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Intrapartum asphyxia in term and post term infants
A Halligan1, M Connolly, T Clarke
1Rotunda Hospital Dublin.
Insights
Identifying infants at risk of asphyxial brain damage is crucial. Referral to fetal assessment units significantly reduces the incidence of asphyxial seizures in newborns, indicating improved perinatal care outcomes.
Area of Science:
- Perinatal Medicine
- Neonatology
- Pediatric Neurology
Background:
- Perinatal asphyxia poses a significant risk for neonatal brain damage.
- Identifying high-risk infants is essential for timely intervention.
- Previous methods for risk identification have limitations.
Purpose of the Study:
- To evaluate the effectiveness of fetal assessment unit referrals in identifying and mitigating risks associated with perinatal asphyxia.
- To compare the incidence of asphyxial complications in referred versus non-referred infants.
Main Methods:
- Retrospective review of 28,655 deliveries over five years.
- Comparison of infants with asphyxial brain damage (deaths or seizures) against a general hospital population.
- Analysis of delivery complications and referral status.
Main Results:
- 13 infant deaths and 32 infants with asphyxial seizures were identified.
- Increased incidence of abnormal presentations, assisted breech, instrumental, and emergency cesarean deliveries in asphyxial cases.
- Referral to fetal assessment units was associated with a significantly lower seizure rate (0.16/1000 live births) compared to non-referred infants (1.4/1000).
- 19% of infants with seizures developed cerebral palsy.
Conclusions:
- Referral to fetal assessment units appears to be an effective strategy for reducing the risk of asphyxial brain damage.
- Assignment to "high risk" status via fetal assessment is linked to better perinatal outcomes.
- Further research into specific interventions within fetal assessment units is warranted.
Abstract:
Many attempts have been made to identify infants at risk of suffering asphyxial brain damage. In a retrospective review of records at the Rotunda Hospital over a five year period all infants who died or suffered seizures, presumed secondary to asphyxia, were compared with the general hospital population. Out of 28,655 deliveries reviewed, there were 13 deaths in infants at or after term associated with perinatal asphyxia, and 32 surviving infants had asphyxial seizures. Seizures were regarded as asphyxial in origin if they occurred in the first forty eight hours of life and were associated with other clinical evidence of asphyxia. The incidence of abnormal presentations, assisted breech deliveries, instrumental deliveries and emergency caesarean sections was all increased in the asphyxial categories compared to the control population. Referral to the fetal assessment unit was associated with a seizure rate of 0.16/1000 live births compared with a rate of 1.4/1000 in the remaining non referred hospital population. Nineteen percent of the infants who seized subsequently developed cerebral palsy. It would appear from our data that referral to the fetal assessment unit and the consequent assignment to "high risk" status is associated with low risk in terms of asphyxial outcome.