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Detecting and Treating Newborn Asphyxia

Skilled providers who are trained in simple resuscitation methods can make a real difference in
saving newborns with asphyxia.
Newborn asphyxia, the inability of a newborn to • Immediately after birth: Infection or preterm
initiate and sustain breathing at birth, is one of the newborn
leading causes of newborn deaths in developing
countries. According to the World Health Organization, Some conditions, such as high blood pressure and
4 to 9 million cases of newborn asphyxia occur infections (such as HIV and syphilis), may cause
Because up to half each year, accounting for about 20 percent of all complications at any point before, during or after
of all newborns who
need resuscitation newborn deaths. More than a million newborns labor and childbirth.
have no identifiable who survive asphyxia at birth develop long-lasting
risk factors before problems such as cerebral palsy, mental retardation, Women who experience any of these complications
birth, providers and speaking, hearing, visual and learning disabilities. may be at greater risk of having a baby with
should be prepared
respiratory distress at birth. However, because up
to resuscitate every
baby. Often caused by health conditions in the mother to half of all newborns who need resuscitation have
or complications during labor or childbirth, newborn no identifiable risk factors before birth, providers
asphyxia is treatable if women and their newborns should be prepared to resuscitate every baby.
receive skilled healthcare during labor and childbirth. Although asphyxia can sometimes be predicted
Basic, effective resuscitation can save the majority during labor, it is often not discovered until a baby
of newborns who develop asphyxia. Many babies is born.
in the developing world who suffer from birth
asphyxia do not receive resuscitative care, however, The incidence of newborn asphyxia is highest in
in part because their families do not have access developing countries because women in low-resource
to skilled providers who know how to use simple settings are more likely to experience predisposing
resuscitation methods and equipment. circumstances such as poor health before and during
their pregnancy, complications during pregnancy,
Recognizing that a skilled provider can make the labor or childbirth, and lack of access to skilled
difference in saving the life of a newborn in distress, healthcare.
the Maternal and Neonatal Health (MNH) Program
advocates the presence of a skilled provider at every Detecting Birth Asphyxia:
birth and promotes and provides training in simple, The Role of the Skilled Provider
low-cost methods for detecting and treating newborn The presence of a skilled provider during labor
asphyxia. and childbirth significantly increases rates of infant
survival in the developing world. Skilled providers
Causes and Predisposing Factors can use simple techniques to monitor labor and
Newborn asphyxia can be caused by conditions that evaluate the health of the woman and the newborn
occur before, during or immediately after labor and before, during and after the birth.
childbirth, including the following:
Following the recommendation of the World Health
• Before labor: Pre-eclampsia or eclampsia, Organization, the MNH Program supports the use
infection, bleeding of the partograph during labor for all women. The
• During labor and childbirth: Premature or partograph is a simple chart that providers use to
prolonged labor, malpresentation (abnormal fetal monitor and record the progress of labor and to
position), general anesthesia during a cesarean identify the need for additional care. Using a
section, bleeding partograph can significantly decrease the likelihood
of prolonged labor and other complications that The Role of Care during Pregnancy
can lead to newborn asphyxia. To help promote overall health and the early detection
of conditions that may lead to birth asphyxia, the
As part of the process of monitoring labor, providers MNH Program advocates that all women receive
should monitor and record the fetal heart rate. focused antenatal care from a skilled provider.
Monitoring the fetal heart rate, especially during the Focused antenatal care consists of interventions
second stage of labor, can help diagnose fetal distress aimed at preventing and detecting problems such as
and signal the need for intrapartum intervention or anemia and pre-eclampsia that may contribute to
postpartum resuscitation of the newborn. A fetal other serious complications during pregnancy and
heart rate that is very slow or very rapid suggests childbirth.
that the fetus is in distress and may need further
intervention. While antenatal care will not necessarily prevent
newborn asphyxia, it can help to ensure that both the
Newborn Resuscitation: mother and her baby are as healthy as possible at
A Simple, Effective Approach the time of birth. Antenatal care visits also provide
A simple self-inflating bag and small mask can be an ideal opportunity for providers to counsel
used to resuscitate most newborns with asphyxia. women about issues related to birth preparedness
In most cases, any skilled provider who is trained and complication readiness, including danger signs
in good resuscitation skills and who continues to during pregnancy and labor and the importance of
maintain those skills can easily perform the procedure. seeking care from a skilled provider at birth. Women
More complex procedures, such as intubation and should be encouraged to plan to give birth where
the use of oxygen, are needed only in about 10 resuscitative care is immediately available.
percent of cases of birth asphyxia, when the
newborn’s prognosis is very poor. MNH Program Activities
The MNH Program promotes these approaches to
Providers should quickly assess the newborn’s detecting and treating newborn asphyxia through its
condition at birth and take immediate action if dissemination of clinical guidelines manuals, such as
the baby appears to be in distress. Following the Managing Complications in Pregnancy and Childbirth and
guidelines outlined in the Managing Complications in Management of Newborn Problems (forthcoming from For more information
Pregnancy and Childbirth manual (published by the the World Health Organization and JHPIEGO with about the MNH
World Health Organization in 2000), the MNH BASICS), and through its clinical training for Program visit our
Program recommends that resuscitation be started healthcare providers. website:
if a baby does not cry or breathe at all or is gasping www.mnh.jhpiego.org
after birth. While keeping the baby wrapped for MNH Program clinical training participants learn
warmth, the provider should use a simple suction to make a rapid assessment of a baby’s condition This publication was made
tube to gently suction the baby’s nose and mouth, at birth and to provide the appropriate response. possible through support
taking care not to introduce the tube deep into the Providers learn that, as long as a baby is crying and provided by the Office of
Health and Nutrition, Center
throat. Then the mask should be placed over the breathing normally, they should avoid any manipulation, for Population, Health and
baby’s nose and mouth, and air should be squeezed such as routine suctioning, which may cause trauma Nutrition, Bureau for Global
from the self-inflating bag through the mask and or introduce infection. If a baby is distressed and Programs, Field Support and
Research, U.S. Agency for
into the baby’s lungs. needs resuscitation, however, the use of the simple International Development,
suction tube and neonatal mask and bag can make under the terms of Award No.
The MNH Program does not promote approaches a real difference in saving the baby’s life. HRN-A-00-98-00043-00.
to resuscitation that are not supported by clinical The opinions expressed herein
are those of the author(s) and
evidence. Techniques such as slapping or hanging The MNH Program promotes this approach to do not necessarily reflect the
an infant by the heels, although commonly used, managing newborn asphyxia because it can be views of the U.S. Agency for
may be traumatic for babies. Another common implemented safely and effectively by all levels of International Development.
practice, the use of sodium bicarbonate, also providers and because the equipment needed for
remains unsupported by clinical evidence and may resuscitation is minimal and the procedure is simple.
be harmful to a newborn. The approach reflects the Program’s focus on low-
technology solutions that are effective and that can
be sustained in areas with few resources.

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