Asphyxia and hypoxic-ischemic encephalopathy in neonates: postnatal interventions

  • G. Motta
  • L. Gagliardi
  • P. Introvini
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


The birth of an asphyxiated neonate is a dramatic event that can affect both the probability of survival and the quality of life of the neonate. About 6/1 000 newborn infants develop asphyxia [1], with a mortality rate of 15%–20% (due to a multiorgan failure syndrome and respiratory complications) and a further 25% probability of later neurodevelopmental sequelae due to hypoxic-ischemic encephalopathy (HIE) [2]. Even when electronically monitoring fetal heart rate, asphyxia is not detected before birth in about 50% of severe cases [3].


Preterm Neonate Birth Asphyxia Moderate Hypothermia Newborn Piglet Human Neonate 
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  1. 1.
    Levene MI, Kornberg J, Williams THC (1985) The incidence of and severity of postasphyxial encephalopathy in full-term infants. Early Hum Devel 11:21–28CrossRefGoogle Scholar
  2. 2.
    Levene MI (1995) Management and outcome of birth asphyxia. In: Levene MI, Bennett MJ, Punt J (eds) Fetal and neonatal neurology and neurosurgery. Churchill Livingstone, Edinburgh, pp 427–442Google Scholar
  3. 3.
    Spencer JAD (1998) Deaths related to intrapartum asphyxia. Br Med J 316:640CrossRefGoogle Scholar
  4. 4.
    Levene MI, Gibson NA, Fenton AC et al (1990) The use of a calcium-channel blocker, nicardipine, for severely asphyxiated newborn infants. Dev Med Child Neurol 32:567–574PubMedCrossRefGoogle Scholar
  5. 5.
    Russell GA, Cooke RW (1995) Randomised controlled trial of allopurinol prophylaxis in very preterm infants. Arch Dis Child 73:F27–F31Google Scholar
  6. 6.
    Bennet P, Edwards AD (1997) Use of magnesium sulphate in obstetrics. Lancet 350:1491CrossRefGoogle Scholar
  7. 7.
    Levene MI (1993) Management of the asphyxiated full-term infant. Arch Dis Child 68:612–616PubMedCrossRefGoogle Scholar
  8. 8.
    Shankaran S (1993) Perinatal asphyxia. Clin Perinatol 20(2)Google Scholar
  9. 9.
    Edwards AD (1993) Protection against hypoxic-ischaemic cerebral injury in the developing brain. Perfusion 8:97–100CrossRefGoogle Scholar
  10. 10.
    Bowen FW (1996) Management issues for the neonatal patient. Clin Perinatol 23:1–30PubMedGoogle Scholar
  11. 11.
    Saugstad OD (1996) Role of xantine oxidase and its inhibitor in hypoxia: reoxygenation injury. Pediatrics 98:103–107PubMedGoogle Scholar
  12. 12.
    Saugstad OD (1996) Mechanisms of tissue injury by oxygen radicals: implication for neonatal disease. Acta Paediatr 85:1–4PubMedCrossRefGoogle Scholar
  13. 13.
    Vannucci RC, Perlman JM (1997) Intervention for perinatal hypoxic-ischemic encephalopathy. Pediatrics 100:1004–1014PubMedCrossRefGoogle Scholar
  14. 14.
    Patel J, Edwards AD (1997) Prediction of neurological outcome after perinatal asphyxia. Curr Opin Pediatr 9:128–132PubMedCrossRefGoogle Scholar
  15. 15.
    Azzopardi D, Wyatt JS, Cady EB et al (1989) Prognosis of newborn infants with hypoxic-ischemic brain injury assessed by phosphorus magnetic resonance spectroscopy. Pediatr Res 25:445–451PubMedCrossRefGoogle Scholar
  16. 16.
    Sarnat HB, Sarnat MS (1976) Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 33:696–705PubMedCrossRefGoogle Scholar
  17. 17.
    Prechtl HFR, Ferrari F, Cioni G (1993) Predictive value of general movements in asphyxiated fullterm infants. Early Hum Devel 35:91–120CrossRefGoogle Scholar
  18. 18.
    Cioni G, Ferrari F, Einspieler C et al (1997) Neurological assessment of preterm infants: comparison between observation of spontaneous movements and neurological examination. J Pediatr 130:704–711PubMedCrossRefGoogle Scholar
  19. 19.
    Lucey JF (1997) Neuroprotection and perinatal brain care: the field of the future, currently going nowhere. Pediatrics 100:1030–1031PubMedCrossRefGoogle Scholar
  20. 20.
    Hall RT, Hall FK, Daily DK (1998) High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr 132:345–348PubMedCrossRefGoogle Scholar
  21. 21.
    Catlin EA, Carpenter MW, Brann BS et al (1986) The Apgar score revisited: influence of gestational age. J Pediatr 109:865–868PubMedCrossRefGoogle Scholar
  22. 22.
    American Heart Association, Emergency Cardiac Care Committee and Subcommittees (1992) Guidelines for cardiopulmonary resuscitation and emergency cardiac care. VII. Neonatal resuscitation. JAMA 268:2276–2281CrossRefGoogle Scholar
  23. 23.
    Bloom RS, Cropley C (1987) Textbook of neonatal resuscitation. AHA and AAP, DallasGoogle Scholar
  24. 24.
    Saugstad OD (1996) Resuscitation of newborn infants; do we need new guidelines? Prenatal Neonatal Med 1:26–28Google Scholar
  25. 25.
    Lundstrom KE, Pryds O, Greisen G (1995) Oxygen at birth and prolonged cerebral vasoconstriction in preterm infants. Arch Dis Child 73:F81–F86Google Scholar
  26. 26.
    Feet BA, Yu X-Q, Rootwelt T et al (1997) Effects of hypoxemia and reoxygenation with 21% or 100% oxygen in newborn piglets: extracellular hypoxanthine in cerebral cortex and femoral muscle. Crit Care Med 25:1384–1391PubMedCrossRefGoogle Scholar
  27. 27.
    Ramji S, Ahuja S, Thirupuram S et al (1993) Resuscitation of asphyxic newborn infants with room air or 100% oxygen. Pediatr Res 34:809–812PubMedCrossRefGoogle Scholar
  28. 28.
    Saugstad OD, Rootwelt T, Aalen O (1998) Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial. The RESAIR 2 study. Pediatrics 102:E1PubMedCrossRefGoogle Scholar
  29. 29.
    Leahy FAN, Cates D, MacCallum M, Rigatto H (1980) Effects of CO2 and 100% O2 on cerebral blood flow in preterm infants. J Appl Physiol 48:468–472PubMedGoogle Scholar
  30. 30.
    Rahilly PM (1980) Effects of 2% CO2, 0.5% CO2 and 100% oxygen on cranial blood flow of the human neonate. Pediatrics 66:685–689PubMedGoogle Scholar
  31. 31.
    Mehmet H, Edwards AD (1996) Hypoxia, ischaemia, and apoptosis. Arch Dis Child 75:F73–F75Google Scholar
  32. 32.
    Roth SC, Edwards AD, Cady EB et al (1992) Relation between cerebral oxidative metabolism following birth asphyxia and neurodevelopmental outcome and brain growth at one year. Dey Med Child Neurol 34:285–295CrossRefGoogle Scholar
  33. 33.
    Lorek A, Takei Y, Cady EB et al (1994) Delayed (“secondary”) cerebral energy failure following acute hypoxia-ischaemia in the newborn piglet: continuous 48-hour studies by 31P magnetic resonance spectroscopy. Pediatr Res 36:699–706PubMedCrossRefGoogle Scholar
  34. 34.
    Edwards AD, Wyatt JS, Thoresen M (1998) Treatment of hypoxic-ischaemic brain damage by moderate hypothermia. Arch Dis Child 78:F85–F91CrossRefGoogle Scholar
  35. 35.
    Du C, Hu R, Csernansky CA et al (1996) Very delayed infarction after mild focal cerebral ischemia: a role for apoptosis? J Cereb Blood Flow Metab 16:195–201PubMedCrossRefGoogle Scholar
  36. 36.
    Gluckman PD, Klempt N, Guan J et al (1992) A role for IGF-1 in the rescue of CNS neurons following hypoxic-ischemic injury. Biochem Biophys Res Commun 182:593–599PubMedCrossRefGoogle Scholar
  37. 37.
    Thoresen M, Wyatt JS (1997) Keeping a cool head, post-hypoxic hypothermia-an old idea revisited. Acta Paediatr 86:1029–1033PubMedCrossRefGoogle Scholar
  38. 38.
    Wyatt JS, Thoresen M (1997) Hypothermia treatment and the newborn. Pediatrics 100:1028–1030PubMedCrossRefGoogle Scholar
  39. 39.
    Westin B, Miller JA, Nyberg R et al (1959) Neonatal asphyxia pallida treated with hypothermia alone or with hypothermia and exchange transfusion of oxygenated blood. Surgery 45:868–879PubMedGoogle Scholar
  40. 40.
    Oates RK, Harvey D (1976) Failure of hypothermia as treatment of asphyxiated newborn rabbits. Arch Dis Child 51:512–516PubMedCrossRefGoogle Scholar
  41. 41.
    Sirimanne E, Blumberg RM, Bossano B et al (1996) The effect of prolonged modification of cerebral temperature on outcome following hypoxic-ischemic brain injury in the infant rat. Pediatr Res 39:591–597PubMedCrossRefGoogle Scholar
  42. 42.
    Silverman WA, Fertig JW, Berger AP (1958) The influence of the thermal environment upon the survival of newly born premature infants. Pediatrics 22:876–886PubMedGoogle Scholar
  43. 43.
    Grether JK, Nelson KB (1997) Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 278:207–211PubMedCrossRefGoogle Scholar
  44. 44.
    Silverman WA (1998) Cooling the asphyxiated newborn-responsibly. Pediatrics 101:697–698PubMedCrossRefGoogle Scholar
  45. 45.
    Edwards AD, Azzopardi D (1998) Hypothermic neural rescue treatment: from laboratory to cotside? Arch Dis Child 78:F88–F91Google Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • G. Motta
  • L. Gagliardi
  • P. Introvini

There are no affiliations available

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