Perinatal asphyxia
Perinatal asphyxia | |
---|---|
Other names | Neonatal asphyxia |
Specialty | Pediatrics, obstetrics |
Perinatal asphyxia (also known as neonatal asphyxia or birth asphyxia) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It remains a serious condition which causes significant mortality and morbidity. It is also the inability to establish and sustain adequate or spontaneous respiration upon delivery of the newborn, an emergency condition that requires adequate and quick resuscitation measures. Perinatal asphyxia is also an oxygen deficit from the 28th week of gestation to the first seven days following delivery. It is also an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs and may be associated with a lack of ventilation. In accordance with WHO, perinatal asphyxia is characterised by: profound metabolic acidosis, with a pH less than 7.20 on umbilical cord arterial blood sample, persistence of an
It results most commonly from antepartum causes like a drop in maternal
Perinatal asphyxia can be the cause of
There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air.
There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons.[7][8] Because of its lack of precision, the term is eschewed in modern obstetrics.[9]
Cause
Basically, understanding of the etiology of perinatal asphyxia provides the platform on which to build on its pathophysiology. The general principles guiding the causes and the pathophysiology of perinatal asphyxia are grouped into antepartum causes and intra partum causes. As these are the various points to which insults can occur to the foetus.[citation needed]
- Antepartum causes
- Inadequate oxygenation of maternal blood due to hypoventilation during anesthesia, heart diseases, pneumonia, respiratory failure
- Low maternal blood pressure due to hypotension e.g. compression of vena cava and aorta, excess anaesthesia.
- Premature separation of placenta
- Placental insufficiency
- Intra partum causes
- Inadequate relaxation of uterus due to excess oxytocin
- Prolonged delivery
- Knotting of umbilical cord around the neck of infant
Risk factors
- Elderly or young mothers
- Prolonged rupture of membranes
- Meconium-stained fluid
- Multiple births
- Lack of antenatal care
- Low birth weight infants
- Malpresentation
- Augmentation of labour with oxytocin
- Antepartum hemorrhage
- Severe eclampsia and pre-eclampsia
- Antepartum and intrapartum anemia[10]
Treatment
- A= Establish open airway: Suctioning, if necessary endotracheal intubation
- B= Breathing: Through tactile stimulation, PPV, bag and mask, or through endotracheal tube
- C= Circulation: Through chest compressions and medications if needed
- D= Drugs: Adrenaline .01 of .1 solution
- Hypothermia treatment to reduce the extent of brain injury
- Epinephrine 1:10000 (0.1-0.3ml/kg) IV
- Saline solution for hypovolemia
Epidemiology
A 2008 bulletin from the World Health Organization estimates that 900,000 total infants die each year from birth asphyxia, making it a leading cause of death for newborns.[11]
In the United States, intrauterine hypoxia and birth asphyxia was listed as the tenth leading cause of neonatal death.[12]
Medicolegal aspects
There is current controversy regarding the medicolegal definitions and impacts of birth asphyxia. Plaintiff's attorneys often take the position that birth asphyxia is often preventable, and is often due to substandard care and human error.
References
- PMID 2124034. Retrieved 2008-03-27.
- PMID 25526846.
- S2CID 24825982.
- PMID 11385146.
- ^ ILCOR Neonatal Resuscitation Guidelines 2010
- ^ Norwegian paediatrician honoured by University of Athens, Norway.gr
- PMID 11733588.
- PMID 8773129.
- ^ ACOG. "Committee Opinion, Number 326, December 2005: Inappropriate Use of the Terms Fetal Distress and Birth Asphyxia". Archived from the original on April 7, 2020. Retrieved June 9, 2010.
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(help)[dead link] - PMID 12762429.
- ^ Spector J, Daga S. "Preventing those so-called stillbirths". WHO. Archived from the original on November 30, 2009. Retrieved 13 December 2013.
- ^ National Center for Health Statistics
- PMID 24237480.
- ^ "APFEL Handout: Birth Asphyxia & Cerebral Palsy" (PDF). Colorado Bar Association. Archived from the original (PDF) on April 16, 2016. Retrieved April 8, 2016.
- S2CID 31057958.
- PMID 17877776.
- ^ Van Eerden, Peter. "Summary of the Publication, "Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology," by the ACOG Task Force on Neonatal Encephalopathy and Cerebral Palsy". Medscape. Retrieved April 8, 2016.