Birth asphyxia occurs when a neonate is unable to breathe sufficiently in their first few minutes of life. One way that this occurs is when the infant still has amniotic fluid in their airway. Suction can help remove this fluid and allow the infant to breathe. Additionally, some infants aspirate mecomium which can cause irritation, infection and other damage and so must be removed immediately after birth.
Mechanism of Action
There are four classes of suction devices that can be used to clear the infant’s airways. Electrical pumps may be used to generate negative pressure which can be connected to a trap and soft suction catheter. The negative pressure is regulated under 100 mmHg for neonatal use to avoid damaging the tissues of the airway. Manual pump suction devices allow users to create suction using a hand or foot powered bellows.
Mucus aspirator bulbs are the simplest devices, consisting of only a simple small rubber bulb which narrows to a soft flexible tip. The user compresses the bulb and then inserts the narrow point into the infant’s nose / mouth before the bulb is released. The bulb’s expansion provides suction.
Current Use in High-Resource Settings
Most high-resource setting hospitals have a negative pressure source readily available in the delivery room, either through a centralized negative pressure source that might serve several rooms (often called “wall suction”) or a dedicated vacuum pump in the room. Caregivers typically connect a mucus trap to the vacuum line and use a thumb hole to control flow. The other end is connected to a disposable, sterile, single use mucus catheter. In addition, high-resource caregivers may have hand operated equipment like a disposable mucus aspirator bulb available as a complementary or back up device.
Application in Low-Resource Settings
In low-resource setting hospitals, electric suction machines are common. They are typically used for both operations and deliveries. Small, portable DeLee suction devices and mucus aspirator bulbs are more common in clinic settings, and may be re-used across multiple newborns. Aspirator bulbs are less expensive, but provide less suction and can be difficult to clean depending on design.