Birth Asphyxia

Birth asphyxia
Content
Introduction
Definition
Aetiology/ Types
Epidemiology
Pathophysiology
Clinical presentation
Management
Complications
Introduction
About 10% of neonates require a certain degree
of resuscitation at birth, but most involve
asphyxia with an increased incidence in babies
with low birth weight.
Definition
Lack of oxygen and perfusion to vital organs.
This is a condition caused by the inadequate intake of
oxygen before, during, or just after birth.
This is a neonatal emergency as it may lead to
possible brain damage or death if not corrected
immediately.
Epidemiology
In Ghana, the main causes of neonatal deaths in 2015 were
prematurity (28.8 percent), birth asphyxia (28.3 percent)
and sepsis (18.9 percent).
In a research conducted in 2017 at KBTH, out of 468 term babies

who were admitted to the NICU, 283 representing 61.8% were
admitted on account of birth asphyxia.
In Dormaa Presby Hospital, a total of 84 cases of Neonatal asphyxia
has been recorded within the past 9 month in 2018.
Aetiology/ Types
MATERNAL FACTORS FETAL FACTORS
Chronic illnesses: Diabetes mellitus, Hypertension Prematurity/ Post Maturity
Infections: UTI, malaria Respiratory Distress syndrome
Placenta Previa Meconium Aspiration syndrome
Placenta Abruptio Sepsis
Polyhydramnious IUGR, Fetal macrosomia
Cord Prolpase
PROM, Prolong labour, Instrumental delivery

Types of Asphyxia
Asphyxia can be classified into mild, moderate and
severe birth asphyxia based on the severity of the
symptoms and the apgar scores.
A low Apgar score is not by itself diagnostic of
perinatal asphyxia but is associated with a risk of
long-term neurologic dysfunction.
Pathophysiology
Before birth oxygen is delivered across the

placental membrane from mother's blood to
baby's blood with very little blood passing through
the lung (the vessels are closed), rather it passes
through the Ductus arteriosus to the aorta and
the lungs are filled with fluid, not with air.
Pathophysiology
At birth, the fluid in the alveoli is absorbed as they begin to fill with
air, the rise in PaO2 and decline in prostaglandin concentration cause
closure of the ductus arteriosus.
Now the baby is breathing air and using his lungs to get oxygen.
Generally asphyxia results from interruption of placental blood flow
with resultant fetal hypoxia, hypercapnia and acidosis.
Prolonged insults of hypoxemia results in hypoxic ischemic injury
leading to cell death.
APGAR SCORE
Score
Sign 0 1 2
Colour Blue, pale Blue hands, pink body Completely pink
Heart rate Absent Slow <100 >100 per min
respiration absent Slow, irregular Good, crying
Muscle tone limp Some flexion Active flexion
Reflex response No response Grimace Cough, sneeze

Clinical Features
Cyanosis, bluish appearance
Bradycardia
Depression of respiratory effort, Gasping
Poor muscle tone (floppy baby) and reflexes
Weak Cry
Seizures
Investigations
FBC
Blood Glucose
Blood, Urea and electrolyte
Chest X ray
Echocardiography
Blood Gases
Management(Neonatal Resuscitation)
Management( Neonatal Resuscitation)
Baby not breathing
Ventilate at 40breathes per minute with improved ventilation( reposition

and reapply the mask, open mouth and clear secretions, squeeze the bag)
If after 1 minute HR <60bpm after effective ventilation, give chest
compressions ( 3 compressions: 1 breathe for 30s) till HR >100bpm
Give oxygen at higher concentration.
Check every 1-2mins for spontaneous breathing and respiration >30cpm
If HR < 60bpm, consider other ventilatory support(intubation) and give IV
adrenaline at (0.3mg/kg).
Management
Monitor Breathing: oxygen <90%(Spo2 check)
Monitor HR, RR, urine output, temperature and neurological status.
Correct shock with IVF per Kg
Keep on maintenance fluid (60mls- day 1)
Control Seizures( phenobarbitone)
Antibiotic cover for moderate to severe asphyxia
Keep NPO 24-48hrs
Maintain normal temperature and head cooling.
Complications
Hypoxic Ischemic encephalopathy
Persistent Pulmonary hypertension
Necrotizing enterocolitis
Acute Kidney Injury
Feeding intolerance
Cerebral Palsy
References
Matthew A. Rainaldi, Jeffery M. Periman. (2016). Pathophysiology of
birth asphyxia, Vol 43,Pg 409-422..
Elk Grove Village,(2011) IL: American Academy of Pediatrics.
WHO-MCEE estimates for child causes of death, 2000-2015.
The Merck Manual of Diagnosis & Therapy, 19th Edition.
Robert M. Kliegman et al,(2011). Nelson textbook of paediatrics, 19th
ed.
WHO (2013). Pocket book of hospital care for children: guidelines for
the management of common childhood illnesses – 2nd ed.

Birth Asphyxia

Uploaded by

Copyright:

Available Formats

Birth Asphyxia

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Birth Asphyxia

Uploaded by

Copyright:

Available Formats

Birth asphyxia

In a research conducted in 2017 at KBTH, out of 468 term babies

Chronic illnesses: Diabetes mellitus, Hypertension Prematurity/ Post Maturity

Infections: UTI, malaria Respiratory Distress syndrome

Placenta Previa Meconium Aspiration syndrome

Placenta Abruptio Sepsis

Polyhydramnious IUGR, Fetal macrosomia

PROM, Prolong labour, Instrumental delivery

Before birth oxygen is delivered across the

Colour Blue, pale Blue hands, pink body Completely pink

Heart rate Absent Slow <100 >100 per min

respiration absent Slow, irregular Good, crying

Muscle tone limp Some flexion Active flexion

Reflex response No response Grimace Cough, sneeze

Ventilate at 40breathes per minute with improved ventilation( reposition

You might also like