Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 19 views

    Perinatal Asphyxia: Prepared by Johannes Negesse

    Uploaded by

    Jhon Negesse
    This document discusses perinatal asphyxia and its effects. It defines asphyxia as failure to initiate breathing at birth or impairment of placental gas exchange leading to hypoxemia and hypercarbia. Asphyxia can cause multi-organ effects including hypoxic-ischemic encephalopathy, cardiovascular and pulmonary issues, and metabolic derangements. Hypoxic-ischemic encephalopathy is a major consequence and can result in death or neurological deficits like cerebral palsy. Diagnosis involves imaging like MRI and management includes therapeutic hypothermia, medications for seizures, and supportive care. Prognosis depends on severity of brain injury but severe asphyxia often leads to death or neurological disabilities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Perinatal Asphyxia: Prepared by Johannes Negesse

    Uploaded by

    Jhon Negesse
    19 views24 pages
    This document discusses perinatal asphyxia and its effects. It defines asphyxia as failure to initiate breathing at birth or impairment of placental gas exchange leading to hypoxemia and hypercarbia. Asphyxia can cause multi-organ effects including hypoxic-ischemic encephalopathy, cardiovascular and pulmonary issues, and metabolic derangements. Hypoxic-ischemic encephalopathy is a major consequence and can result in death or neurological deficits like cerebral palsy. Diagnosis involves imaging like MRI and management includes therapeutic hypothermia, medications for seizures, and supportive care. Prognosis depends on severity of brain injury but severe asphyxia often leads to death or neurological disabilities.

    Original Title

    Peinatal Asphyxia

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses perinatal asphyxia and its effects. It defines asphyxia as failure to initiate breathing at birth or impairment of placental gas exchange leading to hypoxemia and hypercarbia. Asphyxia can cause multi-organ effects including hypoxic-ischemic encephalopathy, cardiovascular and pulmonary issues, and metabolic derangements. Hypoxic-ischemic encephalopathy is a major consequence and can result in death or neurological deficits like cerebral palsy. Diagnosis involves imaging like MRI and management includes therapeutic hypothermia, medications for seizures, and supportive care. Prognosis depends on severity of brain injury but severe asphyxia often leads to death or neurological disabilities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views24 pages

    Perinatal Asphyxia: Prepared by Johannes Negesse

    Uploaded by

    Jhon Negesse
    This document discusses perinatal asphyxia and its effects. It defines asphyxia as failure to initiate breathing at birth or impairment of placental gas exchange leading to hypoxemia and hypercarbia. Asphyxia can cause multi-organ effects including hypoxic-ischemic encephalopathy, cardiovascular and pulmonary issues, and metabolic derangements. Hypoxic-ischemic encephalopathy is a major consequence and can result in death or neurological deficits like cerebral palsy. Diagnosis involves imaging like MRI and management includes therapeutic hypothermia, medications for seizures, and supportive care. Prognosis depends on severity of brain injury but severe asphyxia often leads to death or neurological disabilities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 24

    Perinatal Asphyxia

    Prepared by
    Johannes Negesse
    Terminology
    • Hypoxemia , a decreased arterial concentration of oxygen
    • Hypoxia , decreased oxygenation to cells or organs
    • Ischemia ,refers to blood flow to cells or organs that is inadequate to
    maintain physiologic function.
    • Anoxia , is complete lack of oxygen as a result of a number of primary
    causes.
    • Asphyxia
    • World Health Organization (WHO) defines birth asphyxia as failure to initiate
    and sustain breathing at birth
    • It can also be defined as placental or pulmonary gas exchange impairment
    leading to hypoxemia and hypercarbia.
    Cont...
    Multiorgan Systemic Effects of Asphyxia

    Central nervous Hypoxic-ischemic encephalopathy, infarction, intracranial hemorrhage, seizures,


    cerebral edema,hypotonia, hypertonia

    Cardiovascular Myocardial ischemia, poor contractility,hypotension, tricuspid insufficiency


    Pulmonary Pulmonary hypertension, pulmonary hemorrhage, respiratory distress syndrome
    Renal Acute tubular or cortical necrosis
    Adrenal Adrenal hemorrhage
    Gastrointestinal Perforation, ulceration with hemorrhage, necrosis
    Metabolic SIADHS, hyponatremia, hypoglycemia, hypocalcemia,

    Integumentary Subcutaneous fat necrosis


    Hematologic Disseminated intravascular coagulation
    HIE
    • Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal
    brain injury, morbidity, and mortality globally
    • developed world, incidence is 1-8 per 1,000 live birth
    • and in the developing world, as high as 26 per 1,000.
    • Hypoxic ischaemic encephalopathy can result from lack of oxygen to vital organs
    before, during or immediately after birth
    Etiology
    • Most neonatal encephalopathy and seizure are caused by
    • congenital malformations
    • metabolic
    • genetic syndromes
    • perinatal events
    Clinical manifestation
    • The encephalopathic neonate may have
    • low Apgar scores at delivery
    • metabolic acidosis documented in the cord blood
    • Within 24 hours ,infant may develop apnea and seizures with EEG
    abnormality
    • Abnormal EEG results may be helpful in the prediction of clinical outcome,
    like death and neurologic sequelae, such as spastic quadriplegia or diplegia
    Clinical features cont.…
     Encephalopathy manifest as:
    Mildly affected infants
     Jittery, irritable, some degree of feeding problem
    Moderate degree
     Irritable, vomiting, increased muscle tone, high pitched cry
    Severely degree
     Deeply stuporous or comatose
     Seizure in 50% (usually within 24 hr)
     Hypotonia hyperotonia
    Stages of HIE
    SIGNS STAGE 1 STAGE 2 STAGE 3
    Level of CON Hyperalert Lethargic Stuporous, coma

    Muscle tone Normal Hypotonic Flaccid

    Posture Normal Flexion Decerebrate

    Tendon reflexes Hyperactive Hyperactive Absent

    Myoclonus Present Present Absent

    Moro reflex Strong Weak Absent

    Pupils Mydriasis Miosis Unequal, poor light reflex

    Seizures None Common Decerebration

    EEG Normal Low voltage changing to seizure Burst suppression to isoelectric


    activity
    Duration <24 hr 24 hr to 14 days Days to weeks

    Outcome Good Variable Death, severe deficits


    Diagnosis
    • MRI is the most sensitive imaging modality for detecting hypoxic brain
    injury in neonate
    • Diffusion-weighted sequences obtained in the 1st 3-5days following a
    presumed sentinel event are optimal for identifying acute injury
    • CT is least sensitive for evaluation of HIE because of high water in
    neonatal brain and high protein of the CSF result in poor parenchymal
    contrast resolution.
    • CT scans may be helpful in ruling out focal hemorrhagic lesions or
    large arterial ischemic strokes
    • Sonography is sensitive for the detection of hemorrhage,
    periventricular leukomalacia (PVL), and hydrocephalus
    • US has limited utility in evaluation of hypoxic injury in term infant, but
    it can be useful for excluding hemorrhagic lesions
    • US is the initial preferred (and sometimes only feasible) modality in
    evaluation of the preterm infant
    Cont...
    MAJOR CONVENTIONAL MR FINDINGS IN 1ST WEEK

    • Cerebral cortical gray-white differentiation lost (on T1W or T2W)


    • Cerebral cortical high signal (T1W and FLAIR), especially in parasagittal perirolandic cortex
    • Basal ganglia/thalamus, high signal (T1W and FLAIR), usually associated with the cerebral cortical
    changes but possibly alone with increased signal in brainstem tegmentum in cases of acute severe
    insult
    • Parasagittal cerebral cortex, subcortical white matter, high signal (T1W and FLAIR)
    • Periventricular white matter, decreased signal (T1W) or increased signal (T2W)
    • Posterior limb of internal capsule, decreased signal (T1W or FLAIR)
    • Cerebrum in a vascular distribution, decreased signal (T1W), but much better visualized as
    decreased diffusion (increased signal) on diffusion-weighted MRI
    • Diffusion-weighted MRI more sensitive than conventional MRI, especially in 1st days after birth,
    when former shows decreased diffusion (increased signal) in injury
    Management

    Generalized treatment:
    Ventilation: CPAP, Mechanical ventilation
    Circulation: Dopamine/Dobutamine
    Energy: normal glucose
    Fluid: restriction < 60-80ml/kg/d
    Treatment
    • Therapeutic hypothermia
    • head cooling or systemic cooling
    • High-dose erythropoietin
    • Seizures associated with HIE
    • Tx by phenobarbital
    • for referactory levetiracetam
    Prognosis
    Depend on the severity of brain damage & medical treatment,
    usually:
    Mild or moderate cases could be cured completely, but severe cases
    represent poor prognosis with high mortality or cerebral
    complications such as mental retardation & cerebral palsy.
    Mild HIE: complete recovery
    Moderate HIE: 6% died,30% neurologic disability
    Severe HIE: 70 -80% died, 100% neurologic disability
    Shock In The Neonates
    Significant reduction of systemic perfusion resulting in low tissue
    oxygen and nutrient delivery.
    Hypovolemic shock
    Distributive shock
    Cardiogenic shock
    Obstructive shock
    Septic shock
    Hypovolemic shock
    Commonest cause of shock in neonates
     Hemorrhage (Intracranial/extracranial)
    Abruption of placenta
    Fetomaternal hemorrhage, DIC
    infections (Increased capillary leak/Gastroenteritis)
    Excessive volume depletions (Diuresis)
    Distributive shock
    Sepsis related to increased inflammatory responses
    Rapid heating
    Abnormal vaso response
    Cardiogenic shock
    Asphyxia
    Myocarditis
    Arrhythmia
    Obstructive shock
    It is due to decreased cardiac output
    Cont….
    Tachycardia, BP is maintained (early)
    Cold, pale skin, oliguria and ileus
    Wide pulse pressure hypotension
    Decreased systolic BP
    Altered mentation
    Irreversible organ damage.
    Management
    Supportive treatment
    ABC of life
    Intranasal oxygenation
    Correction of hypoglycemia, hypocalcemia, acidosis
    If large amount of fluid is given 2ml/kg/dose of Calcium gluconate 10% can be
    administered
    Cont…
    Fluid treatment in hypovolemic shock
    Crystalloids (NS 20ml/kg with in 30min to hour)
    Can be given three times (60ml/kg
    End goal directed treatment until V/S, urine output, capillary refill and
    mentation become stable.
    Cont…
    Acute blood loss
    Whole blood 20ml/kg less than 7 days over one hour.
     If blood is not available volume expanders like 0.9% N/S can be used .
    Cont…
    Resistant to fluid treatment consider septic shock or cardiogenic
    shock.
    As much as 60-80ml/kg of NS
    Broad spectrum antibiotics
    Blood transfusion of 20ml/kg of whole blood
    Hydrocortisone administration in suspected septic shock
    Inotropes
    Dopamine
    Dobutamine
     Epinephrine
     Milrinone

    You might also like