ASPHYXIA NEONATORUM

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 ASPHYXIA NEONATORUM

GNC QUESTIONS WITH SHORT ANSWERS
A. DEFINITION ASPHYXIA NEONATORUM [5%]
B. 3 CLASSIFICATIONS OF ASPHYXIA NEONATORUM [10%]
C. 5 PREDISPOSING FACTORS TO ASPHYXIA NEONATORUM [20%]
D. MANAGEMENT OF ASPHYXIA NEONATORUM [50%]
E. COMPLICATIONS OF ASPHYXIA NEONATORUM [15%]
ANSWERS
A. DEFINITION
This is the failure of a viable fetus to initiate and sustain respirations at birth due to intrauterine hypoxia characterized by cyanosis, poor muscle tone and bradypnea.
B. CLASSIFICATIONS
1. Mild asphyxia
👉Here the heart rate is between 60 to 80 beats per minute.
👉 Poor to good muscle tone
👉 The baby tends to breath
👉 Flexion of limbs present
👉 Cyanosis present
2. Moderate asphyxia
👉Heart rate is between 40 to 60 beats per minute
👉 Poor to good muscle tone
👉 May show some flexion
👉 Baby attempts to breath.
3. Severe asphyxia
👉Heart rate is lower than 40 beats per minute
👉 Baby fails to breath
👉No flexion
👉 Color is blue to grey
C. PREDISPOSING FACTORS
1. Preeclampsia or eclampsia
Leads to vasodilation hence reducing oxygen supply to the fetus.
2. Anaemia
When the pregnant woman is anaemic,she will have low levels of haemoglobin which is responsible for oxygen transportation.
3. Placenta abruptio
Early detachment of the placenta from the uterine wall before delivery of the baby will deprive the baby of oxygen.
4. True knots
When the umbilical cord tie it self, there will be little or no blood flowing to the fetus carrying oxygen.
5. Compression of the cord
If the umbilical cord gets compressed for any reason,it will cut off oxygen supply to the fetus.
D. MANAGEMENT
1. Immediate management
This involves resuscitation.
Aims
a. To initiate and maintain respirations
b. To prevent hypothermia
c. To correct metabolic acidosis
c. To prevent atelectasis or other complications
So immediately when the baby is out,
👉Wipe mouth and nose to clear the airways
👉Clamp and cut the cord 2.5cm apart
👉Show the mother for sex identification
👉 Immediately explain the condition to the mother and the need to transfer the baby to the resuscitaire
👉 Wipe the baby dry to prevent hypothermia
👉Put baby on a pre warmed resuscitaire
👉 Suction mouth and nose
👉Assess for any improvement using ABC AND APGAR SCORE
👉If no improvement AMBU BAG
👉Assess again using ABC AND APGAR SCORE
👉If no improvement intubation and give artificial ventilation
👉 Assess again using ABC AND APGAR SCORE
👉If the baby is stable give the mother to start breastfeeding.
👉If no improvement transfer to NICU and give the following drugs as last resort.
Drugs
👉 Naloxone hydrochloride 0.01mg/kg
👉 Sodium bicarbonate 1-2mls/kg
👉 Adrenaline 1:1000
👉 Dextrose 10 %
2. SUBSEQUENT CARE
Aims
👉To maintain respirations
👉 Prevent hypothermia
👉 Provide psychological care to the mother
👉 Prevent Hypoglycemia
USE ACRONYM EPROPHENEMA
1. Environment
👉Nurse in an incubator and regulated temperature and humidity.
👉Add some basics.
2. Position
👉Lateral position to aid in drainage of secretions
👉Turning the baby 2houry to prevent pressure sores
3. Rest
👉Avoid noise, restrict visitors
👉Do procedures in blocks
Add some basics
4. Observations
👉Use APGAR SCORE to assess the improvement in baby's condition.
👉Do vitals
👉Check for reflexes then add some basics
5. Hygiene
👉Top and tail until the baby is stable the switch to baby bath
👉Cord care, eye care, changing pads
6. Nutrition
👉Cannulate and give dextrose 10%
👉If not able to feed,insert NGT and give expressed breast milk
👉When the baby Is able to suck encourage exclusive breastfeeding
Add some basics
7. PREVENTION OF INFECTIONS
👉 Regular hand washing before and after handling the baby
👉 Mother to wash the breasts before and after feeding
👉 Restrict visitors with URTIs
Add some basics
8. Medication
a. Antibiotics for prophylaxis Prevention
Eg Ampicillin 5mg/kg
b. Vitamin K for bleeding Prevention
etc
9. IEC to the mother
a. Exclusive breastfeeding
b. Danger signs
c follow up visits
d. Hygiene
NOTE: THAT YOU NEED TO WRITE THE MANAGEMENT IN PARAGRAPHS AND NOT POINT FORM. WE WROTE IN POINT FORM TO SUMMARIZE IT FOR EASY REMEMBRANCE.
E. COMPLICATIONS
1. Mental retardation
Due to continued deprivation of oxygen supply to the brain
2. Atelectasis
Due to continued laboured breathing
3. Septicaemia
Due lowered immunity
4. Hypoglycemia
Due to poor glycogen stores
5. Brain damage
Due to continued deprivation of oxygen supply

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