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1. ASPHYXIA
NEONATORUM
THE MULAS
MANSA SCHOOL OF
NURSING - 2011

2. Definition
is the failure of the baby to breath at
birth or initiate and sustain breathing at
birth.

3. Assessment of the
condition
• Apgar score is a means of quickly
assessing the presence or absence of
anoxia in a new born infant. The
assessment is based on 5 factors (refer
to the table)
• Which can be assessment at 1 minute or
at 5 minutes.
• A/S is an objective method of evaluating
the newborn condition and it can also be
used to evaluate the effectiveness of
resuscitation effort or measures.

4. Apgar Score
score P R A G A
Heart rate Respiratory
rate
Muscle
tone
Response
to
stimulation
reflex/irrita
bility
colour
0 Absent Absent Limp No
response
Blue, pale
1 Below 100 Slow
irregular
weak cry
Some
flexion of
extremities
Some
mortion
Body pink
extremitie
s blue
2 Over 100 Good cry Active
motion
Cry Completel
y pink

5. Classification of Asphyxia
A/S of 8-10 is normal at 1 minute.
• The body is pink,
• blue extremities, breathes and good
cry
• good muscle tone,
• heart beat is greater than 100
• active response to stimuli.

6. Mild Asphyxia
• Has a score of 5-7, heart rate is severely
depressed (60 – 80 beats/minute)
• Short delay in onset of respiration
• Good muscle tone
• Responsive to stimuli
• Deeply cyanosed
• No significant deprivation of oxygen
during labour
• Asphyxia Livida (cyanosis and apnoea)

7. Severe Asphyxia
• A/S less than 5
• Slow feeble heart rate (less than 40
beats/minute).
• No attempt to breath.
• Poor muscle tone
• Limp, unresponsive to stimuli.
• Pale, grey due to vasoconstriction.
• Oxygen lack has been prolonged before
or after delivery, circulatory failure is
present. Baby in shock.
• Asphyxia Pallida (pallor and apnoea)

8. Causes of Neonatorum
Asphyxia
• Fetal causes
blocked air passages by liquor,
meconium
Birth trauma – after coming head of
breech
Prematurity
Congenital anomalies – encephaly
Diseases of foetus
IUGR
Rhesus isoimmunisation

9. Maternal Causes
• Deficient o2 supply to mother e.g.
severe anaemia, hptn, cardiac
diseases, PTB
• Placental insufficiency e.g. eclampsia,
pre eclampsia, diabetes
• Prolonged labour. Hypertonic uterine
action, obstructed labour.
• Shock

10. Placental Causes.
• APH
• placental previa & abruptio placental
• Infarction
• Diseases like syphilis or haemolytic
disease of the new born.

11. Umbilical Causes
• Cord presentation, cord prolapse
• Compression of the cord for any
reasons especially in cord prolapse
and malpresentation.
• True knots to the cord.

12. Drug causes
• Valium, pethedine, morphine taken by
the mother shortly before delivery
• Anaesthesia – depresses the
respiratory centre of the featus
• Misuse of oxytocic drugs in labour.
Other causes include; instrumental
deliveries such as forceps.

13. Management
• Good preparation and skilled staff.
Have the following equipment as
asphyxia is anticipated.
Suction machine with catheters, cloth
or gauze, flat surface and ambubag,
oxygen face masks, endotracheal
tubes, neonatal laryngoscope – 2.0mm
2.5mm 3mm 3.5mm, stethoscope,
syringes and needles, warm room.

14. Mgt cont.
• Aims of resuscitation
1. To establish & maintain a clear air way,
ventilation & oxygenation
2. To ensure effective circulation
3. To correct acidosis
4. To prevent infection
5. To prevent retrolentalfibroplasia

15. Immediate Mgt.
• As soon as the baby is born –
wipe eyes, mouth, nose to remove
secretion.
Feel the cord around the neck
Deliver the child onto the abdomen
Time of delivery and A/S, wipe the baby,
clump the cord, cut long, show sex to the
mother and wrap the baby.
Put baby on resuscitare for suction
Give o2 and reassess at 5 minutes.

16. Mgt Cont.
• Give drugs 50% (2-3mls), sodium bicarbonate
(2-5mls)
• Suction the baby – head down
• @ 5min check for A=air way, B=breathing,
C=cardiac function, S=shock.
• Give narcan 0.01mg/kg iv in cord if mother
was given pethedine.
• Reassess A/S after 5min, if no improvement
intubation is done with oxygen. If after 20 min
baby doesn't improve transfer to special care
unit in pre warmed incubator & commence on
a ventilator (IPPV)

17. Mgt Cont.
• Other drugs (not a priority in
resuscitation)
Adrenaline 1:1000 – 0.1mg/kg bwt
slowly if slow heart as last resort.
Sodium bicarbonate to correct
respiratory acidosis
Calcium gluconate 1ml/kg slowly to
correct hypocalcaemia.
Dexamethasone 1-2mg (cerebral
oedema).

18. Mgt Cont.
• Reassess the A/S every 5 minutes
until 2 successive scores 8 or greater.
• When the baby improves, the
breathing reflexes will return, the
muscle tone will return to normal and
the baby begins to resist the
endotracheal tube and at this time you
need to remove it.
• Maximum resuscitation time is 20
minutes.

19. Subsequent Mgt.
• Put the baby in an incubator for
warmth and easy observations. If no
incubator maintain the environmental
temperature.
• Maintain a clear airway
• Observations
General condition
Appearance (colour)

20. Observations Cont.
Respirations (30-60 breaths/minute)
Heart rate (normal – 120-160
beats/minute)
Temperature (normal 36.2-36.8oc
Bowel action – meconium,
consistency, amount, frequency
(meconium stop after 3 days).
Bladder – check urine output i.e.
amount, colour, frequency.

21. Observations Cont.
Cord for bleeding
Feeding pattern (if feeding is by the
tube check abdomen distension and
check skin for dehydration.
Chest in drawing and grunting.
Irritability/cry (baby crying too much –
high pitched cry) which can be
suggestive of brain irritation/damage.
Reflexes, sleeping pattern

22. Psychological Care
• Kangaroo method
• Explain to the mother the management
given to the baby and other
expectations.
• Allow the mother to touch the baby
that if in the incubator.

23. Infection Prevention
Practices
• Use sterile methods when doing all
procedures.
• Cord care to prevent infection

24. Nutrition
• Encourage b/feeding, express the
b/milk if the baby cant b/feed.
• Artificial feeding – insert NGT for
feeding purposes.
• Maintain intake and out put to avoid
overload and dehydration.

25. Hygiene
• Top and tail to prevent hypothermia.
• Baby bath when the condition
improves.

26. IEC TO MOTHER
• Prevention of infections.
• Danger signs of the baby.
• Care at home.
• Explain to her on the milestones (ie
may be delayed according to how long
resuscitation took).
• Check for irritability and convulsions.

27. Prevention of Asphyxia
Neonatorum
• Antenatally
Early detection and treatment of illness
like ptb, anaemia, hptn, diabetes.
Good nutrition to prevent anaemia and
malnutrition.
Good antenatal care – include head to
toe examination.
IEC to mothers on effects of traditional
oxytocin.

28. • Labour
Avoid misuse of oxytocic drugs.
Avoid prolonged second stage of
labour (proper mgt of 1st stage labour
by use of a partogram to rule out
deviations from normal).
 vigilant to ensure that the cord is not
tied around the neck.

29. THE END
THANK
YOU!
THE MULAS
2011-MANSA SCHOOL OF
NURSING
29