1. Chapter 3 Problems of the neonate and young infant - Birth Asphyxia

2. Case study: Baby of Ruth
Baby of Ruth is a boy born at term. He is blue and has poor muscle tone. He doesn't cry.

3. Assessment of newborn at delivery
Dry and stimulate baby with clean cloth and place where the baby will be warm
Look for:
Breathing or crying
Good muscle tone
Colour pink NO
Call for Help, check HR, attach sats probe if available
Remember A, B, C - added

4. Airway, Breathing Circulation
Assessment of newborn at delivery
YES NO
Start the resuscitation now!
Early Essential
Remember: A,B,C
Newborn Care
Airway, Breathing Circulation
Does baby of Ruth need resuscitation?
Call for Help, check HR, attach sats probe if available
Remember A, B, C - added

5. (Ref. WHO pocket book p.47) NEW SLIDE Moved from chapter 3
Highlighted A B C

6. Neonatal resuscitation
(A=Airway)
Open airway by positioning the head in the neutral position (Ref. p. 47)
Clear airway and suction, if necessary
Stimulate, reposition
Give oxygen, as necessary
Ruth’s baby is still blue and not breathing.

7. Neonatal resuscitation
(B = Breathing)
Use a correctly fitting mask:
If the baby is still not breathing (Ref. p. 47) :
Check position and mask fit
Continue to give breaths at 40 breaths per minute
Use oxygen if available
Every 1-2 minutes stop and see if the pulse or breathing has improved
Merged slide 5/6 –
Give the baby 5 slow ventilations with bag (Ref. p )
Check the heart rate

8. Neonatal resuscitation
(C=Circulation)
Check the heart rate (HR)
What steps would you take next?

9. Early Essential Newborn Care
Immediate and thorough drying with a clean cloth
Maintain skin-to-skin contact
Give the baby to mother as soon as possible, on chest or abdomen
Cover the baby to prevent heat loss
Properly time cord clamping
Wait for up to mins or until pulsations stop. Keep umbilical cord clean and dry.
Breastfeeding and non-separation
Initiate within the first hour keeping mother and baby together
Further Management after 1hr:
Give vitamin K (phytomenadione), according to national guidelines 1 ampoule IM once
Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis), according to national guidelines
Full examination and weight

10. History
Ruth’s baby was born at term. He came out not crying, blue and with poor muscle tone. He was resuscitated for 2 minutes.
Rupture of membranes happened at home, contractions were regular. Ruth, G1 P1, was in labour for a long period of time, but progressed to normal delivery in hospital.
She had no chronic illness and no pre-eclampsia.

11. Examination after stabilisation
After 2 minutes bag-mask resuscitation baby was breathing well, muscle tone has increased. He was crying.
Vital signs: pulse: 124/min, RR: 46/min, SpO2 93%
Weight: 3.2 kg
Chest: mild chest indrawing, breath sounds heard over both sides, no added sounds
Cardiovascular: both heart sounds were audible and there was no murmur
Abdomen: soft, bowel sounds were active
Neurology: muscle tone improved, no focal signs

12. What supportive care and monitoring are required?

13. Monitoring The baby has to be monitored frequently
Pay attention to colour, breathing, muscle tone and ability to suck

14. Monitoring (continued)
In the days after birth asphyxia the baby may develop following problems (Ref. p ):
Convulsions
check glucose
treat with phenobarbital
Apnoea
oxygen by nasal prongs
resuscitation with bag and mask
Inability to suck
feed with breast milk via a nasogastric tube
Treat only if the problem arises

15. Supportive Care
If no evidence of birth asphyxia at delivery provide normal care for newborn:
Give the baby to mother as soon as possible, place on chest or abdomen
Cover the baby to prevent heat loss
Encourage initiation of breastfeeding within the first hour
Keep umbilical cord clean and dry
Give vitamin K 1 ampoule IM single dose
Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis)
(Ref. p. 46, p. 50)
Take care of the mother

16. Breastfeeding support
Early and exclusive breastfeeding is important for all newborns
Breastfeeding support:
Encouragement
Breastfeeding friendly environment
Breastfeeding assessment and counselling
(Ref. p. 295)

17. Progress
The baby’s motor tone recovered well in the first 4 hours. After some difficulties at the beginning he was sucking well.
Before he was discharged home he also received hepatitis B and BCG vaccines.

18. Follow-up Baby should receive regular MCH follow-up to monitor:
Growth and development
Nutritional intake
Immunization status
Detection of other illnesses or problems

19. Summary Be prepared for resuscitation at every delivery
Don’t need oxygen in most cases, bag-mask ventilation will stimulate the baby to breathe on its own
Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability
The prognosis is good for babies who respond quickly to resuscitation
Learn all steps of neonatal resuscitation, practice and teach others