{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:35:14Z","timestamp":1790739314849,"version":"4.1.0"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Worldwide, every year, 6 to 10 million infants require resuscitation at birth according to estimates based on limited data regarding \u201cnonbreathing\u201d infants. In this article, we aim to describe the incidence of \u201cnoncrying\u201d and nonbreathing infants after birth, the need for basic resuscitation with bag-and-mask ventilation, and death before discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We conducted an observational study of 19\u2009977 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>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 \u201cnoncrying but breathing\u201d 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\u201326.1).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2019-2719","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T12:21:46Z","timestamp":1589286106000},"source":"Crossref","is-referenced-by-count":20,"title":["Not Crying After Birth as a Predictor of Not Breathing"],"prefix":"10.1542","volume":"145","author":[{"given":"Ashish","family":"KC","sequence":"first","affiliation":[{"name":"Uppsala University, Uppsala, Sweden;"},{"name":"Society of Public Health Physicians Nepal, Kathmandu, Nepal;"},{"name":"Contributed equally as co-first authors"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy E.","family":"Lawn","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"},{"name":"Contributed equally as co-first authors"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Peking University Health Science Center, Peking University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Ewald","sequence":"additional","affiliation":[{"name":"Uppsala University, Uppsala, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rejina","family":"Gurung","sequence":"additional","affiliation":[{"name":"Golden Community, Lalitpur, Nepal; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Gurung","sequence":"additional","affiliation":[{"name":"Golden Community, Lalitpur, Nepal; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash K.","family":"Sunny","sequence":"additional","affiliation":[{"name":"Golden Community, Lalitpur, Nepal; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise Tina","family":"Day","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini","family":"Singhal","sequence":"additional","affiliation":[{"name":"University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,6,1]]},"reference":[{"issue":"4","key":"2021121012454835100_B1","doi-asserted-by":"crossref","first-page":"F355","DOI":"10.1136\/archdischild-2013-305703","article-title":"A physiological approach to the timing of umbilical cord clamping at birth","volume":"100","author":"Hooper","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"4","key":"2021121012454835100_B2","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1152\/physrev.00032.2009","article-title":"Regulation of the pulmonary circulation in the fetus and newborn","volume":"90","author":"Gao","year":"2010","journal-title":"Physiol Rev"},{"issue":"pt 19","key":"2021121012454835100_B3","doi-asserted-by":"crossref","first-page":"4695","DOI":"10.1113\/jphysiol.2009.174870","article-title":"Dynamic changes in the direction of blood flow through the ductus arteriosus at birth","volume":"587","author":"Crossley","year":"2009","journal-title":"J Physiol"},{"issue":"10053","key":"2021121012454835100_B4","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/S0140-6736(16)31575-6","article-title":"Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 [published correction appears in Lancet. 2017;389(10064):e1]","volume":"388","author":"GBD 2015 Child Mortality Collaborators","year":"2016","journal-title":"Lancet"},{"issue":"11","key":"2021121012454835100_B5","doi-asserted-by":"crossref","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution [published correction appears in Lancet Glob Health. 2018;6(11):e1162]","volume":"6","author":"Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"10160","key":"2021121012454835100_B6","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1016\/S0140-6736(18)31668-4","article-title":"Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries","volume":"392","author":"Kruk","year":"2018","journal-title":"Lancet"},{"issue":"9941","key":"2021121012454835100_B7","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S0140-6736(14)60582-1","article-title":"Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries","volume":"384","author":"Dickson","year":"2014","journal-title":"Lancet"},{"issue":"11","key":"2021121012454835100_B8","doi-asserted-by":"crossref","first-page":"e635","DOI":"10.1016\/S2214-109X(14)70309-2","article-title":"Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study","volume":"2","author":"Oza","year":"2014","journal-title":"Lancet Glob Health"},{"issue":"9940","key":"2021121012454835100_B9","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? 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