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Perinatal asphyxia
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<h2 id="cause">Cause</h2> <p>Basically, understanding of the etiology of perinatal asphyxia provides the platform on which to build on its pathophysiology. The general principles guiding the causes and the pathophysiology of perinatal asphyxia are grouped into antepartum causes and intra partum causes. As these are the various points to which insults can occur to the foetus. </p> <ul><li>Antepartum causes <ul><li>Inadequate oxygenation of maternal blood due to <a href="/facts/Hypoventilation/ruqIr4oa">hypoventilation</a> during anesthesia, heart diseases, <a href="/facts/Pneumonia/Jw0KquTA">pneumonia</a>, <a href="/facts/Respiratory_failure/R3GcdkJ1">respiratory failure</a></li> <li>Low maternal blood pressure due to <a href="/facts/Hypotension/BhrdVVRS">hypotension</a> e.g. compression of vena cava and <a href="/facts/Aorta/ov2Gp9h4">aorta</a>, excess anaesthesia.</li> <li>Premature separation of <a href="/facts/Placenta/7XUoks1b">placenta</a></li> <li>Placental insufficiency</li></ul></li> <li>Intra partum causes <ul><li>Inadequate relaxation of uterus due to excess <a href="/facts/Oxytocin/xz1Tj3ma">oxytocin</a></li> <li>Prolonged delivery</li> <li>Knotting of umbilical cord around the neck of infant</li></ul></li></ul> <h2 id="risk-factors">Risk factors</h2> <ul><li>Elderly or young mothers</li> <li>Prolonged rupture of membranes</li> <li>Meconium-stained fluid</li> <li>Multiple births</li> <li>Lack of antenatal care</li> <li>Low birth weight infants</li> <li>Malpresentation</li> <li>Augmentation of labour with oxytocin</li> <li>Antepartum hemorrhage</li> <li>Severe eclampsia and pre-eclampsia</li> <li>Antepartum and intrapartum anemia<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a></li></ul> <h2 id="treatment">Treatment</h2> <ul><li>A= Establish open airway: Suctioning, if necessary <a href="/facts/Endotracheal_intubation/5kw0TNxc">endotracheal intubation</a></li> <li>B= Breathing: Through tactile stimulation, PPV, bag and mask, or through <a href="/facts/Endotracheal_tube/DsCm4bJC">endotracheal tube</a></li> <li>C= Circulation: Through chest compressions and medications if needed</li> <li>D= Drugs: <a href="/facts/Adrenaline/k7vvMI7E">Adrenaline</a> .01 of .1 solution</li> <li><a href="/facts/Hypothermia_therapy_for_neonatal_encephalopathy/jxPG5KS3">Hypothermia treatment</a> to reduce the extent of brain injury</li> <li>Epinephrine 1:10000 (0.1-0.3ml/kg) IV</li> <li>Saline solution for hypovolemia</li></ul> <h2 id="epidemiology">Epidemiology</h2> <p>A 2008 bulletin from the <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> estimates that 900,000 total infants die each year from birth asphyxia, making it a leading cause of death for newborns.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p><p>In the United States, <a href="/facts/Intrauterine_hypoxia/oRuxXhlA">intrauterine hypoxia</a> and birth asphyxia was listed as the tenth leading cause of neonatal death.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p> <h2 id="medicolegal-aspects">Medicolegal aspects</h2> <p>There is current controversy regarding the medicolegal definitions and impacts of birth asphyxia. Plaintiff's attorneys often take the position that birth asphyxia is often preventable, and is often due to substandard care and human error.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> They have utilized some studies in their favor that have demonstrated that, "... although other potential causes exist, asphyxia and hypoxic-ihy affect a substantial number of babies, and they are preventable causes of cerebral palsy."<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> The <a href="/facts/American_Congress_of_Obstetricians_and_Gynecologists/9E490I1J">American Congress of Obstetricians and Gynecologists</a> disputes that conditions such as cerebral palsy are usually attributable to preventable causes, instead associating them with circumstances arising prior to birth and delivery.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> </p> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>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. <a href="http://www.ajnr.org/cgi/content/abstract/11/6/1087" target="_blank">http://www.ajnr.org/cgi/content/abstract/11/6/1087</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>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. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300075" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300075</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>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. <a href="/wiki/The_Lancet" target="_blank">/wiki/The_Lancet</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>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. <a href="/wiki/Ola_Didrik_Saugstad" target="_blank">/wiki/Ola_Didrik_Saugstad</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>ILCOR Neonatal Resuscitation Guidelines 2010 <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Norwegian paediatrician honoured by University of Athens, Norway.gr <a href="http://www.norway.gr/News_and_events/Events/Older-articles/Norwegian-paediatrician-honoured-by-University-of-Athens-/" target="_blank">http://www.norway.gr/News_and_events/Events/Older-articles/Norwegian-paediatrician-honoured-by-University-of-Athens-/</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>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. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282294" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282294</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Dhar, KK; Ray, SN; Dhall, GI (1995). "Significance of nuchal cord". Journal of the Indian Medical Association. 93 (12): 451–3. PMID 8773129. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>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) <a href="https://web.archive.org/web/20200407070416/https://www.acog.org/publications/committee_opinions/co326.cfm" target="_blank">https://web.archive.org/web/20200407070416/https://www.acog.org/publications/committee_opinions/co326.cfm</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Kaye, D. (2003-03-01). "Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda". East African Medical Journal. 80 (3): 140–143. doi:10.4314/eamj.v80i3.8683. ISSN 0012-835X. PMID 12762429. <a href="https://doi.org/10.4314%2Feamj.v80i3.8683" target="_blank">https://doi.org/10.4314%2Feamj.v80i3.8683</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Spector J, Daga S. "Preventing those so-called stillbirths". WHO. Archived from the original on November 30, 2009. Retrieved 13 December 2013. <a href="https://web.archive.org/web/20091130182954/http://www.who.int/bulletin/volumes/86/4/07-049924/en/" target="_blank">https://web.archive.org/web/20091130182954/http://www.who.int/bulletin/volumes/86/4/07-049924/en/</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>National Center for Health Statistics <a href="https://www.cdc.gov/nchs/data/hestat/prelimdeaths04/preliminarydeaths04.htm" target="_blank">https://www.cdc.gov/nchs/data/hestat/prelimdeaths04/preliminarydeaths04.htm</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Andreasen, Stine (2014). "Acta Obstetricia et Gynecologica". Acta Obstetricia et Gynecologica Scandinavica. 93 (2): 152–158. doi:10.1111/aogs.12276. PMID 24237480. <a href="https://doi.org/10.1111%2Faogs.12276" target="_blank">https://doi.org/10.1111%2Faogs.12276</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>"APFEL Handout: Birth Asphyxia & Cerebral Palsy" (PDF). Colorado Bar Association. Archived from the original (PDF) on April 16, 2016. Retrieved April 8, 2016. <a href="https://web.archive.org/web/20160416060253/http://www.cobar.org/cle/photos/medical-legal/new/Handouts/APFEL%20HANDOUT%20-%20Birth%20Asphyxia%20%26%20Cerebral%20Palsy-Trial.%20color%20copy.pdf" target="_blank">https://web.archive.org/web/20160416060253/http://www.cobar.org/cle/photos/medical-legal/new/Handouts/APFEL%20HANDOUT%20-%20Birth%20Asphyxia%20%26%20Cerebral%20Palsy-Trial.%20color%20copy.pdf</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Cohen, Frances M. (2003). "Origin and Timing of Brain Lesions in Term Infants with Neonatal Encephalopathy". The Lancet. 361 (9359): 736–42. doi:10.1016/S0140-6736(03)12658-X. PMID 12620738. S2CID 31057958. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Becher, J-C; Stenson, Bj; Lyon, Aj (2007-11-01). "Is intrapartum asphyxia preventable?". BJOG: An International Journal of Obstetrics & Gynaecology. 114 (11): 1442–1444. doi:10.1111/j.1471-0528.2007.01487.x. ISSN 1471-0528. PMID 17877776. <a href="https://doi.org/10.1111%2Fj.1471-0528.2007.01487.x" target="_blank">https://doi.org/10.1111%2Fj.1471-0528.2007.01487.x</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Van Eerden, Peter. "Summary of the Publication, "Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology," by the ACOG Task Force on Neonatal Encephalopathy and Cerebral Palsy". Medscape. Retrieved April 8, 2016. <a href="http://www.medscape.com/viewarticle/457882" target="_blank">http://www.medscape.com/viewarticle/457882</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> </ol>