Major disorder

Major disorder

•       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.

 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.

•       According to American academy of paediatric

vCord umbilical artery PH <7.

vPersistence of APGAR score of 0-3 for more than 5 minute.

vMultiple organ dysfunction (kidney , heart , lung etc ).

vNeurological manifestation eg:-seizure,coma,hypotonia(deficient tension in eyeball).

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

•       INCIDENCE RATE

•       Birth asphyxia in  undeveloped countries

–  10% of newborns suffer mild to moderate birth asphyxia

–  1% of newborns suffer severe birth asphyxia

•       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.

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.

•       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.

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.

•       Neonatal Evaluation and Resuscitation

APGAR Scoring

A Appearance

P Pulse

G Grimace

A Activity

R Respirations

•       Apgar score assessment

7-10 – No or mild depression

4-6 – Moderate depression

0-3 – Severe asphyxia

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”.

NEWBORN RESUSCITATION

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

•       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

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

•       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

•       Which babies need resuscitation?

Assess:

•       Gestation – term or preterm?

•       Breathing or Crying?

•       Good tone?

•       If NO then act quickly

–The first “golden minute”

•       Neonatal Resuscitation

Post resuscitation care:-

vKeep baby warm

vCheck breathing , temperature & colour

vMonitor blood sugar

vWatch for complication

vInitiate breastfeeding

MECONEUM ASPIRATE SYNDROME

•       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

•       Risk Factors for Meconium Passage

•        Postterm pregnancy

•        Preeclampsia-eclampsia

•        Maternal hypertension

•        Maternal diabetes mellitus

•        Abnormal fetal heart rate

•        IUGR

•        Oligohydramnios

•        Maternal heavy smoking

•       Management

•       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:

•             Strong resp. efforts

•             Good muscle tone

•             Heart rate >100b/m

•                 When this is a case-no need for tracheal suctioning, only routine management.

•       Management

•                  When the infant is not vigorous:

v  Clear airways as quickly as possible.

_v     Free flow 0_2.

v  Radiant warmer but drying and stimulation should be delayed.

v  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.

v  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’’.

•    IDIOPATHIC RESPIRATORY DISTRESS SYNDROME

•       IDIOPATHIC RESPIRATORY DISTRESS SYNDROME

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

PATHOGENESIS:-

   Primary cause is inadequate pulmonary surfactant , deficiency of surfactant in lung alveoli increases alveolar surface tension.

CLINICAL FEATURES:-

vRespiration rate more than 60/min.

vNasal flaring.

vExpiratory grunting.

vCyanosis.

PREVENTION:-

vAdminister Betamethasone 12mg , 2 dose , IM

vAssessment of lung maturation before premature induction of labour.

vPrevent fetal hypoxia in diabetic mother.

TREATMENT:-

vAdequate warmed

vOxygen therapy

vCorrection of hypovolemia

vCorrection of anaemia &electrolyte imbalance

vFrequent monitoring

vSurfactant replacement therapy

vVentilator

vMaintain fluid & nutrition

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.

THANK YOU

•       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?