- Birth asphyxia is characterized by hypoxemia (decreased PaCO2), hypercarbia (increased PaCO2), and acidosis (lowered pH).
- Maternal causes include amnionitis, anemia, diabetes, pregnancy-induced hypertension, drugs, and infection.
- Uterine causes include prolonged labor and abnormal fetal presentations.
- Placental causes include placenta previa, abruption placental, and placental insufficiency.
- Umbilical causes include cord prolapsed and cord entanglement.
- Fetal causes include cephalopelvic disproportion, congenital anomalies, and difficult delivery.
- Unless vigorous resuscitation begins promptly, irreversible multi-organ tissue changes will occur, possibly leading to permanent damage or death.
- During the 24 hours after successful resuscitation, the newborn is vulnerable to post-asphyxial syndrome.
Clinical manifestations include:
- Poor response to resuscitative efforts
- Metabolic and or respiratory acidosis
- Minimal or absent respiratory effort
- Altered cardiac function
- Multi-organ system failure
1. Observe the newborn that has been successfully resuscitated for the following constellation of signs.
- Absence of spontaneous respirations
- Seizure activity in the first 12 hours after birth
- Decreased or increased urine output (which may indicate acute tubular necrosis or syndrome of inappropriate antidiuretic hormone)
- Metabolic alterations (e.g., hypoglycemia and hypocalcemia)
- Increased intracranial pressure marked by decreased or absent reflexes or hypertension.
2. Decrease noxious environmental stimuli.
3. Monitor the infant’s level of responsiveness, activity, muscle tone, and posture.
4. Administer prescribed medications, which may include anticonvulsants (e.g., Phenobarbital) as prescribed.
5. Provide respiratory support.
6. Monitor for complications.
- Measure and record intake and output to evaluate renal function.
- Check every voiding for blood, protein, and specific gravity, which suggests renal injury.
- Check every stool for blood, suggesting necrotizing enterocolitis (NEC). NEC is a condition in which the bowel develops necrotic patches that interfere with digestion and possibly cause paralytic ileus, perforation, and peritonitis.
- Take serial blood glucose determinations to detect hypoglycemia, and monitor serum electrolytes, as ordered.
7. Administer and maintain intravenous fluids to maintain hydration and fluid and electrolyte balance.
8. Provide education and emotional support.