This document provides guidance on managing birth asphyxia through proper newborn resuscitation. Key points discussed include: 1. Preparation for delivery is critical as each birth is an emergency, ensuring proper equipment and staff readiness. 2. Initial resuscitation steps are providing warmth, clearing the airway, drying and stimulating the newborn. Positive pressure ventilation may be needed if breathing does not improve. 3. If the heart rate remains low despite adequate ventilation, chest compressions and medications like epinephrine may be administered to support circulation. Intubation should only be considered in specific situations. 4. Post resuscitation care focuses on monitoring vital signs and providing support until stabilization is achieved.

1. Birth asphyxia-managementtobindominic2006 mbbs

2. failure to initiate and sustain breathing at birthIncidence 3-5%,pmr-26%Hypoxia,hypoperfusion,hypercapnia,acidosisMultiorgan dysfunction-HIERisk factors-poor predictors

4. Etiology-placental insufficiencyEach delivery is an emergencyResuscitation successanticipationadequate preparationtimely evaluationquick & correct actionPreparation: warm towels,suctiondevices,self inflating bag,2 infant masks,radiantheater,clock

6. Basic resuscitationProvide warmthClear airwayDry,stimulate,repositionEvaluation Signs: respiration,HR &colourApgar score not a prerequisite

7. Oxygen 100% flow @ 5l/mntpersistent cyanosis-PPV

8. PPVSelf inflating bag & face mask BMVindicationscontraindications-diaphragmatic hernia(non vigourous babies MSL)procedure: 240-750ml, 90-100% oxygen @5-6l/mnt or room airneck slightly extendedappropriate face mask & seal itcompress & w/f chest riseventilation @40-60 breaths/mntadequate pressure-indicator evaluate HRIf ppv>2mnts,orogastric tube for abdomen decompression

9. If no chest riseHR evaluation

10. Chest compressionsHR < 60 even after 30 seconds adequate ventilation with 100% oxygenThumb technique& 2 finger techniqueventilate between compressions 90compressions + 30 breaths/mnt 3 compressions n 1.5sec & ventilaton for .5secDo not lift thumbs/fingers off the chestMonitor periodically carotid /femoral pulseDangers:trauma,broken ribs,laceration of liver,pneumothoraxEvaluate

11. Medicationsif hr<60, despite adequate ventilation with 100%oxygen & chest compression for 30 secto stimulate heart,increase tissue perfusion & restore acid base balanceEpinephrine(1:1000) .1 to.3ml/kg iv umbilical vein,orendotracheal tube if iv not accessibleVolume expanders if shock,isotonic crystalloid(normal saline/ringer lactate) 10ml/kg umbilical veinNalaxone if respiratory depression with history of narcotic administration,.25ml/kg ivadrenalineSodium carbonate if prolonged asphyxia & metabolic acidosis

13. Endotracheal intubationConsidered at any steps,used rarelyIndicationsDiaphragmatic herniaBMV ineffectiveTracheal suction is required (nonvigorous baby MSL)Prolonged BMVIf any medications

14. Post resuscitation carekeep baby with motherPut to breast feeding asap (risk of hypoglycemia)Examine the baby 4 anomalies,hypothermia,danger signsMonitor temp,po2,pco2,perfusion,glucose,metabolic profile. treat cerbralodema,seizuresRecord resuscitationcounsel on complicationsNormal breathing ,body temp ,ocassional cry, good suckling & movements discharge

15. Practices not beneficial:Slapping the newborn, soaking it in cold water, sprinkling it with water,,milkingthe cord,Tactilestimulation,Routineaspiration of upper airway,Routinegastric suctioning,posturaldrainage,slapping the back,squeezingchest,sodium bicarbonateNon-initiation of resuscitationgestation < 23 weeksbirthweight < 400 gramsanencephaly ,severe hydrocephalyconfirmed trisomy 13 or 18Renal agenesisCongenital malformationsIf risk of high survival morbidity & mortalityDiscontinuationeven after 10mnts of resuscitation, if no signs of life

16. Bag and mask –the most important tool in newborn resuscitationThank you