Ten Commandants

Warm Chain

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 Clamping of Cord

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Follow a relaxed approach

Keep the baby at the level of mother
Early clamping Rh iso, Asphyxia
 Oro-pharyngeal Suction
No need in a term crying baby
Early and effective suction in a depressed
baby (before drying the skin)

Suction pressure / tubing / catheter

Vigorous suction is harmful

 Suction in MSAF

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 Hazards of Resuscitation with
100% Oxygen
Delayed recovery with a need for prolonged
resuscitation
Increased oxidative stress at 4 weeks

Increased chances of myocardial and kidney

injury
Increased CBF with risk of IVH
Increased neonatal mortality
Saugstad OD et al. Pediatrics 2006, 118, 789-792
 Resuscitation with Room Air
Room air is as effective as 100 % oxygen for
effective resuscitation and is safer

Start resuscitation with room air and provide

extra oxygen (not 100%) after 90 sec if needed
In rural setting or when oxygen is not
available,effective resuscitation is possible with
room air
Exceptions - preterm
 Selective non-treatment at Birth

Cut off for aggressive care

< 1000g (< 28 weeks) or < 750g (< 26 weeks)
or < 500g (< 24weeks)

How long to resuscitate?

If there are no signs of any life by 10 minutes or if
spontaneous breathing efforts are not established
by 30 minutes
 Vitamin K Prophylaxis
AAP recommends 0.5-1.0 mg vitamin K IM
to all neonates

Risk of HDN is higher in breast fed babies

Vitamin K is safe and also protects against

late-onset HDN
 Eye Prophylaxis
Sterile cleaning of eyes
Avoid a routine policy of prophylaxis

Silver nitrate 1.0% associated with

chemical conjunctivitis

- Erythromycin* 0.5% / Tetracycline* 1.0%

 Controversial Therapies
Prophylactic antibiotics

Corticosteroids

Sodium bicarbonate

Oxygen therapy
 Prophylactic Antibiotics
PROM / Chorioamnionitis / Maternal fever

< 35 w / < 2 kg > 35 w / > 2 kg

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 Utility of Corticosteroids

Congenital adrenal hyperplasia

Prevention of post-weaning laryngeal edema
Attenuation of inflammatory changes in BPD
Treatment of sclerema neonatorum?
Shock unresponsive to volume expansion and
inotropes
Severe thrombocytopenia due to maternal ITP

No role in HIE and sepsis

 Sodium Bicarbonate Therapy

No role in the labor room

Establish effective ventilation!

Definite indications:
- Metabolic acidosis following severe birth asphyxia
- Metabolic acidosis uncorrected by volume expansion

* Avoid bolus administration due to risk of IVH

 Oxygen Therapy
Do not administer as a matter of routine
Difficult to judge the need for oxygen therapy
on clinical grounds alone

Use oxygen when indicated (SaO2 <85%)

and stop as soon as indication resolves
Use the lowest FiO2 to maintain satisfactory
SaO2 (85%-95%) and paO2 (60-80 mmHg)

*Monitor for ROP

 Traditional Practices
Oil massage
Kangaroo mother care
 Oil Massage
Benefits Risks
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 Kangaroo Mother Care
Cultural acceptability

Difficulties and disconnection during sleep,

bathing, toilet needs of mother etc.

Discomfort during hot summer months

Transmission of electro-magnetic energy

from mother to her baby!
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 What to Avoid in the
Care of Preterm Babies?
Routine oxygen administration
Prophylactic IVIG
Prophylactic antibiotics

Prophylactic phototheray
Prophylactic indomethacin
Formula feeds and pacifier
Rough handling, excessive light, loud
sound, pungent odors etc.
 Nature has a Profound Biological Wisdom

Who cuts the cord in mammals ?

Dont be in a hurry to cut the life line

Who cleans the oral cavity of young ones of mammals ?

No need to do it in a crying infant

Why most babies are jaundiced? Antioxidant virtues.

Dont stop BF when you suspect breast milk jaundice.
Nature does nothing without any purpose
Aristotle
Nature has a Profound Biological Wisdom
Breast milk of a healthy mother is a complete
nutritional drink for her healthy baby.
No need for any nutritional supplements

Animals protect and keep their young ones warm

by close skin-to- skin contact
We should also do it !

- Create the ambience of NICU as close to the

womb as possible.
- Be like a God!
 Rational Neonatal Practices
Evidence-based neonatology (Cochrane data base)
should be integrated with individual experience,
expertise and common sense

Use a procedure and drugs only when they are

absolutely indicated

Provide comfort, cuddling and gentle care

Rational Neonatal Practices

Technology should not be allowed to

dehumanize neonatology

Dont be aggressive or passive, follow the middle

path

No body knows the ultimate truth! Be humble

Treat the babies not only with your brain but also
with your heart
 No body knows the ultimate or absolute
truth! Science only provides a tentative or
partial truth or truth for the time being.
Researchers are likely to find new facts and
new data in due course of time. Therefore,
we should not be dogmatic and we must
work with humility and common sense

Our knowledge is like a pond compared to

our ignorance which is Atlantic