Criterion 2.3-11: Securing the care of the newborn at birth, a quality imperative
Criterion 2.3-11 is an essential pillar for guaranteeing the safety and well-being of newborns from the first moments of their lives. It establishes the requirements for healthcare teams to ensure optimal and continuous care, aiming to improve the infant's health and quality of life.
What is Criterion 2.3-11 and why is it essential?
Criterion 2.3-11 is a key indicator for maternity units, considered an imperative. Its main objective is to ensure the safety of newborn care at birth, which is directly linked to improving their health and well-being from the earliest moments. This involves a series of standardized and systematic actions that healthcare teams must follow.
This criterion encompasses several fundamental aspects of the initial management of the newborn, including:
- The immediate identification of the infant.
- The prevention of infections.
- Assessment of vital functions, often via the Apgar score.
In essence, it aims to structure practices so that each newborn benefits from a safe environment and adapted care from birth, by anticipating needs and potential risks.
The foundations of securitization: Continuous care and monitoring
To achieve the objectives of Criterion 2.3-11, particular attention is paid to continuous monitoring and the provision of essential care. Continuous monitoring allows for the rapid detection of any anomaly or complication that would require specialized management.
Essential care that is systematically performed includes:
- Maintaining body temperature. This is all the more crucial as the newborn resuscitation protocol emphasizes maintaining temperature, especially for premature infants where drying and wrapping, as well as the plastic bag, are key measures. Professionals must also record the newborn's temperature when leaving the birth area and upon admission to the care unit.
- The management of nutrition, including support for breastfeeding, which must be part of a formalized quality approach.
In addition, clear communication with parents is fundamental to ensure a smooth transition and promote careful monitoring of the newborn's first moments of life. Specific actions such as delayed umbilical cord clamping and skin-to-skin contact are practices that professionals must document, explaining the reasons if they are not performed. These measures contribute to a better adaptation to extrauterine life, which, in the majority of cases (85%), occurs naturally, but sometimes requires stimulation or, for 5% of children, positive pressure ventilation.
The pivotal role of healthcare professionals: Training and quality approach
The success of Criterion 2.3-11 largely depends on the skills and commitment of healthcare professionals. It is imperative that all professionals caring for newborns in the birth and maternity sector be trained by simulation from the start of their duties and throughout their professional practice. This training includes mastering care procedures, particularly with regard to neonatal resuscitation and the management of neonatal infections.
Newborn resuscitation is primarily respiratory, with only one in 1000 newborns requiring chest compressions. To facilitate this adaptation, anticipating preparation, checking equipment, ensuring the availability of caregivers, and using checklists are essential to limit stress and ensure readiness. Managing an emergency situation is a true team performance, requiring a clearly identified leader, good coordination of actions, and information sharing.
In addition, professionals are required to:
- Document rigorous delayed cord clamping, skin-to-skin contact, and newborn temperatures in the patient record.
- Participate in a formalized quality improvement initiative, for example, to support breastfeeding.
- Analyze their results and define measures for continuous improvement, for example in terms of the rate of delayed clamping, antenatal corticosteroids or length of hospital stay.
This approach ensures continuous improvement of practices and optimal safety of care provided to newborns.
The Safeteam P25 training course: A concrete lever for Criterion 2.3-11
The "Strengthening Practices in Neonatal Resuscitation (P25)" training offered by Safeteam is directly aligned with the requirements of Criterion 2.3-11, in particular the imperative of professional training. This training is intended for a varied audience, including childcare assistants, nurses, midwives, anesthesiologists and pediatricians, who work in the delivery room.
The main objective of the P25 training is to enable participants to manage a newborn in cardio-respiratory arrest according to the current international recommendations of the European Resuscitation Council (ERC). This is crucial since neonatal resuscitation is a skill that professionals must master within the framework of Criterion 2.3-11.
The training emphasizes:
- Mastery of good resuscitation practices, such as the ABCDE algorithm (Airway, Breathing, Circulation, Drugs, Environment). This algorithm includes airway clearance, positive pressure ventilation (PPV), chest compressions, increased FiO2, and tracheal intubation if necessary. Suctioning of the upper airways (UAS) is also part of the clearance and should be performed with caution, never systematically.
- Securing and ensuring the reliability of communication times, including alerts and transmissions.
- Reduction of risks associated with iatrogenic hypothermia.
The pedagogical methodology is innovative, combining an autonomous part and a collective part in videoconference. It uses immersive video simulation to retrace the care of a newborn in cardiorespiratory arrest by the multi-professional team, followed by a video debriefing by field experts. This approach raises awareness of the importance of human factors and teamwork in emergency situations, providing concrete tools for immediate practical application. By training regularly as a team and using cognitive crisis aids, professionals can significantly improve the quality of care, even under stress or fatigue.
