Interventions for Neonatal encephalopathy due to birth asphyxia and trauma

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on the need for regular ANC and skilled birth attendance * Promote good maternal nutrition/including nutritional supplementation	Support regular ANC attendance Support delivery by a skilled attendance Support timely access to obstetric care Support exclusive breastfeeding Encourage good hygienic practices	Recognition of signs and symptoms	Immediate transfer to a higher-level health care facility	Psychological support to parents of babies with birth-related complications
Primary Care
Health education to pregnant women on the need for regular ANC follow up and skilled birth attendance	Partograph Proper 2nd stage management Timely referral	History Physical examination Apgar score at 5 and 10 minutes	Tactile stimulation Immediate transfer to a higher-level health care facility
Referral Facility: General
	Continuous foetal monitoring and timely intervention Prompt delivery of an at-risk foetus Manage pre-eclampsia correctly Corticosteroids for foetal lung maturity, Tocolytics to delay labour Magnesium sulphate for foetal neuroprotection	History Physical examination Complete blood cell (CBC) count Blood gases analysis, Renal function tests Umbilical artery pH Ultrasound Intrapartum electronic foetal heart monitoring (EFM) Antenatal foetal testing	Bag and mask ventilation Maintain normal temperature Oxygen by nasal prongs Normal saline bolus Blood transfusion IV fluids Anti-seizure drugs Intra gastric tube feeding Immediate transfer to a higher-level health care facility If no improvement or deterioration	Physical therapy for children with neurological complications
Referral Facility: Specialist
		History Physical examination Complete blood cell (CBC) count Renal function tests Umbilical artery pH Cardiac enzymes Electrocardiogram, Echocardiography, Cranial and doppler ultrasonography, Magnetic resonance imaging (MRI) Electroencephalogram (EEG) Computerized tomography	Bag-mask ventilation Therapeutic hypothermia Antibiotics Oxygen therapy Chest compression if heart rate does not improve ICU Services -e.g for life support were indicated	Physical therapy for children with neurological complications

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on the need for regular ANC and skilled birth attendance * Promote good maternal nutrition/including nutritional supplementation	Prompt delivery of an at-risk foetus Manage pre-eclampsia correctly Corticosteroids for foetal lung maturity, Tocolytics to delay labour Magnesium sulphate for foetal neuroprotection	Recognition of Neonatal encephalopathy signs and symptoms	Immediate transfer to a higher-level health care facility	Physical therapy for children with neurological complications	Psychological and social support to parents of babies with birth-related complications
Primary Care
Health education to pregnant women on the need for regular ANC follow up and skilled birth attendance	Partograph Proper 2nd stage management Timely referral	History Physical examination Apgar score at 5 and 10 minutes	Tactile stimulation Immediate transfer to a higher-level health care facility	Physical therapy for children with neurological complications	Psychological and social support to parents of babies with birth-related complications
Referral Facility: General
Promote family involvement in the routine care of neonatal encephalopathy infants in health-care facilities	Continuous foetal monitoring and timely intervention Prompt delivery of an at-risk foetus Manage pre-eclampsia correctly Corticosteroids for foetal lung maturity, Tocolytics to delay labour Magnesium sulphate for foetal neuroprotection	History Physical examination Complete blood cell (CBC) count Blood gases analysis, Renal function tests Umbilical artery pH Ultrasound Intrapartum electronic foetal heart monitoring (EFM) Antenatal foetal testing	Bag and mask ventilation Maintain normal temperature Oxygen by nasal prongs Normal saline bolus Blood transfusion IV fluids Anti-seizure drugs Intra gastric tube feeding Referral to a higher-level health care facility If no improvement or deterioration	Physical therapy for children with neurological complications	Psychological and social support to parents of babies with birth-related complications
Referral Facility: Specialist
Promote family involvement in the routine care of neonatal encephalopathy infants in health-care facilities	Prompt delivery of an at-risk foetus Manage pre-eclampsia correctly Corticosteroids for foetal lung maturity, Tocolytics to delay labour Magnesium sulphate for foetal neuroprotection	History Physical examination Complete blood cell (CBC) count Renal function tests Umbilical artery pH Cardiac enzymes Electrocardiogram Echocardiography, Cranial and Doppler ultrasonography, Magnetic resonance imaging (MRI) Electroencephalogram (EEG) Computerized tomography	Bag-mask ventilation Therapeutic hypothermia Antibiotics Oxygen supplementation Chest compression if heart rate does not improve 8 Intensive care if life support indicated	Physical therapy for children with neurological complications	Psychological and social support to parents of babies with birth-related complications