Comparison of effect of suctioning first or drying first on the outcome of hypothermia and respiratory distress at 6 hours of age: a hospital based prospective cohort study

Background: Around 10% of newborns need assistance to start and maintain effective breathing at birth, and perinatal asphyxia contributes to 23% of the 4 million annual neonatal deaths worldwide. Skilled resuscitation in the delivery room can help prevent many of these fatalities and reduce neurodevelopmental disabilities in survivors. Objectives were to compare the effect of suctioning first or drying first on the composite outcome of hypothermia and respiratory distress at 6 hours of age in depressed newborn requiring delivery room resuscitation. Methods: The study was an institution-based prospective cohort study, conducted in tertiary care institute. The 380 depressed newborn requiring resuscitation were included in study and those who have major congenital malformation and preterm and meconium-stained liquor were excluded. All the enrolled newborn were randomised into 2 groups, based on block randomisation done by staff nurse. Those who were in suctioning group, were resuscitated by doing suctioning first and those who were in drying group were resuscitated by doing drying first remaining steps were done as per NRP protocol, all the newborn were admitted to NICU. Temperature, respiratory distress and blood sugar at 0, 1, 6 hour of age is recorded in predesigned proforma. Results: Both the groups were comparable in term of maternal and neonatal characteristics. Incidence of hypothermia at admission was 26.8% for group D and 23.2% for group S (p=0.407). The 7.4% participants required intubation in group D and 4.7% in group S. Respiratory distress at admission was present in 62.1% for group D and 64.7% for group S patients (p value 0.368). At 6 hours of observation, it was seen that the presence of hypothermia in group D was 6.8% in group D and 2.6% in group S (p=0.091). During the same time period respiratory distress was present in 38.4% of group D infants and 38.8% of group S infants respectively (p=0.708). Conclusions: As long as the neonatal resuscitation is performed properly, any one of the two can be done as the first step of the protocol, it can be said that the order of either drying first or suctioning first in the protocol of neonatal resuscitation provide comparable results in terms of neonatal respiratory distress, hypothermia, and other adverse outcomes.