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.

Table 7.1  Assessing the degree of asphyxia.

SignsNo asphyxiaMild asphyxiaModerate asphyxiaSevere asphyxia
Heart rateAbove 100 beats/minuteAbove 100 beats/minuteAbove 60 beats/minuteBelow 60 beats/minute
Skin colourPinkMild blueModerately blueDeeply blue
Breathing patternCrying CryingBreathing but not strongNot breathing, or gasping type
Limb movementMoving wellWeakly moving FloppyFloppy
Meconium-stained NoNoMaybeUsually
ResuscitationNo needFast responseGood responseTakes a long time to respond

Important!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.

Table 7.2  Normal and abnormal physical findings in the newborn immediately after birth.

Signs Normal findingsAbnormal 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 rate120–160 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 mouthNo response to touching the roof of the baby’s mouth

‘Less than’ can be replaced by the < symbol, as in <30/min. ‘More than’ can be replaced by the > symbol, as in >30/min.

7.2.2  Before you start resuscitation

7.4  Neonatal resuscitation procedures