detail description

2. PRESENTED BY
JASNA RANI BEHERA
M.SC.NSG 2nd YEAR
ROLL-1888008
BIRTH ASPHYXIA
&
RESPIRATORY DISTRESS

3. 1. Birth Asphyxia
introduction ,defintion
risk factors,pathophysiology
clinical features,management
2. Respiratory distress
 introduction,causes,clinical features
 diagnostic evaluation and management

4. • To define birth asphyxia and respiratory distress.
• To know causes ,sign and symptoms.
• To apply the knowledge to manage in preventing the
birth asphyxia and respiratory distress in newborn.

5. • Birth asphyxia is also known as Asphyxia neonatorum.
It is one of the most common causes of neonatal
death in lndia.

6. • Asphyxia is derived from a Greek word "as-fikse-ah",
which means " Stopping of Pulse "
• A condition due to lack of oxygen in respired air, resulting
in impending or actual cessation of apparent life".

8. • Perinatal asphyxia is defined by following criteria:
1. Apgar score of 3 or less at 5 min.

10. 2.Umbilical arterial blood pH of <7.0.
3.Clinical evidence of hypoxic ischemic encephalopathy.

11. 4.Evidence of multi-organ system dysfunction.

12. • Placental insufficiency
• Maternal age >35 or <16 years
• Traumatic delivery
• Prolonged / premature labour
• Analgesics
• Sedation or drugs depressing the
respiratory centre

13. birth
oxygen enters into lungs,
pulmonary arterioles
normal breathing
relaxation of arterioles

14. birth
decreased oxygen supply to organs
lungs-primary,secondary apnea
heart- -B.P. low,myocardial infraction ,
brain-death ,others organs dysfunction

15. 1.Asphyxia livida or stage of cyanosis -includes respiration
failure with apgar score (4 - 6).
2.Asphyxia pallida or stage of shock-includes combined and
vasomotor failure with apgar score (0-3)

16. • Immediate Management-neonatal resuscitation
• Post asphyxial Management

17. • pre requisities:
room and environment
equipment
prepartion of staff as well receving of baby after birth

18.  Bag and mask(sizes ‘0’ and ‘1’)
 Suction equipment
 Radiant warmer or other heat surface

19.  2 Warm towels
 Clock with second hand
 Scissors

20.  Oxygen source
 Gloves
 Cord tie/cord clamp
 Stethoscope

21. • Dries baby with dry,warm
towel,removes wet towel and
assess if baby is
crying/breathing.
• If not crying, clamps and cut the
cord immediately
• Place the baby on a warm,firm,
flat surface (radiant warmer)

22. • Position the baby in slight
neck extension

23. • Suctioning of mouth and nose.

24. • Stimulates the baby by gently rubbing .
• Re-positions the head.
• Assesses breathing
• If breathing well-provides observational care with
mother
If not breathing well-
Applies appropriately sized mask correctly
Initiate bag and mask ventilation using room air .

25. • Gives 5 ventilatory breaths using room air and looks for
chest rise.
• If there is no chest rise after 5 breaths ,take corrective
measures(corrects the position/sucks mouth and
nose/checks the seal/gives ventilation with increased
pressure)

26. • If there is adequate chest rise, continues bag and ,mask
ventilation for 30 seconds(Breath -2-3)
• Reassesses the breathing after 30 seconds of
ventilation.
• If still not breathing calls for help. Continues bag and
masks ventilation and asks for trained help .

27. • If heart rate is <100/min and baby is still not breathing
, continue bag and mask ventilation and connects
oxygen.
• If help available- chest compression, intubation and
medication by trained person.
• If not - baby not breathing,
refers to higher centre immediately.

28. • If heart rate is ≥100 and baby is breathing well or at any
point, if baby starts breathing, provides observational care
with mother.

29. Goals of management are:
- To evaluate and monitor injury to various organs
- To prevent secondary brain injury
- To document prognostic indicators

30. • Thermal control: radiant warmer,
(Core temperature 36-37 ℃, skin temperature 36.0 -36.3℃ ).
• Respiratory support: supplemental oxygen,Ventilation
in case of severe encephalopathy.
• Cardiovascular support:-10ml/kg of saline to maintain
CVP-5-8 cm if no response than ionotropes etc..
• Seizure control:-anticonvulasnat drugs
• Cerebral edema management: mannitol,corticosteriods etc..

31. Prognosis
Neonates with multisystem failure often die in neonatal
period.survivours may have long term neurodevelopmental
problems .

33. Respiratory distress in neonates is a common emergency life-
threatening condition. It accounts for significant morbidity and
mortality. It occurs in 4 to 6 percent of neonates.

34. • Pulmonary causes:
• Nonpulmonary causes:

35. • Respiratory distress syndrome (RDS) or hyaline
membrane disease (HMD)
• meconium aspiration syndrome (MAS)
• pleural effusion
• congenital malformations like tracheoesophageal fistula
with esophageal atresia (TEF with EA),

36. :
• Perinatal asphyxia
• metabolic acidosis
• cerebral edema
• neurological disorders

37. • presence of tachypnea (respiration rate more than 60
breaths/ minute),
• chest indrawing (subcostal, substernal, intercostal
retractions)
• expiratory grunting (cyanosis, nasal flaring along with
alteration of air entry )

38. • Antenatal and perinatal history-
 gestational age
 prolonged rupture of membrane more than 24 hours,
 presence of asphyxia
• Examination
 Silverman -Anderson scoring
 Downes score
• Chest X-ray

41. • thermoneutral environment- to keep the baby warm with
normal body temperature.
• clear airway - removal of secretions by suctioning.
• oxygen administration- term neonates- 90 to 93%
preterm neonates -88 to 92%.

42. • Continuous monitoring -general condition, respiratory status
(respiration rate, retractions, grunting, cyanosis, nasal flaring),
heart rate. , body temperature and other parameters.
• IV fluid therapy-
• normal blood glucose and calcium level.

43. • Antibiotic therapy- to treat sepsis, if present.
• Surfactant therapy -preterm , RDS.
• routine care ,infection control measures.

44. Antenatal corticosteroid therapy -Preterm Neonates ,
preterm labor or APH, before 34 weeks of pregnancy
Injection betamethasone -12 mg IM every 24 hours with two
doses
or
injection dexamethasone -6 mg IM every 12 hours with four
doses.

45. • Prognosis of this condition depends upon early
identification of problems, cause of respiratory distress
and the time of initiation of treatment.

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press pp-265-268
• 2.Assuma Beebi “Text book of paediatric Nursing”.2016,Elsevier publishers
Haryana.pp-294-297
• 3.Manoj yadav.“Child health nirsing.(with procedures)”.edition 2016.pee vee
publishers.pp-619-622
• 4.Parul datta.“Pediatric nursing.2 nd edition.jaypee publishers.pp-346-348
• 5.Rimple sharma.“Essential of pediatric nursing.2013”.jaypee publishers.pp-539-545
• 6.Suraj Gupte.“The short textbook of Pediatrics”.11th edition.jaypee publishers.PP-
535-540..
• 7.https://www.slideshare.net/aftabasiddiqui18/respiratory-distress-in-newborn-final
• 8.https://www.slideshare.net/SUDESHNABANERJEE10/neonatal-respiratory-distress-
syndrome