ASPHYXIA IN NEONATES

Pokorn P.
 Characteristics of the neonatal
period
Duration of neonatal period (postnatal age)
Assesment of GA (gestational age)
The accordance of BW to GA (SGA, NGA, LGA)
Early postnatal adaptation (maturation, functional adaptation)

ASPHYXIATED NON ASPHYXIATED NEONATE

Evaluation and management after birth

CPR ILCOR guidelines 2010

Risk pregnancy
Apgar score:
Score

0 1 2

CIRCULATION absent <100 >100

RESPIRATION absent slow good,

crying

TONE limp fl of Extr. active

REFLEXES no grimace sneeze

response

blue, pink body, pink

SKIN blue ex.
pale
 Causes of asphyxia

Prenatal
Risk pregnancy
Postnatal
Perinatal Neonatal

Non - Risk pregnancy

 PERINATAL ASPHYXIA

Essential characteristics

pH 7,0 + BE -12 mmol/l on umbilical cord 1-H blood sample

Apgar score 0-3 (5.min)

Neurological signs (seizures, HIE =72%)

MODSF (Martin-Ancel et al. 1995)

MORTALITY RATE : 15-20% 90% PRENATALLY 10% of PA CP

American Academy of Pediatrics, American College of Obstetricians and Gynecologists

(1996)
 ASPHYXIA

A.Definition inicdence 2-9/1000 neonates

B.Pathophysiology TERM neonates

C.Clinical presentation: TERM neonates

acute phase MODSF+ HIE (72%)

late phase Cerebral palsy

 PERINATAL ASPHYXIA

DIVING REFLEX
LUNG
BOWEL
KIDNEY BRAIN
SPLEEN MYOCARD
ADRENAL GLAND
SKIN
MUSCULATURE

HR, BP, CVP

const. CO and const. BRAIN PERFUSION
 PERINATAL ASPHYXIA
RR
CO

HR CVP

BP BRAIN

Time 3 5 7 (min) Time 3 5 7 (min)

PA PA
pH 7.4 7.1 7.0 6.7 7.4 7.1 7.0 6.7
 PERINATAL ASPHYXIA

asphyxia oxidative proinflamm.

apoptosis
ischemia reperfusion radicals cells

MINUTES MINUTES HOURS HOURS DAYS

THERAPEUTICAL WINDOW
 ASPHYXIA in TERM
MECHANISMS
Hypoxic
Ischemic
Hypoperfusion
Reperfusion
Glutamate release
 HIE

ACUTE PHASE HIE 0- 7 days

Clinical presentation: acute clinical syndrom :

HIE I. 0 H - 48 HYPERALERT
II. 48H - 7 days LETHARGIC
III. >7 days SUPOROUS

LATE PHASE HIE

Cerebral palsy and PM retardation/ death
 Neonatal asphyxia

1. Ischemia of cortex, bas. ggl.,

cerebral neuronal necrosis TERM-HIE

2. cPVleucomalatia PRETERM

3. intraventricular hemorrhage T + P

4. Neonatal seizures T+P

5. Hydrocephalus
CFM - aEEG
 MODSF
Brain

BP

HIE
 MODSF

BP Kidney

RR +/-
HR +/-
Brain
BP +/-
RDS SpO2,RR
Abdomen
NEC Metabolic + ABR
pO2
pCO2 HIE
Haematology infection
Lactate
A- B-C-D
 Diagnosis

Clinical condition (encephaloapathy)

Laboratory tests (ABR, S-Na, K, Cl, lactate,
glycemia, haematology)
Sonography + EEG+MRi
 Selected chemistry normal values
ALT: 3- 54 U/L (< 0,73 ukat/l)
AST 10 65 U/L (< 1,2 ukat/l)
Bilirubin direct:< 0.6 mg/dL
Bilirubin total: cord <2.8 mg/dL (<50 -65 umol/l)
24 H <8.0 mg/dL
48 H <13.0 mg/dL
72H <16.0 mg/dL

7-30 d <7.0 mg/dL

Calcium: term 1 week < 7-12 preterm <6-10mg/dL
Glucose: 40 -1000 mg/dL (1,7 -5,0 mmol/l)
Creatinin: 0,3-1,0 (0,2-0,4) mg/dL (18-62-106 umol/l)
 THERAPY
1. Observation
2. therapy of MODSF
3. therapy of HIE

DRUGS:
a. Anticonvulsants + neruoprotection PHENOBARBITAL, PHENYTOIN, MIDAZOLAM
b. Inotropics
c. Nutrition
d. Sedation, pain control
e. ATB