Birth asphyxia

Question 1

What is birth asphyxia?

Answer 1

Birth asphyxia is a reduction of oxygen delivery and accumulation of carbon dioxide due to cessation of blood supply to the fetus during birth, often causing physical harm, especially to the brain.

Question 2

Define anoxia.

Answer 2

Complete lack of oxygen.

Question 3

Define hypoxia.

Answer 3

Decreased availability of oxygen.

Question 4

Define hypoxemia.

Answer 4

Decreased arterial concentration of oxygen.

Question 5

Define ischemia.

Answer 5

Insufficient blood flow to cells or organs, leading to interrupted metabolism and cell or organ death.

Question 6

What is a key feature of birth asphyxia in neonates?

Answer 6

Neonates with birth asphyxia often lack spontaneous breathing or have irregular breathing movements.

Question 7

Which organs are most affected by hypoxic damage due to birth asphyxia?

Answer 7

Brain, heart, lungs, liver, gut, and kidneys, with brain damage being the most concerning.

Question 8

Why is birth asphyxia particularly dangerous for the brain?

Answer 8

Brain cells are highly sensitive to oxygen deprivation, and hypoxic brain damage can lead to long-term developmental issues or neurological impairment.

Question 9

What are the maternal risk factors for birth asphyxia?

Answer 9

Hypoxia, anemia, diabetes, hypertension, smoking, nephritis, heart disease, advanced or young maternal age.

Question 10

What are delivery-related risk factors for birth asphyxia?

Answer 10

Placental abruption, placenta previa, prolapsed cord, and premature rupture of membranes.

Question 11

What are fetal risk factors for birth asphyxia?

Answer 11

Multiple births, congenital abnormalities, or malformations.

Question 12

What is the APGAR score used for?

Answer 12

To assess the newborn’s condition immediately after birth, evaluating factors like heart rate, respiratory effort, muscle tone, reflex response, and skin color.

Question 13

What APGAR score indicates no asphyxia?

Answer 13

A score of 8-10.

Question 14

What is the Apgar score range for mild or cyanosis asphyxia?

Answer 14

4-8.

Question 15

What Apgar score indicates severe or pale asphyxia?

Answer 15

0-3.

Question 16

What are clinical signs of fetal asphyxia?

Answer 16

Abnormal fetal heart rate (tachycardia or bradycardia), altered fetal movements, and meconium-stained amniotic fluid.

Question 17

How does birth asphyxia affect fetal heart rate patterns?

Answer 17

It can cause tachycardia (fast heart rate) or bradycardia (slow heart rate), both indicators of fetal distress.

Question 18

What are reversible and irreversible hypoxic cellular changes?

Answer 18

Reversible changes include early-stage ATP reduction affecting cellular functions; irreversible changes involve prolonged hypoxia causing permanent cellular damage.

Question 19

What role does oxytocin play in the risk of birth asphyxia?

Answer 19

Excessive oxytocin can cause overly strong uterine contractions, which may reduce blood flow and oxygen delivery to the fetus.

Question 20

How does the body respond to fetal asphyxia?

Answer 20

Blood flow is redistributed to organs such as the brain, heart, and kidneys via inter-organ shunts to prevent hypoxic damage.

Question 21

What is primary apnea?

Answer 21

A stage in asphyxia where breathing stops with normal muscular tone, tachycardia, and hypertension, which can be corrected quickly to avoid organ damage.

Question 22

What is secondary apnea?

Answer 22

A stage in severe asphyxia or failed resuscitation, often resulting in organ function damage.

Question 23

What is persistent pulmonary hypertension (PPHN) and how is it related to birth asphyxia?

Answer 23

PPHN is a condition where the newborn’s blood circulation bypasses the lungs, a potential complication of severe birth asphyxia.

Question 24

What metabolic conditions can result from birth asphyxia?

Answer 24

Hyperglycemia, hypoglycemia, and hyperbilirubinemia.

Question 25

Why does hypoglycemia occur in infants with birth asphyxia?

Answer 25

Due to the stress response and impaired glucose metabolism in asphyxiated infants.

Question 26

What are potential gastrointestinal complications of birth asphyxia?

Answer 26

Necrotizing Enterocolitis (NEC) and stress-related gastric ulcers.

Question 27

What is necrotizing enterocolitis (NEC), and how is it related to birth asphyxia?

Answer 27

NEC is a serious gastrointestinal condition that can arise from low oxygen supply to the intestines, a possible complication of asphyxia.

Question 28

What neurological complications can result from birth asphyxia?

Answer 28

Hypoxic-Ischemic Encephalopathy (HIE) and Intraventricular Hemorrhage (ICH).

Question 29

How is birth asphyxia diagnosed?

Answer 29

Evidence of fetal distress, fetal metabolic acidosis, abnormal neurological state, and multiorgan involvement.

Question 30

What is the AVPU scale, and how does it relate to birth asphyxia diagnosis?

Answer 30

The AVPU scale assesses neurological function, where “A” indicates alertness; abnormal scores suggest potential brain damage from asphyxia.

Question 31

What is the first step in airway management for birth asphyxia?

Answer 31

Open the airway by placing the head in a neutral position and suctioning amniotic fluid.

Question 32

How is a suction catheter used in airway management for birth asphyxia?

Answer 32

It removes meconium or amniotic fluid from the airway to ensure the newborn can breathe.

Question 33

What is the procedure for managing breathing in birth asphyxia?

Answer 33

Ensure face mask covers nose and mouth, connect to an oxygen bag, establish respiration at 30-40 breaths per minute, and intubate if there is no response.

Question 34

When should external cardiac compression be started in birth asphyxia management?

Answer 34

If the heart rate is below 60 beats per minute.

Question 35

What is the compression to ventilation ratio for cardiac resuscitation in birth asphyxia?

Answer 35

3:1 (90 compressions to 30 breaths per minute).

Question 36

Which drug is administered for profound bradycardia in birth asphyxia?

Answer 36

Adrenaline (1:10,000 solution, 0.1-0.3 ml/kg) via endotracheal tube or umbilical vein.

Question 37

What is done if there is no response to adrenaline?

Answer 37

Administer intravenous fluids (saline, albumin, plasma, blood) at 10 ml/kg and sodium bicarbonate for acidosis.

Question 38

What is the typical dose of sodium bicarbonate for correcting acidosis in asphyxiated infants?

Answer 38

3-5 ml/kg of a 5% sodium bicarbonate solution.

Question 39

Why might naloxone be used in birth asphyxia management?

Answer 39

To counteract respiratory depression if opioid exposure is suspected as a cause.

Question 40

What is PPV, and how is it used in birth asphyxia?

Answer 40

Positive Pressure Ventilation (PPV) is used to provide adequate oxygen to an infant struggling to breathe independently.

Question 41

Why might albumin or blood products be administered to an asphyxiated newborn?

Answer 41

To manage hypovolemia or low blood volume, ensuring adequate circulation.

Question 42

What is the purpose of tactile stimulation in birth asphyxia management?

Answer 42

To stimulate breathing and improve the newborn’s respiratory effort.

Question 43

How is epinephrine administered in severe cases of birth asphyxia?

Answer 43

Intravenously or through the umbilical vein, usually at a concentration of 1:1,000.

Question 44

How long should one wait before repeating resuscitation efforts if the first attempt fails?

Answer 44

Resuscitation can be repeated for up to 30 minutes if necessary.

Question 45

What is included in the “ABCDE” treatment summary for birth asphyxia?

Answer 45

A: Open airway; B: Establish breathing; C: Maintain circulation with chest compressions; D: Administer drugs like adrenaline; E: Evaluate effectiveness of resuscitation.

Question 46

What is the purpose of hypothermia treatment in birth asphyxia?

Answer 46

To reduce the extent of brain injury.