bubble_chart Overview

A newborn with only a heartbeat but no breathing or an anoxic state without established regular breathing one minute after birth is called neonatal asphyxia.

bubble_chart Etiology

(1) Persistent fetal distress: Any cause of fetal distress that remains uncorrected can lead to neonatal asphyxia.

(2) Airway obstruction: Prolonged labor may cause the fetus to inhale amniotic fluid, mucus, or blood, resulting in airway obstruction.

(3) Intracranial injury: Factors such as hypoxia, prolonged labor, or forceps delivery may compress the fetal head and cause intracranial hemorrhage.

(4) Use of sedatives or anesthetics: Administration of morphine or barbiturates within 4 hours before delivery, or deep ether anesthesia during labor, can depress the respiratory center of the newborn.

bubble_chart Clinical Manifestations

According to the degree of hypoxia, it can be divided into two categories.

(1) Cyanotic asphyxia: Apgar score 4-7, cyanosis of the skin and face, slow but strong heartbeat, normal muscle tone, hands can be raised, good limb movement, response to external stimuli, and presence of laryngeal reflex.

(2) Pale asphyxia: Apgar score below 4, pale skin and mucous membranes of the lips, slow and irregular heartbeat, flaccid muscle tone, generalized limpness, no response to external stimuli, absence of laryngeal reflex, and a moribund state.

To accurately assess the degree of neonatal asphyxia and provide appropriate resuscitation, the Apgar score can be repeated during the resuscitation process to evaluate whether the newborn has improved and the extent of improvement.

bubble_chart Treatment Measures

(1) Clearing the Airway The first step is to clear the airway to ensure it is unobstructed before stimulating respiration. Use a catheter to suction amniotic fluid and mucus from the mouth, nose, and pharynx. If this is ineffective, perform endotracheal intubation for suction. Handle gently during the procedure.

(2) Stimulating and Establishing Respiration

1. Acupuncture the philtrum and Shixuan points.
2. Rub the chest with alcohol.
3. Inhale ammonia vapor. If breathing still does not commence, proceed with artificial respiration. Various methods include the back-carrying manipulation, lower limb flexion-extension abdominal pressure technique, and mouth-to-mouth respiration. For an Apgar score below 4, perform endotracheal intubation. If available, use a ventilator to provide continuous positive pressure ventilation or intermittent positive pressure ventilation.

(3) Oxygen Administration After clearing the airway, insert a nasal catheter for oxygen delivery. If endotracheal intubation with pressurized oxygen is used, remove the tube only after the newborn establishes normal breathing.

(4) Administering Respiratory Stimulants Inject 0.3 ml of 1% lobeline intramuscularly, or 0.3 ml of 25% nikethamide intramuscularly. Alternatively, slowly inject 10 ml of 50% glucose mixed with 100 mg of vitamin C and 25 mg of 25% nikethamide into the umbilical vein.

(5) Correcting Acidosis Neonatal asphyxia is often accompanied by acidosis, which should be corrected. Slowly inject 5 ml of 5% sodium bicarbonate per kilogram of body weight into the umbilical vein.

(6) Using Circulatory Stimulants In cases of cardiac arrest, inject 0.2 ml of 1‰ adrenaline or 0.2 ml of nikethamide intracardially. Alternatively, perform external cardiac massage.

(7) Other Measures Maintain warmth during resuscitation. Post-recovery, monitor closely as re-asphyxia may occur. Strengthen anti-infection and hemostatic measures to prevent neonatal pneumonia and intracranial hemorrhage.