Birth Asphyxia

Question 1

Risk factors for hypoxia during birth

Answer 1

Maternal shock

Intrapartum haemorrhage

Prolapsed cord, causing compression of the cord during birth

Nuchal cord, where the cord is wrapped around the neck of the baby

Question 2

Investigations in birth asphyxia

Answer 2

Acidosis on umbilical artery blood gas

Poor APGAR score

Features of hypoxic-ischaemic encephalopathy

Evidence of multi-organ failure

Question 3

Management of birth asphyxia

Answer 3

Neonatal unit

Supportive carewith neonatal resuscitation and ongoing optimal ventilation, circulatory support, nutrition, acid base balance and treatment of seizures

Therapeutic hypothermia in certain circumstances to help protect brain from hypoxic injury

Follow up with paediatrician and theMDTto assess development and support any lasting disability

Question 4

Birth asphyxia complications

Answer 4

Ischaemic brain damage

Permanent brain damage causing cerebral palsy

Death

Question 5

Mild hypoxic-ischaemic encephalopathy symptoms

Answer 5

Poor feeding, general irritability and hyper-alert

Resolves within 24hrs

Normal prognosis

Question 6

Moderate hypoxic-ischaemic encephalopathy symptoms

Answer 6

Poor feeding, lethargic, hypotonic and seizures

Can take weeks to resolve

Up to 40% develop cerebral palsy

Question 7

Severe hypoxic-ischaemic encephalopathy symptoms

Answer 7

Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes

Up to 50% mortality

Up to 90% develop cerebral palsy