Buyers Guide

Newborn Resuscitation Devices

Why Newborn Resuscitation Devices are Important

Globally, about one quarter of all neonatal deaths are caused by birth asphyxia, which is defined as the failure to initiate and sustain breathing at birth Often called “The Golden Minute” (2) the period after a baby is born is a critical window to assess their breathing status and take appropriate actions in case of a problem. (1) If a newborn has not started breathing on its own after initial steps of resuscitation (thorough drying and stimulation), the WHO Guidelines on basic newborn resuscitation recommend positive-pressure ventilation to be initiated within 1 minute after birth. (2)

A large proportion of neonatal deaths can be prevented with the appropriate care and available commodities and products. Effective neonatal resuscitation includes immediate care with thorough drying, suction, stimulation, and positive-pressure ventilation in cases when the newborn is not breathing on their own. (2) Neonatal resuscitators are an essential medical device to save newborns from asphyxia at birth and one of 13 products included in the United Nations Commission on Life-Saving Commodities, given their role to end preventable deaths in newborns.

Types of newborn resuscitation devices- Suction and Positive Pressure Ventilation

One cause of asphyxia is when the infant still has fluid in the nasal or oral airway preventing them from breathing. Suction devices are designed to clear excessive mucus from the airway (nasal or oral) passages of a newborn or an infant to facilitate easier breathing. These devices should be portable, hand-held, and easy to use. They may be manual, like a bulb suction, or (hand- or foot-operated) or electrical with rechargeable batteries or “manual”

Manual Suction Bulbs are small, portable hand-held devices designed to suck gently and clear excessive mucus from the nose or mouth of a newborn to facilitate easier breathing, and are either single use (disposable) or multi-use).

Hand or foot-operated suction machines. In these devices, the vacuum effect is generated by human power, either by foot or by hand, but have the other components in common with electrical devices.

Electric suction machines consist of the power source (rechargeable battery and electric circuit), the vacuum source (pump) and the collection bottle (which may be a collection jar or disposable bag, with capacity of 1 L and be transparent), suction tubing, and vacuum gauge and regulator

Images from: WHO Guidelines on Neonatal Resuscitation Devices

Devices for Positive Pressure Ventilation

Although newborns will make efforts to breathe independently, if the newborn does not breathe despite stimulation, positive pressure ventilation (PPV) is required at a rate of 40-60 inflations per minute. This can be done with various devices: a self-inflating bag (SIB), a flow-inflating bag (FIB), or T-piece resuscitators.

Source: WHO Guidelines on Neonatal Resuscitation Devices

Key Considerations when Selecting Newborn Resuscitation Devices

  • Suction safety. Safe ranges for neonatal suctioning depending on the size of the infant and are generally considered to be between 60-100mmHg.
  • Bag with Mask Devices. Should have a bag size of 300-320L and masks of different sizes (0 for pre-term and low birth weight, and 1 for term infants) and a valve to maintain pressure or prevent exceeding a maximum pressure in range of 3kPa (30cmH20) -4.5 kPa (45 cmH20)
  • Oxygen Source. Some T-piece devices may have an integrated blender, but if there are no oxygen sources available, the self-inflating bag may be most appropriate for settings that have very limited resources.
  • Achieving Peak Inflation Pressure (PIP) and Positive End-Expiratory Pressure (PEEP) at 30/5 cm H20 with reducing percentage leak at the face mask with consistency and accuracy can be achieved with all 3 types, but may require different levels of training and practice. (4)
  • Reprocessing and cleaning of reusable devices. When using reusable devices, it is important to adhere to infection prevention control (IPC) and manufacturing guidelines for pre-cleaning, disassembly, cleaning, sterilization, reassembly and storage to ensure clinical safety and duration of the device.

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References and Acknowledgments

(1) World Health Organization. Guidelines on Newborn Resuscitation, 2012. Found here 

(2) World Health Organization. Technical Specifications of Neonatal Resuscitation Devices, 2016. Found  here.

(3) Helping Babies Breathe 2nd Edition, American Academy of Pediatrics, 2016. found here

(4) Dawson J., Gerber et al. Providing PEEP during neonatal resuscitation: Which device is best? Journal of Pediatrics and Child Health. Volume 47, Issue 10. October 2011.