Birth asphyxia and HIE

Dr. Fartun Orey

BIRTH ASPHYXIA

 Birth asphyxia, defined as the failure to establish breathing at birth.

Risk factors of birth asphyxia

 increasing or decreasing maternal age

 PROM , meconium stained fluid, multiple births,
 non-attendance for ANC, LBW infants, mal
presentation

 Augmentation of labour with oxytocin, ante partum

hemorrhage, severe eclampsia and pre-eclampsia, ante
partum and intrapartum anemia
APGAR SCORE
APGAR SCORE

 Apgar can be assessed at intervals of 1 minute and 5

minutes after birth.
 Apgar scores of 4 to 7 warrant close attention
 Apgar score of 0 to 3, most infants with asphyxia severe
enough to cause neurologic injury also manifest fetal
acidosis (pH <7); seizures, coma, or hypotonia; and
multiorgan dysfunction.
HYPOXIC-ISCHEMIC ENCEPHALOPATHY

 Conditions known to reduce uteroplacental blood flow or

to interfere with spontaneous respiration lead to perinatal
hypoxia, lactic acidosis, and, if severe enough to reduce
cardiac output or cause cardiac arrest, ischemia.

 HIE term infant is characterized by cerebral edema, cortical

necrosis, and involvement of the basal ganglia, whereas in the
preterm infant it is characterized by periventricular leukomalacia.
The clinical manifestations
Treatment

 Prevention of asphyxia in high risk babies , proper delivery,

maternal infections
 Supportive include;
 Adequate ventilation and perfusion.
 Careful fluid management.
 Avoidance of hypo/hyperglycemia and hyperthermia.
 Treat the seizure.
 Avoid any further brain injury.
 Whole body cooling (WBC), which reduces body temperature to33 to
34°C.Recommend a cooling period of 48 to 72 hours.
PROGNOSIS

 Survivors of stage 3 hypoxic-ischemic encephalopathy have a

 high incidence of seizures and serious neurodevelopmental
handicaps.
 Infants with Apgar scores of 0 to 3 at 10 minutes have a
20% mortality and a 5% incidence of cerebral palsy
 If the score remains this low by 20 minutes,
the mortality increases to 60%, and the incidence of cerebral palsy
increases to 57%.