ASPHYXIA NEONATORUM

ASPHYXIA NEONATORUM

FAILED TO BREATH SPONTANEOUSLY AND

FAILED TO BREATH SPONTANEOUSLY AND
REGULARLY AT BIRTH OR FEW MINUTE
REGULARLY AT BIRTH OR FEW MINUTE
THEREAFTER
THEREAFTER

80 % SPONTANEOUS BREATHING
20 % FAILED
ASPHYXIA

MATERNAL FETAL
HYPOXIA HYPOXIA ASPHYXIA

•• MATERNAL
MATERNAL FACTOR
FACTOR
•• FETAL
FETAL FACTOR
FACTOR
•• PLACENTAL
PLACENTAL FACTOR
FACTOR
CLINICAL CHANGES
Primary gasping

Primary apnea ---------------- Skin cyanotic

Heart rate :

Secondary gasping

Secondary apnea ----------- Skin pale

Heart rate death

ALWAYS SUGGEST
OR
SUSPECT AS
SECONDARY APNEA
BIOCHEMICAL CHANGES

ONSET

pO2 pCO2

pH

Aerob metabolisme
An aerob metabolisme
DIAGNOSIS of ASPHYXIA

CLINICAL ASSESMENT :
•RESPIRATORY EFFORT
• HEART RATE
• SKIN COLOUR

LABORATORY : Blood Gass Analyis :

• HYPOXIA
• HYPERCAPNEA
• METABOLIC ACIDOSIS
APGAR Score

• Just for Assesment

• Not for starting resuscitation
• For determine prognosis
• 5 variables comprehensively
• Observed consecutively : 1- 5 –
10 minutes
• Divided : - Mild, Moderate, Severe
Asphyxia
SIGTUNA SCORE

•More simple
• 2 variables : - Respiratory rate
- Heart rate
APGAR SCORE

Symptom/Sig 0 1 2
n
Pulse 0 < 100/mnt >100/mnt
Respiratory none grunting Crying
effort

Muscle tone Floppy Partial Full flexion.

flexion active

Sensitive to No response Grimace Crying

stimulation

Color Pale Blue Pink

Ethiology of Depression :

• Intra uterine asphyxia

• Preterm baby
• Medication given to mother
• Neuromuscular diseases
• Congenital malformation
• Intrapartum hypoxia
RESUSCITATION :
equipment

• * SUCTION SET
• * MASK & BAG
• * INTUBATION SET
• *MEDICATION
A B C Resuscitation

• A ( air way ) Make sure

airway is open
• B ( breathing) Starting
breath
• C (circulation) Maintain
circulation
INITIAL STEP of
RESUSCITATION

• * Prevent Heat Loss

• * Airway cleaning, Proper baby
position, suctioning mouth
then nose
• * Stimulate respiration if
needed
• * Asses baby
Action Assesment

Decision
USING Oxygen
(if available )
• Using nasal catheter
• Using Oxygen Mask
• Using Bag and Mask
Prevent Heat Loss

• * Put under Radiant warmer

• * Drying
• * Replace wet linen with
warm one
Opening Airway

• * Make proper position : light

extension,put linen under the
shoulder
• *Suction : No meconeum :
•mouth - nose
• minimal handling : not excessive
• usually - stimulate breath
 MECONEUM
MECONEUM STAINED
STAINED IN
IN AMNION
AMNION LIQUID
LIQUID

SUCTION
SUCTION WHEN
WHEN HEAD
HEAD DELIVERED
DELIVERED

Active baby Apnea or Depressed

Thick
HR < 100
Meconeum
Muscle Tone decrease
Observe

Suction via trachea

By ET

Start
Rescusitation
Assessing Newborn

• * Respiratory effort

• * Heart Rate
• * Skin colour
Keep warm and dry, may be suction or
/stimulation is needed

Oxygen
Provide PPV
effectively, Bag and
Mask, Intubation ET

Chest
compression

Medication
Should be considered :

• Mask attachement : no leakage

• Pressure on bag -- Chest
movement / Chest compliance
• Rate : 40 – 60 x / minute
POSITIVE PRESSURE
VENTILATION ( PPV )

INDICATION :
• APNEA OR GASPING

• HEART RATE < 100 X/mnt

 PPV - 30 Seconds - Evaluate

Asses H R

H
DRJ<
< 60
60 H R 60 -100 HR > 100
Continue PPV Continue PPV Look for
spontaneous
+ Chest compress
breathing
Stop PPV
Provide O2
,gradually
reduced
CHEST
CHEST Compression
Compression
CHEST Compression

Indication
Indication :: HR
HR <
< 60
60 x/mnt
HR < 60 x/mnt
x/mnt

Hypoxemia •HR
• Cardiac contractility

Started : After 15 – 30 seconds

providing PPV with 100 % O2
------- HR < 60 x/mnt
CHEST Compression =
External Cardiac massage
Provide : Artificial Heart Beat

Include :
• Compress heart through
the bone
• Increasing Intra thoracal
pressure
• Ensure blood circulation
in vital organ
 Should be done
together with PPV

Technically : * thumbs
* two fingers

Stopped : HR > 60 x/mnt

Location : - imagination line between 2 niples

- 1/3 sternum below line,
- above proc. xyphoideus
Depth: 1- 2 cm during
pressing and off

Frequency : 90 compression +
30 ventilation
within 1 mnt : Ratio 3 : 1
Complication :
• Rib fracture
• Trauma / laceration of liver
• Pneumothorax