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By ULY CLINIC staff

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Perinatal asphyxia

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Perinatal asphyxia hypoxic  ischaemic encephalopathy is a clinical condition that present with neurological signs during early neonatal period. Caused by inadequate oxygen supply to organs before, during or immediately after birth causing ischemic changes in the brain.

 

Diagnostic Criteria
 

  • Low apgar score

  • Convulsions, apnoea and/or inability to suck

  • Abnormal Thompson’s HIE score

  • Functional disabilities resulting from hypoxic damage to various organs

 

Scoring in newborns with Hypoxic Ischaemic Encephalopathy
 

The assessment should be done daily for the first 7 days of life. The following classification can be made

 

  • Mild HIE 0 - 10

  • Moderate HIE : 11 - 14

  • Severe HIE : > 15

 

Special care should be given to babies with moderate and severe birth asphyxia because the fluid management will be two third of the required fluids per day.

Thompson HIE score chart-ulyclinic

Investigations

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  • FBP

  • Blood for culture and sensitivity

  • CRP

  • CSF for biochemistry, microbiology

  • Urinalysis and urine culture.

  • Swabs for gram stain and culture

  • Chest x ray

  • Serum electrolytes, calcium and magnesium

  • Renal and Liver function tests

 

Treatment


Non pharmacological Treatment

 

  • ​Adequate resuscitation and ventilation especially few hours after birth

  • Oxygen 1.5 to 2L/min

  • Restrict fluids and electrolytes till renal function and urine output evaluation is done.

  • Avoid hyperthermia and hypothermia (Temperature should be maintaine between 36°C -37°C)

  • Commence feeding orally only when baby has passed meconium and is not oxygen dependent.

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Pharmacological Treatment

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  • Give 10% dextrose two third of the required fluids per day

  • Give Phenobarbitone 20mg/kg in 50mls of 10% dextrose for 1 hour.

  • Give Ampicillin IV 50mg/kg 12 hourly (1st week of life), 8 hourly (2- 4weeks of life) and Gentamicin IV 3 mg/kg/dose (low birth weight babies), 5 mg/kg/ dos (normal birth weight babies), 7.5 mg/kg/dose (weeks 2-4 of life) once daily for 10 days.

  • Other specific conditions treat as explained in table 3.1 above

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Note:


If the baby is still floppy or spastic, unresponsive and cannot suck by the end of first week this indicates severe brain injury hence poor prognosis hence, counsel the family for lifelong supportive care

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Last updated on 22.08.2020

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References

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  1. Tanzania standard treatment guideline for pediatrics. Edition 2017

  2. WHO.Perinatal asphyxia. https://www.who.int/bulletin/volumes/86/4/07-049924/en/. August 22.08.2020

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