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| == Perinatal asphyxia == | | {{Short description|A medical condition in newborns}} |
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| '''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 is also the inability to establish and sustain adequate or spontaneous respiration upon delivery of the newborn. It remains a serious condition which causes significant mortality and morbidity. It is an emergency condition and 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 <7.20 on umbilical cord arterial blood sample, Persistence of an APGAR score of 3 at the 5th minute, Clinical neurologic sequelae in the immediate neonatal period,Evidence of multiorgan system dysfunction in the immediate neonatal period. Hypoxic damage can occur to most of the infant's organs ([[heart]], [[lung]]s, [[liver]], [[Gut (zoology)|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]]. | | '''Perinatal asphyxia''' is a medical condition characterized by a lack of oxygen (hypoxia) to a newborn infant that occurs during the perinatal period, which is the time immediately before and after birth. This condition can lead to significant [[neurological]] damage and is a major cause of [[neonatal]] morbidity and mortality. |
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| It results most commonly from antepartum causes like a drop in maternal [[blood pressure]] or some other substantial interference with blood flow to the infant's [[brain]] during [[childbirth|delivery]]. This can occur due to inadequate [[circulatory system|circulation]] or [[perfusion]], impaired respiratory effort, or inadequate [[Ventilation (physiology)|ventilation]]. Perinatal asphyxia happens in 2 to 10 per 1000 newborns that are born at term, and more for those that are born prematurely.<ref>{{cite journal|url=http://www.ajnr.org/cgi/content/abstract/11/6/1087|title=Brain damage from perinatal asphyxia: correlation of MR findings with gestational age |journal=American Journal of Neuroradiology|volume=11|issue=6|pages=1087–1096|accessdate=2008-03-27|date=November 1990|last1=Truwit|first1=C. L.|last2=Barkovich|first2=A. J.}}</ref> WHO estimates that 4 million neonatal deaths occur yearly due to birth asphyxia, representing 38% of deaths of children under 5 years of age.<ref>{{Cite journal|last=Aslam|first=Hafiz Muhammad|last2=Saleem|first2=Shafaq|last3=Afzal|first3=Rafia|last4=Iqbal|first4=Umair|last5=Saleem|first5=Sehrish Muhammad|last6=Shaikh|first6=Muhammad Waqas Abid|last7=Shahid|first7=Nazish|date=2014-12-20|title=Risk factors of birth asphyxia|journal=Italian Journal of Pediatrics|volume=40|pages=94|doi=10.1186/s13052-014-0094-2|issn=1824-7288|pmc=4300075|pmid=25526846}}</ref>
| | ==Pathophysiology== |
| | Perinatal asphyxia occurs when there is an interruption in the supply of oxygen to the infant's brain and other vital organs. This can result from various factors, including complications during [[labor]] and delivery, such as [[umbilical cord]] prolapse, placental abruption, or prolonged labor. The lack of oxygen can lead to [[metabolic acidosis]], where the blood becomes too acidic, and can cause damage to the [[central nervous system]]. |
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| | ==Clinical Presentation== |
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| | Newborns with perinatal asphyxia may present with a variety of symptoms, including poor [[muscle tone]], weak or absent [[cry]], difficulty breathing, and [[cyanosis]] (a bluish discoloration of the skin due to lack of oxygen). In severe cases, the infant may experience [[seizures]], [[coma]], or [[multi-organ failure]]. |
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| Perinatal asphyxia can be the cause of [[hypoxic ischemic encephalopathy]] or [[Intraventricular hemorrhage#Babies|intraventricular hemorrhage]], especially in [[preterm birth]]s. 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]].
| | ==Diagnosis== |
| | The diagnosis of perinatal asphyxia is typically based on clinical findings and laboratory tests. Key indicators include low [[Apgar score]]s at 1 and 5 minutes after birth, evidence of metabolic acidosis in the [[umbilical cord blood]], and signs of [[hypoxic-ischemic encephalopathy]] (HIE) on [[neurological examination]]. |
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| There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air.<ref>{{cite journal |last1=Davis |first1=PG |last2= Tan |first2= A |last3= O'Donnell |first3= CPF |last4= Schulze |first4= A | year= 2004|title= Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis |journal=[[The Lancet]] |volume= 364 |issue= 9442|pages= 1329–1333 |doi= 10.1016/S0140-6736(04)17189-4 |url= |pmid=15474135}}</ref> It has been demonstrated that high concentrations of oxygen lead to generation of oxygen [[free radicals]], which have a role in [[reperfusion injury]] after asphyxia.<ref>{{cite journal |last1=Kutzsche |first1=S |last2= Ilves |first2= P |last3= Kirkeby |first3= OJ |last4= Saugstad |first4= OD | authorlink4 =Ola Didrik Saugstad | year= 2001|title= Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets |journal=[[Pediatric Research]] |volume=49 |issue= 6|pages= 834–842 |doi= 10.1203/00006450-200106000-00020 |url= |pmid=11385146|doi-access= free }}</ref> Research by [[Ola Didrik Saugstad]] and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen.<ref>ILCOR Neonatal Resuscitation Guidelines 2010</ref><ref>[http://www.norway.gr/News_and_events/Events/Older-articles/Norwegian-paediatrician-honoured-by-University-of-Athens-/#.VSkP0rtvt2Y Norwegian paediatrician honoured by University of Athens], Norway.gr</ref>
| | ==Management== |
| | The management of perinatal asphyxia involves immediate resuscitation and stabilization of the newborn. This may include providing [[oxygen therapy]], [[mechanical ventilation]], and [[fluid management]]. Therapeutic [[hypothermia]] is a treatment that has been shown to improve outcomes in infants with moderate to severe HIE by reducing brain injury. |
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| There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons.<ref>{{cite journal | last1 = Blumenthal | first1 = I | title = Cerebral palsy—medicolegal aspects | journal = Journal of the Royal Society of Medicine | volume = 94 | issue = 12 | pages = 624–7 | year = 2001 | pmid = 11733588 | pmc = 1282294 | doi = 10.1177/014107680109401205 }}</ref><ref>{{cite journal | last1 = Dhar | first1 = KK | last2 = Ray | first2 = SN | last3 = Dhall | first3 = GI | title = Significance of nuchal cord | journal = Journal of the Indian Medical Association | volume = 93 | issue = 12 | pages = 451–3 | year = 1995 | pmid = 8773129 }}</ref> Because of its lack of precision, the term is eschewed in modern obstetrics.<ref name=acog>{{cite journal|author=ACOG|title=Committee Opinion, Number 326, December 2005: Inappropriate Use of the Terms Fetal Distress and Birth Asphyxia|accessdate=June 9, 2010|url=http://www.acog.org/publications/committee_opinions/co326.cfm|archive-url=https://web.archive.org/web/20200407070416/https://www.acog.org/publications/committee_opinions/co326.cfm|url-status=dead|archive-date=April 7, 2020}}</ref>
| | ==Prognosis== |
| | The prognosis for infants with perinatal asphyxia varies depending on the severity of the condition and the timeliness of intervention. Mild cases may result in full recovery, while severe cases can lead to long-term [[neurological]] impairments such as [[cerebral palsy]], [[intellectual disability]], or [[epilepsy]]. |
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| ==Cause== | | ==Prevention== |
| 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.
| | Preventive measures for perinatal asphyxia focus on ensuring optimal maternal and fetal health during pregnancy and delivery. This includes regular prenatal care, monitoring of fetal well-being during labor, and timely intervention in cases of fetal distress. |
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| *'''Antepartum causes'''
| | ==Related pages== |
| *Inadequate oxygenation of maternal blood due to [[hypoventilation]] during anesthesia, heart diseases, [[pneumonia]], [[respiratory failure]] | | * [[Hypoxic-ischemic encephalopathy]] |
| * Low maternal blood pressure due to [[hypotension]] e.g. compression of vena cava and [[aorta]], excess anaesthesia. | | * [[Neonatal resuscitation]] |
| *Premature separation of [[placenta]] | | * [[Cerebral palsy]] |
| *Placental insufficiency | | * [[Neonatal intensive care unit]] |
| *'''Intra partum causes'''
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| * Inadequate relaxation of uterus due to excess [[oxytocin]]
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| * prolonged delivery
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| * Knotting of umbilical cord around the neck of infant
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| == Risk factors ==
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| * Elderly or young mothers
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| * Prolonged rupture of membranes
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| * Meconium-stained fluid
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| * Multiple births
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| * Lack of antenatal care
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| * Low birth weight infants
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| * Malpresentation
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| * Augmentation of labour with oxytocin
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| * Antepartum hemorrhage
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| * Severe eclampsia and pre-eclampsia
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| * Antepartum and intrapartum anemia<ref>{{Cite journal|last=Kaye|first=D.|date=2003-03-01|title=Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda|journal=East African Medical Journal|volume=80|issue=3|pages=140–143|issn=0012-835X|pmid=12762429|doi=10.4314/eamj.v80i3.8683|doi-access=free}}</ref>
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| ==Treatment==
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| * A= Establish open airway: Suctioning, if necessary [[endotracheal intubation]]
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| * B= Breathing: Through tactile stimulation, PPV, bag and mask, or through [[endotracheal tube]]
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| * C= Circulation: Through chest compressions and medications if needed
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| * D= Drugs: Adrenaline .01 of .1 solution
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| * [[Hypothermia therapy for neonatal encephalopathy|Hypothermia treatment]] to reduce the extent of brain injury
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| * Epinephrine 1:10000 (0.1-0.3ml/kg) IV
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| * Saline solution for hypovolemia
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| ==Epidemiology==
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| [[File:Birth asphyxia and birth trauma world map - DALY - WHO2002.svg|thumb|[[Disability-adjusted life year]] for birth asphyxia and birth trauma per 100,000 inhabitants in 2002]]
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| 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.<ref name="WHO_2008">{{cite web | url=http://www.who.int/bulletin/volumes/86/4/07-049924/en/ | title=Preventing those so-called stillbirths | publisher=WHO | accessdate=13 December 2013 |vauthors=Spector J, Daga S }}</ref>
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| In the United States, [[intrauterine hypoxia]] and birth asphyxia was listed as the tenth leading cause of neonatal death.<ref>[https://www.cdc.gov/nchs/data/hestat/prelimdeaths04/preliminarydeaths04.htm National Center for Health Statistics]</ref>
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| == Medicolegal aspects ==
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| 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.<ref>{{Cite journal|title=Acta Obstetricia et Gynecologica|last=Andreasen|first=Stine|doi=10.1111/aogs.12276|pmid=24237480|volume=93|issue = 2|journal=Acta Obstetricia et Gynecologica Scandinavica|pages=152–158|year = 2014}}</ref> They have utilized some studies in their favor that have demonstrated that, "... although other potential causes exist, asphyxia and hypoxic-ihy affect a substantial number of babies, and they are preventable causes of cerebral palsy."<ref>{{Cite web|url=http://www.cobar.org/cle/photos/medical-legal/new/Handouts/APFEL%20HANDOUT%20-%20Birth%20Asphyxia%20&%20Cerebral%20Palsy-Trial.%20color%20copy.pdf|title=APFEL Handout: Birth Asphyxia & Cerebral Palsy|website=Colorado Bar Association|access-date=April 8, 2016|archive-url=https://web.archive.org/web/20160416060253/http://www.cobar.org/cle/photos/medical-legal/new/Handouts/APFEL%20HANDOUT%20-%20Birth%20Asphyxia%20%26%20Cerebral%20Palsy-Trial.%20color%20copy.pdf|archive-date=April 16, 2016|url-status=dead|df=mdy-all}}</ref><ref>{{Cite journal|last=Cohen|first=Frances M.|date=2003|title=Origin and Timing of Brain Lesions in Term Infants with Neonatal Encephalopathy|pmid=12620738|journal=The Lancet|doi=10.1016/S0140-6736(03)12658-X|volume=361|issue=9359|pages=736–42}}</ref><ref>{{Cite journal|last=Becher|first=J-C|last2=Stenson|first2=Bj|last3=Lyon|first3=Aj|date=2007-11-01|title=Is intrapartum asphyxia preventable?|journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=114|issue=11|pages=1442–1444|doi=10.1111/j.1471-0528.2007.01487.x|pmid=17877776|issn=1471-0528}}</ref> The [[American Congress of Obstetricians and Gynecologists]] disputes that conditions such as cerebral palsy are usually attributable to preventable causes, instead associating them with circumstances arising prior to birth and delivery.<ref>{{Cite web|url=http://www.medscape.com/viewarticle/457882|title=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|last=Van Eerden|first=Peter|date=|website=Medscape|access-date=April 8, 2016}}</ref>
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| ==References==
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| {{Reflist}}
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| == External links ==
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| {{Medical resources
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| | DiseasesDB = 1416
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| | ICD10 = {{ICD10|P|21}}
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| | ICD9 = {{ICD9|768}}
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| | eMedicineSubj = ped
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| | eMedicineTopic = 149
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| | MeshID = D001238
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| }}
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| {{Certain conditions originating in the perinatal period}}
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| {{stub}}
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| [[Category:Respiratory diseases]]
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| [[Category:Neonatology]] | | [[Category:Neonatology]] |
| | [[Category:Medical emergencies]] |
| | [[Category:Neurological disorders]] |
A medical condition in newborns
Perinatal asphyxia is a medical condition characterized by a lack of oxygen (hypoxia) to a newborn infant that occurs during the perinatal period, which is the time immediately before and after birth. This condition can lead to significant neurological damage and is a major cause of neonatal morbidity and mortality.
Pathophysiology
Perinatal asphyxia occurs when there is an interruption in the supply of oxygen to the infant's brain and other vital organs. This can result from various factors, including complications during labor and delivery, such as umbilical cord prolapse, placental abruption, or prolonged labor. The lack of oxygen can lead to metabolic acidosis, where the blood becomes too acidic, and can cause damage to the central nervous system.
Clinical Presentation
Newborns with perinatal asphyxia may present with a variety of symptoms, including poor muscle tone, weak or absent cry, difficulty breathing, and cyanosis (a bluish discoloration of the skin due to lack of oxygen). In severe cases, the infant may experience seizures, coma, or multi-organ failure.
Diagnosis
The diagnosis of perinatal asphyxia is typically based on clinical findings and laboratory tests. Key indicators include low Apgar scores at 1 and 5 minutes after birth, evidence of metabolic acidosis in the umbilical cord blood, and signs of hypoxic-ischemic encephalopathy (HIE) on neurological examination.
Management
The management of perinatal asphyxia involves immediate resuscitation and stabilization of the newborn. This may include providing oxygen therapy, mechanical ventilation, and fluid management. Therapeutic hypothermia is a treatment that has been shown to improve outcomes in infants with moderate to severe HIE by reducing brain injury.
Prognosis
The prognosis for infants with perinatal asphyxia varies depending on the severity of the condition and the timeliness of intervention. Mild cases may result in full recovery, while severe cases can lead to long-term neurological impairments such as cerebral palsy, intellectual disability, or epilepsy.
Prevention
Preventive measures for perinatal asphyxia focus on ensuring optimal maternal and fetal health during pregnancy and delivery. This includes regular prenatal care, monitoring of fetal well-being during labor, and timely intervention in cases of fetal distress.
Related pages
