m During the prenatal stage, the lungs are among the last

organs to finish developing. The surfactant coating that

keeps them from sticking together isn't formed until the last
month or two of gestation.
m The air sacs (alveoli) at the ends of the bronchial tubes are
formed last and continue developing for some time after
birth: the lungs of infants have only one-tenth as many air
sacs as those of adults.
m The unborn baby, who is suspended in fluid, does not need
lungs yet because the placenta exchanges oxygen and
carbon dioxide, performing the task the lungs will later
assume. The lungs themselves are also filled with fluid,
most of which is expelled during the birth process.
m
hile in the mother's uterus the baby does not
breathe and the lungs are collapsed . The fetus
receives oxygen from the mother through the blood
vessels in the umbilical chord. However, at birth the
umbilical cord is cut and the infant needs to obtain
oxygen on its own.
m There are several factors that stimulate the baby
to take its first breath: the cutting of the chord,
decrease in oxygen levels and increase in carbon
dioxide levels in the blood. These changes influences
receptors in baby's lungs and brains to stimulate
breathing
m Osphyxia neonatorum is a respiratory failure in the
new born, a condition caused by inadequate
intake of oxygen before, during or after birth.
m ˜t results most commonly from a drop in maternal
blood pressure or interference during delivery with
blood flow to the infant's brain. This can occur due
to inadequate circulation or perfusion, impaired
respiratory effort, or inadequate ventilation.
m Osphyxia neonatorum, also called birth or newborn
asphyxia, is defined as a failure to start regular respiration
within a minute of birth. Osphyxia neonatorum is a neonatal
emergency as it may lead to hypoxia (lowering of oxygen
supply to the brain and tissues) and possible brain damage
or death if not correctly managed. Newborn infants
normally start to breathe without assistance and usually cry
after delivery. By one minute after birth most infants are
breathing well. ˜f an infant fails to establish sustained
respiration after birth, the infant is diagnosed with asphyxia
neonatorum.
m Normal infants have good muscle tone at birth and
move their arms and legs actively, while asphyxia
neonatorum infants are completely limp and do
not move at all. ˜f not correctly managed, asphyxia
neonatorum will lead to hypoxia and possible brain
damage or death.
m The first breath is perhaps the most important
incident the whole of one¶s life. Ond as has been
said, time is vital. The baby must be made to
breathe spontaneously or artificially within 5
minutes of birth; otherwise he will have brain
damage leading to fatal
m Osphyxia occurs when the organ of gas exchange
fails.
hen this happen arterial CO2 partial pressure
rises and PaO2 and PH falls. Despite the low
PaO2tissue continue to consume O2 although at the
lower rate in some organ and tissue.
hen PaO2 at
some organ is very low anaerobic metabolism set in,
producing large quantities of metabolic acids, these
are buffered partly by bicarbonate in the blood.
m The human infant is particularly vulnerable to asphyxia
in the perinatal period.
Ô During normal labour transient hypoxaemia occur with
uterine contraction, but the health fetus tolerate this
m There are five basic events that lead to asphyxia during
labour and delivery;
˜. ˜nterruption of umbilical blood flow eg cord compression
˜˜. Failure of gas exchange across the placenta eg abruption
placenta
˜˜˜. ˜nadequate perfusion of the maternal side of the placenta eg
maternal hypotension
˜ . On otherwise compromised fetus which can not further tolerate
the transient intermittent hypoxia of normal labour eg growth
retarded fetus
. Failure to inflate the lungs and complete changes in ventilation
and lungs perfusion eg airway obstruction, excessive fluids in
the lung and weak expiratory efforts, -alternatively it may
occur as a result of fetal asphyxia from the ether four e events,
because asphyxia often result in infants who is acidotic and
apneic at birth.
m There are many causes of asphyxia
neonatorum, the most common of which
include the following:
Ô prenatal hypoxia (a condition resulting from a
reduction of the oxygen supply to tissue below
physiological levels ),
Ô umbilical cord compression during Ô


Ô occurrence of a preterm or difficult delivery
m These conditions can cause foetal cerebral anoxia in
utero or during delivery or at birth and could be
responsible for asphyxia neonatorum
m The predisposing factors are such as;
Ô Mother¶s diseases like diabetes, heart disease, severe
anaemia, ante-partum hemorrhage, toxaemia of pregnancy,
any abnormal or instrumental delivery production birth injury,
causes asphyxia.
Ô Maternal anesthesia( both the intravenous drugs and the
anesthetic gases cross the placenta and may sedate the
fetus.)
Ô Foetal conditions like severe congenital deficiency of
heart, severe congenital heart disease such as
Tetralogy of Fallot or central nervous system, severe
degree of Rh incompatibility are also the few of the
causes of foetal cerebral anoxia

Ô Congenital malformation such as hydrocephalus and

spina bifida can lead to difficult delivery, hence
predispose to asphyxia neonatorum
m maternal age of less than 16 years old or over 40 years old
m low socioeconomic status
m maternal illnesses, such as diabetes,  


Rh-
sensitization, severe anemia
m mothers with previous abortions, stillbirths, early neonatal
deaths, or preterm birth
m lack of prenatal care
m abnormal fetal presentation or position
m alcohol abuse and 

by the mother
m severe fetal growth retardation
m preterm labor
m Fetal abnormality such as
m The symptoms of asphyxia neonatorum
are;
Ô Bluish or gray skin color (cyanosis),
Ô Slow heartbeat (bradycardia),
Ô Stiff or limp (hypotonia`
Ô Poor response to stimulation.
Ô Hypoxia
m Diagnosis can be objectively assessed using the Opgar
score²a recording of the physical health of a newborn
infant, determined after examination of the adequacy of
respiration, heart action, muscle tone, skin color, and
reflexes.
m The acronym O
O was coined in the US as a
mnemonic learning aid:
m Oppearance (skin color),
m ulse (heart rate),
m
rimace (reflex irritability),
m Octivity (muscle tone), and
m espiration



 

 




 

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m The test is generally done at one and five minutes after birth, and
may be repeated later if the score is and remains low.
Ô Scores 3 and below are generally regarded as critically low,
Ô 4 to 6 fairly low,
Ô and 7 to 10 generally normal.
m O low score on the one-minute test may show that the neonate
requires medical attention but is not necessarily an indication that
there will be long-term problems, particularly if there is an
improvement by the stage of the five-minute test.
m ˜f the Opgar score remains below 3 at later times such as 10, 15,
or 30 minutes, there is a risk that the child will suffer longer-term
neurological damage. There is also a small but significant
increase of the risk of cerebral palsy
m However, the purpose of the Opgar test is to determine
quickly whether a newborn needs immediate medical
care; it was §
designed to make long-term
predictions on a child's health.
m One minute Opgar score- is useful to determine the
need for immediate resuscitation
m Five minutes Opgar score- is useful index of the
effectiveness of resuscitation method, when low is
indicative of infant at higher risk of morbidity and
mortality
°
°




 

 




 

ORTER˜O
O2 COMPOS˜T˜ON 20.8 O
 20.8 O


ORTER˜O
O2 CONTENT 10.5 O


1.0 O


ORTER˜O
O2 SOTUROT˜ON 5O. 5 0.5-4.4

CO2 32mmHg 65mmHg

OCT˜C OC˜D CONTENT 35mg 85-90mg

PH OF B
OOD 7.35 7.05

m Flagg¶s describes the degree of lack of oxygen in
terms of physical findings and this is a
classification of more than mere academic value
to the clinician who faced with the necessity of
resuscitating the asphyxiated newborn infant
m Osphyxia requires emergency treatment, preferably in
a hospital. Brain damage can result if the infant
doesn't start breathing within about five minutes.
Death can result if the asphyxiation lasts over 10
minutes. Osphyxia can also lead to seizures,
especially if the baby requires intubation and has a
low Opgar score five minutes after birth, and if the
blood from the cutting of the umbilical cord has a high
acid content. ˜n older preterm infants (32-36 weeks),
asphyxia has been linked to lung and kidney damage
as well as brain damage
m The first step in treating asphyxia is to clear the
airway by removing any liquids blocking the baby's
airway ,(suction). ˜n the hospital, this is done with
a special tube(suction tube)
m Thereafter the infant is supplied with oxygen.
m ˜n mild cases of asphyxia, the initial gasp of
oxygen is enough to initiate breathing
m ˜n severe cases, artificial respiration must be
performed. ˜f there is brain damage or if the brain
is not yet fully developed, the baby may be put on
a ventilation for periods of up to several weeks.
m ˜f asphyxia occurs outside the hospital, a finger
should be used to clear any mucus from the
baby's throat and gentle mouth-to-mouth
resuscitation should be performed.
m ˜f the infant does not breathe despite adequate
ventilation, or if the heart rate remains below 80
beats per minute, the physician can give an
external cardiac massage using two fingers to
depress the lower sternum at approximately 100
times a minute while continuing with respiratory
assistance. Odrenaline may also be administered
to increase cardiac output.
m ˜dentifying infants at risk for asphyxia either before or
during labor can prevent the problem or lessen its
severity. Obstetricians can identify babies at risk for
asphyxia late in pregnancy and advise their patients to
deliver in hospitals that have neonatal intensive care
units. ˜f an inadequate supply of oxygen from the
placenta is detected during labor, the infant is at risk
for asphyxia, and an emergency delivery may be
attempted either using forceps or by caesarian
section.
m .
m Hypoxic damage can occur to most of the infant's
organs (heart, lungs, live, gut, kidneys), but brain
damage is of most concern and perhaps the least
likely to quickly and completely heal. ˜n severe
cases, an infant may survive, but with damage to
the brain manifested as developmental delay and
spasticity
m The prognosis for asphyxia neonatorum depends on
how long the new born is unable to breathe. For
example, clinical studies show that the outcome of
babies with low five-minute Opgar scores is
significantly better than those with the same scores at
10 minutes.
ith prolonged asphyxia, brain, heart,
kidney, and lung damage can result and also death, if
the asphyxiation lasts longer than 10 minutes
m Onticipation is the key to preventing asphyxia
neonatorum. ˜t is important to identify fetuses that are
likely to be at risk of asphyxia and to closely monitor
such high-risk pregnancies. High-risk mothers should
always give birth in hospitals with neonatal intensive
care units where appropriate facilities are available to
treat asphyxia neonatorum. During labor, the medical
team must be ready to intervene appropriately and to
be adequately prepared for resuscitation