Birth Asphyxia: Neonatal Resuscitation

🩺 Priority-Wise Management of Birth Asphyxia: Neonatal ResuscitationGuidelines for Newborn Care

Keywords used: Birth Asphyxia, Neonatal Resuscitation, Newborn Care, Neonatal Emergency Protocols, High CPC Medical Keyword

📘 Introduction

Birth asphyxia is a critical neonatal emergency where the newborn fails to initiate and sustain breathing after delivery. This condition, if not addressed promptly, can lead to severe neurological damage or even neonatal death. In this post, we’ll walk through the priority-wise management of birth asphyxia, based on the latest neonatal resuscitation protocols recommended by the American Academy of Pediatrics (AAP) and NRP (Neonatal Resuscitation Program). This guide is essential for healthcare professionals, nurses, medical students, and NEET PG aspirants.

🚨 What is Birth Asphyxia?

Birth asphyxia, also called perinatal asphyxia, is the failure of a newborn to breathe adequately at birth, resulting in hypoxia, hypercapnia, and metabolic acidosis. It affects oxygen supply to the brain and vital organs, making early intervention crucial.

🔑 Priority-Wise Management of Birth Asphyxia (Neonatal Resuscitation Protocol)

🟢 Step 1: Initial Assessment at Birth (First 30 Seconds)

Ask the 3 golden questions:

• Is the baby full term?
• Is the baby crying or breathing?
• Does the baby have good muscle tone?

👉 If all answers are YES → Routine newborn care.

👉 If any answer is NO → Start neonatal resuscitation immediately.

🟡 Step 2: Initial Steps of Resuscitation (0–60 Seconds)

Also called the Golden Minute, this step focuses on:

• Providing warmth (use a radiant warmer)
• Positioning the head (sniffing position)
• Clearing the airway (mouth before nose)
• Drying and stimulating the baby

🔴 Step 3: Positive Pressure Ventilation (PPV)

Start bag and mask ventilation (BMV) if:

• Apnea (no breathing)
• Gasping respiration
• Heart rate < 100 bpm
• Use room air (21%) or blended oxygen (21–30%) for preterm infants.
• Deliver breaths at 40–60 breaths/minute
• Ensure visible chest rise

⚪ Step 4: Evaluate Heart Rate After 30 Seconds of PPV

• HR ≥ 100 bpm → Continue support.
• HR < 100 bpm → Recheck technique and mask seal.
• HR < 60 bpm → Begin chest compressions.

🟣 Step 5: Chest Compressions

Start chest compressions if heart rate is < 60 bpm after effective PPV.

• Use two-thumb encircling technique
• Compression-to-ventilation ratio: 3:1
• Reassess after 30 seconds

🔵 Step 6: Medications in Neonatal Resuscitation

If HR < 60 bpm despite compressions + PPV:

• Give Epinephrine (Adrenaline) IV or ET:
  
• Dose: 0.01–0.03 mg/kg (1:10,000 dilution)
• If hypovolemia suspected → Use normal saline 10 ml/kg IV.

🟤 Step 7: Post-Resuscitation Care

After stabilization, shift to NICU for close monitoring:

• Maintain normal temperature, glucose, oxygen saturation
• Monitor for seizures, hypoxic encephalopathy, and respiratory distress
• Supportive ventilation may be needed

📌 Summary Chart for Quick Revision

🔍 FAQ Section

Q1. What is the first step in birth asphyxia management?

👉 Initial assessment and airway clearance within the first 30 seconds.

Q2. What is the ideal compression-to-ventilation ratio in newborn CPR?

👉 3:1 (three compressions, one ventilation)

Q3. What is the drug of choice in neonatal resuscitation?

👉 Epinephrine (Adrenaline)