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ASPHYXIA NEONATORUM

ASPHYXIA NEONATORUM
FAILED TO BREATH SPONTANEOUSLY AND
FAILED TO BREATH SPONTANEOUSLY AND
REGULARLY
REGULARLY AT
AT BIRTH
BIRTH OR
OR FEW
FEW MINUTE
MINUTE
THEREAFTER
THEREAFTER
80 %
20 %

SPONTANEOUS BREATHING
FAILED

ASPHYXIA
MATERNAL

FETAL

HYPOXIA

HYPOXIA

MATERNAL
MATERNAL FACTOR
FACTOR
FETAL
FETAL FACTOR
FACTOR
PLACENTAL
PLACENTAL FACTOR
FACTOR

ASPHYXIA

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/Sign

Pulse

< 100/mnt

2
>100/mnt

Respiratory
effort

none

grunting

Crying

Muscle tone

Floppy

Partial
flexion

Full flexion.
active

Sensitive to
stimulation

No response Grimace

Crying

Color

Pale

Pink

Blue

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
AB
BC
C Resuscitation
Resuscitation

A ( air way ) Make sure


airway
airway is
is open
open
B ( breathing) Starting breath
breath
C (circulation) Maintain
circulation
C (circulation) Maintain
circulation

INITIAL
INITIAL STEP
STEP
of
of
RESUSCITATION
RESUSCITATIO
N
Prevent
* PreventHeat
Heat
Loss
Loss
Airway
* Airway
cleaning,
cleaning,
Proper
Proper
baby
baby
position,
position,
suctioning
suctioning
mouth
mouth
then nose
then nose
Stimulate
* Stimulate
respiration
respiration
if if
needed
Asses
* Asses
baby
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
HR < 100
Muscle Tone decrease

Thick
Meconeu
m

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
Medicatio
n

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
DR
J<
<60
60
Continue PPV
+ Chest
compress

H R <100

HR > 100

Continue
PPV

Look for
spontaneous
breathing
Stop PPV
Provide
O2
,gradually
reduced

CHEST
CHEST
CHEST
Indication
Indication ::

Hypoxemia

Compression
Compression
Compression
HR
HR
HR

<
<
<

60
x/mnt
60
60 x/mnt
x/mnt
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
Compress heart
heart through
through
the
the
bone
bone
Increasing
Increasing Intra
Intra thoracal
thoracal
pressure
pressure
Ensure
Ensure blood
blood circulation
circulation
in vital
in vital
organ
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