Birth Asphyxia DefinitionFailure to initiate and sustain breathing at birth is called birth asphyxia. MagnitudeOf the 5 million neonatal deaths that occur worldwide, 19% death occur due to birth asphyxia (WHO 1995).

Factors associated with birth asphyxia1. Fetal distress Meconium Abnormal presentation2. Prolonged or obstructed labor3. Complicated, traumatic or instrumental delivery4. Severe maternal infections5. Maternal sedation, analgesia or anesthesia6. Antenatal or Intrapartam hemorrhage7. Pre-term or post-term birth8. Congenital anomaliesWho will need resuscitation?1. 80 - 90% of newborns require no assistance to initiate breathing at birth2. 10% require some assistance to begin breathing. 3. 1% among them requires extensive resuscitative measures to survive.

Sometimes the need for resuscitation can be predicted, but often it cannot, so... PREPARE FOR RESUSCITATION AT EVERY BIRTH

Neonatal ResuscitationIntroduction:We cannot tell which babies will have asphyxia at birth. Therefore we must prepared to do newborn resuscitation at all births. If a few minute pass before the starts to breath, baby can suffer from brain damage or die. Preparing for resuscitation include, warming the resuscitation area, preparing clean surface for the resucitation and collecting the equipments and supply.Principles of Newborn ResuscitationAccording to Pediatric working Group of the International Liaison Committee on Resuscitation (ILCOR) the principles of newborn resuscitation are as follows:1. Personal capable of initiating resuscitation should attend every delivery to establish a vigorous cry or regular respiration, to maintain a heart rate >100 beats per minute and achieve good color and tone.2.

Preparation of newborn resuscitationWe cannot predict which baby will have asphyxia at birth. Therefore, we must be prepared to do newborn resuscitation at all births. When certain preparations are not done the time will be lost.Preparations for newborn resuscitation include:1. Warming the resuscitation area2. Preparing a clean surface for resuscitation3. Collecting equipment and supplies4. Be prepared to cut the cord immediately if the baby needs resuscitation

Warming the resuscitation area:Keeping a newborn baby warm saves his/her energy for breathing. There are many ways to keep the baby warm. Keep the room warm and free from drafts and fans. Heat should avoided near the resuscitation area if possible The heater or light should not use above the baby but turned on before delivery and during resuscitation. Use a warm cloth to wrap the baby Prepare clean surface for doing the resuscitationUse a flat surface that is clean, dry and covered with warm cloth such as table.Prepare equipment and supplies Ambu bag Face mask size 1 for normal weight newborn baby and size 0 for low birth weight i.e. 100 &Pink give Supportive CareIf Apnea or HR 100 continue ventilate with bag and maskIf HR < 60 or HR >60, Ventilation and Chest compressions OngoingCareStop resuscitation if baby not breathing or gasping after 20 minutes without heartbeat Drugs like epinephrine and volume expanders like normal saline may be tried at this point depending on expertise of the birth attendantEvaluate respiration, heartrate, color and decide action

Step I: On Initial Assessment ask thefollowing: Meconium not present? Breathing or crying? Good muscle tone? Color pink? Term gestation?If the answer is yes, proceed with routine immediate newborn care, If the answer to any one question is no, then go to the next step.Step II: Initial Steps of Resuscitation Dry, stimulate*, warm Position, clear airway (as necessary) Reposition Give O2 (as necessary and if available)* If meconium is present, do not stimulate until after clearing airwayEvaluateAfter initial steps and also after every action (ventilation with/without chest compressions) it is necessary to evaluate the color, respirations and heart beat and then decide what to do further and take appropriate action.. Evaluation. Decision. ActionPrevent heat loss by: Placing newborn under radiant warmer or other heat source Drying thoroughly Removing wet towel

TACTILESTIMULATION

Open the airway by Positioning on back or side Slightly extending neck Aligning posterior pharynx, larynx and trachea

If the newborn is breathing but central cyanosis is present, give oxygen

oxygen mask oxygen tubing

Meconium Present at DeliveryNOYes

Suction mouth, nose and posterior pharynxafter delivery of head but before delivery ofshoulders

Baby vigorous?(strong respiratory effortand good muscle tone with heart rate > 100)YesNO

Suction mouth and trachea

Continue with initial steps of resuscitationSuction mouth first, then nose

Step III. Provide positive pressure ventilation If not breathing or heart rate 100, color ispink with good tone may be given to mother forwarmth and breastfeeding.Frequent assessments of color, tone and vitalsigns for the first six hours needed. Ongoing Care:These babies have had active resuscitation (bagand mask ventilation and/or chest compressions)They may need more monitoring before giving tomother or going to higher level care and thereforeneed to be transferred to the Baby Unit for furtherobservation, evaluation and action based on theircondition.42Care After Unsuccessful Resuscitation(If the baby is not breathing or not gasping after 20minutes without heartbeat, stop resuscitation)- Talk with mother/family about the babys death andanswer their questions- Ask if they want to see and hold the baby- Explain to the mother and family about the motherscare:Rest, support and good dietManagement of engorged breastsRecords- Recording and notification of baby's birth and death- Completion of required medical records for thedelivery