1) Asphyxia neonatorum, or perinatal asphyxia, is the failure to establish spontaneous respiration immediately after birth, which can be caused by factors that lead to hypoxia such as respiratory failure, airway obstruction, or circulatory collapse. 2) Meconium aspiration syndrome is a respiratory condition caused by aspiration of meconium, the newborn's first stool, into the lungs before or during delivery, which can cause inflammation and obstruction of the airways. 3) Treatment for both conditions involves resuscitation and stabilization of the newborn, including clearing the airways, stimulating breathing, warming the infant, and providing respiratory and circulatory support as needed. Ongoing

1. ASPHYXIA
NEONATORUM
&
MECONIUM
ASPIRATION
SYNDROME

2. Normal Respiration
 Normal newborn takes first
respiration: within 6 seconds,
majority within first 20 seconds
 Rhythmic respiration: by 30
seconds, and majority by 90 seconds
after birth
 Normal Rate 40-60/ min

3. ASPHYSIA
NEONATORUM

4. “
”
Asphyxia neonatorum is the failure to establish
spontaneous respiration immediately after
complete delivery of the baby
Definition

5. Perinatal Asphyxia Defining Criteria
APGAR
≤ 3 at 5 mins
Umbilical
arterial pH < 7
Evidence of
HIE
Evidence of
MSD

6. Risk Factors

7. Causes
• Failure of respiratory center
prolonged hypoxia, birth trauma, maternal sedatives
within 4 hours before delivery and preterm
• Failure of pulmonary expansion (atelectasis)
low alveolar surfactant and poor respiratory
movements of preterm baby

8. Causes
• Obstructed air passage
Inhaled mucous or meconium and choanal atresia
• Circulatory collapse in neonatal shock
blood loss or cardiac abnormality

9. Pathophysiology
↓gas exchange
Ischemia
Hypoxia
Hypercapnia
Disruption of
placental
blood flow
↓APGAR
MAS
↓ pH
Acidosis
↓Fetal blood
flow
Primary Apnea
Redistribution
of blood flow
Blood flow
 Renal
 Pulmonary
 Hepatic
 Muscular
Blood flow
 Cerebral
 Coronary
 Adrenal
Inadequate
perfusion to
tissues
Cerebral ischemia
Multiorgan injury
Secondary Apnea
Failure of compensatory mechanism

10. Stages of
Asphyxia
Asphyxia Livida/ Stage of cyanosis
APGAR score 4 – 6
Respiratory failure
Asphyxia Pallida/ Stage of shock
APGAR 0 – 4
Respiratory & Vasomotor failure

11. Clinical Manifestations
Poor/weak/
absent cry
Apnea, Dyspnea,
grunting
Hypotonia, limp
extremities
Cyanosis
Bradycardia

12. Management

13. Immediate Care of the Newborn at Birth
 Step-1: Dry and stimulate
 Step-2: Assess breathing and color
 Step-3: Decide if resuscitation is
needed
 Step-4: Keep warm
 Step-5: Tie and cut the cord
 Step-6: Start breastfeeding

14. ABCDS of resuscitation: if needed
• AIRWAY
 Make sure the airway is open
 Position the baby
 Suction the mouth and nose, and if there is meconium, the pharynx
(back of throat).
• BREATHING
 Make sure the baby is
 Stimulate to initiate breathing
 Use mouth to mouth or AMBU bag breathing as necessary
 Give oxygen, if available

15. ABCDS of resuscitation: if needed
• CARDIAC FUNCTION
 Make sure the heart is beating
 Stimulate the baby.
 Do chest compressions when necessary.
• DRY THE BABY
 Warm the baby with a blanket, a light, or the
mother’s skin.
• SHOCK
 Make sure the baby is warm and dry.

16. MANAGEMENT: If resuscitation is
needed
Steps of resuscitation:
• Dry & Wrap
• Respiration/colour
• Decide for resuscitation
• Position, mouth to mouth respiration, ambu bag
• Cardiac massage
• Intubation
• Drug

17. Subsequent management:
• Fluid and nutrition should be maintained by IV 10% dextrose,
NG tube feeding or oral feeding.
• To control seizure: Inj. Phenobarbitone 20mg/kg IV followed
by maintenance dose of 5-6mg/kg per day.
• To control edema: Fluid restriction 20-25% Mannitol may be
used
• IV antibiotic.
MANAGEMENT: If resuscitation is
needed

18. Resuscitation Procedure
A. Environment
 Maintenance of
temperature
 Radiant heater
 Warm cloths
B. Positioning
 1 inch roll of cloth below shoulder

19. Resuscitation Procedure
C. Suctioning
Should not be done always, when?
 Meconium in amniotic fluid
 Asphyxiated baby, first mouth
then nose
D. Tactile Stimulation
 Drying
 Flicking of soles
 Rubbing the back

20. Resuscitation Procedure
E. Assessment
 Colour
 Respiratory effort.
 Heart rate
 Movements or Muscular activities

21. Resuscitation Procedure
F. Ventilation
Indications:
 Apnea
 Heart rate < 100 beats
 Persistent central cyanosis
Process:
 Mouth to mouth
 Mouth to mask
 Ambu Bag
 Endotracheal intubation

22. Resuscitation Procedure
G. Chest compressions
Indications:
 If heart rate is <60 beats/min or 60-80 beats/min and not rapidly
increasing despite adequate ventilation with 100% O2 for 30 seconds.
 Discontinuation: Heart rate > 80 b/min

23. Resuscitation Procedure
H. Medications: when?
 Heart rate < 80 b/min despite adequate ventilation with
O2 and chest compression for 30 sec.
 Route:
─Umbilical vein
─Endotracheal tube

24. Resuscitation Procedure
What are the drugs used?
• Adrenaline:
 Dose: 0.5-1ml/kg of
1:10,000
• Volume Expanders:
 Dose:10ml/kg (5%
albumin-Saline or Ringers
lactate )
• Sodium Bicarbonate:
 Prolonged arrest/or
profound metabolic acidosis-
Dose: 2meq/kg of 4.2%
• Naloxone:
 Dose: 0.1mg/kg of 1mg/ml

25. Postasphyxial Management
Thermal control
 Keep under radiant
warmer
 Maintain
• Core temp: 36ºc - 37ºc
• Skin temp: 36ºc - 36.3ºc
Respiratory Support
 Supplemental oxygen
 Ventilation

26. Postasphyxial Management
Cardiovascular support
If CVP 4-8cm: 10ml/kg of saline
If CVP >8cm: Ionotropes
• Avoid fluid bolus and ↑BP
• Dobutamine/Dopamine @ 10-20μgm/kg/min

27. Postasphyxial Management
Fluid therapy & Feeding
10% dextrose @ 60ml/kg/day
EBM/NG feeds
Oral feeding once gut motility establishes

28. Postasphyxial Management
Seizure control
Anticonvulsant
• Loading dose: 20mg/kg
• Maintenance: 3-5mg/kg
BD
Cerebral Edema Mng
Osmotic diuretic
Corticosteroid
Hyperventilation
Head end elevation

29. MECONUIM
ASPIRATION
SYNDROME

30. “
”
Respiratory manifestation caused by
aspiration/inhalation of meconium in
amniotic fluid into the tracheobronchial tree
Definition

32. Epidemology
130 million
annual birth
15 million aspirate
meconium
750,000 – 1.8million
develop MAS

33. Meconium
Meconium is a sterile watery, viscous,
greenish yellow, odorless stool passed by
the newborn
 Formed before neonate digests
breastmilk

34. Characteristics of meconium
pH: 5.5 – 7.0
Watery
Moderately stained : greenish yellow
Viscous, Opaque
Odorless

35. Components of meconium
 72 – 78% water
 Desquamated intestine & skin cells
 GI mucous
 Lanugo
 Pancreatic juice & Bile
 Fat from Vernix Caseosa
 Intestinal secretions
 Amniotic fluid
 Glycoproteins

36. Risk factors

37. Pathophysiology
Ball-valve effect

38. Clinical Features
 Yellow green staining of nails, umbilical cord
and skin
 Cyanosis , end- expiratory grunting
 Alar flaring, intercostal retractions
 Tachypnea, rales, rhonchi
 Green urine > 24hrs after birth
 Cerebral irritation signs: seizure & jitteriness

39. Diagnosis
1. Serum studies:
 Na, K, Ca, CBC
2. ABG Analysis:
 Hypoxemia, hyperventilation, metabolic acidosis
3. Chest X-ray:
 Atelectasis, pneumothorax
4. ECG:
 PHN, RL shunt, tricuspid regurgitation

42. Complications
• PPHN
• Parenchymal Pulmonary Disease
• Air block syndrome
• Pneumothorax
• pneumomediastinum

43. Management
• Suctioning
• General management
• Supportive treatment
• Surfactant therapy

44. THANK
YOU