Neonatal Asphyxia

DEFINITION

Neonatal asphyxia is a state where a baby can not breathe spontaneously soon after birth and regularly. When there is interference or transport of O2 gas exchange during pregnancy / childbirth, will occur asphyxia. This situation will affect the function of body cells and if not resolved will lead to death.

Infants with a history of fetal distress before birth, will generally be asphyxiated at birth. This problem is closely related to the health problems of pregnant women, umbilical cord abnormalities, or problems that affect the welfare of the baby during or after childbirth.

CAUSE

Certain factors are known to be the cause of asphyxia in newborns, including the factor of maternal, infant clan umbilical cord following:

1. Maternal factors

Preeclampsia and eclampsia

Abnormal bleeding (placenta previa or placental abruption)

Prolonged labor or obstructed

Fever during labor Severe infections (malaria, syphilis, tuberculosis, HIV)

Limitations of pregnancy (after 42 weeks gestation)

2. Factors Umbilical Cord

Nuchal cord

Short umbilical cord

Knot cord

Umbilical cord prolapse

3. Factors Babies

Baby prematurely (before 37 weeks gestation)

Deliveries to the action (breech, twins, shoulder dystocia, vacuum extraction, extraction forceps)

Congenital abnormalities (congenital)

Amniotic fluid mixed with meconium (greenish color)

CLASSIFICATION neonatal asphyxia:

Mild neonatal asphyxia: 7-10 Apgar scores. Considered healthy baby, and does not require special action.

Neonatal asphyxia were: Apgar score 4-6. On physical examination will look frequencies of more than 100 / min, poor muscle tone or both, cyanosis, no reflex irritability.

Asfisia neonatal weight: Apgar score 0-3. On physical examination found the heart rate of less than 100 / min, muscle tone is bad, severe cyanosis, and sometimes pale, reflex irritability does not exist, the asphyxia with cardiac arrest is heart sounds of the fetus disappeared no more than 10 minutes before it was born full or sounds heart disappeared the same post partum physical examination severe asphyxia 

SYMPTOMS

Signs and symptoms of neonatal asphyxia

·         Not breathing or gasping breathing or slow breathing (less than 30 beats per minute).

·         Irregular breathing, snoring or retraction (pelekukan chest)

·         Weak cries or whimpers

·         Pale or blue skin color (cyanosis)

·         Limb weakness or muscle tone is weak

·         No heartbeat or slow (bradycardia) (less than 100 beats per minute).

DIAGNOSIS

In newborns with asphyxia usually the baby was pale and bluish, irregular breathing, apart from the above physical examination, the diagnosis of asphyxia was also established as follows:

a. FHR <Fetal Heart Rate>

The circumstances in which the frequency of fetal heart rate drops below 100 / min, or irregular heartbeat. Electro cardiogram fetus is used to continuously monitor the fetal heart.

b. Meconium in the amniotic fluid

The presence of meconium in cephalic presentation, showed impaired oxygenation, can be an indication to terminate labor.

c. Examination of the fetal blood pH

By using a blood sample taken amnioskop fetal acidosis caused a decline in pH. When the pH drops below 7.2 a sign of harm to the fetus.

TREATMENT

A very important aspect of neonatal asphyxia resuscitation on infants was to assess, determine the action to be performed and eventually carry out resuscitation. Assessment for resuscitation solely determined by three important signs are: breathing, heart rate, and skin color.

A. Common actions

1) Control of temperature

Newborns relative heat loss followed by a drop in body temperature, so as to enhance the metabolism of tissue cells so that the increased oxygen demand, need to be considered to keep the newborn warm temperatures with:

a) Drying the baby from amniotic fluid and fat.

b) Using light to warm up outside.

c) Wrap the baby with a dry cloth.

2) Adjust the position of the baby

Lay the baby on her back with her head near a helper. Wedge shoulders so that head a little extension.

3) Cleaning the airway

Upper respiratory tract immediately cleared of mucus and amniotic fluid, the baby's head should be lower position so as to facilitate discharge.

4) Tactile stimulation to cause respiratory

Stimulation of pain in infants can be generated with both feet hitting the baby, pressing the achilles tendon or give an injection of vitamin K. It works to improve ventilation.

B. Special measures

1) severe asphyxia (Apgar score 0-3)

Active resuscitation in this case should be done is by:

a) Improving lung ventilation to give O2 directly and repeatedly, or by performing endotracheal intubation and O2 inserted with pressure not more than 30 ml. This prevents the occurrence of excessive lung irritation that can rupture aveoli. Positive pressure is done by blowing air into the catheter from the mouth to the pipe or vent pipe to the bag.

b) Provide natrikus bicarbonate at a dose of 2-4 mEq / kg

c) cardiac Massage done by applying pressure on the sternum regularly 80-100 x / mnt. This action is interspersed with artificial respiration, ie each 5 x massage followed 1x giving breath. It aims to avoid the possibility of complications pneumotoracks if these actions are taken simultaneously.

Emphasis images Finger At Heart Infant Massage

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d) Provide drugs 1 / 10,000 andrelin with 0,5- 1 cc dose intravenously (sebegai inotropes) and calcium gluconate 50-100 mm / kg intravenously, to increase the frequency of heart.

2) asphyxia medium (Apgar score 4-6)

Do stimulation to induce respiratory reflexes with:

a) stimulation 30-60 seconds after the first minute APGAR assessment.

b) Perform artificial respiration by inserting a tube into the nose, O2 flowed at a speed of 1-2 liters / minute. Baby is placed with the head in dorsiflexion, done by opening and closing the nostrils and mouth accompanied by moving the chin up and down in frequency 20 x / min.

c) Perform mouth-to mouth that should be included in the baby's mouth pharingeal airway function push the tongue forward, before the mouth of the helper filled O2 before blowing, blowing is done regularly with a frequency of 20-30 x / min.

C. Other measures in resuscitation

1) Aspiration of gastric fluid carried on certain infants are premature infants, before infants experiencing fetal distress, in mothers who received anesthesia in childbirth.

2) The use of drugs given to infants Nalorphin caused by respiratory suppression due to morphine or pethidine given during labor

REFERENCE

Sarwono, P. 2002. Health Care Practitioner Materials and Neonatal Jakarta: Yayasan Bina Library.

Dep. Kes. RI. 2007. Neonatal Basic Emergency Obstetric Care. Jakarta.

FKUI. 2005. Pediatrics. Jakarta: Infomedika.

Hidayat, A. 2005. Introduction of Nursing Children 1. Jakarta: Salemba Medika.

Ladewig, P. 2006. Handbook Nursing Mother-Newborn. Jakarta: EGC.

Saifuddin, A. 2002. Reference Books National Maternal and Neonatal Health Services. Jakarta: YBP-SP.

Surasmi, A. et al. 2003. High-Risk Infant Care. Jakarta: EGC.

Wong, D. 2004. Guidelines for Nursing Clinical Pediatrics. Jakarta: EGC.