Perinatal Asphyxia

Perinatal asphyxia is usually due to lack of oxygen (hypoxia) and/or lack of perfusion to various organs. It is often linked to tissue lactic acidosis.

The criteria defined for terming a situation preinatal asphyxia in medical terms is ;
1. Prolonged metabolic or mixed acidemia on an umbilical arterial blood sample.
2. Persistence of Apgar score of 0-3 for >5 min
3. Neurological manifestations like seizures, coma, hypotonia or Hypoxic ischemic encephalopathy(HIE) in the immediate neonatal period.
4. Evidence of multiorgan dysfunction in the immediate neonatal period.

Source : Essential Paediatrics by Ghai

Various bodies like National Neonatology forum of India and WHO have certain parameters to define severe and moderate birth asphyxia respectively. NNF defines asphyxia as absence of cry at 1 mins and severe asphyxia as absend or inadequate breathing in five minutes.

Multi organ dysfunction can be a possibility in perinatal asphyxia. It can affect the

  • Central Nervous system
  • Pulmonary
  • Renal
  • Metabolic
  • Gastointestinal
  • Hematological factors

Care must be taken to understand the functions of all the above systems for functioning normalacy.

Post Resuscitation Management of an Asphyxiated Baby

  • Temperature :

Care must be taken to maintain normal temperature of the baby and avoid excessive temperatures.

  • Oxygen

Hypoxia and Hyperoxia can damage neurons. Oxygen saturations are maintained between 90 and 95%. CO2 concentrations are maintained between set parameters medically as hypocarbia and hypercarbia are detrimental to the brain.

  • Perfusion

Cerebral perfusion in asphyxiated babies is in pressure passive state. This means that there is loss of autoregulation and blood supply to the brin is entirely dependant on the BPs.

  • Glucose

Levels between 75-100 mg/dl are recomended. Hyperglycemia and Hypoglycemia effects must be monitoreed. Hypoglycemia is commonly seen in asphyxiated infants and the infants must be regularly monitored.

  • Metabolic Profile

Electrolyte disturbances must be regularly looked for untill the sterilization of the baby and corrected as indicated.

  • Seizures

Seizures are commonly subtle or focal or multifocal. Metabolic disturbances must be ruled out. Seizuers must be treated with anti epileptic drugs. Subtle seizures lasting for a brief duration must not be treated.

Constant communication with the Doctor and the Hospital coordinator must be ensured that the parent understands the significance of the all the steps taken by the hospital to ensure the health of the baby.

All these babies should have regular follow up with monitoring of neurodevelopmental milestones to detect any deficits early and to interevene effectively.

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