Teaching prospective parents basic newborn life support (BNLS) for unplanned out-of-hospital births

Abdul-Qader Tahir Ismail; the PHAID group

doi:10.1515/jpm-2025-0100

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Teaching prospective parents basic newborn life support (BNLS) for unplanned out-of-hospital births

Abdul-Qader Tahir Ismail and the PHAID group

Published/Copyright: April 8, 2025

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From the journal Journal of Perinatal Medicine Volume 53 Issue 5

Keywords: newborn resuscitation; basic newborn life support; basic newborn life support (BNLS); newborn life support (NLS)

To the Editor,

PHAID (PreHospital Aid) recently published a review [1], describing the need for a basic form of newborn life support (BNLS) that can be taught to members of the public in areas impacted by conflict or natural disasters, where healthcare access is limited or unavailable. In these situations, if a newborn in the community fails to breathe at birth, the result is typically death or severe hypoxic ischaemic encephalopathy. We developed a simplified, expert-guided algorithm designed for use by the general public. It emphasizes drying and keeping the baby warm, delaying cord clamping, identifying babies who require assistance, and providing effective inflation breaths.

In 2021, in the UK, there were 694,685 livebirths [2]. 0.5 % of these were unplanned out-of-hospital births [3], and in ∼60 % of these the baby was born before paramedics arrived [4] which means a health professional trained in newborn life support (NLS) was not present. 10 % of these babies will not have breathed at birth and required intervention [5]. This equates to an estimated 208 babies per year. While only a small fraction of total births, each individual case represents a terrifying ordeal, with potentially devastating, life-changing consequences. While the parents wait for paramedics to arrive, wondering why their baby is not crying, with each passing minute the risk increases of hypoxic ischemic encephalopathy and multiorgan damage, leading to death or significant long-term neurodevelopmental problems. This led to the question, should prospective parents be taught a basic form of newborn life support (BNLS) (e.g., the PHAID algorithm as shown in Figure 1), as part of their NHS antenatal classes, in case of unplanned out-of-hospital births?

Figure 1:

PreHospital aid (PHAID) basic newborn life support (BNLS) algorithm.

Training adult members of the public in basic adult and paediatric life support is already well-established, and being extended to children (e.g., WHO backed ‘Kids Save Lives’ initiative) [6]. In the UK, secondary school students are now taught CPR and how to use an automated external defibrillator (AED). This is crucial because, after cardiac arrest, the brain can survive only 3–5 min without oxygen – less time than it typically takes for emergency responders to arrive – resulting in a survival rate of less than 10 %. However, when bystanders provide immediate basic life support, survival rates increase by 2–4 times. These principles are also relevant for newborn resuscitation. Additionally, the BNLS algorithm could contain guidance regarding delayed cord clamping, drying the baby, and putting it skin-to-skin. This would be especially beneficial in preventing hypothermia, which is a significant issue associated with out-of-hospital births [7], and independently associated with poor neonatal outcomes [8]. It would also help standardise the information given to parents by emergency services call handlers while paramedics are en route [4].

Corresponding author: Abdul-Qader Tahir Ismail, UHCW, Clifford Bridge Rd, Coventry, CV2 2DX, UK, E-mail: aqt.ismail@bnc.oxon.org

The PHAID Group includes: May Al-Rawe, Raya Khaled Aryan, Rehnuma Hossain, Abid Husain, Ali Husain, Raja Azhar Iqbal, Abdul-Qader Tahir Ismail, Ikhlas Javaid, Omar Khan, Huda Mahmoud, Israr Ul-Haq

Research ethics: Not applicable.
Informed consent: Not applicable.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

References

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Received: 2025-02-24

Accepted: 2025-03-26

Published Online: 2025-04-08

Published in Print: 2025-06-26

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

https://doi.org/10.1515/jpm-2025-0100

Keywords for this article

newborn resuscitation; basic newborn life support; basic newborn life support (BNLS); newborn life support (NLS)

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