Interventions for Birth asphyxia

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate pregnant women on the need for facility births attended by a skilled birth attendant	Promote Good maternal nutrition Promote early initaion of breastfeeding Promote ANC attendance promote good maternal nutrition/including nutrition supplementation Infection prevention cand control practices Encourage mothers to delier at health faclitiees Timely referall for mothers		Full assessment of any community births with Apgar scores Refer neonates with Apgar score less than 7 to next level for assessment	Follow up neonates treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones Linkage with rehabilitation centres eg for physical rehabilation, speech atc
Primary Care
create awareness on birth aspyxia Health Education to pregnanct women on birth asphyxia Health education to pregancnt women on the need for ANC promote eraly health seeking behaviour Educate pregnant women on the need for facility births attended by a skilled birth attendant Dstribution of IEC materails Strengten health workers knowledge on birth asphyxia including management	Full assessment of all newborns with Apgar score Training of all delivery staff in neonatal resuscitation		Start neonatal resuscitation for nenates with Apgar scores of 0 to 3 as follows; Dry neonate and place supine under overhead warmer Suctioning of airways Tactile stimulation to encourage spontaneous breathing Oxygen therapy, Bag-mask ventilation (Ambu bag) for non-responsive neonates Chest compression if heart rate does not improve Refer to next level with ongoing resuscitation if not responsive to procedures Refer responsive neonates to next level for further assessment and observation	Follow up neonates treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: General
create awareness on birth aspyxia Health Education to pregnanct women on birth asphyxia Health education to pregancnt women on the need for ANC promote eraly health seeking behaviour Educate pregnant women on the need for facility births attended by a skilled birth attendant Dstribution of IEC materails Strengten health workers knowledge on birth asphyxia including management	Training of all delivery staff in neonatal resuscitation Full assessment of all newborns with Apgar score		Start neonatal resuscitation for nenates with Apgar scores of 0 to 3 as follows; Dry neonate and place supine under overhead warmer Suctioning of airways Tactile stimulation to encourage spontaneous breathing Oxygen therapy, Bag-mask ventilation (Ambu bag) for non-responsive neonates Endotracheal intubation for neonates not responsive to bag-mask ventilation * * Chest compression if heart rate does not improve Transfer to neonatal intensive care unit for further assessment
Referral Facility: Specialist
create awareness on birth aspyxia Health Education to pregnanct women on birth asphyxia Health education to pregancnt women on the need for ANC promote eraly health seeking behaviour Educate pregnant women on the need for facility births attended by a skilled birth attendant Dstribution of IEC materails Strengten health workers knowledge on birth asphyxia including management	Promote ANC attendance Promote early initaion of breastfeeding promote good maternal nutrition/including nutrition supplementation clean and safe delivery Infection prevention cand control practices Full assessment of all newborns with Apgar score Monitoring quality of care and instituting remedial measures Timely referall for mothers		Physical and clinical examination ManagEment of neonates with birth asphyxia as per IMCI guidelines Antibiotics therapy for neonates with possible severe bacterial infections Neonatal resuscitation Dry neonate and place supine under overhead warmer *Suctioning of airways Tactile stimulation to encourage spontaneous breathing Oxygen therapy, Bag-mask ventilation (Ambu bag) for non-responsive neonates Chest compression if heart rate does not improve Encourage kangaroo mother care /or kangaroo father care Nutritional support Encourage breastfeeding ICU Services -eg for life support where indfdicated Tests Blood tests -eg blood gases Ultrasound CT scan MRI Electro-encephalogram EEG

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate pregnant women on the need for regular ANC and facility births attended by a skilled birth attendants * Promote good maternal nutrition/including nutritional supplementation	Education of mothers and caregivers about signs and symptoms of asphyxia using job aides Education of mothers on importance of facility delivery, exclusive breastfeeding good hygienic practices		Timely referral to the next level	Health Education to pregnant women to create awareness on birth asphyxia Health education to pregnant women on the need for regular ANC follow up and skilled birth attendance Promote early health seeking behaviour Strengthen health workers knowledge on birth asphyxia including management	Psychological support to parents of babies with birth-related complications Physical therapy for children with neurological complications
Primary Care
Health Education to pregnant women to create awareness on birth asphyxia Health education to pregnant women on the need for regular ANC follow up and skilled birth attendance Promote early health seeking behaviour Strengthen health workers knowledge on birth asphyxia including management	Educate pregnant women to deliver at health facility by skilled birth attendant Full assessment of all newborn with Apgar score Monitoring quality of care and instituting remedial measures Timely referral for mothers Use partograph for labour monitoring. Ensure supportive 2nd stage management based on foetal and maternal condition. Manage pre-eclampsia correctly.		Assess, look and classify all new born using IMNCI guidelines Manage neonate based on the IMNCI classification * Refer to next level with ongoing resuscitation if not responsive to procedures Refer responsive neonates to next level for further assessment and observation	Follow up neonates treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones Referral for management of any complications eg speech therapy if speech is affected, physical rehabilitation	Psychological support to parents of babies with birth-related complications Physical therapy for children with neurological complications
Referral Facility: General
Health Education to pregnant women to create awareness on birth asphyxia Health education to pregnant women on the need for regular ANC and skilled birth attendance Promote early health seeking behaviour Strengthen health workers knowledge on birth asphyxia including management	Educate pregnant women to deliver at health facility by skilled birth attendant * Full assessment of all newborn with Apgar score Monitoring quality of care and instituting remedial measures Timely referral for mothers Use partograph for labour monitoring. Ensure supportive 2nd stage management based on foetal and maternal condition. Manage pre-eclampsia correctly.		History and physical examination Bag and mask ventilation Maintain normal temperature Oxygen by nasal cannula or hood. *Normal saline bolus Transfuse in case of blood loss Intravenous dextrose Anti-epileptic drugs IV fluids Intra gastric tube feeding Monitor urine output Resuscitate in special care baby unit (SCBU) for those not responding Refer If no improvement or deterioration	Managemnet of any complications eg speech therapy if speech is affected, physical rehabilitation Follow up children treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones	Psychological support to parents of babies with birth-related complications Follow up neonates treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones Linkage with rehabilitation centres for physical rehabilitation, speech
Referral Facility: Specialist
Health Education to pregnant women to create awareness on birth asphyxia Health education to pregnant women on the need for regular ANC and skilled birth attendance Promote early health seeking behaviour Strengthen health workers knowledge on birth asphyxia including management	Educate pregnant women to deliver at health facility by skilled birth attendant * Full assessment of all newborn with Apgar score Monitoring quality of care and instituting remedial measures Timely referral for mothers Use partograph for labour monitoring. Ensure supportive 2nd stage management based on foetal and maternal condition. Manage pre-eclampsia correctly.		History and physical examination Dry neonate and place supine under overhead warmer Antibiotics therapy for neonates with possible severe bacterial infections Neonatal resuscitation including oxygen therapy Suctioning of airways Tactile stimulation to encourage spontaneous breathing Bag-mask ventilation (Ambu bag) for non-responsive neonates Chest compression if heart rate does not improve Encourage kangaroo mother care /or kangaroo father care ICU Services -e.g. for life support where indicated Laboratory tests e.g. blood gases analysis, Imaging modalities such as ultrasound, CT scan, MRI Electroencephalogram (EEG)	managemnet of any complications eg speech therapy if speech is affected; physical rehabilitation Follow up children treated for birth asphyxia to detect any signs of neurologic dysfunction such as delayed developmental milestones