ASPHYXIA
NEONATORUM
AUGUST SEMESTER
Sessions outline
Definition
Pathophysiology
Predisposing / risk factors
Signs and symptoms (class discussion)
Prevention
Principles of resuscitation and resuscitation technique
Definition
• Failure of the new born baby to establish spontaneous respirations at birth
• a condition in which a baby does not receive enough oxygen before, during, or
directly after birth.
*About 1 in 10 babies needs help to breathe
Severely depressed 0-3
Moderately depressed 4-6
Good condition 7-10
Signs of an abnormal transition
Pathophysiology
• The pathophysiology of asphyxia generally results from interruption of
placental blood flow with resultant fetal hypoxia, hypercarbia, and acidosis.
• Circulatory and non circulatory adaptive mechanisms exist that allow the
fetus to cope with asphyxia and preserve vital organ function.
• With severe and/or prolonged insults, these compensatory mechanisms fail,
resulting in hypoxic ischemic injury, leading to cell death via necrosis and
apoptosis.
• Permanent brain injury is the most severe long-term consequence of perinatal
asphyxia.
• The severity and location of injury is influenced by the mechanisms of injury,
including degree and duration, as well as the developmental maturity of the
brain.
Principles of resuscitation
• critical for the success of resuscitation
• Anticipate
- Adequate monitoring and appropriate intervention
• Prepare for birth
-two clean (warm) towels for thermal protection (drying and wrapping/covering the newborn to prevent heat
loss)
a draught-free delivery room
- Ambu bag
- Right size caps a suction device (mucus extractor penguin or bulb syringe ),
*IPC measures
RESUCITATION
Ninety percent of newly born babies make the
transition from intrauterine to extra uterine life
without difficulty.
Approximately 10% of newborns require some
assistance to begin breathing at
birth and only about 1% of them need advanced
resuscitative measures to survive.
Resuscitation must be anticipated at each birth. It is
essential for health professionals who attend the
mother at birth to be skilled at resuscitation and know
how to recognize babies at risk.
They must be prepared with the necessary equipment
and support person, know the steps of resuscitation,
and act quickly to save the life of the baby and
prevent complications.
Principles' for successful resuscitation
1. Anticipation
2. Adequate preparation,
3. Timely recognition
4. Quick and correct action
Goals of resuscitation
• 1. Minimizing immediate heat loss by drying and providing warmth, thereby decreasing oxygen
consumption by the neonate.
• 2. Establishing normal respiration and lung expansion by clearing the upper airway and using
positive-pressure ventilation if necessary.
• 3. Increasing arterial PO2 by providing adequate alveolar ventilation. The routine use of added
oxygen is not warranted, but this therapy may be necessary in some situations.
• 4. Supporting adequate cardiac output.
HBB ACTION PLAN
• Dry thoroughly
• Recognize crying
• Keep warm
• Check breathing
• Clamp or tie and cut the umbilical cord
• Position on mother’s chest to encourage breastfeeding
• Continue with essential newborn care, identify the baby, and
• complete the birth record
• Continue with essential newborn care, identify the baby, and complete the birth
record
*check HBB action plan flow chart or watch video https://vimeo.com/72723118
Advanced resuscitation
• A small proportion of infants fail to respond to ventilation with the bag and mask.
• Advanced procedures can be introduced in a health care institution if the following
criteria are met:
• (a) trained staff with the necessary equipment and supplies are available;
• (b) at least two skilled persons are available to carry out the resuscitation;
• (c) there are sufficient deliveries for the skill to be maintained;
• (d) the institution has the capacity to care for or to transfer newborns who suffer severe
birth asphyxia since they are expected to have problems after being resuscitated.
PROCEDURES FOR ADVANCED
RESIPIRATIONS
Chest compression
Endotracheal intubation
Oxygenation
Administration of drugs
• * check details WHO practical guide for resuscitation
• CH 5
Care after successful resuscitation
• Do not separate the mother and the newborn. Leave the newborn skin-to-skin with the mother.
• Measure the newborn's body temperature, count breaths, observe for indrawing and grunting, and observe for malformations,
birth injury or other danger signs.
• Encourage breast-feeding within one hour of birth. The newborn that needs resuscitation is at higher risk of developing
hypoglycaemia. Observe suckling - good suckling is a sign of good recovery.
•
• If the temperature is <36°C or the skin feels cold, the baby has hypothermia. Skin-to-skin contact will rewarm the newborn..
Check the body temperature every hour until it is normal. Small babies must be observed more carefully since danger signs
indicating serious problems are more common and more subtle.
• If the newborn has difficulty breathing or there are other danger signs, organize referral for special care. Explain the findings of
the examination to the mother. Refer with the mother if possible.
• Record the resuscitation and the problems,
• Examine the newborn before discharge. Signs of the newborn's well-being are normal body temperature, normal breathing,
occasional cry, good suckling and movements.
• Discuss the procedure again with the parents: explain need for follow up .
• Clean the equipment and prepare it for the next birth
Strategies for controlling birth asphyxia can be identified
.1. Referral of high-risk pregnant women to a tertiary care level.
2. Early recognition of prenatal signs of possible asphyxia (meconium stained
amniotic fluid, abnormal fetal heart beat pattern).
3. Management of the newborn with asphyxia, in terms of both urgent and skilled
resuscitation.
4. Management of post-asphyctic conditions.
5. Education and counselling
APPLICATION EXERCISE FOR BIRTH ASPHYXIA
Check for national / facility data for the following: ( annual health sector performance
report, District health league table , annual MPDSR report…………..)
• the magnitude of birth asphyxia nationally and or at selected facility
• Risk factors for birth asphyxia at selected facility
• Management for birth asphyxia at selected facility (strengths and gaps)
State one intervention you would like to put in place to enhance good outcomes for
babies with birth asphyxia
Online resources for helping babies breath at
birth
• Global Health Media Project. Download link:
• http://globalhealthmedia.org/videos/
• By Global Health Media Project. Download link: https://
globalhealthmedia.org/videos/
• Age-restricted video (based on Community Guidelines)
