A study of multiorgan dysfunction in asphyxiated neonates

Khangembam S. Singh, G. S. Sengar


Background: Perinatal asphyxia is an important cause of neonatal mortality, morbidity and late sequeale in developing countries like India. Each year 4 million neonates die worldwide, representing 38 % of all deaths of children less than 5 years of age. It is a study of the clinical profile, the frequency and pattern of organ involvement and the impact of different organ system involvement on early neonatal morbidity and mortality in asphyxiated neonates.

Methods: The study was conducted in Level-III NICU of Department of Pediatrics, S P Medical College, Bikaner. 190 asphyxiated neonates were studied after due approval from Ethics committee and parental consent. The clinical and Biochemical parameters were analyzed and classified each of the organ system dysfunction as per the criteria defined. Multiple organ dysfunction is defined as involvement of two or more than two organ system.

Results: Multiple organ dysfunction occurred in 63.1% infants and 27.6% died during the study; Central Nervous System (CNS) was most frequently involved (69.4%). Severe CNS injury (42 infants i.e. 22.1%) always occurred with involvement of other organs, although moderate CNS involvement was isolated in 90 infants. Renal involvement occurred in 52.1%, pulmonary in 44.2%, cardiac in 48.4% infants. Respiratory involvement having 53.3% of mortality had maximum of all other organ system involvement. Involvement of Two organ system occurred in 39 infants as compared to three and four organ system involvement in 44 and 37 infants respectively. Four organ system involvements accounted 72.9% mortality whereas two and three organ system involvement contributed 20.5% and 38.6% respectively. Three and Four organ system involvement had significant statistical association to mortality; p value <0.05 and <0.0001 respectively.

Conclusions: Multiorgan Dysfunction (MOD) remains an essential entity of perinatal asphyxia. The result further delineates the clinical spectrum of Multi organ dysfunction and emphasizes the need of global management in asphyxiated new born babies.


HIE (hypoxic ischemic encephalopathy), MOD, Birth asphyxia

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Birth Asphyxia - Summary of the previous meeting and protocol overview Dr Ornella Lincetto, WHO Geneve Milano. 2007.

American Academy of Paediatrics, American college of Obstetrics and Gynaecology. Use and abuse of Apgar score. Paediatrics. 1996;98:141-2.

Shah P, Riphagen S. Archdis child fetal neonatal ed. Multiorgan dysfunction in infants with post asphyxia HIE. 2004:89:F152-5.

Articles: predicting neonatal morbidityafter birth asphyxia, Ascoring system Ronald J portman, Brian S carter, Mark S Gaylord ,M Jaik Murphy, The university of Colorado health science centre.

Martin-Ancel A, Garcia-Alix A, Gaya F. Multiple organ involvement inperinatal asphyxia. J Pediatr. 1995;127:786-93.

Shankaran S, Woldt E, Koepke T. Acute neonatal morbidity and longterm central nervous system sequelae of perinatal asphyxia in term infants. Early Hum Dev. 1991;25:135-48.

Perlman JM, Tack ED. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child. 1989;143:617-20.

Phelan JP, Ahn MO, Korst L. Intrapartum fetal asphyxial brain injury with absent multiorgan system dysfunction. J Matern Fetal Med. 1998;7:19-22.

Sarnat H. Sarnat M. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch, Neurol. 1995;33:696.

Jedeikin R, Primhak A, Shennan AT. Serial electrocardiographic changes in healthy and stressed neonates. Arch Dis Child. 1983;58:605.

Fisher DJ. Increased myocardial blood flow and oxygen deliveries during hypoxemia in lambs. Pediatr Res. 1984;18:602-6.

Leuthner SR, Das UG. Low Apgar scores and the definition of birth asphyxia. Pediatr Clin N Am. Pediatr Clin North Am. 2004;51(3):737-45.

APGAR Articles: predicting neonatal morbidity after birth asphyxia, Ascoring system Ronald J portman, Brian S carter, Mark S Gaylord, M Jaik Murphy, The university of Colorado health science centre.