Birth Asphyxia DefinitionFailure to initiate and sustain
breathing at birth is called birth asphyxia. MagnitudeOf the 5
million neonatal deaths that occur worldwide, 19% death occur due
to birth asphyxia (WHO 1995).
Factors associated with birth asphyxia1. Fetal distress Meconium
Abnormal presentation2. Prolonged or obstructed labor3.
Complicated, traumatic or instrumental delivery4. Severe maternal
infections5. Maternal sedation, analgesia or anesthesia6. Antenatal
or Intrapartam hemorrhage7. Pre-term or post-term birth8.
Congenital anomaliesWho will need resuscitation?1. 80 - 90% of
newborns require no assistance to initiate breathing at birth2. 10%
require some assistance to begin breathing. 3. 1% among them
requires extensive resuscitative measures to survive.
Sometimes the need for resuscitation can be predicted, but often
it cannot, so... PREPARE FOR RESUSCITATION AT EVERY BIRTH
Neonatal ResuscitationIntroduction:We cannot tell which babies
will have asphyxia at birth. Therefore we must prepared to do
newborn resuscitation at all births. If a few minute pass before
the starts to breath, baby can suffer from brain damage or die.
Preparing for resuscitation include, warming the resuscitation
area, preparing clean surface for the resucitation and collecting
the equipments and supply.Principles of Newborn
ResuscitationAccording to Pediatric working Group of the
International Liaison Committee on Resuscitation (ILCOR) the
principles of newborn resuscitation are as follows:1. Personal
capable of initiating resuscitation should attend every delivery to
establish a vigorous cry or regular respiration, to maintain a
heart rate >100 beats per minute and achieve good color and
tone.2.
STEPS IN RESUSCITATIONI. Assessment at birth to decide need for
resuscitationII. Initial steps of resuscitationEvaluationIII.
Provide positive pressure ventilationEvaluationIV. Provide positive
pressure ventilation and chest compressions
STEPS IN NEONATAL RESUSCITATIONInitial Assessment:Meconium not
present?Breathing or crying?Good muscle tone?Color pink?Term
gestation?YesRoutine Immediate Newborn Care StepsNoInitial
Steps:Dry & stimulate the baby*Warm the babyPosition the
babyClear airway (as necessary)Give oxygen (as necessary and if
available)*Important:If meconium present, baby not vigorous - do
not stimulate until after clearing airwayEvaluate respiration,
heartrate, color & decide actionNormalBreathingHR>100
&PinkSupportiveCareApnea or HR 100HR < 60 HR
>60Ventilation and Chest compressions OngoingCareStop
resuscitation if baby not breathing orgasping after 20 minutes
without heartbeat Drugs likeepinephrine andvolume expanderslike
normal salinemay be tried at thispoint depending onexpertise of the
birthattendantEvaluate respiration, heartrate, color and decide
action21Birth Asphyxia (continued)WHO 2000.Step I: On Initial
Assessment ask thefollowing: Meconium not present? Breathing or
crying? Good muscle tone? Color pink? Term gestation?If the answer
is yes, proceed with routine immediatenewborn careIf the answer to
any one question is no, then go to the nextstep22Birth Asphyxia
(continued)WHO 2000.Step II: Initial Steps of Resuscitation Dry,
stimulate*, warm Position, clear airway (as necessary) Reposition
Give O2 (as necessary and if available)* If meconium is present, do
not stimulate untilafter clearing airwayEvaluateAfter initial steps
and also after every action (ventilationwith/without chest
compressions) it is necessary toevaluate the color, respirations
and heart beat and thendecide what to do further and take
appropriate action.. Evaluation. Decision. ActionPrevent heatloss
by: Placing newbornunder radiantwarmer or otherheat source Drying
thoroughly Removing wettowel
TACTILESTIMULATION
Open the airway by Positioning on back or side Slightly
extending neck Aligning posterior pharynx, larynx and trachea
If the newborn is breathing but central cyanosisis present, give
oxygen
oxygen mask oxygen tubing
Meconium Present at DeliveryNOYes
Suction mouth, nose and posterior pharynxafter delivery of head
but before delivery ofshoulders
Baby vigorous?(strong respiratory effortand good muscle tone
with heart rate > 100)YesNO
Suction mouth and trachea
Continue with initial steps of resuscitation
Suction mouth first,then nose
Step III. Provide positive pressure ventilation If not breathing
or heart rate 100, color ispink with good tone may be given to
mother forwarmth and breastfeeding.Frequent assessments of color,
tone and vitalsigns for the first six hours needed. Ongoing
Care:These babies have had active resuscitation (bagand mask
ventilation and/or chest compressions)They may need more monitoring
before giving tomother or going to higher level care and
thereforeneed to be transferred to the Baby Unit for
furtherobservation, evaluation and action based on
theircondition.42Care After Unsuccessful Resuscitation(If the baby
is not breathing or not gasping after 20minutes without heartbeat,
stop resuscitation)- Talk with mother/family about the babys death
andanswer their questions- Ask if they want to see and hold the
baby- Explain to the mother and family about the motherscare:Rest,
support and good dietManagement of engorged breastsRecords-
Recording and notification of baby's birth and death- Completion of
required medical records for thedelivery
