When a baby is born with asphyxia, meaning the infant is not breathing adequately or has insufficient oxygen supply, the first steps taken are critical and must be performed immediately to prevent brain damage and other organ injuries. The initial focus is on rapidly assessing and stabilizing the newborn’s airway, breathing, and circulation.
The very first action is to **open the baby’s airway**. This is done by placing the infant on their back and positioning the head in a neutral position with the neck slightly extended—not flexed or overextended—to ensure the airway is open. If there is any blockage, such as mucus, blood, or meconium (the baby’s first stool), gentle suctioning of the mouth and throat is performed using a soft catheter. Suctioning the mouth before the nose is important to prevent the baby from gasping and inhaling secretions. Care must be taken not to suction too deeply to avoid triggering vagal nerve stimulation, which can worsen the baby’s condition.
Once the airway is clear, the next step is to **stimulate breathing**. If the baby is not breathing or gasping weakly, positive pressure ventilation (PPV) is started using a bag and mask to help the baby breathe. This ventilation should be effective enough to raise the heart rate above 100 beats per minute and improve oxygenation. The heart rate is the most important indicator of how well the baby is responding to resuscitation efforts.
If after about one minute of effective ventilation the heart rate remains below 60 beats per minute, **chest compressions** are initiated to support circulation. Compressions are coordinated with ventilation to maximize oxygen delivery to vital organs.
If the heart rate does not improve despite ventilation and chest compressions, **medications such as adrenaline (epinephrine)** may be administered to stimulate the heart. Naloxone may be given if opioid exposure is suspected.
Throughout this process, the baby is kept warm to prevent hypothermia, which can worsen outcomes. The baby is dried and placed under a radiant warmer or skin-to-skin contact if possible.
After initial stabilization, the baby is closely monitored for oxygen levels, heart rate, breathing effort, and signs of organ dysfunction. If the baby remains critically ill, advanced support such as intubation with mechanical ventilation, therapeutic hypothermia (cooling to protect the brain), and treatment for complications like kidney injury or infections may be necessary.
In summary, the first steps when a baby is born with asphyxia are:
– Positioning the head to open the airway and clearing any obstructions by gentle suctioning.
– Providing positive pressure ventilation to stimulate breathing and improve oxygenation.
– Monitoring heart rate closely to guide further interventions.
– Starting chest compressions if the heart rate remains low despite ventilation.
– Administering medications like adrenaline if circulation does not improve.
– Keeping the baby warm and providing ongoing supportive care.
These steps must be done quickly and efficiently within the first minute of life to maximize the chances of survival and reduce the risk of long-term brain injury. The process requires trained personnel and equipment ready at delivery to respond immediately to signs of asphyxia.