Birth asphyxia is the inability of an infant to establish regular respiration following birth, which can lead to hypoxia, hypoventilation, hypercapnia, and metabolic acidosis. Approximately 90% of cases are caused by placental insufficiency due to factors before or during delivery like pre-eclampsia, prolonged labor, or meconium aspiration. This can result in complications for the newborn like hypoxic-ischemic encephalopathy, intracranial hemorrhage, or multi-organ dysfunction. Proper antenatal care, monitoring for fetal distress, and resuscitation at birth can help prevent birth asphyxia and its consequences.

1. BIRTH ASPHYXIA
Mrs. Malarkodi.S
Assistant Professor
CON, AIIMS, Rishikesh

2. Introduction
Birth asphyxia is a leading cause of neonatal mortality
&
morbidity .It is also important cause of developmental
delay &
Neurological problems both term & preterm newborn.
Approximately 5 t0 10% neonates experience
asphyxia a t birth.

3. Meaning
Birth asphyxia, also called asphyxia neonatorum, is the
inability of an infant to establish regular respiration
Following birth.

4. Definition
Birth asphyxia is the non establishment of satisfactory
pulmonary respiration at birth.
It is failure of initiation & maintenance of spontaneous
respiration with hypoxia, hypoventilation ,
hypercapnia, hypo perfusion, & metabolic acidosis.

5. Etiological factor
Approximately 90% of asphyxia events occur as a result of
placental insufficiency due to ante partum & intrapartum
factors. Postnatal factors account for the remaining.
 Ante partum
 Intrapartum
Postpartum

6. Ante partum
placental insufficiency due to
 Pre-eclampsia
 Hypertension
 Anemia
 Diabetes Mellitus
 Post maturity
Other factor include
 ante partum hemorrhage
 mal presentation
 Multifetal pregnancy

7. poor fetal growth
 maternal systemic
diseases
 maternal drug therapy
(eg. lithum)
 poly or oligohydramnios
 placental malformation
 vascular anomalies of
the cord
 congenital anomalies of
the fetus.

8. Intra partum
Emergency CS
Instrumental delivery
Abnormal position
Premature labour
Precipitous labour
Prolonged rupture of
membranes
Prolonged labour > 24 hrs
Prolonged 2nd stage of
labour

9. Foetal bradycardia
Non-reassuring foetal heart
rate pattern
General anaesthesia
Narcotics administered
within 4 hours of delivery
Meconium stained liquor
Prolapsed cord
Abruptio placenta
Placenta Previa

10. POST NATAL FACTOR
 pulmonary, cardio
vascular & neurological
abnormalities of the
neonate
 Aspiration

11. CLINICAL FEATURES
Clinical manifestations depends upon the etiology,
intensity, duration of oxygen lack, plasma carbon
dioxide level & acidosis. There are 2 stages
 Asphyxia livida or stage of cyanosis, primarily due to
respiratory failure with Apgar score 4 to 6.
 Asphyxia pallida or stage of shock due to combined
respiratory & vasomotor failure with Apgar score 0- 3.

12. MANAGEMENT

13. COMPLICATION
BRAIN:
 hypoxic- ischemic encephalopathy
 intracranial hemorrhage
 convulsion
HEART:
 hypoxic cardiomyopathy
 cardiac dysrhythmias
 congestive cardiac failure.
 shock

14. LUNGS:
 meconium aspiration syndrome
 hyaline membrane disease
 pulmonary hemorrhage
 pneumonia
KIDNEYS:
 Hematuria
 renal failure
 renal vein thrombosis

15. GASTR0 INTESTINAL:
 necrotizing enterocolitis
 paralytic ileus & obstruction
HEMATOLOGIC :
 DIC, hyperbilirubinemia and sepsis
ENDOCRINE:
 Adrenal hemorrhage
IMMUNOLOGIC:
 septicemia

16. PROGNOSIS
It is depends upon associated factors, maturity of the
baby, duration & intensity of hypoxia & acidosis &
initiation of resuscitative measures in the delivery
room. Subsequent competent care & available
facilities
also influence the out come following birth asphyxia

17. NURSING DIAGNOSIS
 Ineffective Airway Clearance R/T Aspiration Meconium
& mucus
 Impaired breathing pattern r/t immaturity of the lungs
 Impaired thermoregulation (hypothermia) r/t immature
thermoregulatory state of neonates
 Risk for complication r/t loss of oxygen supply to the
vital organ

18. PREVENTIVE MEASURES
 Intensive antenatal care
Intra natal assessment of fetal hypoxia
Careful use & intelligent use of anesthetic agents &
depressant drugs in labor
 Care of neonates at birth
 Special attention to avoidance of preterm delivery
Care of pre term & low birth wt baby

19. Summary
• As we discussed post sequelae of birth asphyxia
is traumatic both physically and psychological
hence it is important for every neonatal nurse to
anticipate the problem and intervene in the right
manner.

20. References
• Assuma Beevi (2009). Concise Textbook of Pediatric
Nursing. 2nd Edition. Elsevier Publication
• OP Ghai (2013) Essentials of Pediatrics. 8th Edition.
CBS Publishers and distributors.
• Datta Parul (2010). Paediatric Nursing. 3rd Edition.
JAYPEE publication