Outcome after intrapartum asphyxia in term infants

doi:10.1053/siny.2000.0011

Seminars in Neonatology

Volume 5, Issue 2, May 2000, Pages 127-140

https://doi.org/10.1053/siny.2000.0011 Get rights and content

Abstract

Investigatory techniques, particularly magnetic resonance (MR) imaging and spectroscopy, performed in the early neonatal period on infants suspected of intrapartum asphyxia i.e. abnormal fetal heart recording, poor cord gases, low Apgar scores and the need for resuscitation, or with neonatal encephalopathy or seizures, have allowed a much better understanding of the patterns of brain injury and the biochemical processes that follow these events. It is usually possible to distinguish these patterns from those seen in other, often confounding, diagnoses. This has allowed far more precision about the timing of insults and in the prediction of particularly motor, feeding and visual outcome and to some extent intellectual outcome. Long-term neurological and psychometric follow-up of infants in whom detailed perinatal clinical histories and examination, haematological and biochemical investigation and MR brain scans are obtained will allow even more accurate prediction of outcome in the future. Such studies also help to validate standardized neonatal and infant clinical neurological examinations, making them useful tools to predict outcome.

References (75)

E Blair et al.
Intrapartum asphyxia: a rare cause of cerebral palsy
J Pediatr
(1988)
K Nelson et al.
Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight
Am J Obstet Gynecol
(1998)
JK Grether et al.
Interferons and cerebral palsy
J Pediatrics
(1999)
FT Kraus et al.
Fetal thrombotic vasculopathy in the placenta: cerebral thrombi and infarcts, coagulopathies, and cerebral palsy
Human Pathology
(1999)
E Blair et al.
Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age
Am J Obstet Gynecol
(1990)
J Foley
Birth weight ratio and cerebral palsy
Early Hum Dev
(1995)
LN Archer et al.
Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia
Lancet
(1986)
CM Robertson et al.
School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term
J Pediatrics
(1989)
L Dubowitz et al.
An optimality score for the neurologic examination of the term newborn
J Pediatr
(1998)
L Haataja et al.
Optimality score for the neurologic examination of the infants at 12 and 18 months
J Pediatr
(1999)

PM Fitzhardinge et al.

The prognostic value of computer tomography as an adjunct to assessment of the term infant with postasphyxial encephalopathy

J Pediatr

(1981)

PR Byrne et al.

Serial magnetic resonance imaging in neonatal hypoxic-ischaemic encephalopathy

J Pediatr

(1990)

J Patel et al.

Prediction of outcome after perinatal asphyxia

Current Opinion in Pediatrics

(1997)

HR Sarnat et al.

Neonatal encephalopathy following fetal distress

Arch Neurol

(1976)

MI Levene et al.

Comparison of two methods of predicting outcome in perinatal asphyxia

Lancet

(1986)

JC Hauth

Fetal monitoring; utility and interpretation of umbilical cord gases and fetal scalp monitoring

Acute Perinatal Asphyxia in Term Infants

(1996)

JAD Spencer et al.

The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study

British J Obstet Gynae

(1997)

N Badawi et al.

Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study

BMJ

(1998)

PL Yudkin et al.

Clustering of perinatal markers of birth asphyxia and outcome at age 5 years

British J Obstet Gynae

(1994)

G Gaffney et al.

Cerebral palsy and neonatal encephalopathy

Arch Dis Child

(1994)

A Johnson et al.

A regional register of early childhood impairments: a discussion paper

Community Medicine

(1999)

G Gaffney et al.

Case-control study of intrapartum care, cerebral palsy, and perinatal death

BMJ

(1994)

N Badawi et al.

Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study

BMJ

(1998)

F Cowan et al.

Neonatal encephalopathy and/or seizures—perinatal or antenatal

Eur J Ped Neurol

(1999)

M Squier et al.

The incidence of prenatal brain injury

Neuropathol Applied Neurobiol

(1991)

NK Rollins et al.

The role of early MR in the evaluation of the term infant with seizures

AJNR

(1993)

E Mercuri et al.

Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores

Arch Dis Child

(1995)

J Estan et al.

Unilateral neonatal cerebral infarction in full term infants

Arch Dis Child

(1997)

E Mercuri et al.

Early prognostic indicators in infants with neonatal cerebral infarction: a clinical, EEG and magnetic resonance imaging study

Pediatrics

(1999)

G Gaffney et al.

Model to identify potentially preventable cerebral palsy of intrapartum origin

Arch Dis Child

(1995)

A MacLennan

A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement

BMJ

(1999)

CL Truwit et al.

Cerebral palsy: MR findings in 40 patients

AJNR

(1992)

I Krageloh-Mann et al.

Bilateral spastic cerebral palsy—MRI pathology and origin. Analysis from a representative series of 56 cases

Dev Med Child Neurol

(1995)

E Mercuri et al.

Incidence of cranial ultrasound abnormalities in apparently well neonates on a postnatal ward: correlation with antenatal and perinatal factors and neurological status

Arch Dis Child

(1998)

L Haataja et al.

Cranial ultrasound abnormalities in full-term infants in a post-natal ward: do they matter

Arch Dis Child

(2000)

KB Nelson et al.

Neonatal cytokines and coagulation factors in children with cerebral palsy

Ann Neurol

(1998)

KB Nelson et al.

Antecedents of cerebral palsy. I. Univariate analysis of risks

Am J Dis Child

(1985)

Cited by (54)

Animal models for neonatal brain injury induced by hypoxic ischemic conditions in rodents
2020, Experimental Neurology
Neonatal hypoxia-ischemia and resulting encephalopathies are of significant concern. Intrapartum asphyxia is a leading cause of neonatal death globally. Among surviving infants, there remains a high incidence of hypoxic-ischemic encephalopathy due to neonatal hypoxic-ischemic brain injury, manifesting as mild conditions including attention deficit hyperactivity disorder, and debilitating disorders such as cerebral palsy. Various animal models of neonatal hypoxic brain injury have been implemented to explore cellular and molecular mechanisms, assess the potential of novel therapeutic strategies, and characterize the functional and behavioural correlates of injury. Each of the animal models has individual advantages and limitations. The present review looks at several widely-used and alternative rodent models of neonatal hypoxia and hypoxia-ischemia; it highlights their strengths and limitations, and their potential for continued and improved use.
MR Imaging of hypoxic ischemic encephalopathy – Distribution Patterns and ADC value correlations
2018, European Journal of Radiology Open
Citation Excerpt :
Periventricular-intraventricular haemorrhage (PIVH) usually occurs between 28 and 32 weeks. Periventricular leukomalacia (PVL)and subcortical leukomalacia occur in insults usually between 32 and 36 weeks and finally hypoxic-ischaemic encephalopathy of the term newborn [4,5]. The purpose of our study was to evaluate the role of MRI in neonatal hypoxic ischaemic brain injuries can patterns considering the perinatal maturation process of the brain and the severity of an insult.
Neonatal hypoxic-ischemic encephalopathy causes hypoxic brain injury. Due to differences in brain maturity at time of insult, severity of hypotension and duration of insult, there are four distinct patterns of brain injury. Magnetic resonance imaging is the most sensitive modality for evaluating these patterns of brain injury. Additional role of Diffusion weighted imaging and ADC values can be useful in the evaluation of such cases. We conducted this study to analyse the usefulness of ADC values in the brain tissue affected by hypoxic-ischemic injury.
We conducted a prospective study of all the patients referred to our department for magnetic resonance scanning of brain with history of hypoxic ischemic encephalopathy and clinical features cerebral palsy. 23 Cases with imaging manifestations of hypoxic ischemic encephalopathy were included in the study. We studied distribution patterns of HIE in our cases and calculated the ADC values of involved as well as normal grey and white matter. Further, sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized diffusion and ADC values were obtained Wilson Score method.
The most common distribution pattern in our study was involvement of peri-rolandic area (15 cases, 65%). ADC values were significantly (p < 0.005) increased in abnormal white matter. No significant changes (p = 0.8) were seen in ADC values of normal and abnormal grey matter.
Due to significant increase in ADC values of affected white matter, ADC value can be used as a marker to detect chronic sequel of hypoxic ischaemic brain injury. Another observation was the perirolandic brain tissue being most common area of involvement in the cases with cerebral palsy.
Magnetic resonance imaging versus transcranial ultrasound in early identification of cerebral injuries in neonatal encephalopathy
2016, Egyptian Journal of Radiology and Nuclear Medicine
Citation Excerpt :
Transcranial ultrasound is an operator dependant, bedside, easily available, cheap and quick method for imaging NE. MR imaging is an established tool to detect the timing, severity and extent of neonatal brain injury and it plays an important role in the prediction of neurological outcome (17). The aim of our study was to investigate the value of TCUS versus MRI in the early detection of brain injuries in newborns with neonatal encephalopathy.
Neonatal encephalopathy (NE) is a condition that causes significant morbidity and mortality to the infant. The diagnosis and severity of NE rely heavily on clinical presentation and imaging findings.
The present study was planned to assess the role of MRI and Transcranial ultrasound (TCUS) in the early identification of cerebral injuries in NE.
Our study enrolled 38 newborns presented with NE. Brain MRI and TCUS were carried out for each case and their results were compared.
MRI was positive in 33 cases. Findings at MRI supported hypoxic-ischemic encephalopathy as an etiology in 25 neonates, and other etiologies included metabolic disorders in 2, congenital neonatal infection in 1, 2 cases of neonatal stroke, congenital brain anomalies in 2 neonates and cerebral venous sinus thrombosis in 1. The overall diagnostic accuracy of TCUS compared to MRI was 78.9%, while the overall sensitivity and specificity were 81.8% and 60% respectively.
TCUS is an effective screening tool in detecting the etiology of NE in suspected cases; it is sometimes crucial in critically sick neonates; however, early MRI is mandatory as it can detect precisely the extent of brain injury compared with TCUS alone.
The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia
2014, Medicina (Lithuania)
The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year.
In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated.
The HI injury groups detected during USG significantly correlated with the mental development groups (r = 0.3; P = 0.01) and the neurological evaluation groups (r = 0.3; P < 0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity – 100%, specificity – 93–100%, positive predictive value (PPV) – 60–100%, and NPV – 100%.
In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P ≤ 0.05), and mean resistive index (RI) values were significantly lower (P < 0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development.
Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.
Morphological evaluation of the cerebral blood vessels in the late gestation fetal sheep following hypoxia in utero
2013, Microvascular Research
Hypoxia can significantly contribute to the development of permanent brain injury in the term neonate; however the response of cerebral blood vessels is not well understood. This study aimed to quantitatively measure vascular density and morphology using laminin immunohistochemistry as a marker of blood vessels, and determine the effects of a single, severe bout of hypoxia (umbilical cord occlusion, UCO) late in gestation on the developing cerebrovasculature in fetal sheep. At 124–126 days gestation singleton fetal sheep underwent surgery for implantation of catheters and placement of an inflatable cuff around the umbilical cord. A 10 min UCO or sham UCO (n = 5) occurred at 132 days gestation. Fetal brains were collected at 24 h (n = 5) or 48 h (n = 4) after UCO for vascular density and morphology analysis of laminin immunohistochemistry. 48 h following a single, brief bout of severe hypoxia late in gestation decreased vascular density was seen in the caudate nucleus and no changes in vascular morphology occurred. However closer analysis revealed a significant shift in the frequency of smaller (≤ 10 μm) to larger (≤ 100 μm) perimeter blood vessels in periventricular and subcortical white matter. Close examination of the frequency distribution of vascular perimeter highlights that alterations in vascular morphology persist in the near term fetal brain for up to 48 h following a brief (10 min) hypoxia in white but not gray matter. These findings suggest that the near term brain may still be vulnerable to white matter injury following in utero hypoxia.
Term intra-partum asphyxia: An analysis of acute non-specific supportive criteria and non-CNS organ injury
2010, European Journal of Paediatric Neurology
The purpose of this study was to describe the frequencies and relationships of non-specific non-essential diagnostic criteria and non-CNS organ system injury in term intra-partum asphyxia.
All children with term intra-partum asphyxia encountered in a single pediatric neurology practice with at least two years follow-up and an abnormal neurologic outcome were identified.
A total of 40 children (28 males, 12 females) were identified. Twenty-four had moderate NE and sixteen severe NE. The mean number of non-specific non-essential diagnostic criteria (out of a possible 7) was 4.75 ± 1.39 SD. Sixty percent had five or more criteria and all criteria were present in only 10% of newborns. The mean number of non-CNS organ systems affected was 2.88 ± 1.96 SD (out of a possible 6). Ten percent of our sample showed no evident non-CNS organ injury acutely.
Most asphyxiated neonates failed to consistently satisfy all elements of present consensus statements.

View all citing articles on Scopus

^f1: Correspondence: Tel: 020 8383 8515; Fax: 020 8740 8281; E-mail:[email protected]

View full text

Regular ArticleOutcome after intrapartum asphyxia in term infants

Abstract

J Pediatr

Am J Obstet Gynecol

J Pediatrics

Human Pathology

Am J Obstet Gynecol

Early Hum Dev

Lancet

J Pediatrics

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Prediction of outcome after perinatal asphyxia

Current Opinion in Pediatrics

Neonatal encephalopathy following fetal distress

Arch Neurol

Comparison of two methods of predicting outcome in perinatal asphyxia

Lancet

Fetal monitoring; utility and interpretation of umbilical cord gases and fetal scalp monitoring

Acute Perinatal Asphyxia in Term Infants

The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study

British J Obstet Gynae

Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study

BMJ

Clustering of perinatal markers of birth asphyxia and outcome at age 5 years

British J Obstet Gynae

Cerebral palsy and neonatal encephalopathy

Arch Dis Child

A regional register of early childhood impairments: a discussion paper

Community Medicine

Case-control study of intrapartum care, cerebral palsy, and perinatal death

BMJ

Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study

BMJ

Neonatal encephalopathy and/or seizures—perinatal or antenatal

Eur J Ped Neurol

The incidence of prenatal brain injury

Neuropathol Applied Neurobiol

The role of early MR in the evaluation of the term infant with seizures

AJNR

Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores

Arch Dis Child

Unilateral neonatal cerebral infarction in full term infants

Arch Dis Child

Early prognostic indicators in infants with neonatal cerebral infarction: a clinical, EEG and magnetic resonance imaging study

Pediatrics

Model to identify potentially preventable cerebral palsy of intrapartum origin

Arch Dis Child

A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement

BMJ

Cerebral palsy: MR findings in 40 patients

AJNR

Bilateral spastic cerebral palsy—MRI pathology and origin. Analysis from a representative series of 56 cases

Dev Med Child Neurol

Incidence of cranial ultrasound abnormalities in apparently well neonates on a postnatal ward: correlation with antenatal and perinatal factors and neurological status

Arch Dis Child

Cranial ultrasound abnormalities in full-term infants in a post-natal ward: do they matter

Arch Dis Child

Neonatal cytokines and coagulation factors in children with cerebral palsy

Ann Neurol

Antecedents of cerebral palsy. I. Univariate analysis of risks

Am J Dis Child

Regular Article
Outcome after intrapartum asphyxia in term infants