Perinatal Asphyxia

Abstract

Asphyxia before, during or after delivery is an important cause of perinatal mortality and neurologic morbidity. The fetus and newborn are equipped with a wide range of adaptive mechanisms to survive an Asphyxia episode, and when these fail, injury can occur. The American academy or pediatrics (AAP) and the American college of obstetrics and gynecology (AcoG) committees on maternal-fetal medicine and fetus and newborn have recently defined certain criteria that must be present: Profound umbilical artery metabolic or mixed academia (PH<700), persistence of an apgar score of 0 to 3 for longer than 5 minutes, neonatal neurologic sequelae (E.g., seizures, coma, hypotonia), and multiorgan system dysfunction (E.g., cardiovascular, gastrointestinal, hematologic, pulmonary or renal). In cases in which such evidence is laking, we cannot conclude that perinatal Asphyxia exists. The staging of the encephalopathy is useful for determination of prognosis. Those with mild encephalopathy do well, those with severe encephalopathy have a poor prognosis. The outcome of these with moderate (Stage II) hypoxic-ischemic encephalopathy is less certain, however, these children are at risk for neurologic disability and future academic failure. Overall tests used to evaluate subtle changes that may relate to perinatal hypoxic-ischemic injury have been inadequate, future studies should include tests of acquisition of new learning, memory, problem solving, and reasoning