Original research
Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy

https://doi.org/10.1016/S0029-7844(02)01959-2Get rights and content

Abstract

OBJECTIVE:

To identify the proportion of major organ system injury in cases of acute intrapartum asphyxia that result in neonatal encephalopathy.

METHODS:

A prospectively maintained database was cross-referenced using medical record coding to identify diagnoses of acute intrapartum asphyxia, acute birth asphyxia, or neonatal encephalopathy over a 6-year period. An acute intrapartum asphyxial antecedent was validated with emphasis on excluding long-standing or chronic conditions where injury likely occurred before presentation. Injury pattern was evaluated using routinely available laboratory and imaging tests.

RESULTS:

Forty-six cases of acute peripartum asphyxia sufficient to result in the diagnosis of neonatal encephalopathy were identified. Clinical central nervous system injury resulting in encephalopathy was present in 100% of cases as it was an entry criteria; of these, 49% had electroencephalogram and 40% had imaging studies diagnostic of acute injury. Liver injury based on elevated aspartate transaminase or alanine transaminase levels occurred in 80%. Heart injury, as defined by pressor or volume support beyond 2 hours of life or elevated cardiac enzymes, occurred in 78%. Renal injury, defined by an elevation of serum creatinine to greater than 1.0 mg/dL, persistent hematuria, persistent proteinuria, or clinical oliguria, occurred in 72%. An elevation in nucleated red blood cell counts exceeding 26 per 100 white blood cells occurred in 41%.

CONCLUSION:

Using common diagnostic tests as markers of acute asphyxial injury, we noted that multiple organs suffer damage during an acute intrapartum asphyxial event sufficient to result in a neonatal encephalopathy.

Section snippets

Materials and methods

A prospectively maintained neonatal database was queried to identify all diagnoses of acute intrapartum asphyxia, acute birth asphyxia, or neonatal encephalopathy from January 1, 1994, to January 1, 2000, at the University of Texas Medical Branch at Galveston. The study was approved by the University of Texas Medical Branch institutional review board. This data set was cross-referenced using diagnostic coding in medical records. Maternal and neonatal records were then hand extracted for

Results

A total of 129 newborns were identified with the diagnosis of either acute intrapartum asphyxia, acute birth asphyxia, or neonatal encephalopathy. Five cases were excluded for insufficient data. Seventy cases were excluded as they failed to meet one of the four essential criteria. Of the remaining 54 cases that sustained an acute intrapartum asphyxial episode, eight were excluded because of gestational ages of less than 32 weeks. The remaining 46 patients are the subjects of this report.

Of the

Discussion

Evidence of multiple organ system damage was the overwhelming rule, and not the exception, in this cohort of 46 cases of clearly demonstrated acute intrapartum asphyxia with resultant neonatal encephalopathy. Combinations of laboratory and imaging studies demonstrated involvement of the renal, hepatic, central nervous, and cardiac systems in over 70% of cases. The least likely organ system to show injury was the hematologic system, and even here, 54% of neonates showed evidence of injury.

We

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