BIRTH ASPHYXIA
Prof RL Mbise
PCH, IMTU
BIRTH ASPHYXIA
OTHER NAME: ASPHYXA
NEONATORUM
Definition
[Link] of the baby on the part of the
baby (newborn infant) to establish
spontaneous respiration immediately
following complete delivery
[Link] of hypoxia after birth resulting in
Apgar score below 7
Etiology
Fetal Anoxia
This has been operational before the
birth of the baby. It is divided into
i. Anoxia resulting from inadequate
supply of oxygen. It arises from:
Maternal CCF
Maternal pneumonia
Maternal bronchial asthma
Bronchitis
Emphysema
Severe PIH.
All of which lower the O2 tension in
the mother’s circulation
ii. Anaemic hypoxia
This is due to severe anaemia of the
foetal blood, so severe that it cannot
carry sufficient oxygen to meet the
needs of the baby’s body tissues.
This occurs in:
Rh incompatibility
Foetal haemorrhage
Foeto-maternal transfusion
iii. Stagnant anoxia due:
Compression of the cord
Cord prolapse
Knotting of the cord
iv. Histotoxic anoxia due to poisoning
or damage of the foetal tissues
especially the CNS by:
Drugs - Pethidine
- Chloroethylene
- Morphine
- Hyoscine and related drugs
Natal and Postnatal anoxia
[Link] placenta
[Link] baby – intra-ventricular
haemorrhage
[Link] hernia
[Link] web
Diagnosis
Use of APGAR SCORE
Sign Score
0 1 2
1 Appearance Blue/pale Body pink Completely
(colour) extremities pink
blue
2 Pulse (heart rate) absent <100 >100
3 Grimace (reflex No Grimace Cry
activity) response
4 Activity (muscle Limp Some flexion of Active motion
tone) (flaccid) limbs
5 Respiration absent Slow or irregular Regular
(respiratory effort) strong cry
TREATMENT
[Link] Naso and oropharynx through
suction
[Link] neck
[Link] stimulation
[Link] ventilation with face mask
and bag (Ambu Bag) – positive
pressure ventilation. Give 100%
oxygen (see below)
[Link] heart beat after 15-30 seconds
Birth asphyxia:
Start External Cardiac massage (chest
compression with 2 thumbs) on mid
third part of sternum
If (a) Heart rate <60 beats/min or
(b) Heart beat between 60-80
beats/min but does not
increase.
Proceed with cardiac compression on
the basis of “squeeze” “one” “two”
squeeze sequence so that the heart
rate is about 90 beats/min
Stop cardiac compression if the heart
beat is above 80 beats/min. There is
an easy rise of chest with each breath.
Since cardiac compression and PPV
are going on at the same time, they
should be done in such a way that PPV
does not interfere with cardiac
compression. So, PPV is given for
every 3 cardiac compressions.
6. Put in a nasogastric tube to deflate the
stomach (feeding tube 6-8 F) if PPV
lasts > 2 minutes
7. Put in an endotracheal intubation tube
Indications of tracheal intubation
a)When prolonged PPV is required
b)When bag and mask is in-effective
c)When tracheal suction is required
d)When diaphramatic hernia is
present
Drugs
[Link] bicarbonate – 8.4%
-1mmol/ml
[Link] 1:10,000 I.V or via
endotracheal tube – when heart rate
<60/min
[Link] as antidote to opiates
(0.4mg/ml)
[Link] – 10%
Stop resuscitation if no breathing after
30 min.
5. Other drugs
[Link] 5-20µg/kg/min by
continuous iv infusion, or
[Link] 2-20µg/kg/min by
continuous iv infusion if there is
hypotension or shock
Prognosis
Immediate complications
A few cases die during the acute stage
because of immediate complications
which include:
[Link]
[Link]
[Link]
[Link] ischaemic encephalopathy
Late complications
These vary with the severity of the
asphyxia neonatorum:
Some of the survivors have long-term
residual brain damage manifesting as:
• Brain damage
• Cerebral palsy
3. Epilepsy
4. Disorders of speech including
mutism
5. Deafness etc
Helping Babies Breathe (HBB)
Introduction
Helping babies breathe is an evidence-
based educational program to teach
neonatal resuscitation techniques in
resource-limited areas.
It is an initiative of the American
Academy of Pediatrics (AAP) in
collaboration with the following
organizations:
World Health Organization (WHO),
US Agency for International
Development (USAID),
Save the Children's Saving Newborn
Lives programme,
National Institute of Child Health and
Development (NICHD), and
A number of other global
health stakeholders
Tanzania has adopted the programme
and has already trained 40 trainers who
will train other health care workers and
ultimately midwives and birth attendants.
Rationale
Birth asphyxia is one of the major causes
of newborn death in regions with limited
resources.
Training midwives and other birth
attendants to help babies start breathing
immediately after birth if they need help
may prevent stillbirths and newborn
deaths in the developing world.
Proper implementation of this strategy
will probably get 90 to 93 percent of
babies breathing who were not breathing
before.
Objective
The objective of HBB is to train birth
attendants in developing countries in the
essential skills of newborn resuscitation,
with the goal of having at least one
person who is skilled in neonatal
resuscitation at the birth of every baby.
The Golden Minute
A key concept of HBB is The Golden
Minute. Within one minute of birth, a
baby should be breathing well or should
be ventilated with a bag and mask.
The Golden Minute identifies the steps
that a birth attendant must take
immediately after birth to evaluate the
baby and stimulate breathing.
Strategy
HBB curriculum is designed to be used
as part of a coordinated educational
approach to early neonatal care and can
be effectively combined with other
curricula.
It can be locally taught to birth attendants
in diverse venues and locations.
HBB focuses on practices that all
persons who care for babies at birth can
learn to care for healthy babies and/or
assist babies who do not breathe on their
own.
Helping Babies Breathe emphasizes:
Skilled attendance at birth
Assessment of every baby immediately
at birth
Suction, if necessary
Drying the baby
Temperature support
Stimulation to breathe, and
Assisted ventilation as needed, all
within "The Golden Minute" after birth.
HBB has developed a comprehensive
training solution, which includes:
An evidence-based educational
program
Culturally sensitive, pictorial-based
learning materials including a Learner
Workbook, Action Plan wall poster,
and Facilitator Flip Chart.
Realistic newborn simulator with
ability to imitate an umbilical pulse,
bag-mask ventilators, and bulb suction
that can be cleaned by boiling.
All equipment has been tested for
durability in a variety of climates and
teaching conditions and will be made
available at cost to MDG countries.
An ongoing mentorship program to
provide:
Expert assistance
Implementation guidance
Knowledge exchange
Integration and evaluation support,
and
Continuous quality improvement for
sustained practice outcomes and
decreased infant mortality.
HBB has a system-based focus
designed to change clinical practice
across systems of care.
Because the initiative is tailored for low-
income environments, it could take us a
step closer to achieving MDG 4 to
reduce child mortality by two thirds
before 2015.
HBB equipment
A demonstrating how to help babies breathe
END
