Perinatal asphyxia: Causes, Symptoms, Treatments & Prognosis
Causes
The risk factors for perinatal asphyxia can be divided into three categories: prenatal, delivery, and postnatal. Risk factors for uterine pregnancy include maternal hypotension, maternal hypotension, maternal respiratory and cardiovascular disease, fetal congenital anomalies, and premature infants. The risk factors for labor are dystocia, fetal rotation, abnormal placenta, placental exfoliation, And hypotension. Postpartum risk factors include severe pulmonary disease of the newborn, severe recurrent apnea, congenital heart disease, patent ductus arteriosus with cardiac insufficiency, sepsis with cardiovascular collapse, persistent fetal circulation. The risk factors for normal birth and delivery are usually 90% of the perinatal asphyxia.
Perinatal asphyxia can be diagnosed by satisfying all four of the following criteria. ① Severe metabolic or mixed acidemia due to arterial blood gas test, ② Apgar scores continuously 0 to 3 even after 5 minutes of birth, ③ Neurological symptoms such as convulsions, coma and hypotonia, ④ More than one Other cardiovascular (cardiovascular, gastrointestinal, blood, lung, kidney, etc.) dysfunction.
Symptoms
Clinical manifestations of perinatal asphyxia vary. First, the peripheral blood flow to the main organs to send a lot of blood flow in the fetal cardiomyocyte, myocardial ischemia, myocardial contractility and hypotension, such as the occurrence of major organs, especially the central nervous system, blood flow reduces the problem occurs. The most common symptom of the central nervous system is hypoxic ischemic encephalopathy, and there are other symptoms such as seizures, cerebral hemorrhage, and decreased muscle tension. Respiratory system diseases caused by diarrhea include respiratory distress syndrome, meconium aspiration syndrome, SIADH, hypoglycemia, hypocalcemia, which are caused by problems in metabolism, and blood diseases such as disseminated intravascular coagulation.
Hypoxic ischemic encephalopathy (HIE) caused by perinatal asphyxia accompanied by encephalopathy is when there is objective data showing that the main factor of neonatal encephalopathy is a hypoxic-ischemic mechanism.
When clinical symptoms are divided according to the time of birth, the cerebral function abnormality occurs first 12 hours after birth, and symptoms such as confusion, coma, hypotonia, and loss of original reflection appear. After 12-24 hours, the patient developed apnea due to dysfunction of the brain stem, and the central nervous system dysfunction occurred 24-72 hours after birth and symptoms such as coma, persistent apnea, brain stem dysfunction, pupil, oculomotor, caloric reflex disappear Brain death can also occur. The diagnosis of HIE is made by referring to the histories of hypoxic problems in terms of the history of the birth, and the clinical findings and brain findings (EEG, brain CT, brain MRI, etc.).
Treatments & Prognosis
In the treatment, perinatal asphyxia is treated first by neonatal resuscitation in the early labor chamber, and in the case of hypoxic-ischemic encephalopathy (HIE), conservative supportive treatment is the basis. In the case of HIE, maintenance of normal body temperature, maintenance of blood perfusion and ventilation, maintenance of metabolism such as electrolytes and acid bases, and control of seizure, which is a typical symptom, are performed to prevent further brain damage.
The prognosis of perinatal asphyxia is due to the incidence of 15-20% of full term infants, and 25% of surviving patients have sequelae such as cerebral palsy. The prevalence of these problems is higher in preterm infants and has a worse prognosis in relatively mild uterus. It is also important for the prognosis of the household that most of the causes of the housekeeping are attributed to the inherent abnormality already existing. The APGAR score is related to the mortality rate because it is a judgment about the whole body condition, but the reliability for the cranial nerve disorder is insufficient. To determine the prognosis for cranial nerve disorder, we judge based on the findings of brain waves, biochemical tests
The risk factors for perinatal asphyxia can be divided into three categories: prenatal, delivery, and postnatal. Risk factors for uterine pregnancy include maternal hypotension, maternal hypotension, maternal respiratory and cardiovascular disease, fetal congenital anomalies, and premature infants. The risk factors for labor are dystocia, fetal rotation, abnormal placenta, placental exfoliation, And hypotension. Postpartum risk factors include severe pulmonary disease of the newborn, severe recurrent apnea, congenital heart disease, patent ductus arteriosus with cardiac insufficiency, sepsis with cardiovascular collapse, persistent fetal circulation. The risk factors for normal birth and delivery are usually 90% of the perinatal asphyxia.
Perinatal asphyxia can be diagnosed by satisfying all four of the following criteria. ① Severe metabolic or mixed acidemia due to arterial blood gas test, ② Apgar scores continuously 0 to 3 even after 5 minutes of birth, ③ Neurological symptoms such as convulsions, coma and hypotonia, ④ More than one Other cardiovascular (cardiovascular, gastrointestinal, blood, lung, kidney, etc.) dysfunction.
Symptoms
Clinical manifestations of perinatal asphyxia vary. First, the peripheral blood flow to the main organs to send a lot of blood flow in the fetal cardiomyocyte, myocardial ischemia, myocardial contractility and hypotension, such as the occurrence of major organs, especially the central nervous system, blood flow reduces the problem occurs. The most common symptom of the central nervous system is hypoxic ischemic encephalopathy, and there are other symptoms such as seizures, cerebral hemorrhage, and decreased muscle tension. Respiratory system diseases caused by diarrhea include respiratory distress syndrome, meconium aspiration syndrome, SIADH, hypoglycemia, hypocalcemia, which are caused by problems in metabolism, and blood diseases such as disseminated intravascular coagulation.
Hypoxic ischemic encephalopathy (HIE) caused by perinatal asphyxia accompanied by encephalopathy is when there is objective data showing that the main factor of neonatal encephalopathy is a hypoxic-ischemic mechanism.
When clinical symptoms are divided according to the time of birth, the cerebral function abnormality occurs first 12 hours after birth, and symptoms such as confusion, coma, hypotonia, and loss of original reflection appear. After 12-24 hours, the patient developed apnea due to dysfunction of the brain stem, and the central nervous system dysfunction occurred 24-72 hours after birth and symptoms such as coma, persistent apnea, brain stem dysfunction, pupil, oculomotor, caloric reflex disappear Brain death can also occur. The diagnosis of HIE is made by referring to the histories of hypoxic problems in terms of the history of the birth, and the clinical findings and brain findings (EEG, brain CT, brain MRI, etc.).
Treatments & Prognosis
In the treatment, perinatal asphyxia is treated first by neonatal resuscitation in the early labor chamber, and in the case of hypoxic-ischemic encephalopathy (HIE), conservative supportive treatment is the basis. In the case of HIE, maintenance of normal body temperature, maintenance of blood perfusion and ventilation, maintenance of metabolism such as electrolytes and acid bases, and control of seizure, which is a typical symptom, are performed to prevent further brain damage.
The prognosis of perinatal asphyxia is due to the incidence of 15-20% of full term infants, and 25% of surviving patients have sequelae such as cerebral palsy. The prevalence of these problems is higher in preterm infants and has a worse prognosis in relatively mild uterus. It is also important for the prognosis of the household that most of the causes of the housekeeping are attributed to the inherent abnormality already existing. The APGAR score is related to the mortality rate because it is a judgment about the whole body condition, but the reliability for the cranial nerve disorder is insufficient. To determine the prognosis for cranial nerve disorder, we judge based on the findings of brain waves, biochemical tests
