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ASPHYXIA NEONATORUM
FAILED TO BREATH SPONTANEOUSLY AND
FAILED TO BREATH SPONTANEOUSLY AND
REGULARLY
REGULARLY AT
AT BIRTH
BIRTH OR
OR FEW
FEW MINUTE
MINUTE
THEREAFTER
THEREAFTER
80 %
20 %
SPONTANEOUS BREATHING
FAILED
ASPHYXIA
MATERNAL
FETAL
HYPOXIA
HYPOXIA
MATERNAL
MATERNAL FACTOR
FACTOR
FETAL
FETAL FACTOR
FACTOR
PLACENTAL
PLACENTAL FACTOR
FACTOR
ASPHYXIA
CLINICAL CHANGES
Primary gasping
Primary apnea ---------------- Skin cyanotic
Heart rate :
Secondary gasping
death
ALWAYS SUGGEST
OR
SUSPECT AS
SECONDARY APNEA
BIOCHEMICAL CHANGES
ONSET
pO2
pCO2
pH
Aerob metabolisme
An aerob metabolisme
DIAGNOSIS of ASPHYXIA
CLINICAL ASSESMENT :
RESPIRATORY EFFORT
HEART RATE
SKIN COLOUR
APGAR Score
SIGTUNA SCORE
More simple
2 variables : - Respiratory rate
- Heart rate
APGAR SCORE
Symptom/Sign
Pulse
< 100/mnt
2
>100/mnt
Respiratory
effort
none
grunting
Crying
Muscle tone
Floppy
Partial
flexion
Full flexion.
active
Sensitive to
stimulation
No response Grimace
Crying
Color
Pale
Pink
Blue
Ethiology of Depression :
RESUSCITATION :
equipment
* SUCTION SET
* MASK & BAG
* INTUBATION SET
*MEDICATION
A
AB
BC
C Resuscitation
Resuscitation
INITIAL
INITIAL STEP
STEP
of
of
RESUSCITATION
RESUSCITATIO
N
Prevent
* PreventHeat
Heat
Loss
Loss
Airway
* Airway
cleaning,
cleaning,
Proper
Proper
baby
baby
position,
position,
suctioning
suctioning
mouth
mouth
then nose
then nose
Stimulate
* Stimulate
respiration
respiration
if if
needed
Asses
* Asses
baby
baby
Action
Assesment
Decision
USING Oxygen
(if available )
Using nasal catheter
Using Oxygen Mask
Using Bag and Mask
Opening Airway
* Make proper position : light
extension,put linen under the
shoulder
*Suction : No meconeum :
mouth - nose
minimal handling : not excessive
usually - stimulate breath
MECONEUM
MECONEUM STAINED
STAINED IN
IN AMNION
AMNION LIQUID
LIQUID
SUCTION
SUCTION WHEN
WHEN HEAD
HEAD
DELIVERED
DELIVERED
Active baby
Apnea or Depressed
HR < 100
Muscle Tone decrease
Thick
Meconeu
m
Observe
Suction via trachea
By ET
Start
Rescusitation
Assessing Newborn
* Respiratory effort
* Heart Rate
* Skin colour
Oxygen
Provide PPV
effectively, Bag
and Mask,
Intubation ET
Chest
compression
Medicatio
n
Should be considered :
Mask attachement : no leakage
Pressure on bag -- Chest
movement / Chest compliance
Rate : 40 60 x / minute
POSITIVE PRESSURE
VENTILATION ( PPV )
INDICATION :
APNEA OR GASPING
HEART RATE < 100 X/mnt
H
DR
J<
<60
60
Continue PPV
+ Chest
compress
H R <100
HR > 100
Continue
PPV
Look for
spontaneous
breathing
Stop PPV
Provide
O2
,gradually
reduced
CHEST
CHEST
CHEST
Indication
Indication ::
Hypoxemia
Compression
Compression
Compression
HR
HR
HR
<
<
<
60
x/mnt
60
60 x/mnt
x/mnt
HR
Cardiac contractility
CHEST Compression =
External Cardiac massage
Provide : Artificial Heart Beat
Include :
Compress
Compress heart
heart through
through
the
the
bone
bone
Increasing
Increasing Intra
Intra thoracal
thoracal
pressure
pressure
Ensure
Ensure blood
blood circulation
circulation
in vital
in vital
organ
organ
Should be done
together with PPV
Technically : * thumbs
* two fingers
Stopped : HR > 60 x/mnt
Location : - imagination line between 2 niples
- 1/3 sternum below line,
- above proc.
xyphoideus
Depth: 1- 2 cm during
pressing and off
Frequency : 90 compression +
30 ventilation
within 1 mnt : Ratio 3 : 1
Complication :
Rib fracture
Trauma / laceration of liver
Pneumothorax