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Problems of the neonate and young infant Birth Asphyxia

Chapter3

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.

Routine care of the newborn at delivery


Dry baby with clean cloth and place where the baby will be warm

Look for:
Breathing or crying Good muscle tone Colour pink

NO
NO NO

Start the resuscitation now!

Neonatal resuscitation (A)


Open airway by positioning the head in the neutral position (Ref. p. 47)

Clear airway, if necessary


Stimulate, reposition

Baby is still blue and not breathing.

Neonatal resuscitation (B)


Use a correctly fitting mask:

Give the baby 5 slow ventilations with bag (Ref. p.47-49)

Observe the chest movement

Neonatal resuscitation (C)


Baby starts breathing

But if the baby is still not breathing (Ref. p. 47) :


Check mask position and seal:

Check the heart rate Continue to bag at rate of about 40 breaths per minute Every 1-2 minutes stop and see if the pulse or breathing has improved Start with air, add oxygen if no response

History
Baby boy of Ruth was born at term. He came out not crying, blue and with poor muscle tone. He was resuscitated for 2 minutes. Rupture of membranes happened at home, contractions were regular. His mother, Ruth, G1 P1, was in labour for a long period of time, but progressed to normal delivery in hospital. No chronic illness and no pre-eclampsia were diagnosed before.

Examination after stabilisation


After 2 minutes bag-mask resuscitation baby was breathing well, muscle tone has increased. He was crying. Vital signs: pulse: 120/min, RR: 50/min Weight: 3.2 kg Chest: air entry was good bilaterally and there were no added sounds, no chest indrawing Cardiovascular: both heart sounds were audible and there was no murmur Abdomen: soft, bowel sounds were active Neurology: muscle tone improved, no focal signs

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

Monitoring (continued)
In the days after birth asphyxia the baby may develop following problems (Ref. p. 51-52):
Convulsions
check glucose treat with phenobarbital

Apnoea
oxygen by nasal catheter resuscitation with bag and mask

Treat only if the problems arise

Inability to suck
feed with milk via a nasogastric tube

Supportive Care
If no evidence of birth asphyxia at delivery provide normal care for newborn: Give the baby to mother as soon as possible, place on chest or abdomen Cover the baby to prevent heat loss Encourage initiation of breastfeeding within the first hour Keep umbilical cord clean and dry Give vitamin K 1 ampoule IM single dose Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis) (Ref. p. 46, p. 50)

Breastfeeding support
Early and exclusive breastfeeding is important for all newborns

Breastfeeding support:

Encouragement Breastfeeding friendly environment Breastfeeding assessment and counselling (Ref. p. 295)

Progress
Ruths babys motor tone recovered well in the first hour. After some difficulties at the beginning he was sucking well. Before he was discharged home he also received oral polio, hepatitis B and BCG vaccines.

Follow-up
Baby should receive regular MCH follow-up to monitor: Growth and development Nutritional intake Immunization status Detection of other illnesses or problems

Summary
Be prepared for resuscitation at every delivery Dont need oxygen in most cases, bag-mask ventilation will stimulate the baby to breathe on its own Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability The prognosis is good for babies who respond quickly to resuscitation Learn all steps of neonatal resuscitation, practice and teach others