II. Asfiksia

8/11/2019 II. Asfiksia

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DELIVERY ROOM MANAGEMENT OF

THE NEWBORN


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OVERVIEW

EARLY INITIATION OF BREASTFEEDING

PERINATAL ASPHYXIA NEONATAL RESUSCITATION


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Rapid assesment after birth

In the first few second after birth, a rapid visual

assesment of the baby should be performed to

answer the following questions:

1. IS THE BABY TERM?

2. IS THE AMNIOTIC FLUID CLEAR?

3. IS THE BABY BREATHING OR CRYING ?

4. IS THERE GOOD MUSCLE TONE?


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If the answer to all of these questions is yes the

baby can remain with the mother

EARLY BREAST FEEDING INITIATION

If the answer to any of these questions is nothe baby

should be managed and evaluated under a radiant

warmer

RESCUSITATION


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PERINATAL ASPHYXIA

Definition Perinatal asphyxia:

A condition caused by a lack of oxygen in

respired air resulting in impaired gasexchange that if persist, leads to progressivehypoxemia and hypercapnia with ametabolic acidosis.

Neonatal resuscitation:

A rapid sequenceof steps to be initiated if ababysbreathing or circulation is impaired


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Neonatal transition requires spontaneousbreathing and successful cardiopulmonarychanges, as well as other changes to

independent organ system functions

Good knowledge of normal transitional

physiology will help in understanding theneeds of the infant experiencing difficulty atbirth


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Lungs and Circulation

In the fetus

In utero, the fetus is dependent on the placentaas the organ of gas exchange

Air sacs are filled with fetal lung fluid


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Relationship between Pulmonary & Cardiovascular

Changes

After delivery Lungs expand

with air

Fetal lung fluidleaves alveoli

Pulmonary

arterioles dilate

Pulmonary blood flow

increases

2000 AAP/AHA


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After deliveryBlood oxygen

levels rise

Ductusarteriosusconstricts

Blood flowsthrough thelungs to pick upoxygen

2000 AAP/AHA


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What Can Go Wrong

During Transition?

Insufficient ventilation,

Sustained constriction of pulmonary

arterioles


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Interruption of Normal Transition:

Apnea

Primary apnea

Rapid attempts to breathe

Respirations cease

Heart rate decreases

Blood pressure is usually maintained

Responds quickly to stimulation

2000 AAP/AHA


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Secondary Apnea

Secondary Apnea

Respirationscease

Heart rate

decreases

Blood pressure

decreases

No response tostimulation

Primary

apneaSecondary

apnea

H

eartrate

Respirations

Blood

pressure

2000 AAP/AHA


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Signs of a Compromised Newborn

Cyanosis

Bradycardia

Low blood pressure

Depressed

respiratory effort

Poor muscle tone

2000 AAP/AHA


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Approximately 10% of newborns require some assistance

to begin breathing at birth.

1 % need extensive resuscitative measures to survive At least 90% of newborn babies make the transition from

intrauterine to extrauterine life without difficulty.

They require little to no assistance initiating spontaneous and

regular respirations and completing the transition from the

fetal to the neonatal blood-flow pattern.

Physiologic Changes During Birth


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A baby encounter difficulty before labor, during labor, after

birth.

Problem encountered after birth more likely to involve the

babys airway and or lungs.

The baby may not breath sufficiently to force fluid from thealveoli/ material such as meconium may block air from

entering the alveoli.

As a resultthe lungs may not fill with the air, preventing

oxygen from reaching the blood circulating through the lungs

(hypoxemia)


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A failure of gaseous distention of the lungs/ lack of oxygen

may result sustained constriction of the pulmonary

arterioles, thus decreasing the blood flow to the lungs and

oxygen supply to body tissues.

Normallythe newborn makes vigorous efforts to inhale

air into the lungs, brings oxygen to the pulmonary arterioles

and causes the arterioles to relax.


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If a baby does not begin breathing immediately after

being stimulated, he or she is likely in secondary apnea

and will require positive-pressure ventilation.

Continued stimulation will not help.


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Neonatal response to asphyxia

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Secondary

apneaPrimary

apnea

HEART RATE

Blood pressure

TIME

TIME


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NEONATAL RESUSCITATION

Neonatal resuscitation is a rapid sequence of

steps to be initiated if a babys breathing orcirculation is impaired

The aim is to optimize the airway, breathing,

andcirculationas quickly as possible


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INITIAL ASSESSMENT BLOCK

At the time of birth ask yourself 4 questions about the

newborn

A. Term gestation ?

B. Clear amniotic fluid ?

C. Breathing or crying ?

D. Good muscle tone ?

If any answer is NO you should continue to the initial

steps of resuscitation.


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R E S U S C I T A T I O N

Initial Steps in Resuscitation A

Positive Pressure ventilationB

Chest Compressions C

Endotracheal Intubation

Medications D

Birth


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Provide positive-pressure ventilation*

Provide positive-pressure ventilation*Administer chest compressions*

Administerepinephrine*

Evaluate respirations,heart rate, and color

Provide warmthPosition ; clear airway*(as necessary)Dry, stimulate ,reposition

No

Givesupplementaloxygen

CyanoticApneic or

HR100 & Pink

Observational Care

Breathing

HR>100 & Pink

Routine CareProvide warmthClear airwayDryAssess color

Yes

30 sec

30 sec

30 sec

Approxim

ateTime


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evaluation Decision

action


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evaluation : 4 question


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Action :

INITIAL STEPS


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PROVIDE WARMTH

The baby should be placed under a radiant warmer so theresuscitation team has easy access to the baby and theradiant heat helps reduce heat loss

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Preventingheatloss

Under

radiant

warmer

Dried with

a warm

towel

Remove

wet linen


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EXTENTION

FLEXIONHYPEREXTENTION


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Dry thoroughly

Remove wet linen

Reposition of the head

DRY


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30


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Oxygen Mask

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Oxygen by tubing heldin cupped hand

Free-flow Oxygen


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40-60 x/minute


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DRUG


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Is an objective method of quantifing the

newborns condition and useful for :

Conveying information about the newborns

overall status

Response to resuscitation

APGAR SCORE


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SIGN 0 1 2

1. Color Blue or Pale Acrocyanotic Completely

Pink

2. Heart Rate Absent < 100/min > 100/min

3. Reflex irritability No response Grimace Cry / active

withdrawal

4. Muscle Tone Limp Some Flexion Active Motion

5. Respiration Absent Weak cry;

Hypoventilation

Good, crying

APGAR SCORE

Total Score : 0-10


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APGAR Scoring


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AS should be assigned at 1 minute and 5 minutes after birth.

However the resuscitation must be initiated before the 1

minute score is assigned.

Therefore AS is not used :

To determine the need for resuscitation

What resuscitation steps are necessary

Or when to use them

When the 5 minute AS < 7, additional score should be

assigned every 5 minutes for up to 20 minutes


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