Birth asphyxia

1. BIRTH ASPHYXIA
Mohebullah Faqiri, MD
E-mail: mohabfaqiri@gmail.com
7.20.1015
4/22/2020
1
SARDAR MOHAMMAD DAWOOD
KHAN NATIONAL MILITARY
HOSPITAL

2. ‫افغانستان‬ ‫اسالمی‬ ‫جمهوری‬ ‫دولت‬
‫ملی‬ ‫دفاع‬ ‫وزارت‬
‫داود‬ ‫محمد‬ ‫سردار‬ ‫شهید‬ ‫شفاخانه‬‫خان‬
‫دیپارتمنت‬‫اطفال‬ ‫داخله‬
4/22/2020
2
‫موضوع‬:Birth Asphyxia
‫ترتیب‬‫کننده‬:‫فقیری‬ ‫هللا‬ ‫محب‬
‫رهنما‬ ‫استاد‬:‫خان‬ ‫عارف‬ ‫متخصص‬

3. ‫تعریفات‬
• Anoxia:
• Complete lack of oxygen.
• Hypoxia:
• Decreased availability of oxygen
• Hypoxemia:
• Decreased arterial concentration of oxygen.
• Ischemia:
• Insufficient blood flow to cells or organ
resulting in interrupted metabolism and death
of the cell or organ affected.
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4. PERINATAL ASPHYXIA (PA)
Perinatal asphyxia, neonatal asphyxia
or birth asphyxia .
‫زیږیدلی‬ ‫نوی‬ ‫په‬ ‫چی‬ ‫دی‬ ‫حالت‬ ‫طبی‬ ‫یو‬
‫وجه‬ ‫په‬ ‫محرومیت‬ ‫د‬ ‫اکسیجن‬ ‫د‬ ‫کی‬ ‫ماشوم‬
‫خاص‬ ‫په‬ ‫او‬ ‫فزیکی‬ ‫د‬ ‫حالت‬ ‫دا‬ ‫او‬ ‫پیداکیږی‬‫ه‬
‫ګرځی‬ ‫سبب‬ ‫افت‬ ‫دماغی‬ ‫د‬ ‫توګه‬.
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5. ‫تعریف‬
Perinatal Asphyxia
۱-‫څخه‬ ‫زیږنی‬ ‫ړی‬‫بشپ‬ ‫د‬ ‫یوماشوم‬ ‫چیری‬ ‫که‬
‫شروع‬ ‫تنفس‬ ‫ډول‬ ‫بنفسهی‬ ‫په‬ ‫سمدستی‬ ‫وروسته‬
‫یادیږی‬ ‫نوم‬ ‫به‬ ‫داسفکسیا‬ ‫زیږیدنی‬ ‫د‬ ‫نکړی‬
۲-‫لومړنیو‬ ‫په‬ ‫عمر‬ ‫د‬ ‫ماشوم‬ ‫چیری‬ ‫که‬۱-۵‫اپګار‬ ‫د‬ ‫کی‬ ‫دقیقو‬
‫د‬ ‫درجه‬ ‫سکور‬۵‫د‬ ‫شی‬ ‫ټیټ‬ ‫یی‬ ‫اچ‬ ‫پی‬ ‫وینی‬ ‫د‬ ‫یا‬ ‫او‬ ‫شی‬ ‫ښکته‬ ‫څخه‬
‫کیږی‬ ‫بلل‬ ‫اسفکسیا‬ ‫زیږیدنی‬.
۳-‫کاربن‬ ‫هایپوکسیا،د‬ ‫دپرمختللی‬ ‫چی‬ ‫کله‬ ‫هر‬ ‫نظره‬ ‫له‬ ‫بیوشیمی‬ ‫د‬
‫اسیدوزس‬ ‫کی‬ ‫نتیجه‬ ‫په‬ ‫زیاتوالی‬ ‫د‬ ‫اسید‬ ‫لکتیک‬ ‫او‬ ‫اکساید‬ ‫دای‬
‫یادیږی‬ ‫نامه‬ ‫په‬ ‫اسفکسیا‬ ‫د‬ ‫زیږیدنی‬ ‫د‬ ‫راشی‬ ‫منتځته‬.
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6. BIRTH ASPHYXIA
‫د‬ ‫هندوستان‬ ‫د‬NNF‫نظره‬ ‫له‬ ‫کتاب‬:
Gasping‫تنفس‬ ‫د‬ ‫یا‬ ‫تنفس‬ ‫ناکافی‬ ‫یا‬‫نه‬
‫د‬ ‫کی‬ ‫دقیقه‬ ‫لمړی‬ ‫په‬ ‫ژوند‬ ‫د‬ ‫موجودیت‬
Birth Asphyxia‫یادیږی‬ ‫نامه‬ ‫په‬.
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7. AMERICAN ACADEMY OF
PEDIATRICS CRITERIA
•‫د‬umbilical‫وینی‬ ‫دشریانی‬PH‫د‬>7
•‫سکور‬ ‫اپګار‬ ‫کی‬ ‫دقیقه‬ ‫پنځمه‬ ‫په‬>_3
•Neonatal Encephalopathy‫کیدل‬ ‫ښکاره‬ ‫عالیمو‬
‫لکه‬seizures, hypotonia or coma
•‫یاد‬multi organ dysfunction‫شواهدو‬
‫موجودیت‬. 4/22/2020
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8. BIRTH ASPHYXIA
•Birth Asphyxia =
Perinatal Asphyxia =
Neonatal Asphyxia.
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8

9. ‫وقوعات‬
•
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10. PERINATAL ASPHYXIA
•Perinatal Asphyxia‫د‬infection,
prematurity،LBW‫الملونه‬ ‫عمده‬ ‫مړینی‬ ‫د‬ ‫شمول‬ ‫په‬
‫جوړوی‬.
•‫د‬ ‫کی‬ ‫ماشومانو‬ ‫په‬ ‫دا‬neurodevelopmental‫افت‬
‫او‬disability‫ګرځی‬ ‫سبب‬.
•‫د‬perinatal asphyxia‫د‬ ‫اصطالح‬Birth Asphyxia
‫او‬ ‫کی‬ ‫جریان‬ ‫په‬ ‫مخکی‬ ‫زیږینی‬ ‫د‬ ‫دا‬ ‫چی‬ ‫دی‬ ‫حالت‬ ‫پیشقدم‬ ‫یو‬‫د‬ ‫هم‬
‫شی‬ ‫کیدالی‬ ‫واقع‬ ‫وروسته‬ ‫زیږینی‬.
4/22/2020
10

11. 4/22/2020
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12. Cause Deaths
(n = 1800)
Prematurity 27 %
Infection 17 %
Perinatal hypoxia 29 %
Malformation 09 %
Other causes 18 %
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‫الملونه‬ ‫لمړنی‬ ‫مړینی‬ ‫د‬ ‫کی‬ ‫زیږیدلوماشومانو‬ ‫نوی‬ ‫په‬

13. ۴‫کیږی‬ ‫مړه‬ ‫ماشومان‬ ‫میلیونه‬–‫کی‬ ‫حال‬ ‫پداسی‬
‫چی‬‫دی‬ ‫حالتونه‬ ‫وقایه‬ ‫د‬ ‫قابل‬ ‫ټول‬ ‫دا‬ ‫تقریبآ‬
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14. 4/22/2020
14
Causes of neonatal death
(n=258)
Not
established
14.7%
Others
10.7% Birth asphyxia
20.9%
Infection
33.2%
Prematurity
15.2%
Congenital
malformation
5.4%
Others: Hypothermia, RD, Jn, Pulm. Haemorrhage,
Seizure etc.

15. PHYSIOLOGY OF ASPHYXIA
‫د‬ ‫یاوروسته‬ ‫مخکی‬ ‫یعنی‬ ‫کی‬ ‫حالته‬ ‫دواړه‬ ‫په‬ ‫ماشوم‬ ‫یو‬ ‫چی‬ ‫کله‬
‫راځی‬ ‫منځته‬ ‫مرحلی‬ ‫دوه‬ ‫نو‬ ‫شی‬ ‫اخته‬ ‫اسپکسیا‬ ‫په‬ ‫څخه‬ ‫زیږیدنی‬‫چی‬
‫لمړی‬Primary Apnea‫تعقیب‬ ‫په‬ ‫ددی‬ ‫او‬secondary
Apnea‫کیږی‬ ‫واقع‬.
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16. PRIMARY APNEA
•‫چی‬ ‫لپاره‬ ‫ددی‬ ‫نو‬ ‫شی‬ ‫محروم‬ ‫څخه‬ ‫اکسیجن‬ ‫د‬ ‫ماشوم‬ ‫چی‬ ‫کله‬
‫زیاتوی‬ ‫تعداد‬ ‫تنفس‬ ‫د‬ ‫لمړی‬ ‫کړی‬ ‫السه‬ ‫تر‬ ‫اکسیجن‬.
•‫د‬ ‫حرکات‬ ‫تنفسی‬ ‫نو‬ ‫پیداکړی‬ ‫دوام‬ ‫هم‬ ‫نوره‬ ‫اسپکسیا‬ ‫چی‬ ‫کله‬‫د‬ ‫ریږی‬
‫عضلی‬ ‫عصبی‬ ‫کوی‬ ‫شروع‬ ‫لویدو‬ ‫په‬ ‫سره‬ ‫تدریج‬ ‫په‬ ‫ضربان‬ ‫زړه‬‫تون‬
‫حالت‬ ‫دی‬ ‫،چی‬ ‫وی‬ ‫نورمال‬ ‫فشار‬ ‫وینی‬ ‫د‬ ‫اما‬ ‫کمیږی‬ ‫سره‬ ‫تدریج‬ ‫په‬
‫ته‬primary apnea.‫وای‬
‫یالمس‬ ‫واسطه‬ ‫په‬ ‫الس‬ ‫د‬ ‫کی‬ ‫جریان‬ ‫په‬ ‫مرحله‬ ‫ددی‬ ‫او‬‫ی‬
‫ګرځی‬ ‫سبب‬ ‫راګرځیدو‬ ‫دبیا‬ ‫دتنفس‬ ‫تحریک‬.
•‫شی‬ ‫سبب‬ ‫پیداکیدو‬ ‫بیا‬ ‫د‬ ‫تنفس‬ ‫د‬ ‫کیدایشی‬ ‫مرحله‬ ‫لمړی‬. 4/22/2020
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17. SECONDARY APNEA
•‫دوام‬ ‫هم‬ ‫نوره‬ ‫اسپکسیا‬ ‫ی‬ ‫چیر‬ ‫که‬‫پ‬‫یداکړی‬Deep gasping
respiration‫طرف‬ ‫کمیدو‬ ‫ضربان‬ ‫دزړه‬ ‫کوی‬ ‫پرمختګ‬ ‫ته‬ ‫مرحلی‬
‫یا‬ ‫حسه‬ ‫بی‬ ‫تقریبآ‬ ‫ماشوم‬ ‫او‬ ‫کوی‬ ‫سقوط‬ ‫فشار‬ ‫وینی‬ ‫د‬ ‫ځی‬ ‫ته‬‫فلج‬
‫وی‬
•‫چی‬ ‫ضعیف‬ ‫ډیر‬ ‫کی‬ ‫حالت‬ ‫پدی‬ ‫تنفس‬ ‫ماشوم‬ ‫د‬Gasp‫لری‬ ‫حالت‬
‫د‬ ‫ته‬ ‫داحالت‬secondary apnea‫وایی‬ ‫مرحله‬.
•‫ت‬ ‫مرحلی‬ ‫لمړی‬ ‫بیا‬ ‫کوالی‬ ‫نشی‬ ‫ماشوم‬ ‫کی‬ ‫جریان‬ ‫په‬ ‫مرحلی‬ ‫ددی‬‫ه‬
‫شی‬ ‫والړ‬.
4/22/2020
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18. APGAR SCORE

19. APGAR Score
 7-10 points : The newborn should be
active and vigorous. Provide routine
care.
 4-6 points : The newborn is
moderately depressed. Provide
stimulation and oxygen.
 0-3 points : The newborn is severely
depressed and requires extensive
resuscitation.

20. APGAR SCORE
• Total Score = 10
score 7-10 normal
score 5-6 mild birth asphyxia
score 3-4 moderate birth Asp
score 0-2 severe birth asphyxia

21. ‫د‬BIRTH ASPHYXIA‫اسباب‬
• Multifactorial,
• Antepartum:
• Placental Insufficiency.
• Intrapartum, and
• Postpartum period.
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22. PLACENTAL INSUFFICIENCY
• Impaired maternal oxygenation,
• Decreased blood flow from the mother to the
placenta,
• Decreased blood flow from placenta to fetus,
• Impaired gas exchange across placenta or fetal
tissues,
• Increased fetal oxygen requirement.
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23. IMPAIRED MATERNAL
OXYGENATION
• Anemia,
• Pulmonary, or
• Cardiac, or
• Neurologic disease in mother.
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24. DECREASED BLOOD FLOW
FROM THE MOTHER TO THE
PLACENTA
• Maternal Infection,
• Shock,
• Dehydration, and
• Hypotension.
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25. DECREASED BLOOD FLOW
FROM THE PLACENTA TO
THE FETUS
•Placental
abruption,
•Cord Prolapse,
•Cord
Entanglement,
• True Knot,
• Cord
Compression,
• Abnormality of the
umbilical vessels.
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26. IMPAIRED GAS EXCHANGE ACROSS
PLACENTA OR FETAL TISSUES
• Maternal Hypertension,
• Vascular Disease,
• Diabetes,
• Drug Abuse,
• Post-Maturity,
• Placental Calcification, infarct or fibrosis.
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27. INCREASED FETAL
OXYGEN REQUIREMENT
•Fetal Anemia,
•Fetal Infection, or
•IUGR
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28. CAUSES
•‫مخکی‬ ‫نه‬ ‫دوالدت‬(Maternal Causes)
•Inadequate oxygenation of
maternal blood.
•Low Maternal Blood Pressure.
•‫کی‬ ‫وخت‬ ‫په‬ ‫دوالدت‬(Fetal or
Neonatal Causes)
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29. INADEQUATE OXYGENATION
OF MATERNAL BLOOD
• Hypoventilation during anesthesia,
• Cyanotic Heart Disease,
• Respiratory Failure,
• CO Poisoning.
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30. LOW MATERNAL BP
• Acute Blood Loss,
• Spinal Anesthesia,
• Great Vessels compression by gravid
uterus.
• Uterine Tetany (oxytocin induced)
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31. LOW MATERNAL BP
(CONTINUED)
• Premature separation of placenta,
• Compression of knotting of umbilical
cord,
• Placental insufficiency due to toxemia
or post maturity.
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32. AT BIRTHS
• Failure of oxygenation:
• Fetal Cyanotic Congenital Heart
Disease,
• Severe Pulmonary Distress.
• Severe Anemia
• Severe Hemorrhage,
• Hemolytic Disease.
• Shock
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33. SHOCK
•Sepsis,
•Massive Blood Loss,
•Intra-Cranial Hemorrhage,
•Adrenal Hemorrhage.
4/22/2020
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34. CAUSES OF
HYPOTENSION
•Myocardial Dysfunction,
•Capillary Leak Syndrome,
and
•Hypovolemia.
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35. ‫یااختالطات‬ ‫تاثیرات‬ BA ‫د‬
•Hypoxic damage‫متاثره‬ ‫اورګانونه‬ ‫زیاتره‬ ‫ماشوم‬ ‫د‬
‫پښتورګی‬ ‫او‬ ‫سیستم‬ ‫،سږی،ځګر،هضمی‬ ‫زړه‬ ‫لکه‬ ‫کوی‬
‫لیکن‬Brain Damage‫اوشاید‬ ‫کیږی‬ ‫واقع‬ ‫زیات‬ ‫ډیر‬
‫راشی‬ ‫منځته‬ ‫پکی‬ ‫والی‬ ‫ښه‬ ‫کم‬ ‫ډیر‬.
•‫ممک‬ ‫والی‬ ‫ښه‬ ‫کی‬ ‫سیستمونو‬ ‫شویو‬ ‫ذکر‬ ‫نوروزیاتو‬ ‫په‬‫ن‬
‫هم‬ ‫یعنی‬ ‫حالته‬ ‫دواړه‬ ‫کی‬ ‫آفت‬ ‫دماغی‬ ‫په‬ ‫،اما‬ ‫شی‬ ‫رامنځته‬
‫ذهنی‬ ‫لکه‬ ‫راځی‬ ‫منځته‬ ‫معیوبیت‬ ‫فزیکی‬ ‫هم‬ ‫او‬ ‫دماغی‬
‫تشن‬ ‫لکه‬ ‫آفت‬ ‫فزیکی‬ ‫هم‬ ‫او‬ ‫یامعیوبیت‬ ‫والی‬ ‫وروسته‬‫جی‬
‫حالت‬
4/22/2020
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36. ‫تاثیرات‬ (CONTINUED)
• Mental Disability:
 Developmental Delay,
 Intellectual Disability.
• Physical Disability:
 Spasticity,
 Motor Deficit.
• Cerebral Palsy.
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37. HYPOXIC-ISCHEMIC
ENCEPHALOPATHY (HIE)
•HI‫په‬ ‫چی‬ ‫ده‬ ‫اشاره‬ ‫ته‬ ‫تظاهراتو‬ ‫عصبی‬ ‫مشخصه‬ ‫هغه‬
‫د‬ ‫کی‬ ‫زیږیدلوماشومانو‬ ‫نوی‬ ‫نږدی‬ ‫ته‬ ‫مودی‬ ‫او‬ ‫مودی‬
‫د‬ ‫سمدستی‬ ‫بعد‬ ‫نه‬ ‫زیږون‬BA‫کیږی‬ ‫واقع‬ ‫تعقیب‬ ‫په‬.
•‫وقوعات‬:3-5 / 1000 full-term live births
•‫ددی‬ ‫نیمای‬moderate to severer HI‫ته‬ ‫طرف‬
‫کوی‬ ‫پیشرفت‬.
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38. HIE
•encephalopathy‫په‬
‫د‬ ‫ته‬ ‫دماغ‬ ‫توګه‬ ‫خاصه‬
hypoxia(‫کموالی‬ ‫اکسیجن‬)
‫او‬ischemia(‫جریان‬ ‫د‬ ‫دوینی‬
‫کموالی‬)‫راځی‬ ‫منځته‬ ‫وجه‬ ‫په‬.
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39. PATHOLOGY
•Lack of adequate breathing  lack
of oxygen supply to heart 
Inability of heart to pump adequate
blood  hypoxia + ischemia to
organs (particularly brain).
•Longer Arrest  Infarct  Brain
Death.
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40. PATHOGENESIS
•Poorly understood,
•Hypoxic Ischemic insult can
damage periventricular
white matter tracks.
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41. ‫د‬DAMAGE‫ساحی‬ ‫متاثره‬ ‫دماغ‬ ‫د‬ ‫وجه‬ ‫په‬
•Hippocampus,
•Purkinje Neurons in
Cerebellum,
•Basal Ganglia, and
•Brain-stem.
4/22/2020
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42. ‫د‬HIE‫اسباب‬ ‫نور‬
•Perinatal
Asphyxia,
•Drowning,
•Airway
Obstruction,
•Trauma,
•Hanging,
•Infection
4/22/2020
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43. PATHOPHYSIOLOGY
Hypoxia
Ischemia
Anaerobic Metabolism
Lactate Inorganic Phosphate
4/22/2020
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44. VULNERABLE ORGAN
• Brain,
• Neonatal Brain has very high
requirements for oxygen and baseline
blood flow.
• Hypoxic insult to the fetus initiates
diving seal reflex.
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45. DIVING SEAL REFLEX
•Shunting of blood to brain,
heart and adrenals and away
from lungs, gut, kidneys, liver,
spleen and skin, in an attempt
to maintain perfusion to more
vital organs.
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46. PATHOPHYSIOLOGY
Accumulation of AA (glutamate) in damaged
tissue.
Increased amount of intracellular Na &
Ca
Tissue
Swelling
Cerebral
Oedema
4/22/2020
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47. Fetal Hypoxia & Ischemia
Term
Cortical
Atrophy
Preterm
1. PVL
2. IVH
4/22/2020
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48. Acidosis
Myocardial
Depression
Reduced Cardiac
Output
Hypotensio
n
Reduced Blood-
Flow to Brain
Ischemia +
Hypoxia
4/22/2020
48

49. Energy Failure
Impaired ion-pumps
Intracellular
Na++, Cl-, H2O, Ca++
Extracellular
K+, Glutamate, Aspartate
4/22/2020
49

50. Reperfusion of ischemic
tissue
Generation of oxygen free
radicals
Neuronal Damage
4/22/2020
50

51. BRAIN DAMAGE
• Term Newborn:
•Cerebral Cortex, and
•Basal Ganglia
•Preterm Newborn:
•Periventricular White Matter.
4/22/2020
51

52. ‫د‬HIE‫یا‬ ‫نتیجه‬OUTCOME
•Immediate outcome: Death.
•Late outcome (if survived):
•Cerebral Palsy,
•Developmental Delay,
•Mental Retardation.
4/22/2020
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53. FURTHER OUTCOME (COMPLICATIONS)
• Death,
• Vegetative State,
• Severe Disability,
• SIRS,
• Multiple Organ Dysfunction Syndrome.
4/22/2020
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54. CLINICAL
FEATURES
4/22/2020
54

55. ‫منظره‬ ‫کلینیکی‬
• Perinatal Asphyxia (no breathing or
difficult breathing at birth).
• IUGR,
• MSAF (Fetal Distress), Meconium Stained
Amniotic Fluid
• Hypotonic State.
4/22/2020
55

56. ‫منظره‬ ‫کلینیکی‬
•Mild HIE,
•Moderate HIE, and
•Severe HIE.
4/22/2020
56

57. MILD HIE
• Transient abnormalities,
• Poor Feeding,
• Irritability, or excessive crying, or sleepiness,
• Slightly increased muscle-tone,
• Brisk DTR.
4/22/2020
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58. MODERATE HIE
•Lethargic,
•Significant hypotonia,
•Diminished DTR,
4/22/2020
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59. MODERATE HIE (CONTINUED)
•Sluggish or absent Grasp,
Moro and Sucking Reflexes.
•Occasional Apnea,
•Seizures.
4/22/2020
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60. SEVERE HIE
• Coma,
• Difficult breathing requiring ventilator
support,
• Decreased Tone,
• Depressed DTR,
• Absent neonatal reflexes.
4/22/2020
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61. SEVERE HIE (CONTINUED)
• Disturbance of ocular motions,
• Loss of “doll’s eye” movement,
• Dilated and fixed pupils with poor LR,
• Seizures,
• Full & bulging AF,
61

62. STAGING OF HIE
Stage-I Stage-II Stage-III
Level of
consciousness
Hyper-alert Lethargic Stupor/coma
Muscle Tone Normal Hypotonic Flaccid
Posture Normal Flexion Decerebrate
DTR/Clonus Hyperactive
Hyperactiv
e
Absent
Myoclonus Present Present Absent
Moro Reflex Strong Weak Absent
4/22/2020
62

63. HIE STAGING
Stage-I Stage-II Stage-III
Pupils Dilated Constricted Unequal
Seizures None Common Decerebrate
Duration < 24 hrs 24 hrs-14 d Days & Weeks
Outcom
e
Good Variable
Death or Severe
Deficit
EEG Normal Low Voltage Bursts
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64. ‫معاینات‬ ‫البراتواری‬
INVESTIGATIONS
•‫د‬ ‫معاینات‬ ‫البراتواری‬ ‫مشخص‬ ‫کوم‬perinatal
asphyxia,‫نلری‬ ‫وجود‬ ‫لپاره‬ ‫تشخیص‬ ‫د‬.
•‫د‬ ‫شدت‬ ‫د‬ ‫آفت‬ ‫ددماغی‬ ‫د‬ ‫چی‬ ‫معاینات‬ ‫ځینی‬ ‫اما‬
‫وظیفوی‬ ‫د‬ ‫اورګانونو‬ ‫سیستمیک‬ ‫د‬ ‫او‬ ‫معلومولو‬
‫دی‬ ‫عبارت‬ ‫تمامیږی‬ ‫ګټور‬ ‫خاطر‬ ‫په‬ ‫دارزیابی‬ ‫حالت‬
‫له‬:
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65. ‫معاینات‬ ‫البراتواری‬
•Blood Sugar,
•ABG,
•SpO2
•US in preterm,
• Serum Electrolytes,
• Diffuse mediated
MRI,
•CT,
•EEG
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66. INVESTIGATIONS (CONTINUED)
• Renal Function Tests:
 Blood Urea,
 Serum Creatinine.
•Liver Function Tests,
•Coagulation Profile
 PT and
 PTT
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67. MANAGEMENT
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68. WHAT TO DO?
Baby Cried immediately after birth
Yes
Routine Care
No
NNR
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69. IF YES ROUTINE CARE
• Dry,
• Provide warmth,
• Clear airway, if needed,
• Initiate Breastfeeding, and
• Monitor Breathing, Heart-Rate and Color.
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70. IF NO NNR (NEONATAL
RESUSCITATION)
• Initial Steps,
• Assisted Ventilation,
 Bag & Mask,
 Endotracheal Intubation.
• Chest Compression,
• Medication.
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71. GOAL OF TREATMENT
1) Maintain TABC,
1) Optimize Cardiac Output and Cerebral
Perfusion,
2) Maintain SpO2
3) Treat / Prevent Hypoglycemia,
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72. PRINCIPLES OF MANAGEMENT
1) Supportive Therapy,
2) Anticonvulsants,
3) Cerebroprotective interventions,
and
4) Monitoring.
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73. 1- SUPPORTIVE THERAPY
• IV Fluid:
• 10% Dextrose,
• 60 ml/kg/day.
• Treat Hypotension:
• Dobutamine, and
• Dopamine.
• Temperature:
• Cool Therapy (33-340 C)
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74. SUPPORTIVE THERAPY
(CONTINUED)
• Glucose:
• Treat hypoglycemia,
• Maintain BS at 75 to 100 mg/dl.
•Calcium:
• Calcium level should be kept in the
normal range (9 – 11 mg/dl)
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75. 2- ANTICONVULSANTS
• Control Seizures:
 Phenobarbitone:
• Loading Dose: 20 mg/kg slowly
• Maintenance Dose: 5 mg/kg/day
 Phenytoin as a second line drug
 Lorazepam
• (0.05-0.1 mg/kg/dose I. V.)
• for seizures not responding to
Phenobarbitone and/or Phenytoin.
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76. 3-
CEREBROPROTECTIVE
INTERVENTIONS
• Therapeutic Hypothermia (cool therapy),
• Free Radical Scavengers,
• Antagonists of excitotoxic amino acids,
• Calcium Channel Blockers.
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77. ‫احتیاط‬!
•Drugs like mannitol,
steroids, and
furosemide used in
past are no longer
recommended.
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78. 4- MONITORING
•Regular clinical
assessment,
•Biochemical monitoring,
•SpO2.
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79. ‫ارزیابی‬ ‫کلینیکی‬
• Respiratory
Rate,
• Heart Rate,
• CRT,
• BP
•Temperature,
•Oxygen
Saturation,
•Urine Output.
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80. PROGNOSIS
•Early Treatment 
•  Better Prognosis.
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81. ‫انزار‬ ‫بد‬:
‫چی‬ ‫وخت‬ ‫هغه‬
Initial cord or initial blood pH < 6.7
 Low Apgar Score (0-3)
 High Base Deficit,
 Decerebrate Posture
 Lack of spontaneous activity.
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82. ‫کچه‬ ‫مړینی‬ ‫د‬
•Moderate
Encephalopathy:
• 10 to 30%
•Severe Encephalopathy:
• Mortality: 60%
• Disability: 100%
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83. ‫مشکالت‬ ‫کی‬ ‫وخت‬ ‫اوږد‬ ‫په‬
• Developmental
Delay,
• Cerebral Palsy,
• Microcephaly,
• Seizures
• Blindness,
• Deafness,
• Problems with
cognition, memory,
fine motor skills and
behaviour.
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