Perinatal Asphyxia I nterruption in oxygen supply to tissues in the foetus or newborn with attendant metabolic consequences which may result in multiorgan dysfunction in the immediate ID: 914690
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Slide1
Criteria for diagnosis of perinatal asphyxia
Slide2Perinatal Asphyxia
I
nterruption
in oxygen supply to tissues
in the foetus or
newborn
with
attendant metabolic consequences which may result in
multiorgan
dysfunction in the immediate
newborn
period as well as long term neurologic
sequelae
.
Slide3American Academy of Paediatrics (AAP) and the American College of Obstetrics and Gynaecology (ACOG
)
4 essential criteria and 5 additional criteria
Slide44 Essential criteria
Metabolic
acidosis (pH < 7.0 and base deficit ≥ 12
mmol
/L) in umbilical artery sample
Moderate
or Severe encephalopathy (Thompson score (appendix 1) or
Sanart
and
Sanart
staging (appendix 2
)
Cerebral palsy of spastic quadriplegia or
dyskinetic
type
Exclusion
of other
etiologies
.
Slide55 additional
Sentinel event
intrapartum
Abrupt changes in foetal heart rate
Apgar score ≤ 3 beyond 5 min;
Multi-system failure within 72 h of life
Early imaging evidence
Slide6Cornerstone
S
evere
metabolic acidosis (pH < 7.0 and base deficit ≥ 12
mmol
/L) at birth in a
newborn
exhibiting early signs of moderate or severe encephalopathy
Slide7WHO DEFINITION
Failure to
intiate
breathing at birth
Slide8Thompson score
Score
Sign
0
1
2
3
Flaccid
Tone
Normal
Hyper
Hypo
LOC
Normal
Hyperalert, stare
Lethargic
Comatose
Fits
None
< 3/day
>2/day
Posture
Normal
Fisting, cycling
Strong distal flexion
Decerebrate
Moro
Normal
Partial
Absent
Grasp
Normal
Poor
Absent
Suck
Normal
Poor
Absent ± bites
Respiration
Normal
Hyperventilation
Brief apnea
IPPV (apnea)
Slide9Thompson score interpretation
Mild 1 – 10
Moderate 11- 14
Severe >
15
Slide10Sarnat and Sarnat
Staging
Stage I
Stage II
Stage III
Alertness
Hyperalert
Lethargy
Coma
Muscle tone
Normal or increased
Hypotonic
Flaccid
Seizures
None
Frequent
Uncommon
Pupils
Dilated, reactive
Small, reactive
Variable, fixed
Respiration
Regular
Periodic
Apnoea
Duration
< 24 Hours
2 - 14 Days
Weeks
Slide11Adaptation
WHO
If a baby required bag and mask ventilation at birth
AAP/ACOG
No facilities for most criterion 1 of 4 essential
Most referral
centres
don
’
t do APGAR scoring
Neuroimaging not widely available
Slide12Thank you