Birth asphyxia management

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Birth asphyxia management

  1. 1. Birth asphyxia-management<br />tobindominic<br />2006 mbbs<br />
  2. 2. failure to initiate and sustain breathing at birth<br />Incidence 3-5%,pmr-26%<br />Hypoxia,hypoperfusion,hypercapnia,acidosis<br />Multiorgan dysfunction-HIE<br />Risk factors-poor predictors<br />
  3. 3.
  4. 4. Etiology-placental insufficiency<br />Each delivery is an emergency<br />Resuscitation success<br />anticipation<br />adequate preparation<br />timely evaluation<br />quick & correct action<br />Preparation: warm towels,suctiondevices,self inflating bag,2 infant masks,radiantheater,clock<br />
  5. 5.
  6. 6. Basic resuscitation<br />Provide warmth<br />Clear airway<br />Dry,stimulate,reposition<br />Evaluation <br />Signs: respiration,HR &colour<br />Apgar score not a prerequisite<br />
  7. 7. Oxygen 100% flow @ 5l/mntpersistent cyanosis-PPV<br />
  8. 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<br />
  9. 9. If no chest riseHR evaluation<br />
  10. 10. Chest compressions<br />HR < 60 even after 30 seconds adequate ventilation with 100% oxygen<br />Thumb technique& 2 finger technique<br />ventilate between compressions<br /> 90compressions + 30 breaths/mnt<br /> 3 compressions n 1.5sec & ventilaton for .5sec<br />Do not lift thumbs/fingers off the chest<br />Monitor periodically carotid /femoral pulse<br />Dangers:trauma,broken ribs,laceration of liver,pneumothorax<br />Evaluate<br />
  11. 11. Medications<br />if hr<60, despite adequate ventilation with 100%oxygen & chest compression for 30 sec<br />to stimulate heart,increase tissue perfusion & restore acid base balance<br />Epinephrine(1:1000) .1 to.3ml/kg iv umbilical vein,orendotracheal tube if iv not accessible<br />Volume expanders if shock,isotonic crystalloid(normal saline/ringer lactate) 10ml/kg umbilical vein<br />Nalaxone if respiratory depression with history of narcotic administration,.25ml/kg iv<br />adrenaline<br />Sodium carbonate if prolonged asphyxia & metabolic acidosis<br />
  12. 12.
  13. 13. Endotracheal intubation<br />Considered at any steps,used rarely<br />Indications<br />Diaphragmatic hernia<br />BMV ineffective<br />Tracheal suction is required (nonvigorous baby MSL)<br />Prolonged BMV<br />If any medications<br />
  14. 14. Post resuscitation care<br />keep baby with mother<br />Put to breast feeding asap (risk of hypoglycemia)<br />Examine the baby 4 anomalies,hypothermia,danger signs<br />Monitor temp,po2,pco2,perfusion,glucose,metabolic profile. treat cerbralodema,seizures<br />Record resuscitation<br />counsel on complications<br />Normal breathing ,body temp ,ocassional cry, good suckling & movements <br />discharge<br />
  15. 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<br />Non-initiation of resuscitation<br />gestation < 23 weeks<br />birthweight < 400 grams<br />anencephaly ,severe hydrocephaly<br />confirmed trisomy 13 or 18<br />Renal agenesis<br />Congenital malformations<br />If risk of high survival morbidity & mortality<br />Discontinuation<br />even after 10mnts of resuscitation, if no signs of life <br />
  16. 16. Bag and mask –the most important tool in newborn resuscitation<br />Thank you<br />

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