ASPHYXIA

NEONATORUM
PRESENTER:JUMA MASOUD MD/8/20/012/TZ
Outlines
• Definition
• Causes
• Classification
• Clinical presentation
• Complications
• Diagnosis
• Investigations
• Treatment
• Preventions
Definition
• Asphyxia neonatorum is also known as birth asphyxia or perinatal
asphyxia.
• Asphyxia neonatorum is the insult to fetus or newborn due to lack of
oxygen[hypoxia] and/or lack of perfusion[ischemia] to various organs.
• WHO define birth asphyxia as failure to initiate and sustain
spontaneous breathing after birth and fetal hypoxia is inadequate
oxygenation before delivery, APGAR score of <7
• It is often associated with tissue lactic acidosis and hypercarbia and
multiorgan dysfunction.
Causes of birth asphyxia
Cord prolapse
Classification of birth asphyxia
• Birth asphyxia is classified from moderate/mild to severe by using the
APGAR SCORE soon after the baby is delivered.
• The classification depend on the severity of the clinical symptoms and
signs baby present with after delivery, scoring is at first minute and
five minute, when baby scores lower in first minute the medical staff
intervene and scoring the baby at five minutes, and if so up to 10
minute.
Cont..
Cont..
• Severe birth asphyxia: with APGAR score of 0-3: No breathing
require bag and mask ventilation and medication.
• Moderate/Mild birth asphyxia with APGAR score of 4-6: Requires bag
and mask ventilation with 100% oxygen to initiate breathing.
• Normal condition with APGAR score of 7-10
Clinical presentation of birth asphyxia
• Poor pulse and circulation
• Weak muscles and reflexes
• Amniotic fluid stained with meconium
• Seizures
• Baby being lethargic
• Low blood pressure
• cyanosis
• Anuria, oliguria
• Lack of breathing or difficulty breathing
• secretions
• Too much acid in blood (acidosis)
Complication of birth asphyxia
Late complications of birth asphyxia
• Developmental delay
• Cerebral palsy
• Mental retardation
• Behavioral abnormalities
• Seizures, epilepsy.
• Visual and auditory processing difficulty
HYPOXIC-ISCHAEMIC
ENCEPHALOPATHY(HIE)
• It is a clinical condition characterized by generalized neurologic
dysfunction emanating from hypoxic injury to the brain tissues.
• It is an important cause of permanent damage to CNS tissues that
may result in neonatal death or manifest later as cerebral palsy or
developmental delay.
• Hypoxic- Ischemic Encephalopathy is categorized into three stages
Stage I , Stage II , and stage III.
• A detail classification of HIE in term neonates was proposed by Sarnat
and Sarnat . And simple and practical classification of HIE by severity
of manifestation provided by Levene is recommended for routine
use.
HIE STAGING BY LEVENE
Cont..
• Mild (stage I) always recovers when symptoms of HIE are carefully
monitored and treated appropriately.
• Moderate(stage2) should be back to normal by 7 to 10 days if
recovery is to be good, Overall 25% disability
• Severe(stage 3) nearly 100% disability or death
Diagnosis & investigation of Birth Asphyxia
• No confirmatory test to diagnose asphyxia
• Investigation are done to assess the severity of brain injury and to monitor the functional status
of systemic organs investigation are
• FBC
• Septic culture
• Urinalysis(ketones and ammonia)
• Ultrasound scan
• CT-scan
• MRI
• EEG
• Screening test in utero
• RFT and LFT
• Serum Electrolytes
Treatment and Management
• Principles of management
Supportive therapy
Anticonvulsants
Cerebral protective interventions and
monitoring
Management and monitoring
• Birth asphyxia and HIE are perinatal emergencies that require quick clinical
evaluation and prompt treatment
• Maintain body temperature, avoid hyperthermia as it increases the severity of
adverse outcome in neonates with moderate to severe HIE ( 33.0º-34.0ºC for 72h)
• Maintain the airway and adequate ventilation
• Cardiac resuscitation when heart rate persist below 80 beats per minute
• Perfusion and blood pressure management, about to avoid decreased cerebral
perfusion
• Careful fluid management to avoid hypotension
• Treatment of seizures
• Treatment of hypoglycemia
Cont...
DETERMINANTS OF
NEURODEVELOPMENTAL
OUTCOMES
• Failure to establish respiration by 5 minutes
• Apgar 3 or less in 5 m
• Onset of seizure in 12 hrs.
• Refractory convulsion
• Stage III HIE
• Inability to establish oral feed by 1 week
• Abnormal EEG and failure to normalize by 7 days of life
• Abnormal CT and MR in neonatal period
Treatment
• Adrenaline 0.01-0.3 mg/kg of 1:10,000 solution by intravenous route incase
of cardiac resuscitation
• Dextrose if hypoglycemia given by 5ml/kg of 10% Dextrose Intravenous
fluid
• Sodium hydrogen carbonate (NaHCO3) can be used for correction of
acidosis. This is used only after respiration is established because CO2 can
further depress the respiration.
• 10% Calcium gluconate using 2ml/Kg diluted and given by Intravenous
route slowly
• Phenobarbitone (in HIE) using 20mg/Kg loading dose stat and then 3-
5mg/Kg/day for 48-72 hrs.
Cont..
• Injection vitamin K 1mg start
• Iv D10 in first 3 days then DNS
• Injection ampicillin 50 mg/kg or injection gentamycin 2.5 mg/kg
( reduce dose of gentamycin in neonate)
• Injection X-pen 0.1MU/kg
prevention
• Health education- educate the masses about it, early ANC booking
• Specific protection- identify risks in pregnancy and institute
preventive measures
• Early diagnosis and treatment-identify, neonatal resuscitation and
treat asphyxia promptly
• Limitations of disabilities-physiotherapy
• Rehabilitations -integration of mother and the baby into community
through counselling especially at developmental delay.
References
• Ghai Essential pediatrics 8^th edition
• WHO pocket book for pediatrics
• Baby Nelson pediatrics
• Post –resuscitation management of asphyxiated neonates as retrived
from newbornwhocc
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