Birth

Asphyxia/Resuscitation

EmONC
 Maternal Causes

 Hypertension and vascular disease

 Hypoxia-cardio-pulmonary disease
 Hypertonic uterine action
 Hyperventilation-hypo perfusion of placental
site
 Cord prolapse/compression, true knot in cord
 Placental disease, dysfunction or separation
 Anemia
Fetal Causes

 Meconium aspiration
 Amnionitis
 Opiods to the mother
 Cerebral hypoxia during labor/traumatic
delivery
Fetal Causes (continued)

 Immaturity
 Intra natal pneumonia-very early
rupture of membranes
 Severe anemia-feto-maternal
hemorrhage, Rhesus incompatibility
 Fetal Causes (continued)

 CNS/RS congenital abnormalities

 Choanal/tracheal atresia
 - Atresia is closure or absence of a usual
opening or canal
 - Choanal atresia-(bilateral)membranes or
bony obstruction of the nares, baby is blue
when sleeping and pink when crying.
 Aims of resuscitation

1. Establish and maintain a clear airway by

ventilation and oxygenation
2. Ensure effective circulation
3. Correct acidosis
4. Prevent hypothermia, hypoglycaemia,
hemorrhage
……/cont
Aims of resuscitation (continued)

3. External cardiac massage

4. Use of drugs
5. Observations and aftercare
 Equipment
 Resuscitaire with overhead heater, suction
machine, oxygen, clock timer
 Straight bladed infant laryngoscopes
working with batteries/bulbs sizes 0 and 1
 Neonatal endotracheal tubes 2.0, 2.5, 3.0
and 3.5mm with connectors
 Neonatal airway sizes 0, 00, 000
 Equipment (continued)

 Suction catheters sizes 6, 8 and 10 FG

 Neonatal bag and mask-face masks of
assorted sizes (clear, soft masks)
 Magills forceps
 Endotracheal tube introducer
 Syringes 1, 2, 5, and 20 ml assorted needles
 Drugs

 Naloxone HCL 400mcg/ml-100 mcg/kg

 Adrenaline 1:10,000 and 1:1000-0.1-
0.3ml/kg of 1:10,000 i.v, 0.1 ml/kg of
1:1000 via ETT
 Dextrose 10%-3ml/kg iv to correct a blood
sugar<2.5mmol/L
Drugs

 Sodium bicarbonate-2-4ml/kg slow iv

injection-1ml/min to avoid intracranial
hemorrhage
 Normal saline 0.9%
Other requirements

 Stethoscope
 Cord clamps
 Warmed towels
 Adhesive tape for tube fixation
Resuscitation action plan

Principles
1. Stimulation
2. Warmth
3. Clearing the airway
4. Ventilation and oxygenation
Resuscitation action plan (continued)

 A-anticipation-assessment, airway
 B-breathing, bag+mask, ETI
 C-circulation, cardiac massage, caring-
warmth, comfort
 D-doctor, drugs, documentation
 E-explanation, family
 F-Follow up, environment
Key points

1. Anticipate problems
2. Check resusc. Equipment
3. Start clock
4. Suctioning
5. Keep warm
6. Apgar score
7. Oxygen
…/cont
Key Points

8. Bag & mask ventilation

9. Endotracheal intubation
10. Cardiac massage
11. Drugs
12. Other problems
 External cardiac massage

 Chest compression if HR<60/min

 Best is encircle the baby’s chest with the
fingers and thumbs on the lower
midsternum
 Depression rate 100-120/min
 Ratio of 3 compression to 1 ventilation
 Depth of a third of baby’s chest
Note

 Do not cause rib fracture, lung damage

or liver damage.
End of Presentation

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