Chapter 3

Problems of the neonate and young infant -

Birth asphyxia
Assessment of newborn at delivery

Well baby Non-breathing baby

Early Essential Neonatal

Newborn Care resuscitation
Test
Early Essential Newborn Care
Immediate and thorough drying with a clean cloth
Maintain skin-to-skin contact
Give the baby to mother as soon as possible, on her chest
or abdomen
Cover the baby to prevent heat loss
Time cord clamping
Wait for up to 1 - 3 mins or until pulsations stop
Breastfeeding and non-separation
Initiate within the first hour keeping mother and baby
together
 Case study: baby of Ruth

Baby of Ruth is a boy born at term.

He is blue and has poor muscle tone. He doesn't cry.
Assessment of newborn at delivery

Look for:

 Breathing or crying NO
 Good muscle tone NO
 Colour pink NO
Ref. WHO Pocket book
inside cover, and pages
47-49
 A: Neonatal resuscitation
• Open airway by positioning the head in the neutral position
(Ref. p. 47)
• Clear airway and suction, if necessary
• Stimulate, reposition
• Give oxygen, as necessary

Ruth’s baby is still blue and not breathing.

 B: Neonatal resuscitation

• Use a correctly fitting mask:

• If the baby is still not breathing (Ref. p. 47) :

• Check position and mask fit
• Continue to give breaths at 40 breaths per
minute

• Use oxygen if available

• Every 1-2 minutes stop and see if the pulse or

breathing has improved
 C: Neonatal resuscitation
• Check the heart rate (HR)
• What steps would you take next? If <60, 60-100, >100
 Further history
Ruth, G1 P1, 24 year old
Rupture of membranes at home, contractions were
regular.
In labour for over 24 hours, but progressed to normal
delivery in hospital.

Ruth had no chronic illness and no pre-eclampsia

No maternal fever
No bleeding
Meconium at delivery +++
 Examination after stabilisation
After 2 minutes bag-mask resuscitation baby was
breathing well, muscle tone has increased. He cried at
4 mins.
Vital signs: pulse: 120/min, RR: 44/min, SpO2 93%
Weight: 3.2 kg
Chest: mild chest indrawing, breath sounds heard
over both sides, no added sounds
Cardiovascular: both heart sounds were audible and
there was no murmur
Abdomen: soft, bowel sounds were active
Neurology: muscle tone improved, no focal signs
 Further management after 1 hour
• Give vitamin K 1 ampoule IM once
• Apply antiseptic ointment or antibiotic eye drops
(e.g. tetracycline) to both eyes once (prophylaxis)
• Cord care with chlorhexidine / GV paint / dry cord
care
• Record weight and full examination
What supportive care and monitoring
are required?
 Monitoring

• The baby has to be monitored frequently

• Pay attention to colour, breathing, muscle tone and
ability to suck
• Anticipate problems
 Monitoring – anticipate problems
• In the days after birth asphyxia the baby may
develop following problems (Ref. p. 51-52):

 Convulsions
 manage ABC
 check glucose
 treat with phenobarbitone Treat only if
 Apnoea the problem
 oxygen by nasal prongs arises
 resuscitation with bag and mask
 Inability to suck
 feed with breast milk via a nasogastric tube
 Breastfeeding support
Early breastfeeding is
important for all newborns

Create a breastfeeding
friendly environment – non-
separation, even for the sicker
infants

Breastfeeding assessment and

counselling
(Ref. p. 295)
 Progress of Ruth’s baby
The baby’s motor tone recovered well in the first
24 hours. After some difficulties at the beginning
he was sucking well.

Before discharge home he also received hepatitis

B and BCG vaccines.
 Follow-up
Baby should receive regular follow-up to monitor:
– Growth and development
– Nutritional intake
– Immunisation status
– Detection of other illnesses or problems
 Summary
• Be prepared for resuscitation at every delivery
• Bag-mask ventilation will stimulate the baby to
breathe, add oxygen if the newborn does not
• Prognosis for the baby with perinatal asphyxia can
be predicted by recovery of motor function
(movements), sucking ability, colour, breathing
and alertness
• The prognosis is good for babies who respond
quickly to resuscitation
• Learn all steps of neonatal resuscitation, practice
and teach others
• Do not separate mothers and newborns