If you are attending a delivery or a baby is brought to you immediately after birth, you should assess for birth asphyxia. Assess the baby after drying and wrapping him or her with a dry cloth. To assess for birth asphyxia, you need to look and listen for breathing patterns.

Assess asphyxia

No breathing: the newborn has not cried or there are no spontaneous movements of the chest.
Gasping: the newborn attempts to make some effort to breathe with irregular and slow breathing movements.
Breathing poorly: count breaths in one minute. The normal breathing rate of a newborn baby is 30‒60 per minute. If the breathing rate is less than 30 per minute it is a sign of asphyxia.

Classify asphyxia

There are two possible classifications:

Birth asphyxia
No birth asphyxia.

It is critical that you treat birth asphyxia quickly; if you don't, the baby may die or may develop complications from which he or she never fully recovers. The table below sets out a summary of the signs of asphyxia and the treatment that should be given.

SIGNS	CLASSIFY AS	TREATMENT
lf any of the following signs: Not breathing Gasping ls breathing poorly (less than 30 per minute)	Birth Asphyxia	Cut the cord Start resuscitation Position the newborn supine with neck slightly extended Clear the mouth and nose with gauze or clean cloth or bulb syringe Ventilate with appropriate size mask and self-inflating bag If the resuscitation is successful continue giving essential newborn care If the baby remains weak or still has irregular breathing after 20 minutes of resuscitation refer urgently to hospital: continue to resuscitate the baby on the way Stop resuscitation after 20 minutes if no response (no spontaneous breathing) Monitor continuously for 6 hours Followup care after 6--24hrs, days 3 and 7
Strong cry Breathing more than 30 per minutes	No Birth Asphyxia	Cord care Eye care Vitamin K Initiate skin to skin contact Initiate breastfeeding Advise mother when to return Give OPVO and BCG vaccination Followup care after 6 hrs, 3 days and 6 weeks

SIGNS

CLASSIFY AS

TREATMENT

lf any of the following

signs:

Not breathing

Gasping

ls breathing

poorly (less than

30 per minute)

Birth Asphyxia

Cut the cord

Start resuscitation

Position the newborn supine with

neck slightly extended

Clear the mouth and nose with

gauze or clean cloth or bulb

syringe

Ventilate with appropriate size

mask and self-inflating bag

If the resuscitation is successful

continue giving essential newborn

care

If the baby remains weak or still

has irregular breathing after 20

minutes of resuscitation refer

urgently to hospital: continue to

resuscitate the baby on the way

Stop resuscitation after 20 minutes

if no response (no spontaneous

breathing)

Monitor continuously for 6 hours

Followup care after 6--24hrs, days 3 and 7

Strong cry

Breathing more

than 30 per

minutes

No Birth Asphyxia

Cord care

Eye care

Vitamin K

Initiate skin to skin contact

Initiate breastfeeding

Advise mother when to return

Give OPVO and BCG vaccination

Followup care after 6 hrs, 3 days

and 6 weeks

If there is no birth asphyxia and the baby is crying strongly or breathing more than 30 breaths per minute you should continue with essential newborn care, as summarised in flowchart below.

Steps of immediate newborn care.