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ASPHYXIA

Rinawati Rohsiswatmo Divisi Neonatologi Departemen Ilmu Kesehatan Anak FKUI - RSCM

Definision
Asphyxia

is defined as the failure to breathe well within one minute after delivery.
is defined as too little oxygen in the cells of the body.
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Hipoxia

Apgar Score
Is

a method of assessing an infants clinical condition after delivery.The APGAR SCORE is based on 5 vital signs.

Apgar/

SIGN
Appearance*

S 0

R 1

Central Cyanosis Peripheral Cyanosis All Pink (blue, pale) Pulse* ------< 100 x/m > 100 x/m Grimace ------Grimace Cough of Sneeze Activity Limp Some flexion Active of extremities motion Respiratory* ------Irregular Good criying 4

ALL INFANTS WITH 1 a (ONE) MINUTE APGAR SCORE < 7 REQUIRE RESUSCITATION

All Infants/
What

causes a low APGAR SCORE * Fetal distress due to hypoxia before delivery * Maternal anesthesis or recent analgesia * Preterm infant * Difficult suctioning of the pharynx after delivery * Severe respiratory distress
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Which baby will need resuscitation at birth?


Sign

of fetal distress during labour. Delivery < 37 weeks of gestation. Abn.presentation of the fetus. Difficult of traumatic delivery. General anaesthesia or recent analgesia . All infant can have asphyxia at birth without warning signs during labour.
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Equipments for infant resuscitation

Suction Apparatus It is not necesssary to routinely

suction the mouth and nose of infants after delivery. Meconium stained infants must be suctioned before they start breathing. A stomach washout is only needed if the infant is meconium stained.
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Equipment/
O

xygen Resuscitator Endotracheal tubes Laryngoscope Naloxone ---------- Sod.Bicarbonate, adrenaline Wall clock
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How do you resuscitate an infant


A

B C D Airway Breathing Circulation Drugs


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ALUR RESUSITASI

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What organs are commonly damaged by Hypoxia


The

Brain The Kidneys The Heart The Gut The Lungs Haematuria in the newborn infant is a useful clinical marker of prenatal hypoxia.

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Prevention of infections
Exclusive

breastfeeding Keep cord dry Hand washing by care givers Hygiene of baby No unneccessary interventions
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SIX STEPS OF HAND

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Hypothermia
Significant

problem in neonates at birth and even at 24 hrs of age and beyond. Mortality rate twice in hypothermic babies.
Contributes to significant morbidity & mortality.

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Why are newborns prone to develop hypothermia ?


Larger

surface are per unit body weight. Decreased thermal insulation due to lack of subcutaneous fat. Reduced amount of brown fat ( LBW infant).
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Temperature recording
Axillary

temperature recording for 3 minutes is recommended for routine monitoring. Dont record rectal temperature in all babies as a standard protocol. Record rectal temperature in a sick hypothermic neonate.
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Prevention of hypothermia at birth


Delivery

in warm room. Dont bathe immediately after birth. Dry baby immediately with warm clean towel. Warp baby in pre-warmed cloth, cover head. Keep next to mother.
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Signs and symptoms of hypothermia

Peripheral vasoconstriction - acrocyanosis, cool extremities - decreased perfusion CNS depression - lethargy, bradycardia, apnea, poor feeding.
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Signs and/
Increased

metabolism - hypoglycemia, hypoxia, acidosis. Increased pulmonary artery pressure - distress, tachypnea. Chronic signs - weight loss, poor weight gain.
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