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Chapter3
Baby of Ruth is a boy born at term. He is blue and has poor muscle tone. He doesn't cry.
Look for:
Breathing or crying Good muscle tone Colour pink
NO
NO NO
Check the heart rate Continue to bag at rate of about 40 breaths per minute Every 1-2 minutes stop and see if the pulse or breathing has improved Start with air, add oxygen if no response
History
Baby boy of Ruth was born at term. He came out not crying, blue and with poor muscle tone. He was resuscitated for 2 minutes. Rupture of membranes happened at home, contractions were regular. His mother, Ruth, G1 P1, was in labour for a long period of time, but progressed to normal delivery in hospital. No chronic illness and no pre-eclampsia were diagnosed before.
Monitoring
The baby has to be monitored frequently Pay attention to colour, breathing, muscle tone and ability to suck
Monitoring (continued)
In the days after birth asphyxia the baby may develop following problems (Ref. p. 51-52):
Convulsions
check glucose treat with phenobarbital
Apnoea
oxygen by nasal catheter resuscitation with bag and mask
Inability to suck
feed with milk via a nasogastric tube
Supportive Care
If no evidence of birth asphyxia at delivery provide normal care for newborn: Give the baby to mother as soon as possible, place on chest or abdomen Cover the baby to prevent heat loss Encourage initiation of breastfeeding within the first hour Keep umbilical cord clean and dry Give vitamin K 1 ampoule IM single dose Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis) (Ref. p. 46, p. 50)
Breastfeeding support
Early and exclusive breastfeeding is important for all newborns
Breastfeeding support:
Encouragement Breastfeeding friendly environment Breastfeeding assessment and counselling (Ref. p. 295)
Progress
Ruths babys motor tone recovered well in the first hour. After some difficulties at the beginning he was sucking well. Before he was discharged home he also received oral polio, hepatitis B and BCG vaccines.
Follow-up
Baby should receive regular MCH follow-up to monitor: Growth and development Nutritional intake Immunization status Detection of other illnesses or problems
Summary
Be prepared for resuscitation at every delivery Dont need oxygen in most cases, bag-mask ventilation will stimulate the baby to breathe on its own Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability The prognosis is good for babies who respond quickly to resuscitation Learn all steps of neonatal resuscitation, practice and teach others