A newborn who fails to establish regular breathing and appears blue and or pale is likely to have asphyxia.

Apgar scoring is used for assessing the degree of asphyxia.

Causes of neonatal asphyxia and anoxia include placental accident (abruptio placentae), cord prolapse and cord compression, maternal administration of drugs which depress respiration (e.g. pethidine), prolonged labour and difficult delivery.

Clinical Features

Irregular foetal heart: Foetal bradycardia or tachycardia (normal foetal heart; 120-140/min). Meconium stained liquor. Low APGAR score: less than 5 at 5 minutes.

Management - APGAR Over 2

• Apgar score 8-10 - none

• Apgar score 5-7;

- clear the airway

- provide oxygen by mask over the face

• Apgar score 3-4 heartbeat below 100/minute;

- clear the air way

- ventilation by bag and mask, pressure 20-25 cm of water at a rate of 30 breaths per minute.

Management - APGAR 0-2

Usually blue and limp with heart rate below 100 per minute the baby should be resuscitated in a warm heated room:

• Suction of nasal and oral pharynx

• Use laryngoscope if possible for suction of oral pharynx

• Give oxygen by bag and mask

• Heart rate: If less than 60 per minutes do cardiac massage

• If no spontaneous respiration intubate

• Establish IV line

If the mother had received pethidine:

• Give naloxone 0.01 mg/kg/IV STAT

• Give sodium bicarbonate 2 mEq/kg IV STAT

• Give 10% dextrose 10 ml/kg slowly

If the heart rate is still below 60 per minute:

• Epinephrine 0.05-0.1 ml; concentration 1:1,000 IV STAT.

Complications

Low Apgar at 1 minute. Recover well with successful resuscitation.

Low Apgar at 5 minutes may end up with having cerebral palsy and/or convulsions.