Birth asphyxia is one of contributors to neonatal death, Some of the causes are easily preventable. Health care workers should be equipped with knowledge, skills, equipment and supplies for management of asphyxiated newborns.
• Birth asphyxia occur when the fetus is deprived of
an adequate supply of oxygen at birth.
Failure to initiate or maintain spontaneous resp at birth .
• Intrauterine Hypoxia is used to describe
inadequate oxygen availability during the gestation
• Perinatal asphyxia a state of decreased oxygen
delivery to the fetus or neonate resulting in
inadequate tissue perfusion.
Common cause of perinatal death
BA may occur
Immediately prior to(intrauterine),
During( intrapartum) or
Just after delivery(postpartum).
There is considerable controversy over the diagnosis
of birth asphyxia due to medicolegal reasons
Because of its lack of precision, the term is avoided
in modern obstetrics
Requirements for resp
• Intact neuro and resp apparatus
• Clear airway
• Adequate alveolar area
• Expanded alveoli with surfactant
• Sufficient pulmonary perfusion
• Satisfactory lymphatic drainage
• Oxygen diffusion and dissociation capacity
• Carbonic anhydrase activity of the blood
Why birth asphyxia?
10% NB need some
1% more adv
717,000 (23%) NB
deaths related to
Incidence for sev.
BA. 1/1000 V.S 510
Where Tz stands
2.9miln NB deaths in
1.8mln in 10 countries
alone making up
Same account for
nearly 57% of MD
Tz , IMR 65.74 deaths
per 1,000 live births
NMR rate of 26 deaths
per 1000 live births in
Hege et al 2012, Birth asphyxia , a major cause of neonatal mortality in Northern
Tanzania. (Journal American Academy of Paediatrics) prospective study at
Persistent pulmonary hypertension of the newborn
Severe circulatory insufficiency (eg, acute blood loss, septic
Congenital heart diseaseal
When deprived of oxygen, either before or after
birth, infants demonstrate a well-defined sequence
of events leading to apnea
Oxygen deprivation results initially in a transient
period of rapid breathing.
If such deprivation persists- primary apnea.
This stage is accompanied by a fall in heart rate and loss of
Simple stimulation and exposure to oxygen will usually reverse
If oxygen deprivation and asphyxia persist
the infant will develop deep gasping respirations followed by
a further decline in heart rate,
falling blood pressure,
loss of neuromuscular tone
Infants in secondary apnea
will not respond to stimulation
will not spontaneously resume respiratory efforts.
Unless ventilation is assisted, death will occur
Clinically, primary and secondary apnea are
thus, secondary apnea must be assumed
resuscitation of the apneic infant must be started immediately.
Apgar score Vs birth asphyxia
Apgar score-based on characteristics of
, muscle tone,
assessed and assigned a value of 0 to 2
1-min As reflects the need for immediate
-effectiveness of resuscitative efforts.
prognostic significance for neonatal survival,
- 1 in 5000 (scores 7 to 10),
1 in 4( scores of 3 or less)
There has been erroneous definitions of asphyxia
and prediction for subsequent neurological outcome
basing upon low Apgar scores
certain elements of the Apgar score are partially
dependent on the physiological maturity of the
a healthy preterm infant may receive a low score only because
Apgar scores may be influenced by a variety of
to equate the presence of a low Apgar score solely
with asphyxia or hypoxia represents a misuse of the
The Apgar score alone cannot establish hypoxia as
the cause of cerebral palsy
Criteria for Neurological Injury to be related to
• Profound metabolic or mixed acidemia (pH<7.0)
• Early onset of severe or moderate neonatal
encephalopathy in infants born at 34 or more weeks
• Cerebral palsy of the spastic quadriplegic or
• Exclusion of other identifiable etiologies such as
trauma, coagulation disorders, infectious conditions,
or genetic disorders.
Antenatal high risk detection
Close fetal monitoring
Intrapartum use of electronic fetal monitoring
Judicious administration of anaethetics and sedatives during
A (air way)
Complications of BA
BA can cause HIE
manifesting with-in 48 hours of birth
This results in an increased mortality rate, including an
increased risk of SIDS.
Oxygen deprivation have been implicated in
HIE classification sarnat and sarnat
• Grd1: Mild:
– hyperalert, hyperexcitable, normal muscle tone, no seizures
– sympathetic over-stimulation with tachycardia, dilated
pupils and jitteriness. EEG is normal
• Grd2: Moderate:
– hypotonia, decreased movements, coupious secretions
– EEG is abnormal and 70% of infants will have seizures
• Grd3: Severe:
– stuporous, flaccid, and absent primitive reflexes, usually
– The infant may have seizures and has an abnormal EEG with
decreased background activity and/or voltage suppression.