"Neonatal asphyxia" redirects here. For the more general term covering inadequate oxygen supply to the fetus, see intrauterine hypoxia.
Medical condition
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 Apgar score of 3 at the 5th minute, clinical neurologic sequelae in the immediate neonatal period, or evidence of multiorgan system dysfunction in the immediate neonatal period. 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 antepartum causes like 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] WHO estimates that 4 million neonatal deaths occur yearly due to birth asphyxia, representing 38% of deaths of children under 5 years of age.[2]
Perinatal asphyxia can be the cause of hypoxic ischemic encephalopathy or intraventricular hemorrhage, especially in preterm births. An infant with 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 has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air.[3] 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.[4] 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.[5][6]
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]
^Truwit, C. L.; Barkovich, A. J. (November 1990). "Brain damage from perinatal asphyxia: correlation of MR findings with gestational age". American Journal of Neuroradiology. 11 (6): 1087–1096. PMC 8332119. PMID 2124034. Retrieved 2008-03-27.
^Aslam, Hafiz Muhammad; Saleem, Shafaq; Afzal, Rafia; Iqbal, Umair; Saleem, Sehrish Muhammad; Shaikh, Muhammad Waqas Abid; Shahid, Nazish (2014-12-20). "Risk factors of birth asphyxia". Italian Journal of Pediatrics. 40: 94. doi:10.1186/s13052-014-0094-2. ISSN 1824-7288. PMC 4300075. PMID 25526846.
^Davis, PG; Tan, A; O'Donnell, CPF; Schulze, A (2004). "Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis". The Lancet. 364 (9442): 1329–1333. doi:10.1016/S0140-6736(04)17189-4. PMID 15474135. S2CID 24825982.
^Kutzsche, S; Ilves, P; Kirkeby, OJ; Saugstad, OD (2001). "Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets". Pediatric Research. 49 (6): 834–842. doi:10.1203/00006450-200106000-00020. PMID 11385146.
^ILCOR Neonatal Resuscitation Guidelines 2010
^Norwegian paediatrician honoured by University of Athens, Norway.gr
^Blumenthal, I (2001). "Cerebral palsy—medicolegal aspects". Journal of the Royal Society of Medicine. 94 (12): 624–7. doi:10.1177/014107680109401205. PMC 1282294. PMID 11733588.
^Dhar, KK; Ray, SN; Dhall, GI (1995). "Significance of nuchal cord". Journal of the Indian Medical Association. 93 (12): 451–3. 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. {{cite journal}}: Cite journal requires |journal= (help)[dead link]
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