asphyxia in neonates
TRANSCRIPT
ASPHYXIA IN NEONATES
Pokorná P.
Characteristics of the neonatal
period
• Duration of neonatal period (postnatal age)
• Assesment of GA (gestational age)
• The accordance of BW to GA (SGA, NGA, LGA)
• Early postnatal adaptation (maturation, functional adaptation)
ASPHYXIATED – NON ASPHYXIATED NEONATE
CPR – ILCOR guidelines 2010
Risk pregnancy
Evaluation and management after birth
Apgar score:
0 1 2
absent <100 >100
absent slow good,
crying
limp fl of Extr. active
no
response
grimace sneeze
blue,
pale
pink body,
blue ex.
pink
CIRCULATION
RESPIRATION
Score
TONE
REFLEXES
SKIN
Causes of asphyxia
• Prenatal
• Postnatal
• Perinatal
Risk pregnancy
Neonatal
Non - Risk pregnancy
Essential characteristics
• pH≤ 7,0 + BE ≤-12 mmol/l on umbilical cord 1-H blood sample
• Apgar score 0-3 (≥5.min)
• Neurological signs (seizures, HIE =72%)
• MODSF (Martin-Ancel et al. 1995)
MORTALITY RATE : 15-20% → 90% PRENATALLY → 10% of PA → CP
American Academy of Pediatrics, American College of Obstetricians and Gynecologists
(1996)
PERINATAL ASPHYXIA
ASPHYXIA
• A.Definition inicdence 2-9/1000 neonates
• B.Pathophysiology TERM neonates
• C.Clinical presentation: TERM neonates
acute phase MODSF+ HIE (72%)
late phase Cerebral palsy
DIVING REFLEX
LUNG
BOWEL
KIDNEY
SPLEEN
SKIN
MUSCULATURE
BRAIN
MYOCARDADRENAL GLAND
↑↑↑↑ HR, ↑↑↑↑ BP, ↑↑↑↑ CVP
↑↑↑↑ const. CO and const. BRAIN PERFUSION
PERINATAL ASPHYXIA
pH 7.4 7.1 7.0 6.7
RR
HR
BP
CO
CVP
BRAIN
Time 3 5 7 (min)
PERINATAL ASPHYXIA
7.4 7.1 7.0 6.7
Time 3 5 7 (min)PA PA
asphyxia
ischemia
proinflamm.
cells ↑↑↑↑
oxidative
radicals ↑↑↑↑reperfusion apoptosis ↑↑↑↑
MINUTES HOURS – DAYS
THERAPEUTICAL WINDOW
MINUTES – HOURS
PERINATAL ASPHYXIA
ASPHYXIA in TERM
MECHANISMS
• Hypoxic
• Ischemic
• Hypoperfusion
• Reperfusion
• Glutamate release
HIE
ACUTE PHASE HIE 0- 7 days
• Clinical presentation: acute clinical syndrom :
HIE I. 0 H - 48 HYPERALERT
II. 48H - 7 days LETHARGIC
III. >7 days SUPOROUS
LATE PHASE HIE
• Cerebral palsy and PM retardation/ death
Neonatal asphyxia
• 1. Ischemia of cortex, bas. ggl.,
cerebral neuronal necrosis TERM-HIE
• 2. cPVleucomalatia PRETERM
• 3. intraventricular hemorrhage T + P
• 4. Neonatal seizures T+P
• 5. Hydrocephalus
CFM - aEEG
MODSFBrain
HIE
BP
MODSF
Metabolic + ABR
pO2
pCO2
Lactate
Kidney
Brain
RR +/-
HR +/-
BP +/-RDS SpO2,RR
HIE
BP
Abdomen
NEC
infectionHaematology
A- B-C-DA- B-C-D
Diagnosis
• Clinical condition (encephaloapathy)
• Laboratory tests (ABR, S-Na, K, Cl, lactate,
glycemia, haematology)
• Sonography + EEG+MRi
Selected chemistry normal values
• ALT: 3- 54 U/L (< 0,73 ukat/l)
• AST 10 – 65 U/L (< 1,2 ukat/l)
• Bilirubin direct:< 0.6 mg/dL
• Bilirubin total: cord <2.8 mg/dL (<50 -65 umol/l)
• 24 H <8.0 mg/dL
• 48 H <13.0 mg/dL
• 72H <16.0 mg/dL
• 7-30 d <7.0 mg/dL
• Calcium: term 1 week < 7-12 preterm <6-10mg/dL
• Glucose: 40 -1000 mg/dL (1,7 -5,0 mmol/l)
• Creatinin: 0,3-1,0 (0,2-0,4) mg/dL (18-62-106 umol/l)
THERAPY
• 1. Observation
• 2. therapy of MODSF
• 3. therapy of HIE
DRUGS:
a. Anticonvulsants + neruoprotection PHENOBARBITAL, PHENYTOIN, MIDAZOLAM
b. Inotropics
c. Nutrition
d. Sedation, pain control
e. ATB