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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Not Crying After Birth as a Predictor of Not Breathing

Ashish KC, Joy E. Lawn, Hong Zhou, Uwe Ewald, Rejina Gurung, Abhishek Gurung, Avinash K. Sunny, Louise Tina Day and Nalini Singhal
Pediatrics June 2020, 145 (6) e20192719; DOI: https://doi.org/10.1542/peds.2019-2719
Ashish KC
aUppsala University, Uppsala, Sweden;
bSociety of Public Health Physicians Nepal, Kathmandu, Nepal;
*Contributed equally as co-first authors
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Joy E. Lawn
cLondon School of Hygiene and Tropical Medicine, London, United Kingdom;
*Contributed equally as co-first authors
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Hong Zhou
dPeking University Health Science Center, Peking University, Beijing, China;
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Uwe Ewald
aUppsala University, Uppsala, Sweden;
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Rejina Gurung
eGolden Community, Lalitpur, Nepal; and
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Abhishek Gurung
eGolden Community, Lalitpur, Nepal; and
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Avinash K. Sunny
eGolden Community, Lalitpur, Nepal; and
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Louise Tina Day
cLondon School of Hygiene and Tropical Medicine, London, United Kingdom;
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Nalini Singhal
fUniversity of Calgary, Calgary, Canada
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Abstract

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BACKGROUND: Worldwide, every year, 6 to 10 million infants require resuscitation at birth according to estimates based on limited data regarding “nonbreathing” infants. In this article, we aim to describe the incidence of “noncrying” and nonbreathing infants after birth, the need for basic resuscitation with bag-and-mask ventilation, and death before discharge.

METHODS: We conducted an observational study of 19 977 infants in 4 hospitals in Nepal. We analyzed the incidence of noncrying or nonbreathing infants after birth. The sensitivity of noncrying infants with nonbreathing after birth was analyzed, and the risk of predischarge mortality between the 2 groups was calculated.

RESULTS: The incidence of noncrying infants immediately after birth was 11.1%, and the incidence of noncrying and nonbreathing infants was 5.2%. Noncrying after birth had 100% sensitivity for nonbreathing infants after birth. Among the “noncrying but breathing” infants, 9.5% of infants did not breathe at 1 minute and 2% did not to breathe at 5 minutes. Noncrying but breathing infants after birth had almost 12-fold odds of predischarge mortality (adjusted odds ratio 12.3; 95% confidence interval, 5.8–26.1).

CONCLUSIONS: All nonbreathing infants after birth do not cry at birth. A proportion of noncrying but breathing infants at birth are not breathing by 1 and 5 minutes and have a risk for predischarge mortality. With this study, we provide evidence of an association between noncrying and nonbreathing. This study revealed that noncrying but breathing infants require additional care. We suggest noncrying as a clinical sign for initiating resuscitation and a possible denominator for measuring coverage of resuscitation.

  • Accepted March 9, 2020.
  • Copyright © 2020 by the American Academy of Pediatrics

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Pediatrics
Vol. 145, Issue 6
1 Jun 2020
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Not Crying After Birth as a Predictor of Not Breathing
Ashish KC, Joy E. Lawn, Hong Zhou, Uwe Ewald, Rejina Gurung, Abhishek Gurung, Avinash K. Sunny, Louise Tina Day, Nalini Singhal
Pediatrics Jun 2020, 145 (6) e20192719; DOI: 10.1542/peds.2019-2719

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Not Crying After Birth as a Predictor of Not Breathing
Ashish KC, Joy E. Lawn, Hong Zhou, Uwe Ewald, Rejina Gurung, Abhishek Gurung, Avinash K. Sunny, Louise Tina Day, Nalini Singhal
Pediatrics Jun 2020, 145 (6) e20192719; DOI: 10.1542/peds.2019-2719
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