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Birth Asphyxia
Definition
When the baby does not initiate and sustain adequate
breathing at birth is called birth asphyxia.
Magnitude
Neonatal Resuscitation
Introduction:
We cannot tell which babies will have asphyxia at
birth. Therefore we must prepared to do newborn
resuscitation at all births. If a few minute pass
before the starts to breath, baby can suffer from
brain damage or die. Preparing for resuscitation
include, warming the resuscitation area, preparing
clean surface for the resuscitation and collecting
the equipments and supply.
Preparation of personnel
Ideally at every delivery one person whose primary
responsibility is the baby and who is capable of doing
resuscitation.
Anticipated high risk birth-at least 2 person with
varying degree of resuscitation skills.
If only one person to care for both mother and baby:
if baby needs resuscitation , do resuscitation in a
place where you can observe the mothers perineum
for bleeding or ask a family member to look for
bleeding.
III. Reposition
If the baby still not crying or breathing reposition the baby with
slightly extended the head. Some time the head may be flexed
which may difficult for breathing.
IV. Stimulate for breathing*
If the baby is not breathing, stimulation can be provided by
flicking the bottom of the foot or rubbing up and down the back
with your hand over the cloth while the other persons proceed
with resuscitation and assessment.
V. Give O2 (as necessary)
*Important: If meconium present, baby not vigorous - do not
stimulate until after clearing airway.
Evaluate
Respiration
Heart rate
Color
Decide action based on evaluation
Give supportive care: if the baby breathing, heart rate is above
100, the baby is pink and has good tone baby may be given to
mother for warmth, breast feeding and love. This baby will need
frequent assessment of color, tone and vial signs for the first six
hours. It should be done within first 30 seconds.
Keep warm, stimulate and give oxygen (if available): If the
baby is breathing, heart rate is above 100 but baby has cyanosis.
This baby will need frequent assessment of color, tone and vital
signs for the first six hours.
If the baby is not breathing or is gasping or the heart rate <100,
Start Ventilation to the baby.
In the health post or home setting or facility level id the baby still
is not breathing after 20 minutes of resuscitation, stop
resuscitation.
STEP IV. Provide positive pressure ventilation with chest
compression
If heart rate < 60 bpm despite adequate ventilation:
Support circulation by starting chest compressions while
continuing ventilation. Then, evaluate again
Chest Compression:
Almost all babies needing help at birth will respond to successful
lung inflation with an increase in heart rate followed quickly by
normal breathing. However, in some cases chest compression is
necessary.
in babies, the most efficient method of delivering chest
compression is to grip the chest in both hands in such a way that
the two thumbs can press on the lower third of the sternum,
Drugs
Drugs are needed rarely and only if there is no significant cardiac
output despite effective lung inflation and chest compression.
The drugs used include adrenaline (1:10,000), occasionally sodium
bicarbonate (ideally 4.2%) and dextrose (10%). They are best delivered
via an umbilical venous catheter.
The recommended intravenous dose for adrenaline is 10 mcg kg-1
(0.1ml kg-1 of 1:10,000 solution). If this is not effective, a dose of up to
30 mcg kg-1(0.3 ml kg-1 if 1:10,000 solution) may be tried.
If the tracheal route is used, it must not interfere with ventilation or
delay acquisition of intravenous access. The tracheal dose is thought to
be between 50-100mcg kg-1.
The dose for sodium bicarbonate is between 1 and 2 mmol of
bicarbonate kg-1 (2 to 4 ml of 4.2% bicarbonate solution).
The dose of dextrose recommended is 250 mg kg-1 (2.5 kg -1 of 10%
dextrose).
Records
- Prepare a referral note
- Prepare records for health facility and for family to take home
Do follow -up
Care after unsuccessful resuscitation
Counsel/advice mother and family
- Talk with them about the babys death and answer their questions
- Ask the mother and family if they want to see and hold the baby
- Explain to the mother and family about the mothers care
- Rest, support and good diet
- Management of engorged breasts
Records
- Recording and notification of babys birth and death
- Completion of required medical records for the delivery
Do follow-up care of the mother