This document discusses asphyxia of the newborn, including its definition, etiology, clinical features, assessment, management, and complications. Asphyxia is defined as a combination of hypoxemia, hypercapnia, and metabolic acidemia. It can be caused by various maternal and fetal conditions as well as complications during labor and delivery. Clinical features may include abnormal fetal heart rate patterns, low Apgar scores, and signs of organ damage. Assessment involves Apgar scoring, umbilical cord blood gases, and neurological examination. Management follows the ABCDE resuscitation steps and may include ventilation, cardiac compression, drugs, and treatment of complications such as brain injury, respiratory distress, and multiple organ failure.

1. Asphyxia of newborn Xin Yue PEDIATRIC DPT. GENERAL HOSPITAL TIANJIN MEDICAL UNIVERSITY

3. Etiology Labor and delivery conditions Maternal conditions Fetal conditions

11. Pathophysiology

13. Clinical features

35. Mask ventilation— ( does not start to breathe, or if HR<100/min, or the color remains cyanotic) airway opened by placing the infant’s head in the neutral position. mask over mouth and nose. rate-40-60 breaths/min. pressure-to achive chest wall movement, the first few breaths may require higher pressures.

36. Intubation— ( if effective mask ventilation not established, intubate and start artificial ventilation) The laryngoscope blade is advanced to lift the epiglottis, as shown, and the laryngoscope is then lifted upwards. Gentle pressure on the trachea with the little finger or by an assistant helps bring the vocal cords into view.

37. External cardiac massage in a newborn infant External cardiac massage using with hands encircling the chest, the thumbs two fingers. on the sternum just below the nipple line. Circulation— external cardiac compression (start if pulse absent or heart rate <60 beats/min or 60-80 beats/min and not increasing) ratio of cardiac compression:lung inflation is 3:1

38. Drugs– (if bradycardia persists in spite of adequate ventilation and external cardiac compression) Adrenaline: 1:10000, 0.1 ml/kg via endotracheal tube Cannulate umbilical vein Adrenaline: 1:10000, 0.1ml/kg via umbilical vein Adrenaline: 1:10000, 0.3ml/kg via umbilical vein Repeat if necessary Sodium bicarbonate (1-2 mmol/kg) Volume expander (20ml/kg of 0.9% saline or blood if acute blood loss

39. Keep warm and dry Position,suction,stimulate Oxygen Establish effective ventiation : Mask ventilation Endotracheal ventilation Chest compression Drugs Always needed Rarely needed The inverted pyramid showing the relative frequency of procedures in neonatal resuscitation.

53. Keys to be remembered Etiology of asphyxia Clinical features of perinatal asphyxia: ------fetal and postnatal The Apgar scoring system The resuscitation steps: ABCDEs Complication and sequelae

54. Thank You ! 4th Mar, 2009