Perinatal Asphyxia

• Birth Asphyxia Definition: Defined by WHO as the failure to initiate and maintain spontaneous respiration.
• There is a proposal to use terms describing timing (intrapartum, perinatal) and adverse outcome (neonatal encephalopathy).
• Less than 1% of neonates require extensive resuscitation; emphasis is on the golden minute and initiation of respiration.

Asphyxia is considered in the presence of:

• Foetal Acidosis: pH < 7
• 5-minute Apgar Score: 0-3
• Hypoxic-Ischaemic Encephalopathy and multiple organ-system signs.

Hypoxic-Ischaemic Encephalopathy:

• It is an important cause of permanent damage to CNS cells that may result in neonatal death, cerebral palsy, or mental deficiency.

System	Effect
Central Nervous System	Hypoxic-Ischaemic Encephalopathy, Infarction, Seizures, Cerebral Oedema, Intracranial Haemorrhage
Cardiovascular	Poor Contractility, Myocardial Ischaemia, Cardiac Stun, Tricuspid Insufficiency, Hypotension
Pulmonary	Pulmonary Hypertension, Haemorrhage, Respiratory Distress Syndrome (RDS)
Renal	Acute Tubular or Cortical Necrosis
Adrenal	Adrenal Haemorrhage
Gastrointestinal	Perforation, Ulceration, Necrosis
Metabolic	Syndrome of Inappropriate Antidiuretic Hormone (SIADH), Hyponatremia, Hypocalcemia
Integument	Subcutaneous Fat Necrosis
Haematology	Disseminated Intravascular Coagulation (DIC)

Foetal

• Placental insufficiency due to toxaemia and postmaturity
• Inadequate oxygenation of maternal blood
• Low maternal blood pressure
• Premature separation of the placenta
• Impedance of blood flow due to compression and knotting of the cord
• Uterine vessel vasoconstriction with cocaine use

At Birth

• Anaemia from severe haemorrhage or haemolysis
• Severe shock impeding oxygen transport from overwhelming infection, massive blood loss, intracranial or adrenal haemorrhage
• Failure to breathe normally due to cerebral defect, narcosis or injury
• Failure of oxygenation due to cyanotic CHD or pulmonary disease

• Within minutes of the onset of total foetal hypoxia:
• Bradycardia
• Hypotension
• Decreased cardiac output
• Severe metabolic and respiratory acidosis
• The initial foetal circulatory response is increased shunting:
• Maintenance of perfusion to the brain, heart, and adrenals
• Preference to these organs over the lungs, kidneys, and intestine
• This is known as the diving reflex

• Meconium-stained liquor is evidence of foetal distress.
• Depressed infants and failure to breathe spontaneously.
• Hypotonia, hypertonia, or normal tone.
• Pallor, cyanosis, bradycardia, congestive cardiac failure.
• Seizures may be severe and intractable.

Treatment for perinatal asphyxia involves:

• Supportive care directed at organ-system manifestations.
• Seizures: Phenobarbital is the drug of choice for managing seizures.
• Metabolic Complications: Correcting metabolic issues such as hypocalcemia and hypoglycemia.

The prognosis for perinatal asphyxia depends on:

• Treatment of metabolic or cardiopulmonary complications.
• Gestational age of the infant.
• Severity of hypoxic-ischemic encephalopathy.

General Health Promotion:

• Encourage good nutrition for girls.
• Promote access to quality ANC services.
• Provide health education.
• Advocate for good hygiene practices.
• Promote female empowerment.
• Address detrimental social and cultural practices.
• Ensure hospitals have adequate staffing of trained birth attendants.

Specific Interventions:

• Utilize Rhogam for specific cases.
• Administer antihypertensives and insulin/diet as needed.
• Consider tocolytics for appropriate situations.
• Provide intrapartum oxygen support when necessary.

Early Diagnosis and Treatment:

• Monitor foetal heart during labour.
• Anticipate complications and take prompt action.
• Ensure immediate delivery and resuscitation as required.

Limitation of Disability:

• Treat seizures promptly.
• Implement measures to prevent and manage cerebral oedema.
• Follow fluid restriction guidelines.

Rehabilitation:

• Adopt a multidisciplinary approach to rehabilitation.
• Manage cerebral palsy with appropriate interventions.
• Consider shunts for specific cases.
• Provide hearing aids as needed.
• Offer specialized education in special schools.