Short and long term prognosis in perinatal asphyxia: An update

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.

Short-Term Outcomes of Neonatal Resuscitation

Introduction: Neonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It can end in either survival or death. Survivors may develop short-term complications in the immediate postnatal period. Objective: Determine the short-term outcomes following neonatal resuscitation. Materials and Methods: A retrospective cross-sectional study was conducted for seven months running from November 2021 to June 2022 in two hospitals in Yaounde. Admission files of newborns who benefited from neonatal resuscitation at birth from the year 2019 to 2022 were included. We recorded the clinical characteristics of newborns (gestational age, gender, and birth weight), the frequency of transfers, the duration of admission, the rate and types of complications in an operating sheet The results were analysed using IBM SPSS 23.0 software and the data expressed as frequencies, percentages, and means. The threshold of significance was set at 5%. Results: A total of 245 files of newborns who benefited from neonatal resuscitation were included. The mean gestational age at delivery was 36.7 ± 3.6 weeks with a minimum and maximum of 25 weeks and 46 weeks respectively. 61.6% of newborns were born at term and were of the male sex (55.5%, sex ratio of 1.25). The average birth weight was 2748.4 ± 794.3 g (range: 800 - 5600 g) with 62.4% of newborns weighing between 2500 and 4000 g. 97.1% of the newborns were transferred to the neonatology unit with a median length of hospitalization of 5 days. The frequency of short-term complications during the study was 26.9% and hypoxic-ischemic encephalopathy was the most common (97%). Newborns resuscitated for more than 5 minutes were more likely to develop a short-term complication. Conclusion: Hypoxic-ischaemic encephalopathy was the most frequent complication post-resuscitation and a prolonged duration of resuscitation favoured the development of short-term complications.