A.
Definition
Asphyxia
is a condition characterized by the occurrence of respiratory gas exchange, resulting in reduced levels of oxygen (hypoxia)
is accompanied by an increase in carbon
dioxide (hiperkapnea). Thus
organs deprived of oxygen (hypoxic hypoxia) and
the death (Forensic Medicine, 1997). Clinical condition
is often called anoxia asphyxia or hypoxia
(Amir, 2008).
Asphyxia neonatorum is respiratory failure in the newborn, a condition caused by the inadequate intake of oxygen before, during, or just after birth.
Asphyxia neonatorum is respiratory failure in the newborn, a condition caused by the inadequate intake of oxygen before, during, or just after birth.
B.
Etiology
Some of the
specific conditions in pregnant women can cause uteroplacental blood
circulation so that oxygen supply to the baby is reduced. Hypoxia baby in the
womb is indicated by fetal distress which may progress to asphyxia newborns.
Some certain
factors are known to be the cause of asphyxia in the newborn, such as maternal
factors, baby, and cord following:
1.
Maternal factors
a.
Pre-eclampsia and eclampsia
b.
Abnormal bleeding (placenta previa or placental
disruption)
c.
Prolonged labor or obstructed
d.
Fever during labor Severe infections (malaria,
syphilis, tuberculosis, HIV)
e.
Pregnancy Through Time (after 42 weeks gestation)
2.
Umbilical Cord Factor
a.
Coil cord
b.
The cord is short
c.
Knot the cord
d.
Prolapse of the umbilical cord
3.
Factors Babies
a.
Premature infants (before 37 weeks gestation)
b.
Delivery to the action (breech, twins, shoulder
dystocia, vacuum extraction, forceps extraction)
c.
Congenital abnormalities (congenital)
d.
amniotic fluid mixed with meconium (greenish color)
C.
Pathophysiology
The cause of
asphyxia can be derived
from maternal factors, fetal and placenta.
The presence of hypoxia and tissue ischemia causes
functional and biochemical changes in the fetus. The
factors that play a role in the
incidence of asphyxia.
Some of the
specific conditions in pregnant women
can cause uteroplacental blood circulation so that oxygen supply to the baby is reduced. Hypoxia baby
in the womb is indicated by fetal distress which may
progress to asphyxia newborns.
Spontaneously
breathing newborn depends on the condition of the fetus during pregnancy
and childbirth. If there is interference or transport of O2 gas
exchange during pregnancy or childbirth will
occur more severe asphyxia. This situation will affect the function of cells of the body and if not
resolved will cause asphyxia
deaths that occurred beginning a period of apnea
is accompanied by a decrease in frequency. In patients with severe asphyxia, breathing effort and subsequent
infant does not seem to be in the second period
apnea. At this
level occurs bradycardia and decreased blood pressure.
In
asphyxia occurs also
metabolic disorders and changes in acid-base balance in the body of the baby.
At the first level only respiratoric acidosis.
When the baby's body will continue in a
process of anaerobic metabolism
in the form of glycogen glycolysis body, so
that the glycogen body especially
the heart and liver will be reduced.
On the next level
will occur due to
cardiovascular changes some settings such as: loss
of source of glycogen in the heart affects
cardiac function. The occurrence of
metabolic acidosis will cause weakness of the heart muscle. Charging inadequate alveolar
air will result
in continued high pulmonary
vascular resistance so that blood circulation to the lungs and into
the circulatory system of the
body will be impaired.
D.
Assessment
Babies
may not immediately experience symptoms of asphyxia neonatorum. An abnormal
fetal heart rate prior to being born can be one indicator.
After
the baby is born, he or she may experience immediate symptoms, such as:
·
Blue-appearing
skin or very pale skin
·
Difficulty
breathing, which may cause symptoms such as nasal flaring or belly breathing
·
A
slow heart rate
·
A
weak muscle tone
Amniotic fluid that is stained with
meconium (fetal stool) can be another symptom of perinatal asphyxia. The
severity of symptoms often depends on how long a baby was without oxygen. The
longer a baby did not have oxygen, the more likely he or she is to experience symptoms
such as failure or injury to organs, including the lungs, heart, brain, and
kidneys.
Per the guidelines of the American Academy of Pediatrics (AAP) and the
American College of Obstetrics and Gynecology (ACOG), all of the following must
be present for the designation of asphyxia (1992):
•
Profound metabolic or mixed acidemia (pH <7.00)
in an umbilical artery blood sample, if obtained
•
Persistence of an Apgar score of 0-3 for longer than
5 minutes
•
Neonatal neurologic sequelae (eg, seizures, coma, hypotonia)
•
Multiple organ involvement (eg, of the kidney,
lungs, liver, heart, intestines)
E.
Diagnosing
In
order to establish the diagnosis
of fetal distress can be determined by examining the following:
1. In
utero
a. Irregular
fetal heart rate and frequency of more than 160
x / min or less than 100x/min
b. There
is meconium in
the amniotic fluid (the location
of the head) due to the stimulation of nerve X,
so peristalktik increased
bowel and anal sphincter open
c. Analysis
of amniotic fluid / amnioscopy
Examination
of the fetal blood
pH. By using amnioskop inserted through a small cervical incision was
made on the scalp of the fetus.
This blood checked their pH acidosis
causes a drop in pH, if the pH drops below 7.2 it was
regarded as a sign of danger.
d. CTG
e. USG
2. Once
the baby is born
a. Babies
appear pale and
bluish, and not Breathe
/ assign Apgar
score.
b. If
it is bleeding the
brain then there are neurologic
symptoms such as seizures, mistagmus
and crying poor
/ not crying.
c. In
addition, the diagnosis can be made by assessing the Apgar scores at 1 minute.
Results
Apgar scores:
0-3: severe
asphyxia
4-6: moderate asphyxia
7-10: normal
Monitoring: When the 5-minute Apgar score was less than 7, continued assessment every 5 minutes, until the score reaches 7
4-6: moderate asphyxia
7-10: normal
Monitoring: When the 5-minute Apgar score was less than 7, continued assessment every 5 minutes, until the score reaches 7
|
|
0
|
1
|
2
|
|
Appearance
(Color)
|
Blue
or Pale Body
|
Pink,
limbs blue
|
Pink
all over
|
|
Pulse (Heart
Rate)
|
Nil
|
<100/min
|
>100/min
|
|
Grimace
(response to catheter put into nostril)
|
Nil
Grimace,
|
feeble
cry
|
Cough
or sneezing
|
|
Activity and
tone
|
Limp
|
Some flexion of limbs
|
Active
movements
|
|
Respiration
|
Nil
|
Slow,
irregular
|
Good,
crying
|
F.
Midwifery
care plan
1. The basic principles of
resuscitation are:
a. Providing a good environment in
infants and commercialize airways remain free and induce respiratory
b. Provide assistance actively
breathing in infants who showed weak breathing effort
c. Make corrections to the acidosis
that occurs
d. Keeping the blood circulation
remains good.
2. Common actions
a. Temperature monitoring
Do not let the baby was cold to elicit asphyxia conditions. Can be done with the use of light strong enough for outdoor heating and drying the baby's body needs to be done to reduce evaporation.
Do not let the baby was cold to elicit asphyxia conditions. Can be done with the use of light strong enough for outdoor heating and drying the baby's body needs to be done to reduce evaporation.
b. Cleaning airway
At the
time cleaning the upper respiratory tract of mucus and amniotic fluid layout
should be lower head to facilitate and expedite the release of lenders. If
there are lenders in trachea inherent viscous and difficult to remove with
normal exploitation, can be used neonatal laryngoscope.
3. Stimulation to cause respiratory
a. Most can be done with a suction
mucus and amniotic fluid through the nasopharynx.
b. O2 rapid drainage into the nasal
mucosa
c. Stimulation of pain can be caused by
hitting the baby's foot pressing tendom achilles
LIST SOURCES
Mochtar.
1998: 428 and
Manuaba, 1998: 320
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