Neonatology: Asphyxia of The Newborns at birth Lecture Points Clinical definition and Epidemiology: incidence/mortality Etiology and Pathophysiology Apgars score significance of clinical use reevaluation of the score Resuscitation Complication and prognosis Clinical Definition/Epidemiology Clinical definition Failure to initiate respiration no / irregular breathing with hypoxemia and acidosis Incidence : 6-10%, in live birth Mortality: leading death in neonates account for 1/3 in neonates death Etiology Maternal Systematic diseases hypertension/hypoxia Obstetric/pregnant complication Addiction Age at pregnancy/multiple pregnancy Etiology Intrapartum Abnormal umbilical cord Abnormal fetal position Procedure: Forceps Medication narcotic Sedatives Etiology Fetus Premature, SGA, LGA, Macrosomia Various abnormality Intrauterine aspiration Nerves injury Pathophysiology Hypoxic/ Ischemia Organ/system injury Hypoxemia/acidosis O 2, CO 2 Exchange Obstacle Failure to initiate breath Pathophysiology repiration change HR HR stop Primary apneaSecondary apnea System/organ Ischemia/hypoxicBiochemical/metabolism ________ Hypoxemia, acidosis Organ/system damage Blood redistribution: compensation decompensation Catecholamine Glucagon Free fatty acids ANP PCO2 Acidosis Hyperglycemia Hypoglycemia Hypocalcemia Hyponatremia Apgar Scoring System SCORE012 Heart rateAbsent 100/min RespirationsAbsentSlow, irregularGood, crying Muscle tone LimpSome motionActive motion Reflex irritability No response GrimaceCough, sneeze, cry ColorBlue, pale Body pink, blue limbs Completely pink Apgar Scoring System Apgar Score Methods: at 1 and 5 min. post birth till >7 min. or 20 min. after birth Clinical Manifestation Fetal distress Fetal motion or no Fetal HR or Meconium-stained amniotic fluid Apgar Score 4 at 10 min. Brain Damage only 1% in children at 7 years old In brain damaged children 75% were normal for Apgar score. Reevaluation of Apgar Score American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2 The relevance to the outcome of asphyxia with survival and system/organ function Umbilical artery PH 7.00 BE: -20mEq/L Papile LA. The Apgar score in the 21st century. N Engl J Med 2001;344: Reevaluation of Apgar Score NRP 5th edition : 5th edition; Suction when Meconium present Resuscitation with oxygen or room air Epinaphrine for bradycardia or cardiac arrest NRP 5th edition 2006 Neonatal Resuscitation 5th edition Birth Term gestation Clear amniotic fluid Breathing or crying Good muscle tone yes No Routine care Provide warmth Clear airway Dry Assess color Neonatal Resuscitation 5th edition Provide warmth Position Clear airway EIT (if necessary) Dry stimulate Reposition No Evaluate respiration HR and color Apnea Or HR100 and pink Cyanosis 30s Persistent cyanosis Pink Neonatal Resuscitation 5th edition Positive pressure ventilation EIT Administer chest compressions EIT HR60 Apnea Or HR100 bpm Good muscle tone No Yes No Suctioning Meconium Epinephrine for Bradycardia 2006 Guideline Intravenous administration of epinephrine 0.01 0.03 mg/kg/dose is the preferred route (Class IIa). While access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. Neonatal Resuscitation 5th edition SpO 2 Monitoring: Once per 30Sec. To 95% for new a born baby: 10 min. Premature: Use Blend and Oxygen air Adjust the oxygen air to SpO 2 near 90% International Liaison Committee on Resuscitation.Part 13: Neonatal resuscitation guidelines. Circulation 2005:112(24, Suppl):IV188-IV195 Resuscitation technology Suction beginning from Oral then Nasal Resuscitation technology Tactile stimulation Tap the plantar Resuscitation technology Tactile stimulation Rubber the Back Resuscitation technology O 2 supply via PPV bag Resuscitation technology Chest compress: Resuscitation technology Endotracheal intubation Method by nasal or by oral Indication Meconium aspiration Normal SaO 2 only maintained by PPV Serious hypoxemia Persistent irregular breathing Resuscitation technology Endotracheal intubation by oral Resuscitation technology Endotracheal intubation: Vocal and Tracheal Resuscitation technology Monitoring post resuscitation Temp, Respiration, HR BP, Urine volume Skin color CNS signs Acid base, Balance of electrolytes, Infection American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2 Indications of poor outcome or CNS damage Umbilical artery showed severe acidosis (PH 3 Prognosis Prevention of Asphyxia Antenatal care To avoid premature delivering and obstetric procedure (forceps) Monitoring high risk prehnent Pre and post born preparations and adequate care Summary The importance of early detection and recognition of the fetal distress Pathophysiological Changes of the asphyxia Use and reevaluation of the Apgars score Main procedure of the delivery resuscitation (New guideline and ABCs sequence) Prognosis Thanks and questions?