APGAR SCORE
SILVERMAN SCALE
RESUSCITATION AND INTENSIVE
CARE OF NEWBORN ASPHYXIA
APGAR SCORE
• Apgar is a quick test performed on a baby at 1 and 5 minutes after
birth. The 1-minute score determines how well the baby
tolerated the birthing process. The 5-minute score tells the health
care provider how well the baby is doing outside the mother's womb.
In rare cases, the test will be done 10 minutes after birth.
SILVERMAN SCALE
• The Silverman Andersen Respiratory Severity Score
(RSS) evaluates five parameters of work of breathing and
assigns an overall score with a patient breathing comfortably a
“0” and a patient in severe respiratory distress a “10”.
NEWBORN ASPHYXIA
• Asphyxia: means to be pulseless,but more useful is a definition of
impaired or interrupted gas exchange. These situations can take
place:a.Intrauterine: the gas exchange depends on the function of
placenta,and the blood-flow in the umbilical
vessels.b.Intrapartumc.Postnatal: after delivery the gas exchange
take place in the pulmonary vesicles or alveoli and depends on the
function of the heart, lungs and brain.The asphyxia can be acute or
chronic. The chronic asphyxia can be complicated by an acute
asphyxia.
FREQUENCY
• The frequency of asphyxia depends on which assessment you use to
define asphyxia.The Apgar score define asphyxia as < 7 p at one minute/
The majority of these infants are mostly in very good condition some
minutes later and few of them suffer a severe asphyxia.A National survey
in Sweden gave an incidence of 1,7 % with a low Apgar score (3 or less at
1 minute or 6 or less at 5 minutes).The biochemical definition of asphyxia
is pH< 7,10 in the umbilical artery.The electrophysiological definition of
(intrauterine)asphyxia is prolonged bradycardia assessed by FHR.Recent
studies have reported that 2 % of all newborns required assisted
ventilation directly after the delivery.
TREATMENT
• 1.General principles. The primary objective in treating perinatal asphyxia
is to restore an oxygen supply to the body tissues, especially the
brain.This requires ventilation with oxygen and ensuring an adequate
cardiac output. The secondary objective is evaluate the degree of hypoxic
injury and to plan treatment.
• 2. Specific therapy. Problems commonly associated with asphyxia are
listed in Table 2. These conditions should be anticipated or considered
and treated if present. When the heart rate is less than 100 beats/min
ventilation is necessary. In 450 % ventilation with bag and mask is
satisfactorily and the other 20 % had to be intubated.
Management of the severely
asphyxiated newborn
• :Prevention of intrauterine asphyxia:-recognition of risk factors-fetal
monitoring during labour-appropriate intervention Supportive care:adequate ventilation-prevention of hypoxemia, hyperoxaemia,
hypercapnia-optimal perfusionMaintenance of adequate blood
glucose levels Control ofseizures Avoidance of fluid overload
Ethical aspects of resuscitation
•
Recommendation from the Swedish Pediatric Association.No further
resuscitation:-Cardiac arrest in 20 minutesNormal' heart rate but no
spontaneous breathing after 45 minutes of resuscitation.
PROGNOSIS
Prognosis is difficult because of the inability to establish the precise extent and
duration of cerebral insult and injury. At the time of delivery low delayed Apgar
scores between 0 and 3 at 10, 15 and 20 minutes of age are associated with
significantly increased mortality and morbidity, e.g. cerebral palsy.
The single most useful prognostic factor is the severity of the neonatal
neurological syndrome.There are generally no long -term abnormalities reported
following mild encephalopathy, whereas essentially all infants with severe
encephalopathy have either died or developed multiple neurological sequel
PROGNOSIS
• Outcome is related to the severity and duration of the asphyxial
insult and to the adequacy of compensatory mechanisms,
resuscitation procedures, and specific treatment of multiorgan
system involvement.
• Neurologic outcome is the most difficult to predict but is best related
to the degree of hypoxic encephalopathy and EEC activity in the
neonatal period, and to findings on physical examination of the infant
at 9 -12 months of age.
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