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For infants born with severe asphyxia, delayed spontaneous respiration beyond 30 minutes after birth indicates a poor prognosis. Resuscitation efforts after this critical window may not be beneficial for neonatal outcomes.
Area of Science:
- Neonatal Medicine
- Perinatal Asphyxia Research
- Pediatric Resuscitation
Background:
- Severe birth asphyxia poses significant risks to newborns.
- Establishing reliable prognostic indicators for asphyxiated infants is crucial for clinical decision-making.
Purpose of the Study:
- To investigate the relationship between the time to spontaneous respiration after birth and the subsequent outcome in infants with severe birth asphyxia.
- To identify critical time intervals for intervention and prognosis.
Main Methods:
- Retrospective case file review of 54 infants born with severe asphyxia (birth weight >2500 g, gestational age >37 weeks).
- Infants categorized into three groups based on time to spontaneous regular active respiration: within 15 min (Group A), 15-30 min (Group B), and >30 min (Group C).
Main Results:
- Infants in Group C (>30 min recovery), often with a history of prolonged intrapartum asphyxia, had uniformly poor outcomes.
- Audible heartbeat at birth was not a reliable prognostic sign.
- In one-third of cases, regular respiration started at twice the time of the first gasp, highlighting variability in initial resuscitation response.
Conclusions:
- A combination of prolonged intrapartum asphyxia and delayed spontaneous respiration (>30 min post-birth) strongly predicts a uniformly bad prognosis.
- Resuscitation attempts beyond 30 minutes after birth in severely asphyxiated infants may not be clinically warranted due to poor expected outcomes.
Abstract:
Fifty-four infants born severely asphyxiated with birth weights of more than 2500 g and gestational ages older than 37 weeks were studied with help of careful review of the case files. To establish a relationship between the time elapsed after birth to spontaneous regular active respiration and later outcome, the infants were divided into three groups: group A of 34 children, established spontaneous active respiration within 15 min; group B of 7 children recovered in 15-30 min, and group C of 13 children recovered 30 min after birth. The outcome in group C, in which the infants also had a history of prolonged intrapartum asphyxia, was uniformly bad. The absence or presence of an audible heart beat at birth was not a reliable clinical sign for a prognosis. The time that elapsed between the start of resuscitation and the first gasp had to be doubled to indicate the likely start of regular active respiration in one third of our babies. The results indicated that the combination of prolonged intrapartum asphyxia and a delay in onset of spontaneous regular respiration of more than 30 min following birth predicted a uniformly bad prognosis. Attempts at resuscitation after this interval did not appear to be warranted.