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. 2023 Sep 12;10(9):1540.
doi: 10.3390/children10091540.

Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania

Carolyn Purington  1 , Joar Eilevstjønn  2 , Ingvild Dalen  3 , Anita Yeconia  4 , Ladislaus Blacy  4 , Estomih Mduma  4 , Ingunn Haug  2 , Kari Holte  5 , Catherine Chang  6 , Jeffrey Perlman  6 , Hege Ersdal  7   8
Affiliations

Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania

Carolyn Purington et al. Children (Basel). .

Abstract

Suctioning of newborns immediately after birth, as part of delivery room resuscitation, is only recommended if the airway is obstructed. The aim of this study was to describe the use of suctioning during newborn resuscitation among survivors versus those who died within 3 days and potential suction-related heart rate responses and associations to newborn characteristics. This was a retrospective observational study from July 2013 to July 2016 in a referral hospital in rural Tanzania. Research assistants observed and documented all deliveries, newborn resuscitations were video-recorded, and newborn heart rates were captured with a dry-electrode electrocardiogram. Liveborn infants ≥34 weeks gestation who received ventilation and with complete datasets were eligible. All 30 newborns who died were included, and a total of 46 survivors were selected as controls. Videos were annotated and heart rate patterns were observed before and after the suction events. Suctioning was performed more frequently than recommended. No differences were found in suctioning characteristics between newborns who died versus those who survived. In 13% of suction events, a significant heart rate change (i.e., arrhythmia or brief/sustained >15% fall in heart rate) was observed in relation to suctioning. This represents a potential additional harm to already depressed newborns undergoing resuscitation.

Keywords: birth asphyxia; neonatal resuscitation; newborn mortality; oro/nasopharyngeal suction.

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Conflict of interest statement

Ingunn Haug and Joar Eilevstjønn are employees of Laerdal Medical and Carolyn Purington was formerly an employee of Laerdal Global Health. The specific roles of these authors are articulated in the ‘author contributions’ section. All other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Cohort diagram.
Figure 2
Figure 2
Box plots of all SEs, not suction-related HR changes, and suction-related HR changes in the 135 suction events. Outliers are marked in red.
Figure 3
Figure 3
Illustrations of different types of changes in heart rate related to a suction event (annotated between the red horizontal lines in the upper panel): (a) arrhythmia (bigeminy); (b,c) brief or sustained fall in HR > 15%; and (d) no change in HR during suctioning. Red vertical lines indicate the start and stop of the suction event.
Figure 4
Figure 4
Predicted probabilities (with a 95% confidence band indicated by grey shaded area) of suction-related HR changes as a function of HR prior to starting suction.
See this image and copyright information in PMC

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