Table 1 List of agreed upon criteria for standard management of birth asphyxia at Balaka district hospital
1. Adequate initial assessment  Airway (secretions), Breathing (chest resections, apnea attack), Circulation (skin color, Coma (AVPU), Convulsions, Dehydration (urine, stool & vomiting), Vital signs (Temperature, respirations rate, pulse rate & oxygen saturation. (all should be assessed and documented during admission) |
2. Appropriate laboratory Investigations  Random Blood Sugar (RBS) checked 12 hourly, Full Blood Count (FBC), check if temperature is 38.50C for 2 consecutive readings. |
3. Correct diagnosis  Apgar < 7 at 5 min. For neonates not born at hospital should have the following on admission: cyanosis, floppy, convulsions & unable to suck. |
4. Correct Treatment  The treatment of birth asphyxia depends on the presenting signs, for example; Antibiotics based on FBC results/temperature 390C/rupture of membranes (ROM) > 18 h, Anticonvulsants (Phenobarbitone) given to neonate with convulsions, RBS < 45 mg/dl (given glucose 10%), temperature > 38.50C (given antipyretic paracetamol), oxygen saturation < 90% (given oxygen therapy). NB: check indication for treatment, dose, frequency & route. |
5. Vital signs monitoring 4hourly  Respirations, pulse rate, temperature & oxygen saturation checked at least 4hourly. |
6. Thermal support  At least one of the following should be done to the neonate; drying, wrapping & putting a neonate on radiant warmer. |
7. Airway management  Suctioning of secretions if present. |
8. Observations  Skin color, AVPU, convulsions, apneic attack, chest recessions & secretions checked at least 4hourly. |
9. Daily Weight check  Checked once a day throughout admission period. |
10. Correct Feeding  Method: Breast/cup/orogastric tube, type of feed: EBM/formula, amount, interval: 2–3 h |
11. Ward rounds by Clinical officers  Twice a day (Monday- Friday) & once a day (Saturday & Sunday) |
12. Explain findings to guardian/parent  Explained at least once a day throughout the duration of hospital stay |