Perinatal asphyxia is a condition resulting from insufficient oxygen delivery to the fetus or newborn. It requires immediate and systematic evaluation and management to prevent long-term neurological damage and other complications.

Initial Assessment and Stabilization

1. Immediate Assessment:
   • Apgar Score: Evaluate at 1, 5, and 10 minutes.
   • Respiratory Effort: Check for spontaneous breathing or gasping.
   • Heart Rate: Monitor, ideally above 100 bpm.
   • Color: Assess for cyanosis or pallor.
   • Muscle Tone: Observe movements and tone.
2. Resuscitation Steps:
   • Warmth: Place the neonate under a radiant warmer.
   • Positioning: Position the head in a slightly extended ‘sniffing’ position.
   • Clearing Airway: Suction the mouth and nose if there is obvious obstruction.
   • Stimulation: Dry and stimulate the newborn to initiate breathing.
3. Positive Pressure Ventilation (PPV):
   • If the newborn is not breathing or has a heart rate <100 bpm, start PPV using a bag and mask.
   • Ensure a proper seal and appropriate ventilation rate (40-60 breaths per minute).
   • Use 21% oxygen initially for term neonates; consider higher concentrations if no improvement.
4. Chest Compressions:
   • If the heart rate remains <60 bpm after 30 seconds of effective PPV, start chest compressions.
   • Coordinate compressions with ventilations in a 3:1 ratio.
5. Medications:
   • Epinephrine: Administer if the heart rate remains <60 bpm despite effective ventilation and compressions. Dose: 0.01-0.03 mg/kg IV or via endotracheal tube.
   • Volume Expansion: Consider if there is evidence of shock or blood loss. Use isotonic saline or blood products (10 ml/kg).

Post-Resuscitation Care

1. Monitoring:
   • Continuous monitoring of heart rate, respiratory rate, oxygen saturation, and blood pressure.
   • Frequent neurological assessments.
2. Supportive Care:
   • Oxygen Therapy: Maintain SpO2 within target range (90-95%).
   • Thermoregulation: Prevent hypothermia or hyperthermia.
   • Glucose Monitoring: Regular monitoring and maintenance of normoglycemia.
   • Fluid Management: Administer fluids judiciously to avoid fluid overload.
3. Neurological Protection:
   • Therapeutic Hypothermia: Consider for eligible neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE). Initiate within 6 hours of birth.
   • Seizure Management: Monitor for seizures and treat with antiepileptic drugs if necessary.
4. Investigations:
   • Blood Gases: Assess for metabolic acidosis.
   • Complete Blood Count (CBC): Check for infection or anemia.
   • Blood Glucose: Monitor for hypoglycemia.
   • Electrolytes and Renal Function: Assess for renal impairment.
   • Neuroimaging: Consider MRI or cranial ultrasound for HIE evaluation.
5. Family Support:
   • Keep the family informed and involved in the care process.
   • Provide emotional support and counseling.

Follow-Up and Long-Term Care

1. Neurological Monitoring:
   • Regular follow-up for developmental assessments.
   • Early intervention programs if developmental delays or neurological deficits are detected.
2. Multidisciplinary Care:
   • Involve a team of neonatologists, neurologists, physiotherapists, and occupational therapists.
   • Individualized care plans for each child based on ongoing assessments and needs.
3. Parent Education:
   • Educate parents about potential long-term outcomes and early signs of developmental delays.
   • Provide resources and support for at-home care and follow-up appointments.