1. Birth asphyxia-management tobindominic 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

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

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

7. Oxygen 100% flow @ 5l/mntpersistent cyanosis-PPV

8. PPVSelf inflating bag & face mask BMVindicationscontraindications-diaphragmatic hernia(non vigourous babies MSL)procedure: 240-750ml, 90-100% oxygen @5-6l/mnt or room airneck slightly extendedappropriate face mask & seal itcompress & w/f chest riseventilation @40-60 breaths/mntadequate pressure-indicator evaluate HRIf ppv>2mnts,orogastric tube for abdomen decompression

9. If no chest riseHR evaluation

10. 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

11. Medications if hr<60, despite adequate ventilation with 100%oxygen & chest compression for 30 sec to stimulate heart,increase tissue perfusion & restore acid base balance Epinephrine(1:1000) .1 to.3ml/kg iv umbilical vein,orendotracheal 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

13. 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

14. 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 cerbralodema,seizures Record resuscitation counsel on complications Normal breathing ,body temp ,ocassional cry, good suckling & movements discharge

15. Practices not beneficial:Slapping the newborn, soaking it in cold water, sprinkling it with water,,milkingthe cord,Tactilestimulation,Routineaspiration of upper airway,Routinegastric suctioning,posturaldrainage,slapping the back,squeezingchest,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

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