7.3 Assessing the degree of asphyxia
Moderate to severely asphyxiated babies usually require intensive resuscitation, so the next thing you have to learn is how to grade asphyxia in a newborn. Within no more than 5 seconds after the birth, you should make a very rapid assessment to find out whether the baby is alive or dead, and (if it is alive) to assess whether it has any degree of asphyxia. A severely asphyxiated baby may not breathe at all, there may be no movement of its limbs (arms and legs), and the skin colour may be deeply blue or deeply white. A baby who is not breathing at all after birth, or who is only gasping for breath, or who is breathing less than 30 breaths per minute needs help immediately. If a baby does not breathe soon after birth, it may get brain damage or die. Most babies who are not breathing can be saved if resuscitated correctly and quickly.
From Table 7.1, you can learn how to assess a newborn’s degree of asphyxia. Also look again at the three photos of newborns with different level of asphyxia (Figures 7.1, 7.2 and 7.5).
Gasping is when the newborn can take only a few breaths with difficulty and with wide gaps in between; it is usually a sign that the baby is close to death.
| Signs | No asphyxia | Mild asphyxia | Moderate asphyxia | Severe asphyxia |
|---|---|---|---|---|
| Heart rate | Above 100 beats/minute | Above 100 beats/minute | Above 60 beats/minute | Below 60 beats/minute |
| Skin colour | Pink | Mild blue | Moderately blue | Deeply blue |
| Breathing pattern | Crying | Crying | Breathing but not strong | Not breathing, or gasping type |
| Limb movement | Moving well | Weakly moving | Floppy | Floppy |
| Meconium-stained | No | No | Maybe | Usually |
| Resuscitation | No need | Fast response | Good response | Takes a long time to respond |
Assessment of the degree of asphyxia should not take you more than 5 seconds. Do it fast but don’t panic.
Since neonatal resuscitation is an action that you need to perform rapidly (within one minute after delivery), it is better to estimate than to count the heart rate, and to observe the pattern of breathing rather than to count the respiratory rate. Table 7.2 gives you a simplified description of the signs that indicate what is normal and abnormal immediately after birth.
| Signs | Normal findings | Abnormal findings |
|---|---|---|
| Colour | Should be pink | Blue or cyanosed (shortage of oxygen) White, pallor (anaemia) Yellowish (jaundice) |
| Breathing | 40–60 breaths/minute | No breathing Breathing rate less than 30/minute Gasping (very few breaths with difficulty breathing) |
| Heart rate | 120–160 beats/minute | No heartbeat at all Heartbeat less than 100/minute |
| Muscle tone | Full term newborn has semi-flexed arms and legs (Figure 7.1) | Poor flexion of the limbs; arms and legs floppy (Figure 7.2), indicates moderate to severe asphyxia affecting the brain |
| Reflexes | Baby responds to a finger put into the roof of its mouth | No response to touching the roof of the baby’s mouth |
‘Less than’ can be replaced by the symbol, as in >30/min.
7.2.2 Before you start resuscitation