ASPHYXIA NEONATORUM.pptx

ASPHYXIA NEONATORUM

1. ASPHYXIA NEONATORUM & MECONIUM ASPIRATION SYNDROME

2. Normal Respiration Normal newborn takes first respiration : within 6 seconds, majority within first 20 seconds Rhythmic respiration : by 30 seconds, and majority by 90 seconds after birth Normal Rate 40-60/ min

3. ASPHYSIA NEONATORUM

4. Asphyxia neonatorum is the failure to establish spontaneous respiration immediately after complete delivery of the baby Definition

5. Perinatal Asphyxia Defining Criteria

6. Risk Factors

7. Causes Failure of respiratory center prolonged hypoxia, birth trauma, maternal sedatives within 4 hours before delivery and preterm Failure of pulmonary expansion (atelectasis) low alveolar surfactant and poor respiratory movements of preterm baby

8. Causes Obstructed air passage Inhaled mucous or meconium and choanal atresia Circulatory collapse in neonatal shock blood loss or cardiac abnormality

9. Pathophysiology ↓gas exchange Ischemia Hypoxia Hypercapnia Disruption of placental blood flow ↓APGAR MAS ↓ pH Acidosis ↓Fetal blood flow Primary Apnea Redistribution of blood flow Blood flow Renal Pulmonary Hepatic Muscular Blood flow Cerebral Coronary Adrenal Inadequate perfusion to tissues Cerebral ischemia Multiorgan injury Secondary Apnea Failure of compensatory mechanism

10. Stages of Asphyxia

11. Clinical Manifestations Poor/weak/absent cry Apnea, Dyspnea, grunting Hypotonia, limp extremities Cyanosis Bradycardia

12. Management

13. Immediate Care of the Newborn at Birth Step-1 : Dry and stimulate Step-2 : Assess breathing and color Step-3 : Decide if resuscitation is needed Step-4 : Keep warm Step-5 : Tie and cut the cord Step-6 : Start breastfeeding

14. ABCDS of resuscitation: if needed • AIRWAY Make sure the airway is open Position the baby Suction the mouth and nose, and if there is meconium, the pharynx (back of throat ). • BREATHING Make sure the baby is Stimulate to initiate breathing Use mouth to mouth or AMBU bag breathing as necessary Give oxygen, if available

15. ABCDS of resuscitation: if needed • CARDIAC FUNCTION Make sure the heart is beating Stimulate the baby. Do chest compressions when necessary. • DRY THE BABY Warm the baby with a blanket, a light, or the mother’s skin. • SHOCK Make sure the baby is warm and dry.

16. MANAGEMENT: If resuscitation is needed Steps of resuscitation: • Dry & Wrap • Respiration/colour • Decide for resuscitation • Position, mouth to mouth respiration, ambu bag • Cardiac massage • Intubation • Drug

17. Subsequent management: Fluid and nutrition should be maintained by IV 10% dextrose, NG tube feeding or oral feeding. To control seizure: Inj. Phenobarbitone 20mg/kg IV followed by maintenance dose of 5-6mg/kg per day. To control edema: Fluid restriction 20-25% Mannitol may be used IV antibiotic. MANAGEMENT: If resuscitation is needed

18. Resuscitation Procedure A. Environment Maintenance of temperature Radiant heater Warm cloths B. Positioning 1 inch roll of cloth below shoulder

19. Resuscitation Procedure C. Suctioning Should not be done always, when? Meconium in amniotic fluid Asphyxiated baby, first mouth then nose D. Tactile Stimulation Drying Flicking of soles Rubbing the back

20. Resuscitation Procedure E. Assessment Colour Respiratory effort. Heart rate Movements or Muscular activities

21. Resuscitation Procedure F. Ventilation Indications: Apnea Heart rate < 100 beats Persistent central cyanosis Process: Mouth to mouth Mouth to mask Ambu Bag Endotracheal intubation

22. Resuscitation Procedure G. Chest compressions Indications: If heart rate is <60 beats/min or 60-80 beats/min and not rapidly increasing despite adequate ventilation with 100% O 2 for 30 seconds. Discontinuation : Heart rate > 80 b/min

23. Resuscitation Procedure H. Medications : when? Heart rate < 80 b/min despite adequate ventilation with O 2 and chest compression for 30 sec. Route : Umbilical vein Endotracheal tube

24. Resuscitation Procedure What are the drugs used? • Adrenaline: Dose : 0.5-1ml/kg of 1:10,000 • Volume Expanders: Dose:10ml/kg (5 % albumin-Saline or Ringers lactate ) • Sodium Bicarbonate: Prolonged arrest/or profound metabolic acidosis-Dose : 2meq/kg of 4.2% • Naloxone: Dose : 0.1mg/kg of 1mg/ml

25. Postasphyxial Management Thermal control Keep under radiant warmer Maintain Core temp: 36 ºc - 37ºc Skin temp: 36 ºc - 36.3ºc Respiratory Support Supplemental oxygen Ventilation

26. Postasphyxial Management Cardiovascular support If CVP 4-8cm: 10ml/kg of saline If CVP >8cm: Ionotropes Avoid fluid bolus and ↑BP Dobutamine/Dopamine @ 10-20 μ gm/kg/min

27. Postasphyxial Management Fluid therapy & Feeding 10% dextrose @ 60ml/kg/day EBM/NG feeds Oral feeding once gut motility establishes

28. Postasphyxial Management Seizure control Anticonvulsant Loading dose: 20mg/kg Maintenance: 3-5mg/kg BD Cerebral Edema Mng Osmotic diuretic Corticosteroid Hyperventilation Head end elevation

29. MECONUIM ASPIRATION SYNDROME

30. Respiratory manifestation caused by aspiration/inhalation of meconium in amniotic fluid into the tracheobronchial tree Definition

31. Epidemology 130 million annual birth 15 million aspirate meconium 750,000 – 1.8million develop MAS

32. Meconium Meconium is a sterile watery, viscous, greenish yellow, odorless stool passed by the newborn Formed before neonate digests breastmilk

33. Characteristics of meconium pH: 5.5 – 7.0 Watery Moderately stained : greenish yellow Viscous, Opaque Odorless

34. Components of meconium 72 – 78% water Desquamated intestine & skin cells GI mucous Lanugo Pancreatic juice & Bile Fat from Vernix Caseosa Intestinal secretions Amniotic fluid Glycoproteins

35. Risk factors

36. Pathophysiology Ball-valve effect

37. Clinical Features Yellow green staining of nails, umbilical cord and skin Cyanosis , end- expiratory grunting Alar flaring, intercostal retractions Tachypnea, rales, rhonchi Green urine > 24hrs after birth Cerebral irritation signs: seizure & jitteriness

38. Diagnosis Serum studies: Na, K, Ca, CBC ABG Analysis: Hypoxemia, hyperventilation, metabolic acidosis Chest X-ray: Atelectasis, pneumothorax ECG: PHN, R L shunt, tricuspid regurgitation

39. Complications PPHN Parenchymal Pulmonary Disease Air block syndrome Pneumothorax pneumomediastinum

40. Management Suctioning General management Supportive treatment Surfactant therapy

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