During the prenatal stage, the lungs are among the

last organs to finish developing. The surfactant

coating that keeps them from sticking together isn't
formed until the last month or two of gestation.
The air sacs (alveoli) at the ends of the bronchial
tubes are formed last and continue developing for
some time after birth: the lungs of infants have only
one-tenth as many air sacs as those of adults.
The unborn baby, who is suspended in fluid, does not
need lungs yet because the placenta exchanges
oxygen and carbon dioxide, performing the task the
lungs will later assume. The lungs themselves are
also filled with fluid, most of which is expelled during
the birth process.
 While in the mother's uterus the baby does not
breathe and the lungs are collapsed . The fetus
receives oxygen from the mother through the
blood vessels in the umbilical chord. However, at
birth the umbilical cord is cut and the infant
needs to obtain oxygen on its own.
There are several factors that stimulate the baby
to take its first breath: the cutting of the chord,
decrease in oxygen levels and increase in carbon
dioxide levels in the blood. These changes
influences receptors in baby's lungs and brains to
stimulate breathing
 Asphyxia neonatorum is a respiratory failure
in the new born, a condition caused by
inadequate intake of oxygen before, during
or after birth.
 It results most commonly from a drop in
maternal blood pressure or interference
during delivery with blood flow to the infant's
brain. This can occur due to inadequate
circulation or perfusion, impaired respiratory
effort, or inadequate ventilation.
 Asphyxia neonatorum, also called birth or newborn
asphyxia, is defined as a failure to start regular
respiration within a minute of birth. Asphyxia
neonatorum is a neonatal emergency as it may lead
to hypoxia (lowering of oxygen supply to the brain
and tissues) and possible brain damage or death if
not correctly managed. Newborn infants normally
start to breathe without assistance and usually cry
after delivery. By one minute after birth most infants
are breathing well. If an infant fails to establish
sustained respiration after birth, the infant is
diagnosed with asphyxia neonatorum.
 Normal infants have good muscle tone at
birth and move their arms and legs actively,
while asphyxia neonatorum infants are
completely limp and do not move at all. If not
correctly managed, asphyxia neonatorum will
lead to hypoxia and possible brain damage or
death.
 The first breath is perhaps the most
important incident the whole of ones life.
And as has been said, time is vital. The baby
must be made to breathe spontaneously or
artificially within 5 minutes of birth;
otherwise he will have brain damage leading
to fatal
 Asphyxia occurs when the organ of gas
exchange fails. When this happen arterial CO2
partial pressure rises and PaO2 and PH falls.
Despite the low PaO2tissue continue to consume
O2 although at the lower rate in some organ and
tissue. When PaO2 at some organ is very low
anaerobic metabolism set in, producing large
quantities of metabolic acids, these are buffered
partly by bicarbonate in the blood.
The human infant is particularly vulnerable to
asphyxia in the perinatal period.
During normal labour transient hypoxaemia occur
with uterine contraction, but the health fetus
tolerate this
 There are five basic events that lead to asphyxia
during labour and delivery;
I. Interruption of umbilical blood flow eg cord compression
II. Failure of gas exchange across the placenta eg abruption
placenta
III. Inadequate perfusion of the maternal side of the placenta
eg maternal hypotension
IV. An otherwise compromised fetus which can not further
tolerate the transient intermittent hypoxia of normal
labour eg growth retarded fetus
V. Failure to inflate the lungs and complete changes in
ventilation and lungs perfusion eg airway obstruction,
excessive fluids in the lung and weak expiratory efforts,
-alternatively it may occur as a result of fetal
asphyxia from the ether four e events, because asphyxia
often result in infants who is acidotic and apneic at birth.
 There are many causes of asphyxia
neonatorum, the most common of which
include the following:
prenatal hypoxia (a condition resulting from a
reduction of the oxygen supply to tissue
below physiological levels ),
umbilical cord compression during childbirth
occurrence of a preterm or difficult delivery
 These conditions can cause foetal cerebral
anoxia in utero or during delivery or at birth and
could be responsible for asphyxia neonatorum
The predisposing factors are such as;
Mothers diseases like diabetes, heart disease, severe
anaemia, ante-partum hemorrhage, toxaemia of
pregnancy, any abnormal or instrumental delivery
production birth injury, causes asphyxia.
Maternal anesthesia( both the intravenous drugs and the
anesthetic gases cross the placenta and may sedate the
fetus.)
 Foetal conditions like severe congenital deficiency
of heart, severe congenital heart disease such as
Tetralogy of Fallot or central nervous system,
severe degree of Rh incompatibility are also the
few of the causes of foetal cerebral anoxia

Congenital malformation such as hydrocephalus

and spina bifida can lead to difficult delivery,
hence predispose to asphyxia neonatorum
 maternal age of less than 16 years old or over 40 years old
low socioeconomic status
maternal illnesses, such as diabetes, hypertension, Rh-
sensitization, severe anemia
mothers with previous abortions, stillbirths, early
neonatal deaths, or preterm birth
lack of prenatal care
abnormal fetal presentation or position
alcohol abuse and smoking by the mother
severe fetal growth retardation
preterm labor
Fetal abnormality such as
 The symptoms of asphyxia
neonatorum are;
Bluish or gray skin color (cyanosis),
Slow heartbeat (bradycardia),
Stiff or limp (hypotonia)
Poor response to stimulation.
Hypoxia
 Diagnosis can be objectively assessed using the
Apgar scorea recording of the physical health of a
newborn infant, determined after examination of the
adequacy of respiration, heart action, muscle tone,
skin color, and reflexes.
The acronym APGAR was coined in the US as a
mnemonic learning aid:
Appearance (skin color),
Pulse (heart rate),
Grimace (reflex irritability),
Activity (muscle tone), and
Respiration
The five criteria of the Apgar score:

Component of
Score of 0 Score of 1 Score of 2
acronym
blue or
Skin color/Complexion pale all blue at No cyanosis
over extremities Appearance
body body and
pink(ACROCYA extremities
NOSIS) pink

Pulse rate Absent <100 100 Pulse

grimace/feeble cry or pull
Reflex irritability no response to
cry when away when
stimulation stimulated stimulated Grimace
flexed arms
and legs that
Mucle tone resist
some flexion extension Activity

weak, irregular, strong, lusty

Breathing none gasping cry Respiration
 The test is generally done at one and five minutes after
birth, and may be repeated later if the score is and
remains low.
Scores 3 and below are generally regarded as critically low,
4 to 6 fairly low,
and 7 to 10 generally normal.
A low score on the one-minute test may show that the
neonate requires medical attention but is not necessarily
an indication that there will be long-term problems,
particularly if there is an improvement by the stage of the
five-minute test.
If the Apgar score remains below 3 at later times such as
10, 15, or 30 minutes, there is a risk that the child will
suffer longer-term neurological damage. There is also a
small but significant increase of the risk of cerebral palsy
 However, the purpose of the Apgar test is to
determine quickly whether a newborn needs
immediate medical care; it was not designed to
make long-term predictions on a child's health.
One minute Apgar score- is useful to
determine the need for immediate resuscitation
Five minutes Apgar score- is useful index of
the effectiveness of resuscitation method,
when low is indicative of infant at higher risk of
morbidity and mortality
CHEMICAL DETERMINATION NORMAL NEWBORN SEVERE ASPHYXIA

ARTERIAL O2 COMPOSITION 20.8VOL% 20.8VOL%

ARTERIAL O2 CONTENT 10.5 VOL% 1.0VOL%

ARTERIAL O2 SATURATION 5O. 5% 0.5-4.4%

CO2 32mmHg 65mmHg

LACTIC ACID CONTENT 35mg% 85-90mg%

PH OF BLOOD 7.35 7.05

 Flaggs describes the degree of lack of
oxygen in terms of physical findings and this
is a classification of more than mere
academic value to the clinician who faced
with the necessity of resuscitating the
asphyxiated newborn infant
 Asphyxia requires emergency treatment,
preferably in a hospital. Brain damage can result
if the infant doesn't start breathing within about
five minutes. Death can result if the asphyxiation
lasts over 10 minutes. Asphyxia can also lead to
seizures, especially if the baby requires
intubation and has a low Apgar score five minutes
after birth, and if the blood from the cutting of
the umbilical cord has a high acid content. In
older preterm infants (32-36 weeks), asphyxia
has been linked to lung and kidney damage as
well as brain damage
 The first step in treating asphyxia is to clear
the airway by removing any liquids blocking
the baby's airway ,(suction). In the hospital,
this is done with a special tube(suction tube)
Thereafter the infant is supplied with
oxygen.
In mild cases of asphyxia, the initial gasp of
oxygen is enough to initiate breathing
 In severe cases, artificial respiration must be
performed. If there is brain damage or if the
brain is not yet fully developed, the baby may
be put on a ventilation for periods of up to
several weeks.
If asphyxia occurs outside the hospital, a
finger should be used to clear any mucus
from the baby's throat and gentle mouth-to-
mouth resuscitation should be performed.
 If the infant does not breathe despite
adequate ventilation, or if the heart rate
remains below 80 beats per minute, the
physician can give an external cardiac
massage using two fingers to depress the
lower sternum at approximately 100 times a
minute while continuing with respiratory
assistance. Adrenaline may also be
administered to increase cardiac output.
 Identifying infants at risk for asphyxia either
before or during labor can prevent the problem
or lessen its severity. Obstetricians can identify
babies at risk for asphyxia late in pregnancy and
advise their patients to deliver in hospitals that
have neonatal intensive care units. If an
inadequate supply of oxygen from the placenta is
detected during labor, the infant is at risk for
asphyxia, and an emergency delivery may be
attempted either using forceps or by caesarian
section.
.
 Hypoxic damage can occur to most of the
infant's organs (heart, lungs, live, gut,
kidneys), but brain damage is of most
concern and perhaps the least likely to
quickly and completely heal. In severe cases,
an infant may survive, but with damage to the
brain manifested as developmental delay and
spasticity
 The prognosis for asphyxia neonatorum depends
on how long the new born is unable to breathe.
For example, clinical studies show that the
outcome of babies with low five-minute Apgar
scores is significantly better than those with the
same scores at 10 minutes. With prolonged
asphyxia, brain, heart, kidney, and lung damage
can result and also death, if the asphyxiation
lasts longer than 10 minutes
 Anticipation is the key to preventing asphyxia
neonatorum. It is important to identify fetuses
that are likely to be at risk of asphyxia and to
closely monitor such high-risk pregnancies.
High-risk mothers should always give birth in
hospitals with neonatal intensive care units
where appropriate facilities are available to treat
asphyxia neonatorum. During labor, the medical
team must be ready to intervene appropriately
and to be adequately prepared for resuscitation