birth asphyxia management
TRANSCRIPT
Birth asphyxia-management
tobin dominic2006 mbbs
failure to initiate and sustain breathing at birthIncidence 3-5%,pmr-26%Hypoxia,hypoperfusion,hypercapnia,acidosisMultiorgan dysfunction-HIERisk factors-poor predictors
antepartum intrapartum
GDM,PIH,DM,HTN CS,traumatic delivery
Maternal age >35 or <16
Premature labour
Maternal infections Prolonged labour
Poly/oligohydraminos Abnormal presentation
Post term gestation GA,sedation.analgesics
Multiple gestation Prolapsed cord
Maternal drug abuse ROM >24 hrs
Bleeding p/v Non reassuring FHR pattern
Congenital anomalies Meconium+ amniotic fluid
Etiology-placental insufficiencyEach delivery is an emergencyResuscitation success anticipation adequate preparation timely evaluation quick & correct actionPreparation: warm towels,suction devices,self
inflating bag,2 infant masks,radiant heater,clock
Basic resuscitationProvide warmthClear airwayDry,stimulate,repositionEvaluation Signs: respiration,HR &colourApgar score not a prerequisite
Oxygen 100% flow @ 5l/mntpersistent cyanosis-PPV
Breathing,HR>100,pink
Observational care
Breathing,HR.>100cyanotic Oxygen
supplimentationObservational
care
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
Apneic,HR<100
Persisting cyanosis
PPVPost
resuscitation care
If no chest rise
HR evaluation
ACTION CONDITIO CORRECTED
Reapply mask Inadequate seal
Reposition head Blocked airway
Check for secretions & suction Blocked airway
Ventilate with open mouth Blocked airway
Increase pressure slightly Inadequate pressure
HR ACTION
>100 If spontaneous resp present,discontinue ventilation gradually, tactile stimulation & monitor
60 -100 Continue ventilation
<60 Continue ventilation,start chest compressions
Chest compressionsHR < 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
Medicationsif hr<60, despite adequate ventilation with 100%oxygen &
chest compression for 30 secto stimulate heart,increase tissue perfusion & restore acid
base balanceEpinephrine(1:1000) .1 to.3ml/kg iv umbilical vein,or
endotracheal tube if iv not accessibleVolume expanders if shock,isotonic crystalloid(normal
saline/ringer lactate) 10ml/kg umbilical veinNalaxone if respiratory depression with history of narcotic
administration,.25ml/kg ivadrenalineSodium carbonate if prolonged asphyxia & metabolic acidosis
Endotracheal intubationConsidered at any steps,used rarelyIndicationsDiaphragmatic herniaBMV ineffectiveTracheal suction is required (nonvigorous
baby MSL)Prolonged BMVIf any medications
Post resuscitation carekeep baby with motherPut to breast feeding asap (risk of
hypoglycemia)Examine the baby 4
anomalies,hypothermia,danger signsMonitor
temp,po2,pco2,perfusion,glucose,metabolic profile. treat cerbral odema,seizures
Record resuscitationcounsel on complicationsNormal breathing ,body temp ,ocassional cry,
good suckling & movements discharge
Practices not beneficial:Slapping the newborn, soaking it in cold water, sprinkling it with water,,milking the cord,Tactile stimulation,Routine aspiration of upper airway,Routine gastric suctioning,postural drainage,slapping the back,squeezing chest,sodium bicarbonate
Non-initiation of resuscitationgestation < 23 weeksbirthweight < 400 gramsanencephaly ,severe hydrocephalyconfirmed trisomy 13 or 18Renal agenesisCongenital malformationsIf risk of high survival morbidity & mortalityDiscontinuation even after 10mnts of resuscitation, if no signs of life
Bag and mask –the most important tool in newborn resuscitation
Thank you