Study birth asphyxia

1. Birth asphyxia
Neonatal Emergencies

2. Asphyxia
 APGAR score at 1 minute < 7
 Interruption in oxygen delivery to the fetus
• Hypoxia
• Hypercapnia

3. Causes of Neonatal Mortality
Infection
32%
Other
5%
Congenital
Anomalies
10%
Birth Asphyxia
29%
Complications
of Prematurity
24%
Source: WHO 2001 estimates (based on data collected around 1999)

4. Etiology
 Birth asphyxia in undeveloped countries
 10% of newborns suffer mild to moderate birth
asphyxia
 1% of newborns suffer severe birth asphyxia

5. Risk factors
Antepartum :
Placental infection post-term gestation
Pregnancy induced hypertension multiple gestation
Chronic hypertension size-dates discrepancy
Previous Rh sensitization maternal drug abuse
Chorioamnionitis maternal age >35 or<16
Bleeding in second or third trimester no prenatal care
Maternal viral infection
Polyhydramnios or oligohydramnios

6. Risk factors
Intrapartum :
Elective or emergency c/s
Precipitous labour, prolonged labour
Prolonged second stage of labour
Premature labour
Abnormal presentation
Rupture of membranes > 24 hours
Instrumental delivery
Intrapartum fever
Use of general anesthesia
Prolapsed cord

7. Effects of Asphyxia
 Central nervous system
• infarction, intracranial hemorrhage,
cerebral edema, seizure, hypoxic-
ischemic encephalopathy (HIE)
 Cardiovascular
• bradycardia, ventricular hypertrophy,
arrhythmia, hypotension, myocardial
ischemia

8. Effects of Asphyxia
 Respiratory system
• apnea, respiratory distress syndrome
cyanosis
 KUB
• acute tubular necrosis, bladder paralysis
 Gastrointestinal tract
• necrotizing enterocolitis , stress ulcer

9. Effects of Asphyxia
 Hematology
• Disseminated intravascular coagulation
 Metabolic
• hypoglycemia, hyperglycemia,
hypocalcemia, hyponatremia
 Integument
• subcutaneous fat necrosis

10. Hypoxic-ischemic encephalopathy(HIE)
 Hypoxic-ischemic encephalopathy is an
important cause of permanent damage to
central nervous system cells, which may
result in
- neonatal death
- manifest later as cerebral palsy or
mental deficiency

11. Assessment
 Thick meconium-stained amniotic fluid
 Apgar score (also assess at 15 & 20 min)
 Level of consciousness
 Presence of acidaemia
 Muscle tone
 Sucking
 Seizures
 Reflexes
 Respirations

12. Management- this is an emergency!
 ABC !
 Vitals + all findings from assessment,
including CRT & Urine output monitoring.
 Volume expansion with NS (or Ringers
lactate) 10mls/kg over 5-10 min if CRT<2sec
 10% dextrose
 Cefotaxime
 1mg Vitamine K
 20mg/kg IV stat Phenobarbitone if having seizures
 Refer for further management!