Definition:

It is an insult to brain & other organs of the body of a fetus or newborn resulting from hypoxia or ischemia and is usually associated with hypercapnea and tissue lactic acidosis.

Classification:

Perinatal asphyxia is classified according to APGAR SCORE as following-

1. Mild asphyxia: APGAR score is 7 -9 at 1 min.
2. Moderate asphyxia: APGAR score is 4 -6 at 1 min (slow gasping breathing). Also known as asphyxia livida
3. Severe asphyxia: APGAR score is 0 -3 at 1 min (bag & mask ventilation are required. Also known as asphyxia palida.

Management of Perinatal asphyxia:

Management of perinatal asphyxia is given below-

1. Establishment of respiration & circulation by resuscitation-

a) Assessment of color, breathing and heart rate(HR) immediately after birth
b) If the newborn is healthy (color-pink, breathing-normal, HR-100/min or more)-
no need of resuscitation
c) If the newborn is not so well (color-blue, breathing-weak, HR-less than 100/min)-

• Airway is opened by extending the neck by placing a rolled towel below the neck
• Oro-pharyngeal & then naso-pharyngeal suction is given
• Rubbing over vertebral column and flickering at the soles of the foot may induce respiration
• If respiration is not yet established- five inflation breaths are given to the neonate through Umbo bag & mask over 10 seconds (i.e. at a rate of 1 breath/ 2 seconds)
• HR is measured, if it is 100/min or more – inflation breaths are continued at a rate of 30 breaths/min until respiration is established
• If HR is still less than 100/min – more five inflation breaths are given and HR is measured again
• If HR is still less than 100/min – Cardiac message/compression and inflation breaths are given at a ratio of 3:1 for 3 cycles (i.e. 3 cardiac message/compression and 1 inflation breath in each cycle)
• HR is measured again, if it is 100/min or more – inflation breaths are continued at a rate of 30 breaths/min until respiration is established
• If HR is still less than 100/min Cardiac message/compression and inflation breaths are given at a ratio of 3:1 for more 3 cycles
• HR is measured again, if it is 100/min or more – inflation breaths are continued at a rate of 30 breaths/min until respiration is established
• If HR is still less than 100/min it should be ensured that all above measures are taken accurately
• Then Inj. Adrenaline is given through umbilical veins
• If respiration is established- Inj. NaHCO3( sodium bi carbonate) is given
• If respiration is not yet established- endotracheal intubation is administered. Normal saline should be given if mother had APH & 25% DA is given if mother has DM
• If respiration is not yet established- Cardiac message/compression and inflation breaths are continued at a rate of 30 breaths/min upto 20 minutes from begining of the process
• If HR is still less than 100/min  – ” No More Resuscitation” .

d) If the newborn is ill (color-pale, breathing-gasping or absent, HR-less than 60/min or none)- measures should be started from step vii (described above).

2. Maintenance of body temperature by-

i) Wrapping of the whole body of the baby with warm cotton & the head by double cap after drying the baby
ii) Keeping the newborn infant in incubator
iii) Using radiant warmer, if the baby is born at home- electric heater should be used

3. IV infusion should be started but 2/3 rd of the required amount
4. Inj. Vitamin K should be given at a dose of 1 mg IM or 2 mg orally
5. Antibiotics should be started if needed
6. Normal saline 10 ml/kg should be administered over 5 – 10 min if capillary refilling time is more than 3 seconds. It can be repeated if needed.
7. For better neurodevelopment- phenobarbitone can be given prophylactically as a single dose of 40 mg/kg IV within 6 hours of delivery
8. Regular monitoring of respiration, heart rate, temperature, urine output, capillary refilling time, oxygen saturation ,blood glucose level, serum electrolytes, serum Ca, serum Mg, Hb%.