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Improving cardiopulmonary resuscitation of newborn babies in the delivery room

Associate Professor Graeme Polglase, Institution: Monash University

2019 Vanguard Grant

Years funded: 2020-2021


In its severest form perinatal asphyxia causes severe oxygen deficiency (hypoxia) to the fetus/newborn before or during birth, has multiple causes and is common in under-developed countries. Severe perinatal asphyxia causes an estimated 1 million deaths worldwide annually, with most deaths occurring within the first hours of life. These newborns require significant intervention in the form of cardiopulmonary resuscitation (CPR; artificial breathing, chest compressions and adrenaline administration). While a significant proportion will not survive CPR, survivors often have devastating outcomes, including have a high risk of cardiovascular disease and brain injury, particularly brain bleeding. 

The current clinical guidelines recommend immediately removing the neonate from the umbilical cord by clamping and cutting it, and transferring the neonate to a nearby bed where CPR can be initiated. However, there is now mounting evidence that supporting these infants in a way that reduces cerebrovascular injury, both before and after CPR, achieves the best neuro-developmental outcomes. In this application we propose that the risks of brain injury in these infants can be greatly reduced by not immediately clamping the umbilical cord and rushing the infant away, but rather commencing CPR while the infant is still attached to the cord.

This will result in a more rapid restoration of heart output and function, improve blood vessel integrity, particularly within the brain, thus protecting the brain from bleeding. If correct, this is a very simple change to clinical practise that COSTS NOTHING and has the potential to improve outcomes for newborn infants both in our society and in under-developed countries where more severe forms of birth asphyxia are common.

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