Birth asphyxia management

1. Birth asphyxia-management t obin dominic 2006 mbbs

2. failure to initiate and sustain breathing at birth Incidence 3-5%,pmr-26% Hypoxia,hypoperfusion,hypercapnia,acidosis Multiorgan dysfunction-HIE Risk 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

3. Etiology-placental insufficiency Each delivery is an emergency Resuscitation success anticipation adequate preparation timely evaluation quick & correct action Preparation: warm towels,suction devices,self inflating bag,2 infant masks,radiant heater,clock

4. Basic resuscitation Provide warmth Clear airway Dry,stimulate,reposition Evaluation Signs: respiration,HR & colour Apgar score not a prerequisite

5. Oxygen 100% flow @ 5l/ mnt persistent cyanosis-PPV

6. PPV Self inflating bag & face mask BMV indications contraindications -diaphragmatic hernia(non vigourous babies MSL) procedure : 240-750ml, 90-100% oxygen @5-6l/ mnt or room air neck slightly extended appropriate face mask & seal it compress & w/f chest rise ventilation @40-60 breaths/ mnt adequate pressure-indicator evaluate HR If ppv >2mnts,orogastric tube for abdomen decompression

7. 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

8. Chest compressions HR < 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

9. Medication s if hr<60, despite adequate ventilation with 100%oxygen & chest compression for 30 sec t o stimulate heart,increase tissue perfusion & restore acid base balance Epinephrine (1:1000) .1 to.3ml/kg iv umbilical vein,or endotracheal tube if iv not accessible Volume expanders if shock,isotonic crystalloid(normal saline/ringer lactate) 10ml/kg umbilical vein Nalaxone if respiratory depression with history of narcotic administration,.25ml/kg iv adrenaline Sodium carbonate if prolonged asphyxia & metabolic acidosis

10. Endotracheal intubation Considered at any steps,used rarely Indications Diaphragmatic hernia BMV ineffective Tracheal suction is required ( nonvigorous baby MSL) Prolonged BMV If any medications

11. Post resuscitation care keep baby with mother Put to breast feeding asap (risk of hypoglycemia) Examine the baby 4 anomalies,hypothermia,danger signs Monitor temp,po2,pco2,perfusion,glucose,metabolic profile. treat cerbral odema,seizures Record resuscitation counsel on complications Normal breathing ,body temp , ocassional cry, good suckling & movements discharge

12. 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 resuscitation gestation < 23 weeks birthweight < 400 grams anencephaly ,severe hydrocephaly confirmed trisomy 13 or 18 Renal agenesis Congenital malformations If risk of high survival morbidity & mortality Discontinuation even after 10mnts of resuscitation, if no signs of life

13. Bag and mask –the most important tool in newborn resuscitation Thank you