Title: Chapter 3 Problems of the neonate and young infant - Birth Asphyxia
1Chapter 3Problems of the neonate and young
infant -Birth Asphyxia
2Case study Baby boy of Ruth
- Baby of Ruth is a boy born at term. He is blue
and has poor muscle tone. He doesn't cry.
3- Assessment of newborn at delivery
4- Assessment of newborn at delivery
YES Start the resuscitation now!
Remember A,B,C Airway,
Breathing Circulation NO Early
Essential Newborn Care
Does baby of Ruth need resuscitation?
5- (Ref. WHO pocket book p.47)
6Neonatal resuscitation (AAirway)
- Open airway by positioning the head in the
neutral position (Ref. p. 47) - Clear airway and suction, if necessary
- Stimulate, reposition
- Give oxygen, as necessary
Ruths baby is still blue and not breathing.
7Neonatal resuscitation (B Breathing)
- Use a correctly fitting mask
- If the baby is still not breathing (Ref. p. 47)
- Check position and mask fit
- Continue to give breaths at rate
- of 40 breaths per minute
- Use oxygen if available
- Every 1-2 minutes stop and
- see if the pulse or breathing has improved
- Observe the baby closely!
8Neonatal resuscitation (CCirculation)
- You check the heart rate (HR)
- What steps would you take next?
9Early Essential Newborn Care
- Immediate and thorough drying with a clean cloth
- Maintain skin-to-skin contact
- Give the baby to mother as soon as possible, on
chest or abdomen - Cover the baby to prevent heat loss
- Properly time cord clamping
- Wait for up to 1 - 3 mins or until pulsations
stop. Keep umbilical cord clean and dry. - Breastfeeding and non-separation
- Initiate within the first hour keeping mother and
baby together - Further Management after 1hr
- Give vitamin K (phytomenadione), according to
national guidelines 1 ampoule IM once - Apply antiseptic ointment or antibiotic eye drops
(e.g. tetracycline) to both eyes once
(prophylaxis), according to national guidelines - Full examination and weight
10History
Baby boy of Ruth was born at term. He came out
not crying, blue and with poor muscle tone. He
was resuscitated for 2 minutes. Rupture of
membranes happened at home, contractions were
regular. His mother, Ruth, G1 P1, was in labour
for a long period of time, but progressed to
normal delivery in hospital. No chronic illness
and no pre-eclampsia were diagnosed before.
11Examination after stabilisation
After 2 minutes bag-mask resuscitation baby was
breathing well, muscle tone has increased. He was
crying. Vital signs pulse 120/min, RR
50/min Weight 3.2 kg Chest air entry was good
bilaterally and there were no added sounds, no
chest indrawing Cardiovascular both heart sounds
were audible and there was no murmur Abdomen
soft, bowel sounds were active Neurology muscle
tone improved, no focal signs
12What supportive care and monitoring are required?
13Monitoring
- The baby has to be monitored frequently
- Pay attention to colour, breathing, muscle tone
and ability to suck
14Monitoring (continued)
- In the days after birth asphyxia the baby may
develop following problems (Ref. p. 51-52) - Convulsions
- check glucose
- treat with phenobarbital
- Apnoea
- oxygen by nasal catheter
- resuscitation with bag and mask
- Inability to suck
- feed with milk via a nasogastric tube
Treat only if the problems arise
15Supportive Care
- If no evidence of birth asphyxia at delivery
provide normal care for newborn - Give the baby to mother as soon as possible,
place on chest or abdomen - Cover the baby to prevent heat loss
- Encourage initiation of breastfeeding within the
first hour - Keep umbilical cord clean and dry
- Give vitamin K 1 ampoule IM single dose
- Apply antiseptic ointment or antibiotic eye drops
(e.g. tetracycline) to both eyes once
(prophylaxis) - (Ref. p. 46, p. 50)
16Breastfeeding support
- Early and exclusive breastfeeding is important
for all newborns - Breastfeeding support
- Encouragement
- Breastfeeding friendly environment
- Breastfeeding assessment and counselling
- (Ref. p. 295)
17Progress
- Ruths babys motor tone recovered well in the
first hour. After some difficulties at the
beginning he was sucking well. - Before he was discharged home he also received
oral polio, hepatitis B and BCG vaccines. -
18Follow-up
- Baby should receive regular MCH follow-up to
monitor - Growth and development
- Nutritional intake
- Immunization status
- Detection of other illnesses or problems
19Summary
- Be prepared for resuscitation at every delivery
- Dont need oxygen in most cases, bag-mask
ventilation will stimulate the baby to breathe on
its own - Prognosis for the baby with perinatal asphyxia
can be predicted by recovery of motor function
and sucking ability - The prognosis is good for babies who respond
quickly to resuscitation - Learn all steps of neonatal resuscitation,
practice and teach others