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Prognosis in infants with birth asphyxia
1Department of Paediatrics, Monash University, Melboune, Victoria, Australia.
Insights
The risk of neurodevelopmental disability from birth asphyxia is often overestimated, with less than 10% of cerebral palsy cases directly caused by it. Predicting outcomes remains challenging due to measurement limitations.
Area of Science:
- Perinatal Medicine
- Neurodevelopmental Pediatrics
- Obstetrics
Background:
- Birth asphyxia, often linked to intrapartum complications, is frequently cited as a cause of neurodevelopmental disabilities.
- Cerebral palsy (CP) is associated with adverse perinatal events, but the direct contribution of asphyxia is debated.
- Current methods for assessing fetal well-being and neonatal status show poor correlation with long-term outcomes.
Purpose of the Study:
- To critically evaluate the actual risk of neurodevelopmental disability attributed to birth asphyxia.
- To examine the correlation between various intrapartum and neonatal assessment methods and actual outcomes.
- To discuss the challenges in quantitatively measuring birth asphyxia and predicting neurodevelopmental outcomes.
Main Methods:
- Review of existing studies on birth asphyxia, cerebral palsy, and neurodevelopmental outcomes.
- Analysis of the correlation between fetal monitoring, neonatal parameters, and clinical outcomes.
- Examination of diagnostic criteria for substantial cerebral hypoxia.
Main Results:
- The contribution of birth asphyxia to cerebral palsy is likely less than 10%, with the overall risk often overestimated.
- Intrapartum assessment methods (fetal heart rate, scalp pH, meconium) poorly predict neonatal status and outcomes.
- The prevalence of CP has not decreased despite increased obstetric and neonatal interventions for birth asphyxia.
Conclusions:
- The direct causal link between birth asphyxia and neurodevelopmental disability, including CP, is less significant than commonly perceived.
- Accurate quantitative measurement of birth asphyxia and prediction of neurodevelopmental outcomes remain significant challenges.
- Established criteria, including Apgar scores, acidosis, hypotonia, and seizures, are crucial for diagnosing severe hypoxic-cerebral injury.
Abstract:
The risk of neurodevelopmental disability from birth asphyxia secondary to intrapartum complications and obstetric mismanagement is generally overestimated. Between 8-17% of all cerebral palsy is associated with adverse perinatal events suggestive of asphyxia. Less than 10% is probably due directly to birth asphyxia itself. Studies have shown that different methods of intrapartum assessment of fetal well-being (fetal heart rate monitoring, fetal scalp pH, presence of meconium) do not correlate well with each other or with neonatal parameters (acid-base status at birth, Apgar scores, seizures, neurological behaviour) and outcome measures (death, cerebral palsy, mental retardation). The prevalence rate of cerebral palsy in most communities of 2.0-2.5 per 1000 children is not falling in spite of increasing use of obstetric and neonatal interventions aimed at preventing or treating birth asphyxia. Prediction of neurodevelopmental outcome of birth asphyxia is difficult because of a limited ability to measure birth asphyxia quantitatively in the antenatal and neonatal period. The terminology used to describe the condition is often confusing. It has been recommended that substantial cerebral hypoxia can only be presumed when four criteria are met: the infant has an Apgar score < or = 3 at 10 minutes, metabolic acidosis at birth, hypotonia for several hours and seizures. For the paediatrician, a number of clinical observations and laboratory investigations have been suggested as helpful in the prediction of death or disability among term infants with birth asphyxia.