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    5 Asphyxia Neonetrum

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    Rana Vandana
    This document discusses asphyxia neonatorum, or birth asphyxia. It defines it as impaired respiratory gas exchange accompanied by acidosis. It then discusses how asphyxia occurs, ways to assess severity using Apgar scores, predisposing maternal and fetal factors, the pathophysiology which affects organs like the brain, heart, lungs and kidneys, signs and symptoms, investigations, management including supportive care and treatment of shock, cerebral edema and kidney failure, and differential diagnosis.

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    5 Asphyxia Neonetrum

    Uploaded by

    Rana Vandana
    127 views27 pages
    This document discusses asphyxia neonatorum, or birth asphyxia. It defines it as impaired respiratory gas exchange accompanied by acidosis. It then discusses how asphyxia occurs, ways to assess severity using Apgar scores, predisposing maternal and fetal factors, the pathophysiology which affects organs like the brain, heart, lungs and kidneys, signs and symptoms, investigations, management including supportive care and treatment of shock, cerebral edema and kidney failure, and differential diagnosis.

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    Gynecology and pediatric topic

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    This document discusses asphyxia neonatorum, or birth asphyxia. It defines it as impaired respiratory gas exchange accompanied by acidosis. It then discusses how asphyxia occurs, ways to assess severity using Apgar scores, predisposing maternal and fetal factors, the pathophysiology which affects organs like the brain, heart, lungs and kidneys, signs and symptoms, investigations, management including supportive care and treatment of shock, cerebral edema and kidney failure, and differential diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    127 views27 pages

    5 Asphyxia Neonetrum

    Uploaded by

    Rana Vandana
    This document discusses asphyxia neonatorum, or birth asphyxia. It defines it as impaired respiratory gas exchange accompanied by acidosis. It then discusses how asphyxia occurs, ways to assess severity using Apgar scores, predisposing maternal and fetal factors, the pathophysiology which affects organs like the brain, heart, lungs and kidneys, signs and symptoms, investigations, management including supportive care and treatment of shock, cerebral edema and kidney failure, and differential diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    ASPHYXIA NEONATORUM

    ASPHYXIA NEONATORUM

    Defined as impaired respiratory gas exchange


    accompanied by the development of acidosis
    Definition of perinatal asphyxia
    WHO :
    A failure to initiate and sustain breathing
    at birth.

    NNF :
     Moderate asphyxia
     Slow gasping breathing or an apgar score
    of 4-6 at 1 minute of age
     Severe asphyxia
     Nobreathing or an apgar score of 0-3 at 1
    minute of age
    HOW DOES ASPHYXIA OCCUR?
     Interruption of umbilical cord blood flow, eg: cord
    compression during labour

     Failure of exchange across the placenta, eg: abruption

     Inadequate perfusion of maternal side of placenta, eg: maternal


    hypotension

     Compromised fetus who cannot tolerate transient


    intermittent hypoxia of normal labour

     Failure to inflate lungs


    TO ASSESS THE SEVERITY OF
    ASPHYXIA - Apgar Scores
    Signs 0 1 2

    Colour Blue/pale Blue peripheries Pink

    Heart rate 0 <100 >100

    Respiration 0 Weak, gasping Regular

    Suction response 0 Slight Cries

    Tone 0 Fair Active

    A -Appearance P- Pulse G- Grimace A-Activity R-Respiration


    Quiz:
    At birth, a newborn infant is noted to have the following findings: heart
    rate – 70/min, respiratory effort – poor and irregular, limp, no reflex
    irritability, blue all over the body.

    The Apgar score of the baby at this point is?

    HR 1, RR 1, Tone 1, reflex 0, color 0


    APGAR=3
    PREDISPOSING FACTORS
    Maternal Causes

     Medical conditions eg Pulmonary hypertension


    Chronic HPT (hyperpatathyroidism)

     Antenatal conditions eg Abnormal uterine contraction


    Antepartum haemorrhage
    Prolapsed cord
    Malpositions etc
    PREDISPOSING FACTORS

    Fetal Causes

     Multiple pregnancies

     Big baby with CPD


     Fetal anomalies - Congenital abnormalities
    of the lung
    PATHOPHYSIOLOGY
    Fetal adaptation to oxygen lack

    1. Preferential flow to heart, brain and adrenals

    aerobic anaerobic metabolism

    glucose pyruvic acid lactic acid Acidosis

    Acidosis failure of autoregulation impaired perfusion


    increasing acidosis Death unless resuscitated
    PATHOPHYSIOLOGY

    2. Primary and Secondary apnoea

    Occur as an attempt to minimize metabolic work


     3.Fetal response to asphyxia

    Respiratory metabolic acidosis

     4. EEG changes

    Loss of faster rhythm iso-electric rhythms


    Prolonged voltage suppression with burst of
    spike waves indicating risk of significant brain
    CLINICAL FEATURES
     Apnoea, bradycardia
     Altered respiratory pattern
     Cyanosis

     Pallor-shock

     Hypotonia

     Unresponsiveness
    ORGANS INVOLVED IN ASPHYXIA (1)

    Asphyxia results in alteration in blood flow to various organs,


    hence multiple organ injury

    Kidney abnormalities occur in 50% of asphyxiated infants


    CNS abnormalities in 30% & CVS & pulmonary abnormalities in
    25%

    • Renal abnormalities - Oliguria, elevated β2 , microglobulin,


    • azotaemina, elevated serum creatinine, acute tubular
    necrosis
    ORGANS INVOLVED IN ASPHYXIA (2)

     CNS abnormalities - HIE, PV-IVH

     CVS abnormalities - Ventricular failure (R > L)


    Tricuspid regurgitation
    Hypotension

     Pulmonary abnormalities - PFC, pulmonary


    haemorrhage
     GIT abnormalities - bleeding GIT, NEC
    (necrotizing enterocolitis)
    PATHOLOGY OF BRAIN DAMAGE
    Extent of damage depends on:

     duration of asphyxia
     severity of asphyxia
     gestational age
     alteration in cerebral blood flow
     changes in glucose/glycogen metabolism
    in vulnerable areas of brain.
    In hypoxic-ischaemic encephalopathy, as the
    cerebral edema develops, the brain function is
    affected in descending order.
    Preventing asphyxia
    • Perinatal assessment
    – Regular antenatal check ups
    – High risk approach
    – Anticipation of complications during labour
    – Timely intervention ( eg. LSCS)
    • Perinatal management
    – Timely referral
    – Management of maternal complications
    Prevention,
    PREVENTION
    Recognition of at risk pregnancies
    Antenatal monitoring
     fetal movements, fetal growth
     CTG for change in baseline, loss of variability, decelerations
     fetal scalp pH
    < 7.2 --------------------- immediate delivery
    7.2 - 7.25 ------------- repeat in 1 hour
    7.25 normal
     Co-ordinated care at delivery by paediatrician
    MANAGEMENT-Investigations
     Hx - of pregnancy and resuscitation

     Metabolic tests - sugar, Ca/P04/Mg, cord BG, ABG,


    metabolic screen

     CSF - to exclude infection; assay brain specific creatine


    kinase
     EEG - to help with seizure Dx and prognosis
     Tech. scan - for abnormal uptake in damaged area
    MANAGEMENT
     U/S - to exclude PV-IVH

     CT scan - to exclude IVH/trauma, demonstrate severity of edema and for


    prognosis

     MRI scan

    • Supportive care
     Monitor B/p, To, blood sugar, correct acidosis and electrolyte
     inbalance Care of renal failure - low fluid, dialysis
     Care of cardiac failure - Dopamine, restrict fluid
     Management of inappropriate ADH secretion - prevent overhydration
    MANAGEMENT-1
    BASIC CARE :Should be a daily routine in the management of all
    these babies -
    1. Strict asepsis.
    2. Ensure neutral thermal environment.
    3. Monitor vital parameters – HR,RR,BP,and Pulse Oximetry.
    4. Urine output.
    5. Daily weight.
    6. Nutrition.
    1. Management of shock
    1. Hypovolumic shock needs replacement with fluids, plasma, or
    blood.
    2. Cardiogenic shock warrants use of pressors like dopamine and /
    or dobutamine. In case of refractory shock inspite of use of
    pressors of 20 microgram/kg/mt steroids may be tried.
    3. Septic shock should be suspected based on intrapartum risk
    factors for sepsis, core axillary mismatch and results of sepsis
    screen.
    2-MANAGEMENT of Cerebral Oedema
    • Minimise cerebral edema
     Ventilation - to prevent apnoea and maintain PC02 of 25 - 30 mmHg
     Ensure adequate oxygenation
     Restrict fluid intake
     Mannitol/frusemide - if urine output is established
    3-MANAGEMENT OF KIDNEY FAILURE
    Urine output is by itself not a reliable marker renal
    parameters need to be monitored.
    2.Fluid restriction is required once renal failure sets in. A
    careful evaluation of electrolytes would direct the
    fluid management.
    3.Daily monitoring of urine output, urine specific gravity,
    and body weight are adjuvant to basic care.
    4.Rarely peritoneal dialysis is required in case of
    persistent oliguria
    Whole Body Hypothermia Selective Head Cooling
    DIFFERENTIAL DIAGNOSIS
     Drug depression - maternal drugs, GA
     Prematurity
     Trauma - tentorial tear
     Anaemia
     Neuromuscular disorder
     Infection
     Inborn error of metabolism - Pyridoxine Dependency
     Respiratory tract malformation
    That’s a wrap

    Got questions?

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