Birth asphyxia-management

tobin dominic2006 mbbs

failure to initiate and sustain breathing at birthIncidence 3-5%,pmr-26%Hypoxia,hypoperfusion,hypercapnia,acidosisMultiorgan dysfunction-HIERisk factors-poor predictors

antepartum intrapartum

GDM,PIH,DM,HTN CS,traumatic delivery

Maternal age >35 or <16

Premature labour

Maternal infections Prolonged labour

Poly/oligohydraminos Abnormal presentation

Post term gestation GA,sedation.analgesics

Multiple gestation Prolapsed cord

Maternal drug abuse ROM >24 hrs

Bleeding p/v Non reassuring FHR pattern

Congenital anomalies Meconium+ amniotic fluid

Etiology-placental insufficiencyEach delivery is an emergencyResuscitation success anticipation adequate preparation timely evaluation quick & correct actionPreparation: warm towels,suction devices,self

inflating bag,2 infant masks,radiant heater,clock

Basic resuscitationProvide warmthClear airwayDry,stimulate,repositionEvaluation Signs: respiration,HR &colourApgar score not a prerequisite

Oxygen 100% flow @ 5l/mntpersistent cyanosis-PPV

Breathing,HR>100,pink

Observational care

Breathing,HR.>100cyanotic Oxygen

supplimentationObservational

care

PPVSelf inflating bag & face mask BMVindicationscontraindications-diaphragmatic hernia(non vigourous babies MSL)procedure: 240-750ml, 90-100% oxygen @5-6l/mnt or room airneck slightly extendedappropriate face mask & seal itcompress & w/f chest riseventilation @40-60 breaths/mntadequate pressure-indicator evaluate HRIf ppv>2mnts,orogastric tube for abdomen decompression

Apneic,HR<100

Persisting cyanosis

PPVPost

resuscitation care

If no chest rise

HR evaluation

ACTION CONDITIO CORRECTED

Reapply mask Inadequate seal

Reposition head Blocked airway

Check for secretions & suction Blocked airway

Ventilate with open mouth Blocked airway

Increase pressure slightly Inadequate pressure

HR ACTION

>100 If spontaneous resp present,discontinue ventilation gradually, tactile stimulation & monitor

60 -100 Continue ventilation

<60 Continue ventilation,start chest compressions

Chest compressionsHR < 60 even after 30 seconds adequate ventilation with

100% oxygen

Thumb technique & 2 finger technique

ventilate between compressions

90compressions + 30 breaths/mnt

3 compressions n 1.5sec & ventilaton for .5sec

Do not lift thumbs/fingers off the chest

Monitor periodically carotid /femoral pulse

Dangers:trauma,broken ribs,laceration of liver,pneumothorax

Evaluate

Medicationsif hr<60, despite adequate ventilation with 100%oxygen &

chest compression for 30 secto stimulate heart,increase tissue perfusion & restore acid

base balanceEpinephrine(1:1000) .1 to.3ml/kg iv umbilical vein,or

endotracheal tube if iv not accessibleVolume expanders if shock,isotonic crystalloid(normal

saline/ringer lactate) 10ml/kg umbilical veinNalaxone if respiratory depression with history of narcotic

administration,.25ml/kg ivadrenalineSodium carbonate if prolonged asphyxia & metabolic acidosis

Endotracheal intubationConsidered at any steps,used rarelyIndicationsDiaphragmatic herniaBMV ineffectiveTracheal suction is required (nonvigorous

baby MSL)Prolonged BMVIf any medications

Post resuscitation carekeep baby with motherPut to breast feeding asap (risk of

hypoglycemia)Examine the baby 4

anomalies,hypothermia,danger signsMonitor

temp,po2,pco2,perfusion,glucose,metabolic profile. treat cerbral odema,seizures

Record resuscitationcounsel on complicationsNormal breathing ,body temp ,ocassional cry,

good suckling & movements discharge

Practices not beneficial:Slapping the newborn, soaking it in cold water, sprinkling it with water,,milking the cord,Tactile stimulation,Routine aspiration of upper airway,Routine gastric suctioning,postural drainage,slapping the back,squeezing chest,sodium bicarbonate

Non-initiation of resuscitationgestation < 23 weeksbirthweight < 400 gramsanencephaly ,severe hydrocephalyconfirmed trisomy 13 or 18Renal agenesisCongenital malformationsIf risk of high survival morbidity & mortalityDiscontinuation even after 10mnts of resuscitation, if no signs of life

Bag and mask –the most important tool in newborn resuscitation

Thank you