Clinical Aspects

Abstract

Despite the better identification of prenatal causes associated with subsequent neurodevelopmental impairments (Naeye and Peters 1988; Naeye et al. 1989), perinatal asphyxia remains one of the most important causes of brain injury in neonatal medicine (Levene et al. 1985). However, there is still much controversy as to how perinatal asphyxia should be defined (Clark and Quirk 1990; Levene 1987). Ideally, modern indicators of fetal well being and sensitive clinical and paraclinical criteria of the infant’s condition at birth should be taken into account (Jacobs and Phibbs 1989; Sarnat and Sarnat 1976). Unfortunatly, it is often difficult to routinely collect all these parameters. Furthermore, Apgar score relates poorly to preceding events, is partially gestational-age-dependent, and is only a weak predictor of further neurodevelopmental deficits. Nevertheless, it remains a very effective and reliable system for describing the infant’s condition shortly after birth and is still widely used for diagnosing neonatal asphyxia (Nelson and Ellenberg 1981; Ergander et al. 1983). In this chapter, we refer to asphyxia when the Apgar score is ≤4 at 1min and/or ≤6 at 5min (Swiss Neonatal Group definition) in association with the development of neurological signs.