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
Source: http://donadewani.blogspot.com
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.
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