Perinatal asphyxia

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"Neonatal asphyxia" redirects here. For the more general term covering inadequate oxygen supply to the fetus, see intrauterine hypoxia.
Perinatal asphyxia
Classification and external resources
ICD-10 P21
ICD-9 768
DiseasesDB 1416
eMedicine ped/149
MeSH D001238

Perinatal asphyxia, 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. Hypoxic damage can occur to most of the infant's organs (heart, lungs, liver, gut, kidneys), but brain damage is of most concern and perhaps the least likely to quickly or completely heal. In more pronounced cases, an infant will survive, but with damage to the brain manifested as either mental, such as developmental delay or intellectual disability, or physical, such as spasticity.

It results most commonly from a drop in maternal blood pressure or some other substantial interference with blood flow to the infant's brain during delivery. This can occur due to inadequate circulation or perfusion, impaired respiratory effort, or inadequate ventilation. Perinatal asphyxia happens in 2 to 10 per 1000 newborns that are born at term, and more for those that are born prematurely. [1]

An infant suffering severe perinatal asphyxia usually has poor color (cyanosis), perfusion, responsiveness, muscle tone, and respiratory effort, as reflected in a low 5 minute Apgar score. Extreme degrees of asphyxia can cause cardiac arrest and death. If resuscitation is successful, the infant is usually transferred to a neonatal intensive care unit.

There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons.[2][3] Because of its lack of precision, the term is eschewed in modern obstetrics.[4]

Epidemiology[edit]

Disability-adjusted life year for birth asphyxia and birth trauma per 100,000 inhabitants in 2002

A 2008 bulletin from the World Health Organization estimates that 900,000 infants die each year from birth asphyxia, making it a leading cause of death for newborns.[5]

In the United States, intrauterine hypoxia and birth asphyxia was listed as the tenth leading cause of neonatal death. [6]

Etiology[edit]

  • 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
  • Inadequate relaxation of uterus due to excess oxytocin
  • Premature separation of placenta
  • Placental insufficiency
  • Knotting of umbilical cord around the neck of infant

Delivery Room Treatment[edit]

  • A= Establish Patent 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

References[edit]

  1. ^ "Brain damage from perinatal asphyxia: correlation of MR findings with gestational age -- Barkovich and Truwit 11 (6): 1087 -- American Journal of Neuroradiology". www.ajnr.org. Retrieved 2008-03-27. 
  2. ^ Blumenthal, I (2001). "Cerebral palsy—medicolegal aspects". Journal of the Royal Society of Medicine 94 (12): 624–7. PMC 1282294. PMID 11733588. 
  3. ^ Dhar, KK; Ray, SN; Dhall, GI (1995). "Significance of nuchal cord". Journal of the Indian Medical Association 93 (12): 451–3. PMID 8773129. 
  4. ^ ACOG. "Committee Opinion, Number 326, December 2005: Inappropriate Use of the Terms Fetal Distress and Birth Asphyxia". Retrieved June 9, 2010. 
  5. ^ Spector J, Daga S. "Preventing those so-called stillbirths". WHO. Retrieved 13 December 2013. 
  6. ^ National Center for Health Statistics

External links[edit]