ASPHYXIA NEONATORUM

This is a term which refers to a condition in which the baby fails to breath at birth.

TYPES OF ASPHYXIA

         The degree of asphyxia is determined by Apgarscorein which the following features are observed and score 0-2

· Appearance (colour of the body)

· Pulse (heart rate)

· Grimace (response to stimuli)

· Activity (muscle tone)

· Respiration /respiratory effort

A score between 8- 10 does not show asphyxia. There are three types of asphyxia namely:

1. Mild asphyxia – Apgar score is 6-7. It requires clearing of the airway and application of external stimuli to in initiate breathing

2. Moderate asphyxia – Apgar score is 4-5. It requires resuscitation, administration of oxygen and drugs to initiate breathing.

3. Severe asphyxia – Apgar score is 0-3. It requires intensive resuscitative measures and intubation to survive.

PREDISPOSING FACTORS

 

ü Any condition causing foetal distress e.g. cord prolapse, prolonged labour,APH, intrauterine hypoxia due to placental insufficiency, post maturity, placenta abruption.

ü Anaemia, Pre-eclampsia

ü Pre- maturity due to under development of the respiratory centre.

ü Blockage of the airway by mucus or liquor amnii at birth.

ü Birth injuries e.g. intracranial injury

ü Severe maternal disease inpregnancy e.g. sickle cell anaemia, cardiac disease

ü Depression of respiratory center due to drugs e.g. GA and narcotics

SIGNS AND SYMPTOMS

 

MILD AND MODERATE ASPHYXIA

1. Apex beat (pulse rate) 100/min or less

2. Skin colour is pink with blue extremities

3. Response to stimuli may be present

4. Cry may be weak or strong

5. Makes effort to breath and may gasp with irregular respiration

SEVERE ASPHYXIA

1. No attempt to breath and may gasp periodically

2. it does not cry

3. Entire body skin is blue i.e. cyanosed-central.

4. No response to stimuli

5. Pulse rate very low or absent

6. Poor muscle tone

NURSING MANAGEMENT

 

ü Clear the airway as soon as possible.

ü Nurse the baby in an incubator for at least 48 hrs to keep it warm at body temperature.

ü Resuscitation may be needed to promote ventilation and ensure effective circulation to prevent acidosis, hypoglycaemia and intracranial hemorrhage

v Do suctioningwhenever necessary

v Closely observe the baby for skincolour, TPR.

v  Administer oxygen by mask, ambu bag or nasal catheter whenever there is an apnoeic attack.

v  Give IV fluids for rehydration.

v  Aspirate mucus to unblock the airway or may intubate the baby.

v Give fluids with electrolytes to maintain fluid – electrolyte balance.

v  If the mother was given narcotics during labour, administer its antidote naloxonethro the umbilical vein.

v Administer the following drugs:

· Sodium bi- carbonate 1-2 mls to combat acidosis.

· Vitamin K 0.5 -1 mg i.mto prevent haemorrhagic disorders.

· Aminophylline to improve respiration.

· Calcium gluconate to strengthen heart muscles.

² Maintain accurate input output chart to prevent over hydration and under hydration

²  When the baby is stable pass NG tube and start feeding.

² Observe aseptic technique to prevent cross infection.

²  Administer broad spectrum antibiotic prophylactically.

PREVENTION OF ASPHYXIA

 

Ø Proper screening of mothers to detect those mothers at risk and advice on hospital delivery for proper management.

Ø Pelvic assessment should be done at 36 weeks gestation to rule out pelvic inadequacy e.g. CPD.

Ø Proper management of maternal diseases in pregnancy.

Ø  Drugs that depress respiratory center e.g. sedatives, GA and narcotics should be avoided in late first stage.

Ø  Early detection and management of foetal distress.

Ø Clearing baby’s airway as soon as the head is born.

Ø  Avoiding instrumental deliveries but rather prepare for caeserian section.

 

 

 COMPLICATIONS

1. Brain damage

2. Cardiac arrest

3. Respiratory distress syndrome

4. Respiratory acidosis.