Consensus on Science with Treatment Recommendations (CoSTR)
Being worked in Canada and in resource limited settings abroad, I believe using T-piece for ventilation is much easier vs. Self inflating bag, especially for all those working in resource limited area. It does not need lots of skills, additionally better pressure can be maintained with less leaks. There is less probability of inadvertent pressure delivery and less chances of pneumothorax.
In my experience in the delivery room, especially with neonatology and pediatric residents, having a previous conversation with the multiprofessional team about the care to be provided, considering the possible needs of the child, defining roles for each member of the team, qualifies the care. Debriefing is essential to identify possible inadequacies in care, discuss the reasons that led to the inadequacy so that they do not recur, in addition to sedimenting the sequence of resuscitation procedures.
The use of a manual T-ventilator in the care of premature newborns in the delivery room has greatly reduced the indication for intubation during resuscitation procedures in the services where I work. The big difference seems to be the possibility of offering CPAP. Establishing and maintaining functional residual capacity soon after initial care and during transport makes a difference. The main problems we face is the quality of the equipment available. Very fragile, the pieces are lost in the sector of sterilization of the components and the great difficulty of acquiring compressed air for the gas mixture to be used during transport. The self-inflating bag is cheaper and easily available in our services.
Dear Sir/Madam,I have tremendous respect for the committee members for their diligent work but the following improvements could be done to make the babies better quickly without any delay to avoid brain damages from hypoxia and hypoglycemia. The whole life is ahead of them:
1) Suctioning of amniotic fluid causes more hypoxia because it delays the oxygen delivery and delays babies own breathing. It is simply not helping the newborn babies to breathe. It is simply harmful than helpful.
2) 90% of newborn babies are pink without any intervention and achieve Apgar 9 within 1 minute. Therefore remaining 10% who needs help from us, we should help them aggressively to achieve normal oxygen saturation (FT 95-100%; PT 90-94%) within 1 minute; keeping the newborn babies blue up to 10 minutes of life is simply defying the gravity of physiologic needs because babies brain needs 3-4 mL of oxygen/ 100 gm of brain tissues/ minute. During hypoxia babies are not getting any glucose that should be checked in the delivery room, Babies brain needs 3-4 mg of glucose/ 100 gm of brain tissues/ minute. Both hypoxia and hypoglycemia causes brain damages and delays speech, languages and other developmental delays.
3) Babies heart rate should be normal within 15-30 seconds. Adequate oxygen delivery and positive pressure ventilation should be started within 15 seconds without any delay in sick babies. That is the only way we can make babies better quickly and we can avoid medications. As soon as the oxygen reaches the heart, heart rate picks up rapidly and babies improve quickly.
Thanks and Highest Regards