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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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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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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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ALUR RESUSITASI
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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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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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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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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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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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