Abstract

Background: Birth asphyxia is a leading cause of perinatal and neonatal morbidity and mortality with intrapartum factors rather than antepartum or post-partum having a major impact, hence effective resuscitation of newborns takes on priority in saving lives. Genetic differences in Asian and Caucasian population necessitates new ethnic specific perinatal definitions

Aim: Quick and safe resuscitation of hypoxic/asphyxiated newborns transiting from fetal fluid filled lungs to well aerated neonatal lungs by sustained nasal oxygen inflation with onset of rhythmic respiration, increase heart rate, as a low heart rate indicates vagal-induced bradycardia in response to perinatal asphyxia, triggering large reduction in Pulmonary Vascular Resistance (PVR), facilitates a series of cardiovascular changes essential for survival after birth. New perinatal strategy for ethnic Asians with peak delivery at 38 weeks gestation requires implementation of ethnic Asian Due Date for well-being of Asian foetuses and newborns.

Method: The study comprised of 1,383 consecutive singleton live births during 14-month period from 1^st April 2016 to 31^st May 2017, wherein 60% (n=830/1383) deliveries were attended, exclusion criteria 12 twin pregnancies and 10 stillbirths. Resuscitation of hypoxic/asphyxiated newborns involves one to three steps. STEP 1: Assessment of score zero to +5 by pulse oximetry based on peripheral oxygen saturation. STEP 2: Classification as “Normal” and hypoxic/asphyxiated newborns Graded I-V based on SpO 2, pattern of respiration, rate/min and heart rate (bpm). STEP 3: Lalana Newborn Resuscitation (LNR) Protocol I and II by sustained nasal oxygen inflation, proven both scientifically and physiologically to initiate rhythmic respiration. The mean gestation at birth among 2705 live births was analysed using SPSS version 21.

Results: Incidence of birth asphyxia was 21.4%, all 178 hypoxic/asphyxiated newly borns Graded I-V within 20-60 seconds of birth, were successfully resuscitated by sustained nasal inflatory, oxygen flow at rate of 4-15 Litres/minute directed to baby’s nostrils through a wide bore tube for up to 1 to 3 minutes, initiating rhythmic breathing, respiratory rate 30-60/min, heart rate 120-160 beats per minute (bpm) and, SpO 2 >96% monitored continuously by Pulse Oximeter. The peak gestation Asian South Indian newborns is 38.2 weeks gestation.

Conclusion: ‘Lalana Newborn Resuscitation’ (LNR) proved effective in all 178 asphyxiated newborns, Grade I-V by continuous positive pressure ventilation with sustained nasal oxygen inflation at flow rates of 4-15 L/min, commenced rhythmic breathing within 1-3 minutes of birth, respiratory rate 30-60/min, heart rate 120-160 bpm and Zero pulse oximetry score, SpO 2 >96%. The mean gestation at birth in Asian South Indian newborns is 38.2 weeks gestation and Asian Due Date (ADD) for delivery being 36 +6 weeks gestation

Keywords

Lalana Newborn Resuscitation (LNR); Continuous Positive Pressure Ventilation (CPPV); Sustained Nasal Oxygen Inflation; Pulse Oximetry Score; Grade I to V; Perinatal strategy Asian Due Date (ADD)