Care after resuscitation focuses on temperature, oxygenation, ventilation, cerebral perfusion, glucose, and metabolic stability.
Temperature and therapeutic hypothermia
•
Maintain normal temperature and avoid hyperthermia.
•
In a resourceful setting, moderate induced hypothermia at a core temperature of 33° to 34°C reduces death or severe neurodevelopmental handicap.
•
A multicenter trial in India, Bangladesh, and Sri Lanka found no benefit of therapeutic hypothermia for neonatal mortality or disability at 18–24 months and observed an increased risk of death at discharge.
•
The National Neonatology Forum India recommends therapeutic hypothermia only in a tertiary care setting with a trained team, for selected neonates with a precise diagnosis of asphyxia.
Oxygenation and ventilation
•
Both hypoxia and hyperoxia can damage neurons; maintain oxygen saturation between 90% and 95%.
•
In ventilated neonates, maintain carbon dioxide between 40 and 50 mm Hg because both hypocarbia and hypercarbia are detrimental to the brain.
Cerebral perfusion
•
Cerebral perfusion is pressure passive because autoregulation is lost: cerebral blood supply falls when blood pressure falls and rises when blood pressure rises.
•
The specified systemic mean arterial pressure is 45–50 mm Hg for term neonates, 35–40 mm Hg for those weighing 1–2 kg, and 30–35 mm Hg for those weighing less than 1 kg.
•
Judicious fluid boluses and vasopressors help maintain blood pressure. Correct hyperviscosity due to polycythemia by partial exchange.
Glucose and metabolic monitoring
•
Maintain glucose between 75 and 100 mg/dL. Hyperglycemia enhances cerebral edema and compromises perfusion, whereas hypoglycemia potentiates excitotoxic damage.
•
Hypoglycemia is common in asphyxiated infants and requires regular monitoring.
•
Look regularly for hypocalcemia and electrolyte disturbances until stabilization, and correct them as indicated.