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- Annually, almost 1 million deaths worldwide are related to birth asphyxia.
- 10% of newborns require some assistance at birth.
- 1% of newborns require extensive resuscitation.
- Consider NOT initiating resuscitation if:
- Newborns confirmed to be <23-wk gestation or 400 g
- Babies with confirmed trisomy 13 or 18
- Ideally, discuss with family and health care team prior to delivery.
- Activity, pulse, grimace, appearance, respiration (APGAR) scores do not guide resuscitation:
- Do not wait to assign APGAR scores before starting resuscitation.
- APGAR scores should NOT guide resuscitative efforts. It is a measure of an infant's status and response to resuscitation.
- APGAR score: 5 categories with score of 0, 1, or 2 in each at 1 and 5 min
- Heart rate (HR): 0 = absent; 1 = <100 bpm; 2 = >100 bpm
- Respirations: 0 = absent; 1 = slow, irregular; 2 = good, crying
- Muscle tone: 0 = limp; 1 = some flexion; 2 = active motion
- Reflex irritability: 0 = no response; 1 = grimace; 2 = cough, sneeze, cry
- Color: 0 = blue or pale; 1 = pink body and blue extremities; 2 = all pink
- Newborn's transition from dependence on the placenta to dependence on the lungs for oxygen.
- Hypoxia initially causes tachypnea followed by primary apnea.
- Stimulation may cause resumption of breathing during primary apnea.
- Continued hypoxia leads to secondary apnea.
- Secondary apnea requires assisted ventilation.
- Antepartum risk factors associated with need for resuscitation include:
- Maternal diabetes
- Pregnancy-induced hypertension
- Chronic hypertension
- Previous fetal or neonatal death
- Bleeding in 2nd or 3rd trimester
- Maternal infection
- Maternal cardiac, renal pulmonary, thyroid or neurologic disease
- Premature rupture of membranes
- Post-term gestation
- Multiple gestation
- Size–dates discrepancy
- Drug therapy
- Maternal substance abuse
- Fetal malformation
- Diminished fetal activity
- No prenatal care
- Maternal age <16 yr or >35 yr
- Intrapartum risk factors associated with need for resuscitation include:
- Emergency C-section
- Forceps or vacuum assist
- Breech or other abnormal presentation
- Premature labor
- Precipitous labor
- Prolonged rupture of membranes
- Prolonged 2nd stage of labor
- Fetal bradycardia
- Nonreassuring fetal heart tracing
- General anesthesia
- Uterine tetany
- Narcotics administered to mother within 4 hr:
- Meconium-stained amniotic fluid
- Prolapsed cord
- Abruptio placenta
- Placenta previa
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