MANAGEMENT OF BIRTH ASPHYXIA Overview of Birth Asphyxia
• Birth asphyxia: Failure of a newborn infant to establish spontaneous respiration
(breathing) immediately after delivery
• Also referred to as asphyxia neonatorum
• Perinatal asphyxia is an insult to the foetus or newborn due to lack of oxygen and/or a
lack of perfusion to various organs
• Perinatal asphyxia can cause hypoxic ischemic encephalopathy (HIE) which is cellular
damage within the central nervous system (brain and spinal cord) from inadequate oxygen
• Birth asphyxia is a serious clinical problem worldwide
• Each year approximately 4 million babies are born asphyxiated, which results in 1 million
deaths and an equal number of serious numerous neurological and neuropsychiatric
disorders (such as cerebral palsy, mental retardation and epilepsy)
• Birth asphyxia is one of the very common neonatal problems in our country and is the
most common cause of newborn admission in hospitals.
Causes birth Asphyxia
• Maternal Causes
o Prolonged labour
o Obstructed labour
o Breech delivery in full-term infants
o Antepartum haemorrhage (APH)
o Pregnancy induced hypertension (pre-ecclampsia)
o Diabetes mellitus
o Drugs (e.g. halothane, pethidine, diazepam)
o Anaemia
o Sedation
o Smoking.
• Placental and/or foetal causes
o Cord compression
o Cord prolapsed
o Cord occlusion
o Placental infarction
o Prematurity
o Birth injuries
o Multiple births
o Intra uterine growth restriction (IUGR) (may be the cause or the result of hypoxia)
o Foetal anomalies
o Respiratory distress syndrome (RDS).
Clinical Features of Birth Asphyxia
• Lethargy
• Generalized hypotonia
• Absent or diminished moro and grasp reflexes
• Apnoea
• Fits/seizures
• Respiratory rate > 60 or < 30 breaths/minute
• Cyanosis
• Slow heart rate
• Multiorgan dysfunction is a hallmark of HIE
• Organ systems involved include:
o CNS
May present with neonatal seizures, lack of activity mediated by cranial nerves,
reduced and or asymmetry/absence in movement and posture, generalized
hypotonia
o Heart
May present as reduced myocardial contractility, severe hypotension
o Lungs
Respiratory distress, some infants may require ventilation
o Renal
Renal failure presenting as oliguria, and during recovery may have significant
water and electrolyte imbalances
o Gastrointestinal
Elevated liver function test results, poor peristalsis and delayed gastric emptying
are common; necrotizing enterocolitis is rare (intestinal problems may not be
apparent in the first few days of life or until feeds are initiated)
o Hematologic
Anaemia, neutropenia or neutrophilia, thrombocytopenia, jaundice and
coagulopathy
o Immune system
Increased risk of infections.
Assessment and Management of Birth Asphyxia
Assessment
• The assessment of asphyxiated infant must be done immediately (just) after delivery
• Is done using the APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score in
the first and fifth minutes respectively
• Determination of the APGAR score should NEVER preclude proper resuscitation
techniques.
Management •Clear airways (suction, wiping)
• Ventilation by using Ambu bag or oxygen if available
• Position
• Keep a newborn dry and warm
• Gently stimulate newborn with drying, rubbing of back, extremities.
• If convulsing, give phenobarbitone 10-20mg/kg IM