Acute fetal asphyxia and permanent brain injury: a retrospective analysis of current indicators (original) (raw)
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Intrapartum fetal asphyxial brain injury with absent multiorgan system dysfunction
The Journal of Maternal-fetal Medicine, 1998
Current understanding of the physiologic mechanisms of intrapartum fetal asphyxial brain injury has suggested a strong association with multiorgan system injury. Thus the purpose here is to describe 14 cases of severe fetal brain injury with absent multiorgan system dysfunction (MSD). The study population was drawn from a national registry for brain injured infants. MSD was defined by clinical criteria demonstrated to reflect asphyxial injury to the pulmonary, renal, cardiac, hematologic, hepatic, and gastrointestinal systems. Involvement of one other organ in addition to the brain was defined as multiorgan system dysfunction. All infants were diagnosed with hypoxic-ischemic encephalopathy (HIE) in the neonatal period and went on to have permanent central nervous system (CNS) injury and MSD criteria were not met. Of the 292 term, singleton infants with HIE and permanent neurologic injury, 57 (20%) satisfied the entry criteria; of these, 14 (36%) had no MSD. The underlying basis for the fetal brain injury were: uterine rupture, 6 (43%), prolonged FHR deceleration, 5 (36%), fetal exsanguination, 1 (7%), cord prolapse, 1 (7%), and maternal cardiopulmonary arrest, 1 (7%). The mean duration of the prolonged FHR deceleration was 32.1 Ϯ 9.1 (range 19-51) minutes. All infants were later diagnosed with cerebral palsy. Intrapartum fetal asphyxial brain injury may not necessarily proceed through a physiologic mechanism in which the fetal circulation is centralized and endorgans damaged. These acute injuries, associated with a prolonged FHR deceleration, may be linked to severely decreased cardiac output and hypotension that cause vulnerable portions of the brain to be injured before other organs.
Early Human Development, 1991
Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) 1 84, 3 had a GCI between 68 and 83 and 12 scored < 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI < 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay. asphyxia; multisystem involvement; neurodevelopmental sequelae.
Introduction – Perinatal asphyxia is an important cause of permanent brain damage. It can result in neonatal mortality, multi organ dysfunction or long term disability in the form of cerebral palsy or mental retardation. Material and Methods – 100 term neonates with birth asphyxia admitted in the neonatal intensive care unit (NICU) of a tertiary care hospital were included in the study. Signs and symptoms of various organ dysfunction were assessed alongwith relevant laboratory investigations. Babies were followed up every three months for a period of one year after the discharge. Appropriate statistical tests were applied to the data collected. Results – 76% cases developed multi organ dysfunction (at least one organ dysfunction in addition to central nervous system). Central nervous system (CNS) was affected in all cases followed by respiratory failure in 58%. At the end of one year; 29% babies were normal, 33% developed neuro motor delay, while 30% had expired. 8% cases were lost to follow up. The severity of HIE (Hypoxic ischemic encephalopathy) and the number of organ system involved had a significant association with poor outcome i.e. mortality or neuro developmental delay (p<0.001). Conclusion – Involvement of more than one organ was seen in majority of cases in our study. Poor outcome was more likely in babies with multi organ dysfunction and/or with higher degree of encephalopathy.
Early and long-term consequences of intrapartum asphyxia
International Congress Series, 2005
The role of intrapartum asphyxia remains relatively obscure because of difficulties with definition and incidence of this problem. The importance of antenatal insults becomes more and more clear. When intrapartum asphyxia occurs, outcome can be very different depending on the duration and the extent of the asphyxia. Approximately 10-20% of children end up with a clinical picture of cerebral palsy. Many of these children develop cognitive and visual disturbances. The majority of children are normal to follow-up. Early magnetic resonance imaging can help to define the extent of the injury and correlate this finding with outcome. D
Asphyxia, Neurologic Morbidity, and Perinatal Mortality in Early-Term and Postterm Birth
PEDIATRICS, 2016
BACKGROUND AND OBJECTIVES: Neonatal outcomes vary by gestational age. We evaluated the association of early-term, full-term, and postterm birth with asphyxia, neurologic morbidity, and perinatal mortality. METHODS: Our register-based study used retrospective data on 214 465 early-term (37+0–38+6 gestational weeks), 859 827 full-term (39+0–41+6), and 55 189 postterm (≥42+0) live-born singletons during 1989–2008 in Finland. Asphyxia parameters were umbilical cord pH and Apgar score at 1 and 5 minutes. Neurologic morbidity outcome measures were cerebral palsy (CP), epilepsy, intellectual disability, and sensorineural defects diagnosed by the age of 4 years. Newborns with major congenital anomalies were excluded from perinatal deaths. RESULTS: Multivariate analysis showed that, compared with full-term pregnancies, early-term birth increased the risk for low Apgar score (<4) at 1 and 5 minutes (odds ratio 1.03, 95% confidence interval 1.03–1.04 and 1.24, 1.04–1.49, respectively), CP (...
Progress in perinatal asphyxia
Seminars in Neonatology, 1999
Key words: birth asphyxia, neonatal encephalopathy, hypoxic-ischaemic encephalopathy, flesh stillbirth, perinatal mortality, meconium, traditional birth attendant Neonatal encephalopathy (NE) is a more specific marker than low Apgar score for significant perinatal asphyxia in term infants. The proportion of NE associated with intrapartum hypoxia is probably higher in low income than high income settings. The perinatal mortality rate associated with asphyxia ranges typically between 10 and 20 per 1000, and the prevalence of neonatal encephalopathy between 5 and 25 per 1000 total births in low income countries. The impact of traditional birth attendant programmes is limited by the low specificity of maternal risk assessment schemes and poor referral pathways, although there is emerging evidence of a role for domiciliary resuscitation. Primary prevention in hospital settings should focus on intrapartum monitoring and appropriate management guidelines, including amnioinfusion for meconium-stained liquor. Resuscitation guidelines should emphasize measures to minimize meconium aspiration in the depressed infant. Neuroprotective strategies are entering the stage of clinical trials. Appropriate neonatal management guidelines for the developing country clinician are described.
Intrauterine Asphyxia: Clinical Implications for Providers of Intrapartum Care
Journal of Midwifery & Women's Health, 2005
Advances in science and technology have allowed researchers to gain a better understanding of the pathophysiology leading to long-term neurologic damage in newborns. Intrapartum events are now known to be an infrequent cause of adverse neurologic outcome. Clinicians caring for women during labor must have an understanding of the pathophysiology of intrauterine asphyxia as well as an awareness of the capabilities and limitations of available intrapartum fetal assessment tools to diagnose intrauterine fetal asphyxia or predict neurologic outcome. This article reviews the physiology of acid-base balance and fetal gas exchange as well as the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Recommendations for care and documentation are included.
Introduction: Perinatal asphyxia is a major cause of neonatal mortality and morbidity in developing nations. The study aims to evaluate the clinical profile and outcome at discharge of term asphyxiated newborns in an Indian tertiary care center. Material and methods: This is a prospective observational study of 120 term asphyxiated neonates admitted in NICU of an Indian tertiary care center. Maternal risk factors associated with birth asphyxia were recorded. Babies were treated as per the standard treatment protocol for birth asphyxia. Neurological assessment at discharge was done by clinical examination, Amiel-Teison tone assessment and neuroimaging. Results: Of 120 asphyxiated infants, 82 infants were delivered via normal vaginal delivery while 22 were extracted by LSCS and 16 babies by forceps/vaccum delivery. The most common associated maternal risk factor was meconium stained amniotic fluid. 51 infants developed mild HIE, 66 moderate HIE and 3 severe HIE. Acute Kidney Injury was diagnosed in 19 infants with moderate to severe HIE. Among 69 infants with moderate to severe HIE, 52 developed seizures which were controlled in 42 infants within 2 days. Among infants with moderate to severe HIE, 53 infants were on direct breast feeds, 54 infants had normal neurobehavior and 48 infants had normal neuroimaging at discharge. The mean duration of hospital stay was 8 days. The overall mortality rate was 1.6%. Conclusions: Early identification of maternal risk factor, timely obstetric intervention and optimum neonatal care will improve the outcome of perinatal asphyxia. Even majority of infants with moderate to severe HIE had normal neurobehavior and were on oral feeds at discharge.
The Journal of Pediatrics, 1998
Objective: To prospectively validate a previously reported scoring system for identifying the near-term infant at risk for the multiple organ system sequelae of acute perinatal asphyxia. Study design: Prospective observational study. Setting: Three Denver teaching hospitals, each providing comprehensive obstetric care. Subjects: Newborn infants of 36 weeks or more gestation. Intervention: None. Statistical analysis: Chisquared analysis with Fisher's exact test.
Background: Perinatal asphyxia a leading cause of mortality and morbidity in under 5 years age group is a manifestation of both maternal and child health status of a country. Identifying both maternal and fetal health risk factors contributing to perinatal asphyxia, proper intervention and appropriate newborn care and follow up of NICU graduates can plummet the health burden of asphyxia. Our study aims at identifying both maternal and fetal risk factors precipitating perinatal asphyxia, monitoring the outcome of asphyxia on standard treatment protocol, and follow up of surviving asphyxiated babies and their neurological impairment. Materials and Methods: It's a combination of cross sectional descriptive and observational prospective single center based study with a cohort of 98 newborns who satisfied the inclusion criteria and got enrolled consecutively. The study was conducted at Pediatric Medicine department at a tertiary care hospital over a time period of 1 year from May 2018 till April 2019. We followed the definition of perinatal asphyxia enunciated by WHO and NNF, and excluded babies with birth weight < 1500gm or with major congenital anomalies. Results: Out of 98 enrolled newborn who suffered perinatal asphyxia, 6 babies died during hospital stay and rest 92 got discharged and they were followed up till next 6 months. The mean maternal age is 23.98 ± 3.38 years and mean birth weight of the babies were 2.34 ±0.38 kg , with Anemia being the commonest maternal risk factor (34.69%) and preterm delivery (42.85%) was the commonest fetal risk factor. Vaginal delivery (73.47%) being the commonest mode of delivery and most of the labour cases were booked (75.5%) and multigravida (52.04%). 68.3% babies suffered mild to moderate asphyxia and rest 31.6% had severe asphyxia but total 55% total had hypoxic-ischemic encephalopathy(HIE) consequences. There was variable level of organ damage with perinatal asphyxia and most of them had statistically significant correlation with extent of asphyxia except necrotizing enterocolitis (NEC). On post discharge 6 months follow up we recorded and found, 26.08% having feeding problem, 19.55% having microcephaly, 22.83% neurological problem as per Hammersmith infant neurological examination chart (HINE) , 7.6% having hearing loss, 17.39% having vision problem. Conclusion: Anemia correction, adequate antenatal care, essential newborn care and socioeconomic elevation can bring down incidence of perinatal asphyxia. Also early neurological assessment of newborn can detect anomaly and an early intervention will minimize neurological handicap due to neuronal plasticity.