Birth Asphyxia

Now called perinatal asphyxia and not birth asphyxia. Perinatal asphyxia is lack of blood flow to the foetus immediately before, during or after the birth process. Causes profound metabolic and neural sequelae.

WHO criteria

Multi organ dysfunction should be secondary to asphyxia. Apgar score at 5 min is important here.

Brain damage less likely to be reversible. Secondary preventive measures and early intervention are essential.

Cardiac system - MI

Pulmonary circulating during, persistent pulmonaey hypertension one cause is this,

Poor renal perfection ⇒ ATN

Renal function test

Serum lactate >>>>

SiADH stuff and what electrolyte abnormalities?

Necrotising encephalitis usually due to infection & not feeding, more common in preterm babies but here due to gut ischaemia

Must check liver function - LFTs - AST, Alt, gamma GT, etc check more

Internal bleeding!

Need to admit to postnatak care + burden to sorlciety later. Costly. Epilepsy, and cerebral palsy etc

Premature baby! Not mature enough of organs!

Primitive reflexes - grasp reflex, sucking, moro's

Stages of HIE

Scores for assessing HIE (Thompson (modified) and sarnet)

Another aetiological factor - oxytocin induced inadequate contraction of uterus (so CTG needed for foetal heart rate and uterine contractions) , chronic placental insufficiency, umbilical knots, reduced placental perfusion due to anaesthesia etc, prolonged second stage of labour, foetal stuff congenital abnormalities

Failure to establish respiration - need foetal life support (neonatal resuscitation)

Kick count chat, amniotic fkuix index etc from us scan and doppler effect, foetal scalp blood sampling - pH, bicarbonate, lactate, unbiblical blood gases during delivery

Umbilical cord contains three vessels - two arteries and one vein

Hie can lead to cerebral oedema so must reduce it. Can also lead to cerebral haemorrhage.

Which babies term ones we consider therapeutic hypothermia?

Lactate?

Earlier days supporting treatment played the major role.

Oxygen target saturation in preterm babies 90-95% and term baby 95% to 100%

What affects cerebral perfusion? Must minimise ICP (cerebral oedema) and must increase mean arterial pressure (ionotrophes etc)

Hypoglycaemia is usual in hie but during seizure can develop hyperglycaemia

Maintain normal glucose and electrolytes

Primary insults cannot be prevented but secondary brain damage can be minimised

Therapeutic hypothermia - started in SL-Colombo Castle, kaluboeila, ragama etc at least one in every province also so other hospitals can refer. Add slides about this - criteria etc (just for information) - at least within 6-8 hrs after birth, contraindications? Eg surgery for diaphragmatic hernia

For every treatement modality need evidence - TOBI trial

Standard guidelines for neonatology - Nice, BAPMsomething

Must monitor complications