Birth asphyxia is the failure to initiate and sustain breathing at birth. About one in twenty newborn babies fail to breath spontaneously and require resuscitation. Nearly one million of these infants die and others have damage from the lack of oxygen in the critical minutes after birth.
Mechanism of Action
All resuscitation is based on the mechanical ventilation of the lungs with the aim of initiating spontaneous breathing. There are several types of equipment to help this process. Tube and mask devices use the operator’s breath to ventilate the infant. Self-inflating bag and mask devices use a self-inflating elastic bulb which is compressed to ventilate the infant. Flow-inflating bag and mask uses pressurized air, but requires the operator to compress a bag to ventilate the patient. T-piece mechanical devices have a pressurized gas source which the operator typically controls by manually covering and uncovering a valve. These methods help after the mouth has been suctioned out and may be combined with chest compression in some cases.
Current Use in High-Resource Settings
Resuscitation using flow-inflating and T-piece devices are more common in high-resource settings, with the majority of American hospitals using T-piece devices bundled into resuscitation systems like the CosyCot. In the relatively rare cases when basic resuscitation fails, it is often supplemented with oxygen, tracheal intubation, and the use of intravenous epinephrine or plasma volume expanders. When initial resuscitation fails, CPAP or mechanical ventilation are used.
Application in Low-Resource Settings
Self-inflating bag and mask devices are the preferred technology in low-resource settings, and have been successfully deployed in homes and clinics. Ideal bag and mask devices are reusable, have a pressure relief valve (to prevent lung damage), have minimal dead airspace (to increase efficiency) and are designed for easy cleaning between uses. In 2006, PATH embarked on a global inventory of bag and mask devices, cataloging over 50 disposable devices from $3-$106 and over 50 reusable devices from $8-$310.
Related Technologies in Development
PATH Neonatal Resuscitator