The document discusses birth asphyxia, its causes, signs, and treatment which involves prompt neonatal resuscitation following the PSSR method of positioning, suctioning, stimulation, and repositioning. It also reviews meconium aspiration syndrome and its management, as well as idiopathic respiratory distress syndrome which affects preterm infants and its treatment through oxygen therapy, surfactant replacement, and ventilation support.

1. Major disorder of newborn
Mrs Shipra Sachan
Assistant Professor Rama
University

2. INTRODUCTION
• Apgar score is traditionally used to identify
birth asphyxia. It is most common emergency
in delivery room. about 5-10 % of newborn do
not establish adequate breathing efforts at
birth & need assistance to establish adequate
breathing or ventilation. Asphyxia contribute
25% of neonatal death.

3. According to National Neonatology forum
of India:-
BIRTH ASPHYXIA :-birth asphyxia should be
diagnosed when “ baby has gasping &
inadequate breathing & no breathing at 1
minute.

4. According to American academy of
paediatric
Cord umbilical artery PH <7.
Persistence of APGAR score of 0-3 for more
than 5 minute.
Multiple organ dysfunction (kidney , heart ,
lung etc ).
Neurological manifestation eg:-
seizure,coma,hypotonia(deficient tension in
eyeball).

5. Asphyxia neonatorum, also called birth or
newborn asphyxia, is defined as a failure
to start regular respiration within a minute
of birth.

6. INCIDENCE RATE
• Birth asphyxia in undeveloped countries
–10% of newborns suffer mild to moderate
birth asphyxia
–1% of newborns suffer severe birth asphyxia

7. The high risk factors of fetal
(antenatal) hypoxia development:
1.Maternal age of less than 16 years old or over
40 years old.
2. Postmaturity.
3.Bed obstetrical history.
4. Multiple pregnancy.
5. Threatened preterm labor.
6. Diabetes mellitus in pregnant women.

8. 7. Bleedings and infectious diseases in II-III
trimester of pregnancy.
8. preeclampsia & anemia.
9. Smoking or drug addiction in pregnant
women.
10. Intrauterine growth restriction .
11.poly & oligohydromnious.

9. The high risk factors of acute
(intranatal) asphyxia development:
1. Cesarean operation (planned or urgent).
2.Malpresentation (breech,).
3.Cord prolapse, tight umbilical cord around the
fetal neck .
4.Meconium stained liquor.
5. Placenta previa.
6. Obstetrical forceps or vacuum-extractor use.

10. 7. Birth trauma.
8. Congenital malformations of fetus.
9.Maternal distress like hypotension ,
dehydration.
10.Maternal anaesthesia (both the intravenous
drugs and the aesthetic gases cross the
placenta and may sedate the fetus).
11.Prolonge labour.

12. Neonatal Evaluation and Resuscitation
APGAR Scoring
A Appearance
P Pulse
G Grimace
A Activity
R Respirations

13. Apgar score assessment
7-10 – No or mild depression
4-6 – Moderate depression
0-3 – Severe asphyxia

15. Moderate birth asphyxia – adequate breathing
wasn’t established during the first minute
after birth, but heart rate is 100 per minute
and more; there is decreased muscle tone and
poor reflex irritability. Apgar score is 4-6 at the
first minute. “Blue asphyxia”.
Severe birth asphyxia  heart rate is less than
100 per minute, breathing is absent or labored
(gasping breathing), skin is pale, muscle atony.
Apgar score is 0-3 at the first minute. “White
asphyxia”.

16. NEWBORN
RESUSCITATION

17. NEONATAL RESUSCITATION:-It mean to
revive or restore a life of baby from the
state of asphyxia.

18. Equipments
• Warmth towels & heater
• Airway – suction catheters
• Ventilate – bag (500ml). & masks (sizes)
• Source of oxygen
• Auscultate – stethoscope
• Pulse oximeter (if possible)
• Intubation equipment
• Clock
• A folded piece of cloth

19. PSSR OF
RESUSCITATION:-
P:- position
S:-suction
S:-stimulation
R:-reposition

21. Facts About Newborn Resuscitation
The most important is to get air into the lungs

22. Newborn Resuscitation AHA/AAP
Guidelines
• Meconium -stained amniotic fluid: endotracheal
suctioning of the depressed child
• Hyperthermia should be avoided
• 100% oxygen is still recommended, however if
supplemental oxygen is unavailable room air should
be used
• Chest compression: Initiated if heart rate is absent or
remains < 60 bpm despite adequate ventilation for
30 sec
• Medications: Epinephrine 0.01-0.03 mg/kg if heart
rate < 60 bpm in spite of 30 seconds adequate
ventilation and chest compression

23. Which babies need resuscitation?
Assess:
• Gestation – term or preterm?
• Breathing or Crying?
• Good tone?
• If NO then act quickly
–The first “golden minute”

24. Neonatal
Resuscitation

25. Appx I
p342/x
Newborn life
support algorithm
Courtesy of the New Zealand
Resuscitation Council and
Australian Resuscitation Council
www.resus.org.au

26. Assessment and airway

27. Breathing

28. Circulation

34. Post resuscitation care:-
Keep baby warm
Check breathing , temperature & colour
Monitor blood sugar
Watch for complication
Initiate breastfeeding

35. MECONEUM ASPIRATE
SYNDROME

36. What is me conium aspiration?
• Meconium is the first intestinal discharge of
the newborn
– Epithelial cells, fetal hair, mucus, bile
• Intrauterine stress may cause in utero passage
of meconium
• Aspirated by the fetus when fetal gasping or
deep breathing .
– Warning sign of fetal distress

37. Risk Factors for Meconium Passage
• Postterm pregnancy
• Preeclampsia-eclampsia
• Maternal hypertension
• Maternal diabetes mellitus
• Abnormal fetal heart rate
• IUGR
• Oligohydramnios
• Maternal heavy smoking

38. Infant Active Infant Depressed
Observe
Intubate and suction
trachea
Other resuscitation as indicated
Intrapartum suctioning of
mouth nose
Meconium in Amniotic Fluid

39. Management

40. Management
• Skilled resuscitation team should be present at all
deliveries that involve MSAF(meconium stained
amniotic fluid).
• Pediatric intervention depends on whether the
infant is vigorous.
• Vigorous infant is if has:
1. Strong resp. efforts
2. Good muscle tone
3. Heart rate >100b/m
• When this is a case-no need for tracheal
suctioning, only routine management.

41. Management
• When the infant is not vigorous:
 Clear airways as quickly as possible.
 Free flow 02.
 Radiant warmer but drying and stimulation
should be delayed.
 Direct laryngoscope with suction of the mouth
and hypo pharynx under direct visualization,
followed by intubation and then suction directly
to the ET tube as it slowly withdrawn.
 The process is repeated until either ‘‘little
additional meconium is recovered, or until the
baby’s heart rate indicates that resuscitation
must proceed without delay’’.

42. IDIOPATHIC RESPIRATORY
DISTRESS SYNDROME

43. IDIOPATHIC RESPIRATORY DISTRESS
SYNDROME
This occur commonly in preterm neonates ,
babies of diabetic mother & infant delivered
by caesarean section or following breech
delivery.

44. PATHOGENESIS:-
Primary cause is inadequate pulmonary
surfactant , deficiency of surfactant in lung
alveoli increases alveolar surface tension.
CLINICAL FEATURES:-
Respiration rate more than 60/min.
Nasal flaring.
Expiratory grunting.
Cyanosis.

45. PREVENTION:-
Administer Betamethasone 12mg , 2 dose , IM
Assessment of lung maturation before
premature induction of labour.
Prevent fetal hypoxia in diabetic mother.

46. TREATMENT:-
Adequate warmed
Oxygen therapy
Correction of hypovolemia
Correction of anaemia &electrolyte imbalance
Frequent monitoring
Surfactant replacement therapy
Ventilator
Maintain fluid & nutrition

47. Summary- Today I have covered birth
asphyxia, its etiology, diagnostic
finding, neonatal resuscitation,
meconium aspirate syndrome, its
etiology & management, respiratory
distress syndrome, its etiology,
manifestation & management.

48. THANK YOU

49. Its time for evaluation??????????
1.What are the three things assessed after the
delivery in newborn?
2.What is PSSR of resuscitation?
3.How can we check the reflex response in
newborn?
4.Dose of Betamethasone?
5.Write any four risk factor of birth asphyxia?