The Conscious Neonate and the Neonatal Faint

Abstract

The Resuscitation Council (UK) explains the pathophysiology of acute perinatal hypoxia. They explain that “If subjected to sufficient hypoxia in utero, or during passage through the birth canal, the fetus will attempt to breathe. If the hypoxic insult is continued the fetus will eventually lose consciousness. Shortly after this the neural centers in the brainstem which control these breathing efforts will cease to function because of lack of oxygen. Thus the fetus born after significant and prolonged intrapartum hypoxia will be unconscious and if the neural center of the brainstem is affected the neonate will make no respiratory efforts”. Therefore, the neonate is floppy and unresponsive from unconsciousness, and will make no respiratory efforts in response to the hypoxia as a result of depression of the respiratory center. This neonate requires ventilation to rescue it from increasing hypoxia. Previous researches described a simple scoring system to the neonate in the first minute after birth so that the healthy neonate requiring no attention could be differentiated from the neonate that required ventilatory assistance. The Apgar score measures muscle tone and responsiveness and the effectiveness of the cardiac output, circulation and respiration.