This document discusses asphyxia neonatorum (birth asphyxia), which is respiratory failure in newborns caused by inadequate oxygen intake before, during, or after birth. It can result in hypoxic-ischemic encephalopathy (brain damage from lack of oxygen). Symptoms include altered breathing, cyanosis, pallor, hypotonia, and lack of response. Treatment involves resuscitation efforts like oxygen, ventilation, and drugs to support breathing and circulation. Outcomes depend on duration of asphyxia - prolonged asphyxia over 10 minutes can cause organ damage or death. Management involves monitoring labor, timely intervention for complications, and post-birth care like cooling therapy and seizure control for affected newborns.

2.  Asphyxia —Lack of oxygen
 Asphyxia neonatorum, also called birth or newborn asphyxia
 Asphyxia neonatorum is respiratory failure in the newborn, a condition caused by
the inadequate intake of oxygen before, during, or just after birth.
 Asphyxia neonatorum infants are completely limp and do not move at all
 Profound metabolic or mixed acidemia (pH< 7.00) in umbilical cord blood.
 Persistence of low Apgar scores less than 3 for more than 5 minutes.
 Evidence of multiple organ involvement (such as that of kidneys, lungs, liver, heart
and intestine).

3. ASPHYXIA LIVIDA
• Blue asphyxia
• Baby response to
stimuli
• Muscle tone is good
ASPHYXIA PALLIDA
• White/ pale asphyxia
• Baby is pale, flaccid
• Irresponsible to
stimuli
Categorised into 2 grades

7. RESPIRATORY FACTORS
• Failure of the respiratory
center
• Prematurity
• Intrauterine hypoxia
• Umbilical cord anomalies
and accidents
• Hypovolemia secondary to
antepartum hemorrhage
• Maternal conditions
(cardiovascular problems,
pulmonary disease,
toxemia, other systemic
illness)
Obstetrical factors
• Uterine and
cervical
malformation
• Multiple gestation
• Abnormal
presentation
• Difficult delivery

10. CLINICAL MENIFESTATIONS
• Altered Respiratory Patteren : grunting,
grasping
• Cynosis
• Pallor – shock
• Hypotonia
• Irresponsiveness

11. Bluish or gray skin color
(cyanosis)
Slow heartbeat (bradycardia)
Stiff or limp limbs
(hypotonia)
A poor response to stimulation.

15. EARLY COMPLICATIONS

16. Risk Factors
• Prolonged rupture of membranes
• Meconium-stained fluid
• Multiple births
• Lack of antenatal care
• Low birth weight infants
• Malpresentation
• Augmentation of labour with oxytocin
• Antepartum hemorrhage

17. Prognosis
• Depends on how long the new born is unable to
breathe.
• For example, clinical studies show that the outcome
of babies with low five-minute Apgar scores is
significantly better than those with the same scores at
10 minutes.
• With prolonged asphyxia, brain, heart, kidney, and
lung damage can result and also death, if the
asphyxiation lasts longer than 10 minutes

18. Perinatal asphyxia is closely associated with hypoxic-
ischemic encephalopathy (HIE) which is one of the leading
causes of neonatal mortality and long-term neurological
disabilities.

19. • Hypoxia
• Ishemia
• Clinical Neurological Syndrome
• Sarnat and Sarnat classified HIE into 3 Grades
• Grade I (MILD)
• Grade II (MODERTE)
• Grade III (SEVERE)

20. GRADE I
 Hyper-alert, jittery and dilated pupils.
 Strong Moro reflex.
 Resolves within 24 hours without long term sequelae
GRADE II
 Lethargic with seizures.
 Weak suck and Moro reflex.
 Mild hypotonia.
 15-30% chance of severe sequelae.
 Duration 2-14 day
GRADE III
 Flaccid, stuporous, co-matose
 No suck, no Moro and pro-longed seizures.
 •Raised intra-cranial pres-sure. Lasts for weeks.

21. HYPOXIA- ISCHEMIA LEADS TO BRAIN
INJURY

23. Diagnosis
• Normally, the Apgar score is of 7 to 10.
• Infants with a score between 4 and 6
have moderate depression of their vital
signs while infants with a score of 0 to 3
have severely depressed vital signs and
are at great risk of dying unless actively
resuscitated.

24. DIFFERENTIAL DIAGNOSIS
• Drug depression
• Prematurity
• Trauma
• Anemia
• Neuromuscular Disorder
• Infection
• Inborn Error of metabolism- Pyridoxin
dependency
• Respiratory track malformation

25. Treatment
giving the mother
extra amounts of
oxygen before
delivery
medications to
support the
baby's breathing
and sustain
blood pressure
extracorporeal
membrane
oxygenation
(ECMO)
Alternative treatment
• If an inadequate supply of
oxygen from the placenta is
detected during labor, the
infant is at high risk for
asphyxia.
• An emergency delivery may be
attempted either using forceps
or by cesarean section.

26. • Selective cerebral or whole
bodytherapeutic Hyothermia
(Cool Therapy)
• Control Seizures :
Phenobarbitone, Phenytoin,
Midazolam.
• Mechanical Ventilaion, or
(ECMO)
• Volume expansion
• Pressue Amines

27. • A= Establish open airway: Suctioning, if
necessary endotracheal intubation
• B= Breathing: Through tactile stimulation, PPV, bag and
mask, or through endotracheal tube
• C= Circulation: Through chest compressions and
medications if needed
• D= Drugs: Adrenaline .01 of .1 solution
• Hypothermia treatment to reduce the extent of brain
injury
• Epinephrine 1:10000 (0.1-0.3ml/kg) IV
• Saline solution for hypovolemia

28. MANAGMENT
 Newborn with birth asphyxia Baby requiring bag and mask
ventilation (BMV) OR Intubation with or without medications at
birth
MILD ASPHYXIA
 Requiring BMV for less than 60 seconds
 No intubation or medications at birth based on the severity of asphyxia
 Assess at 5 minutes after birth: Assess sensorium and tone Look for abnormal
movements
 IF Normal tone and sensorium; No abnormal movements; No other
complications
 Then
 Shift to mother’s side; Initiate breastfeeding; If not able to breastfeed, start
alternative methods of feeding
 IF Abnormal sensorium/tone OR Abnormal movements

29. • Moderate or severe asphyxia
• Requiring BMV for 60 seconds or more
• Required bag and mask ventilation (BMV) for 60
seconds or more at birth,
OR
• Needed intubation or medications at birth
• Check vitals :
Temperature, heart rate, capillary refill time
(CRT), colour, oxygen saturation (SpO2), respiratory
rate, lower chest retractions, abnormal
movements

30. • Anticipation is the key to preventing asphyxia neonatorum.
• During labor, the medical team must be ready to intervene
appropriately and to be adequately prepared for resuscitation.
• Use partograph for vigilant labor monitoring
PERINATAL ASSESMENT:
• Regular perinatal checkups
• Timely interventions
PERINATAL MANAGEMENT:
• Timely refferal
• Management of maternal complication prevention

31. INVESTIGATIONS
Serum biochemistry
• electrolyes ureacreainine, ca+ phosphate
URINALYSIS AND MICROSCOPY
• Heamaturia, Heamoglobinuria, Myoglobinuria, Proteinuria
BLOOD
• Heamoglobin, platelet count, pH, Base deficit or Bicarbonate
URINE BIOCHEMISTRY
• Creatinine, sodium, osmolatily
ULTRASOUND (SELECTED CASES)
• Abnormality of Renal structural or parenchyma
• Rena tracts including bladder size
• Doppler assesment of renal vasculature

32. REFERENCES
• www.healthline.com
• http://www.healthofchildren.com/A/Asphyxia-
Neonatorum.html#ixzz6ce6eQfEc
• : http://www.healthofchildren.com/A/Asphyxia-
Neonatorum.html#ixzz6ce6HpKPZ
• https://www.newbornwhocc.org/STPs/STP_Asphyxia-management_Pre-
Final.pdf
• https://www.researchgate.net/publication/270340840_Birth_Asphyxia
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5261744/
• CAUSES Raul C. Banagale, MD, and Steven M. Donn, MD Ann Arbor, Michigan
• http://www.healthofchildren.com/A/Asphyxia-
Neonatorum.html#ixzz6ce6xHWFr
• ASPHYXIA NEONATORUM BY IAN DONALD Department of Midwifery, University
of Glasgow, Scotland Brit. J. Anaesth. (1960), 32, 106
• https://www.ucsfbenioffchildrens.org/conditions/birth_asphyxia/treatment.htm
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