A. Definition
Asfiksia neonates is a situation where the baby is born impaired gas exchange and transport 02 so that 02 patients shortage and difficulty out C02. (A.H Markum, 2002)
Asfiksia neonaturum is a state of newborns who failed to breathe spontaneously and regularly soon after birth (Hutchinson, 1967)
So asfiksia is a condition where the baby fails in attempt to breathe spontaneously, causing disturbances in the exchange of 02 and C02
B. Aetiology
1. Maternal factors
Hipoksi mother, maternal blood oxygenation is not sufficient due hipoventilasi during anesthesia, heart disease, cyanosis, respiratory failure, carbon monoxide poisoning, the mother’s blood pressure low.
Uterine blood flow interruption, compression vena cava and aorta when gravida, disruption of uterine contractions, sudden hypotension due to hemorrhage, hypertensive disease eklamsia
2. Placental factors
Asfiksia occur due to sudden disturbances such as solusio placenta placenta, bleeding
3. Fetal factors
Compression umbillikus, menumbung umbilical cord, the cord loops, compression of the cord between the fetus and the birth canal
4. Neonatal factors
Anesthetic drugs, the trauma caused by birth, congenital abnormalities such as diaphragmatic hernia, atresia / stenosis respiratory tract, lung hipoplasia
C. Pathophysiology
In the patient was noted that asfiksia disruption of gas exchange and transport 02 will cause the loss provision expenses 02 and C02 difficulties. This situation will affect the function of cells and depends on the weight and length of this function can asfiksia reversible or permanent, resulting in complications, symptoms of rest, or the death of the patient. At the beginning level, and 02 uptake disturbance C02 spending this body may simply lead to respiratory acidosis. If the situation continues, there will be a form of anaerobic metabolism of glycogen body glycolysis. Organic acids formed by this metabolic causes acid base balance in the form of metabolic acidosis. Ni will disturb the state of organ function, which may decrease cardiovascular circulation is characterized by a decrease in blood pressure and pulse frequency
Pathway:
Attached
D. Clinical manifestations
1. Vigorous Baby: Apgar score (7 – 10). Babies are considered healthy, do not need special actions.
2. Mild moderate asfiksia (asfiksia was) Apgar scores (4 – 6), physical examination found the heart frequency of less than 100 / minute, less good muscle tone, or both, cyanosis, no reflex irritability.
3. Asfiksia weight, Apgar scores (0 – 3), physical examination found the heart frequency is less than 100 / minute, poor muscle tone, severe cyanosis, no reflex irritability.
Asfiksia weight with cardiac arrest, the state of heart sounds disappeared Post Partum, other physical examination with weight asfiksia
E. Diagnostic Examination
1. Blood gas analysis (ph less than 7.20)
2. SCOR Apgar assessment include (skin color, breathing effort, muscle tone)
3. EEG examination and CT scan when it happened complications
4. Specific Assessment
Assessment Stage 2 Stage 1 Stage 3
Level of consciousness
Muscle tone
Posture
Tendon reflexes
Moro reflex
Pupils
Seizures
Very old guard
Normal
Normal
Hyperactive
Strong
Midriasis
Nothing
<24 hours Lesu (lethargy)
Hypotonic
Flexi
Hyperactive
Weak
Miosis
Lazim
24-14 days Stupor, coma
flasid
deserebrasi
nothing
nothing
anisokor, no light reflex
cramps, deserebrasi
several days to several weeks
F. Medical Treatment
1. Temperature control: do not let the baby was cold, decreased body temperature will enhance the metabolism of tissue cells so that oxygen demand increases.
2. Cleaning the airway: airway of mucus and cleared from the amniotic fluid. Actions performed with the heart – the heart does not need to rush – rush. Exploitation carried out with reckless penyulit will arise as spasms of the larynx, lung kolap, damage airway mucosa cells. In heavy Asfiksia do cardio pulmonary resuscitation
3. Stimulation to induce breathing: Infants who showed no effort to breathe 20 seconds after birth showed respiratory depression. So after the exploitation given the rapid O2 into the nasal mucosa. If not successful pain stimuli by beating the soles of the feet. If not managed to install ET.