Spectrum of multi-organ system involvement in perinatal asphyxia in neonatal intensive care unit department of Pediatrics, King George hospital, Visakhapatnam, Andhra Pradesh, India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192043Keywords:
Hypoxic ischemic encephalopathy, Multiorgan dysfunction, Perinatal asphyxiaAbstract
Background: The objective of the current study to find out the maternal risk factors associated and spectrum of involvement of multiorgan dysfunction in perinatal asphyxia.
Methods: This is a prospective study comprises of 102 asphyxiated neonates. At the time of admission blood samples were taken for complete blood picture, random blood sugar, serum electrolytes, septic screen & blood culture. For the assessment of the central nervous system a neurosonogram would be carried out in all asphyxiated new-borns. Computed tomography scan was done who had abnormal neurosonogram. Chest x ray was done for all respiratory cases. Echocardiogram was done for cardiac assessment. Renal system evaluated by serum creatinine and urine output.
Results: Of these 102 babies, 59 were males and 43 were females. Major risk factors in the study were meconium stained amniotic fluid cases, eclampsia, pregnancy induced hypertension, premature rupture of membranes and prolonged second stage of labour. central nervous system (CNS) involvement occurred in all 102 (100%) neonates. Hypoxic ischemic encephalopathy was the most common presentation of CNS involvement. Respiratory involvement was noted in 42 (41.5%). Renal involvement was seen in 27 (26.5%). Cardiovascular system involvement was observed in 26 (25.5%). Gastrointestinal involvement was observed in 16 (15.68%). Hematological abnormalities were seen in 14.7%.
Conclusions: Multiorgan dysfunction is common in neonates with perinatal asphyxia. Overall mortality was 24.5%, which clearly indicates the need for early detection of maternal risk factors, better obstetric management and the prompt resuscitator measures.
References
Oh W, Blackmon LR, Escobedo M, Fanaroff AA, Kirkpatrick BV, Light IJ, et al. Use and abuse of the Apgar score. Pediatr. 1996;98(1):141-2.
Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2004 Mar 1;89(2):F152-5.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol. 1976;33:695-706.
Mohammed LH, Khairy MA, El-Hussieny NA, Zaazou MH, Aly RM. Multi-organ dysfunction in neonates with hypoxic-ischemic encephalopathy. Med J Cairo Univ. 2010;78(1):461-7.
Martin-Ancel A, Garcia Alix A, Gaya F, Cabanas F, Buergeros M. Multiple organ involvement in perinatal asphyxia. J Pediatr.1995;127:786-9.
Futrakul S, Praisuwanna P, Thaitumy AP. Risk factors for hypoxic-ischemic encepha-lopathy in asphyxiated newborn infants. J Med Assoc Thai. 2006;89(3):322-8.
Parkash J, Das N. Pattern of admissions to neonatal unit. J Coll Physic Surg. Pak. 2005;15:341- 4.
Singh KS, Sengar GS. A study of multiorgan dysfunction in asphyxiated neonates. Int J Contemp Pediatr. 2016;3:625-30.
Ross MG, Gala R. Use of umbilical artery base excess: Algorithm for the timing of hypoxic injury. AM J Obstet Gynecol. 2002;187 (1)1-9.
Shrestha M, Shrestha L, Shrestha PS. Profile of asphyxiated babies at Tribhuvan university teaching hospital. J Nepal Paediatr Soc. 2009;29(1):3-5.
Bennet L, Dean JM, Wassink G, Gunn AJ. Differential effects of hypothermia on early and late epileptiform events after severe hypoxia in preterm fetal sheep. J Neurophysiol. 2007;97(1):572-8.
Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Children. 1989;143(5):617-20.
Shankaran S, Woldt E, Koepke T, Bedard, Nandyal R. Acute neonatal morbidity and long term central nervous system sequelae of perinatal asphyxia in term infants. Early Hum Dev. 1991;25:135-48.
Chishty AL, Iqbal A, Anjum A, Maqbool S. Spectrum of multiorgan systemic involvement in birth asphyxia. Pak Pediatr Assoc. 2001;25(3).
Pattar RS, Raj A, Yelamali BC. Incidence of multiorgan dysfunction in perinatal asphyxia. Int J Contemp Pediatr. 2015;2:428-32.