs from the faraway continents where the devices are currently produced, a lack of regional distributors in the low-resource regions in which the products are required, maintaining high quality in the life-saving tools, and keeping up with the enormous demand for the devices.
The relatively sophisticated battery of resuscitation devices require specific manufacturing facilities, meaning the products are usually shipped internationally and rarely succeed in supplying beyond tertiary and district hospitals. This leaves lower-level hospitals and rural childbirth centers who need them most, without means of saving newborns who fail to breathe at birth. The standard of care is a self-inflating bag and mask device.
While some groups hold that the OPTIMAL equipment for neonatal resuscitation requires a (relatively) expensive kit and training--a neonatal bag-valve mask, suction devices, a resuscitation training mannequin, and tactile stimulation training--many midwives in the field stress that a large number of lives can be saved with a simple alternative. The nasal aspirator bulb (if you've had infants it's the balloon-like rubber ball with a snout) provides a simple and cheap way to suction mucous from a baby who is not breathing. Many midwives prefer the aspirator bulb to more sophisticated mucous traps and other devices.
Suction bulbs are cheaper and simpler than mucous traps and other devices. They require less training and are much more likely to make it to the edges of that network to assist newborns. Bulbs certainly have limits--they do not provide the positive pressure ventilation required to revive many neonates who fail to draw breath, for example. They do not take the place of the bag-and-mask. The nasal aspirator bulb also has the drawback of spreading infection if the inside of the bulb is not properly cleaned.
This does indeed bring up the thorny questions of OPTIMAL versus ADEQUATE? IDEAL versus PREFERRED by end users? What are your thoughts?
By: Lizi Jones