The Indian Journal of Pediatrics

, Volume 75, Issue 2, pp 175–180 | Cite as

Post-resuscitation management of asphyxiated neonates

  • Ramesh Agarwal
  • Ashish Jain
  • Ashok K. Deorari
  • Vinod K. Paul
Symposium on AIIMS Protocols in Neonatology - II

Abstract

Inspite of major advances in monitoring technology and knowledge of fetal and perinatal medicine, perinatal asphyxia is one of the significant causes of mortality and long term morbidity. Data from National Neonatal Perinatal Database suggests that perinatal asphyxia contributes to almost 20% of neonatal deaths in India. “Failure to initiate or sustain respiration after birth” has been defined as criteria for the diagnosis of asphyxia by WHO. Perinatal asphyxia results in hypoxic injury to various organs including kindneys, lungs and liver but the most serious effects are seen on the central nervous system. Levene’s classification is a useful clinical tool for grading the severity of hypoxic ischemic encephalopathy. Good supportive care is essential in the first 48 hours after asphyxia to prevent ongoing brain injury in the penumbra region. Strict monitoring and prompt correction is needed for common problems including temperature maintenance, blood sugars, blood pressure and oxygenation. Phenobarbitone is the drug of choice for the treatment of convulsions.

Key words

Asphyxia HIE 

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References

  1. 1.
    Costello A, Francis V, Byrne A, Puddephatt C. State of the world’s newborns. Kinetik Communications 2001.Google Scholar
  2. 2.
    World Health Organization. Perinatal mortality: a listing of available information. FRH/MSM.96.7.Geneva:WHO, 1996.Google Scholar
  3. 3.
    Report of the National Neonatal Perinatal Database (National Neonatology Forum, India) 2000Google Scholar
  4. 4.
    Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. New Engl J Med 2001; 344: 467–471.PubMedCrossRefGoogle Scholar
  5. 5.
    Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: A population based study in term infants. J Pediatr 2001; 138: 798–803.PubMedCrossRefGoogle Scholar
  6. 6.
    Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants fter asphyxia. Am J Dis Child 1989; 143: 617–620.PubMedGoogle Scholar
  7. 7.
    Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol 1976; 33: 695–706.Google Scholar
  8. 8.
    Levene MI. The asphyxiated newborn infant. In Levene MI, Lilford RJ, ed. Fetal and neonatal neurology and neuro-surgery. Edinburgh; Churchil Livingstone, 1995: 405–426.Google Scholar
  9. 9.
    Du-Pleiss AJ, Johnston MV. Hypoxic ischemic injury in newborn: cellular mechanism and potential strategies for neuroprotection. Clinics in Perinatology 1997; 29: 627–654.Google Scholar
  10. 10.
    Vannucci RC. Current and potentially new management strategies for perinatal hypoxic ischemic encephalopathy. Pediatrics 1990; 85: 961–968.PubMedGoogle Scholar
  11. 11.
    Thoresen M, Wyatt J. Keeping a cool head, post-hypoxic hypothermia — an old idea revisited. Acta Paediatr 1997; 86: 1029–1033.PubMedCrossRefGoogle Scholar
  12. 12.
    Gluckman PD, Wyatt JS, Azzopardi D, Ballardi R, Edwards AD, Ferreio DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: Multicenter randomized trial. Lancet 2005; 365: 663–670.PubMedGoogle Scholar
  13. 13.
    Shankaran S, Laptook AR, Ehraenkranz RA, Tyson JE, Mc Donald SA, Donovan TF et al. Whole body hypothermia for neonates with hypoxic ischemic encephalopathy. NEJM 2005; 353: 1574–1584.PubMedCrossRefGoogle Scholar
  14. 14.
    Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32: 11–17.PubMedCrossRefGoogle Scholar
  15. 15.
    Kecskes Z, Healy G, Jensen A. Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia. In The Cochrane Library: Issue 3, 2005.Google Scholar
  16. 16.
    Lianne J, Woodward, Peter J Anderson, Nicole C Austin, Kelly Howard, Terrie E Inder. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. NEJM 2006; 355: 685–694.CrossRefGoogle Scholar
  17. 17.
    Hall RT, Hall FK, Daily DK. High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr 1998; 132: 345–348.PubMedCrossRefGoogle Scholar
  18. 18.
    Evans DJ, Levene MI. Anticonvulsants for preventing mortality and morbidity in full term newborns with perinatal asphyxia. Cochrane Database Syst Rev 2000; CD001240.Google Scholar
  19. 19.
    Vargas-Origel A, Espinosa-Garcia JO, Muniz-Quezada E, Vargas-Nieto MA, Aguilar-Garcia G, Prevention of hypoxic-ischemic encephalopathy with high dose, early phenobarbitol therapy. Gac Med Mex 2004; 140: 147–153.PubMedGoogle Scholar
  20. 20.
    John S, Wyatt, Peter D, Gluckman, Ping Y, Liu, Denis Azzopardi, Roberta Ballard, A. David Edwards et al. Gunn for the CoolCap Study Group Determinants of Outcomes After Head Cooling for Neonatal Encephalopathy. Pediatrics 2007; 119: 912–921.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2008

Authors and Affiliations

  • Ramesh Agarwal
    • 1
  • Ashish Jain
    • 1
  • Ashok K. Deorari
    • 1
  • Vinod K. Paul
    • 1
  1. 1.Division of Neonatology, Department of PediatricsAll India Institute of Medical SciencesAnsari Nagar, New DelhiIndia

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