2. Asphyxia
APGAR score at 1 minute < 7
Interruption in oxygen delivery to the fetus
• Hypoxia
• Hypercapnia
3. Causes of Neonatal Mortality
Infection
32%
Other
5%
Congenital
Anomalies
10%
Birth Asphyxia
29%
Complications
of Prematurity
24%
Source: WHO 2001 estimates (based on data collected around 1999)
4. Etiology
Birth asphyxia in undeveloped countries
10% of newborns suffer mild to moderate birth asphyxia
1% of newborns suffer severe birth asphyxia
5. Risk factors
Antepartum :
Placental infection post-term gestation
Pregnancy induced hypertension multiple gestation
Chronic hypertension size-dates discrepancy
Previous Rh sensitization maternal drug abuse
Chorioamnionitis maternal age >35 or<16
Bleeding in second or third trimester no prenatal care
Maternal viral infection
Polyhydramnios or oligohydramnios
6. Risk factors
Intrapartum :
Elective or emergency c/s
Precipitous labour, prolonged labour
Prolonged second stage of labour
Premature labour
Abnormal presentation
Rupture of membranes > 24 hours
Instrumental delivery
Intrapartum fever
Use of general anesthesia
Prolapsed cord
7. Effects of Asphyxia
Central nervous system
• infarction, intracranial hemorrhage,
cerebral edema, seizure, hypoxic- ischemic
encephalopathy (HIE)
Cardiovascular
• bradycardia, ventricular hypertrophy,
arrhythmia, hypotension, myocardial ischemia
10. Hypoxic-ischemic encephalopathy(HIE)
Hypoxic-ischemic encephalopathy is an important cause
of permanent damage to central nervous system cells,
which may result in
- neonatal death
- manifest later as cerebral palsy or mental
deficiency
11. Assessment
Thick meconium-stained amniotic fluid
Apgar score (also assess at 15 & 20 min)
Level of consciousness
Presence of acidaemia
Muscle tone
Sucking
Seizures
Reflexes
Respirations
12. Management- this is an
emergency!
ABC !
Vitals + all findings from assessment, including CRT & Urine output
monitoring.
Volume expansion with NS (or Ringers lactate) 10mls/kg over 5-10 min
if CRT<2sec
10% dextrose
Cefotaxime
1mg Vitamine K
20mg/kg IV stat Phenobarbitone if having seizures
Refer for further management!