INTRODUCTION

A survey of 127 institutions in 16 developed and developing countries has shown that there was often no basic resuscitation equipment, or that it was in poor condition, and that health personnel were not properly trained in newborn resuscitation.¹ A study in eight African countries showed that, even in central hospitals, resuscitation measures were inappropriate for a significant proportion of newborns with asphyxia.²

According to WHO estimates, around 3% of approximately 120 million infants born every year in developing countries develop birth asphyxia requiring resuscitation. It is estimated that some 900,000 of these newborns die each year. ^3,4

The incidence of birth asphyxia is higher in developing countries than in developed ^5,6 because of a higher prevalence of risk factors, namely: women are in poor health when they become pregnant; the incidence of pregnancy and delivery complications in these women is high; care during labour and delivery is often inadequate or nonexistent; and about 10% of infants are estimated to be born preterm. Thus, resuscitation of newborns is more often needed in developing countries than in developed. However, most newborns do not at present receive adequate care because most birth attendants do not have the necessary knowledge, skills and equipment to help them. Some traditional practices are not only ineffective in reviving depressed newborns but are also harmful to them.

The common worry of health professionals and parents is the permanent brain damage that birth asphyxia can cause and the common aim is to reduce the number of newborns affected. Improving women's health and health care will reduce the risk factors and decrease the number of newborns needing resuscitation. However, as there is no single cause of poor maternal health there is no single intervention that will improve it. Reducing the incidence of birth asphyxia will therefore take time.

Nevertheless, there is one single intervention for dealing with asphyxia when it occurs - resuscitation. The need for resuscitation can sometimes be predicted though very often it cannot. Therefore every birth attendant must be both skilled and equipped to resuscitate newborns who do not start breathing spontaneously. The approach should be feasible even where resources are limited.

Because of the lack of reliable evidence there are still many unanswered questions concerning newborn resuscitation. More research is needed to find the best possible method of resuscitation. However, we already know enough to help most infants who have trouble starting to breathe.

This document does not deal in detail with the physiology and pathophysiology of breathing at birth. It focuses mainly on one method of resuscitation, gives evidence for the effectiveness of this method, raises ethical concerns about it, and describes special situations when the method might need to be modified. The recommendations in this document are based on scientific evidence, where available, and on experience from both developing and developed countries. ^7,8,9,10,11 The information provided is intended to facilitate the preparation of national and local standards and guidelines.