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You will receive a link to create a new password. Home Topics Documents komplikasi Asfiksia neonatorum. Size px x x x x Start Page 1 2 3 4 5. Published on May Categories: Iga Amanda Subscribe 0. Birth asphyxia is a serious clinical problem worldwide.

There are many reasons a baby may not be able to take in enough oxygen before, nneonatorum, or just after birth. Damage to brain tissues is a serious complication of low oxygen that can cause seizures and other neurological problems.

This study was designed to asses the risk factors of birth asphyxia in neonates. This descriptive, prospective study was conducted in the Department of Paediatrics, Isra University Hospital, Hyderabad, from April to April Detailed maternal history was taken, regarding their age, gestational age, and complications, if any.

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Risk of neonatal encephalopathy increased with increasing or decreasing maternal age. Multiple births increased risk in 4.

Particulate meconium was associated with encephalopathy in 9.

Vaginal bleeding was strongly associated with birth asphyxia in Lack of antenatal care, poor nutritional status, antepartum hemorrhage and maternal toxaemia were associated with higher incidence of asphyxia. Improvements in the public health of women with associated gains in female growth and nutrition must remain a longer-term goal. Early identification of high-risk cases with improved antenatal and perinatal care can decrease such high mortality.

Safe motherhood policy is recommended.

komplikasi Asfiksia neonatorum

Each year approximately 4 million babies are born asphyxiated, which results in 1 million deaths and an equal number of serious neurological sequelae, such as cerebral palsy, mental retardation, and epilepsy 1. Asphyxia is an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs 2. A mother may have medical conditions that can lower her oxygen levels; there may be a problem with the placenta that prevents enough oxygen from circulating to the fetus; or the baby may be unable to breath after delivery.

Damage to the brain tissue is a serious complication of low oxygen that can cause seizures and other asfiksiw problems. In mild HIE, muscle tone may be increased slightly and deep tendon reflexe neonztorum may be brisk during the first few days.

Transient behavioral abnormalities, such as poor feeding, irritability, or excessive crying or sleepiness, may be observed.

By days of life, the central nervous system examination findings become normal. In moderately severe HIE, the infant is lethargic, with significant hypotonia and diminished deep tendon reflexes. The grasping, Moro, and sucking reflexes may be sluggish or absent.

The infant may experience occasional periods of apnea. Seizures may occur within the first 24 hours of life. Full recovery within weeks is possible and is associated with a better long-term outcome.

An initial period of well being or mild HIE may be followed by sudden deterioration, suggesting ongoing brain cell dysfunction, injury, and death; during this period, seizure intensity might increase. In severe HIE, stupor or coma is typical. The infant may not respond to any physical stimulus. Breathing may be irregular, and the infant often requires ventilatory support. Generalized hypotonia and depressed deep tendon reflexes are common. Disturbances of ocular motion may be present.

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Pupils may be dilated, fixed, or poorly reactive to light. Seizures occur early and often and may be initially resistant to conventional treatments. The seizures are usually generalized, and their frequency may increase during the hours after onset, correlating with J Ayub Med Coll Abbottabad ; 19 3 68 the phase of reperfusion injury. As the injury progresses, seizures subside and the electroencephalogram becomes isoelectric or shows a burst suppression pattern.

At that time, wakefulness may deteriorate further, and the fontanel may bulge, suggesting increasing cerebral edema. Irregularities of heart rate and blood pressure are common during the period of reperfusion injury, as is death from cardio respiratory failure. In settings where many mothers are stunted, do not access antenatal care, and receive poor obstetric care, it seems likely that intrapartum factors remain important in neonatal encephalopathy We aimed to identify avoidable risk factors for neonatal encephalopathy in a low income setting where studies of risk factors have not previously been reported.

We focused on neonatal manifestations and maternal factors as the most likely practicalintervention point. Hyderabad is the second biggest city of Sindh province.

The estimated population of Hyderabad is 02 million. Newborns with history of delayed cry or Apgar score of less than 7 were admitted.

A total of consecutive asphyxiated newborns who met the inclusion criteria asgiksia enrolled in the study, with evidence of neurobehavioral disturbance. The findings were komlikasi on a standard proforma Table1. A specially designed questionnaire was administered, to assess the role maternal factor and neonatal presentation of asphyxia.

Formal operational criteria to grade the severity of encephalopathy in term infants were asfikzia from the syndromic descriptions of Fenichel modified according to more recent studies. Neonatoorum with mild Grade 1 encephalopathy were irritable or hyperalert, with either poor suck or an abnormality of tone. Infants with moderate Grade 2 encephalopathy were lethargic, with moderately abnormal tone, poor suck, and depressed Moro and grasp reflexes seizures were often clinically evident.

Infants with severe Grade 3 encephalopathy were comatosed, with severely abnormal tone, absent suck, and brainstem malfunction including impaired respiratory drive. Their birth weights and their level of consciousness were also assessed and manifestation was noted as hypoxic ischemic encephalopathy 1, 2 and grade 3. Gestational age less than 34 weeks newborns with major congenital malformations involving central nervous or cardiovascular system, dysmorphism obvious chromosomal abnormalitiessevere hyperbilirubinemia bordering on kernicterus, evidence of meningitis or bleeding disorders were excluded.

Maternal characteristics and antepartum history were obtained during an asfiksix of the mothers, using structured proformas.

Proforma was filled on each case. Maternal history was taken, regarding their age, gestational age, and complications.

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Special emphasis was on presentation other then cephalic. Anemia, hypertension, edema and vaginal bleeding was inquired about. Prolonged rupture of membranes, meconium stained liquor and fever was noted. Prolonged rupture labelled when rupture of membranes was more than 18 hours before the komplioasi of baby.

Antenatal care was inquired about in detail. Mode of delivery and instrumentation, if any, was also noted. In case of clinic or hospital delivery, referral notes were reviewed. Major portion of study population mothers, i. Most of the mothers, i. Place of delivery had significant impact on the grade of encephalopathy In home born newborns, 8 6. Meconium stained liquor and especially thick particulate meconium was importantly associated with encephalopathy 12 9. Multiple births were noticed in 6 4.


Most of the mothers were between years of age. Since it is a preventable problem and long- term neurological sequelae are almost untreatable once asphyxia happened, so it is better to avoid at first or if occurred at all, refer as early as possible. Though the topic has been extensively studied and reviewed worldwide, limited local data is available. Previously published data proved that there is huge difference in the neonatal deaths among those mothers who had regular antenatal komplikssi as compared to unbooked cases.

J Ayub Med Coll Abbottabad ; 19 3 70 There is no data available in which risk factors are highlighted in asphyxiated newborns. The possible causes of neoantorum could be as simple as astiksia or hypoglycemia or even diaphragmatic hernia neonatoorum congenital myopathy, which had to be managed kompliksai.

So it is important to train people and paramedics about the early recognition and referral of asphyxiated newborns with outcome which depends upon level and duration of neuronal insult at the time of birth, clinical presentations of HIE, involvement of other organs, stage of HIE and treatment modalities. This study was hospital based and addressed a common problem of our community Majority of study population as not being delivered under care of trained professionals primarily at home and private clinics also reflects another important issue pertaining to perinatal mortality and morbidity.

Ko,plikasi preliminary study has shown that neonahorum factors may play a role in the etiology of neonatal encephalopathy. A large proportion of these cases had a significant antepartum history, so that the intrapartum period alone nfonatorum implicated in the etiology of neonatal encephalopathy.

Vaginal bleeding in pregnancy was found to be a significant risk factor for neonatal encephalopathy in this study. An association between antepartumhaemorrhage and cerebral palsy has also been shown 19, That early prenatal factors had contributed to the neonatal encephalopathy Pyrexia during labour and a longer interval between membrane rupture and delivery were associated with neonatal encephalopathy. Fetal sepsis at term has been associated with deterioration in the fetal acid-base status and a prolongation of labour 20, 29 while Nelson and Ellenberg have shown that prolonged rupture of membranes and chorioamnionitis are noenatorum predictors of cerebral palsy.

The most striking finding relates to mode of delivery. These data suggest an important inverse association between elective caesarean section and newborn encephalopathy There are several possible explanations for this finding. Chance alone is an unlikely explanation, although mode of delivery was not one of the initial study hypotheses. Anemia is a great risk for neonatotum, probably because neonarorum intrapartum hypoxia. In the short jomplikasi there are likely to be continuing gains from improvements to intrapartum care.

Improvements in the public health of women with associated gains in female growth and nutrition must remain a longer term goal.

Absent antenatal care was associated with an increased risk of encephalopathy in our study. The safe motherhood policy recommendation of a minimum of three antenatal visits during pregnancy, focusing on risk screening, immunization, anemia prophylaxis and treatment, and health and nutrition education.

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