Clinico-Biochemical Correlation in Birth Asphyxia and Its Effects on Outcome

Abstract

Background Birth asphyxia is a major cause of early neonatal death and leads to severe consequences such as epilepsy, cerebral palsy, and developmental delay. This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxic-ischemic encephalopathy (HIE) and to find out major risk factors contributing to the severity of HIE and neonatal death. Methods In this prospective cohort study (n=150), term babies weighing ≥ 2.5 kg at birth, with the diagnosis of birth asphyxia, admitted in a medical college in Odisha state from September 2014 to August 2016 were included. Clinical findings, biochemical parameters, treatment, and outcome of HIE babies were recorded. Result The majority of the asphyxiated babies were having moderate HIE (HIE II) (57.33%), whereas mild and severe stages were seen in 15.33%, and 27.34% of babies, respectively. Factors like prolonged labor (87.8%) and meconium-stained liquor (63.4%) were mostly attributed to the severe degree of birth asphyxia (p < 0.001). Apnea, lethargy, and hypothermia were the most remarkable feature of HIE III. The degree of hyponatremia, hypocalcemia, and hyperkalemia (124.4±4.4 mmol/l, 0.83±0.08 mmol/l, and 6.17± 0.89 mmol/l, respectively) were more severely affected in HIE III as compared to HIE l (137.5±3.8 mmol/l, 1.06±0.17 mmol/l, and 5.0±0.79 mmol/l, respectively). Serum urea and creatinine increased proportionately with an increase in the severity of HIE grade. The mildly asphyxiated neonates recovered completely, whereas all the cases who died (n=29,19.3%) belonged to the moderate or severe degree of birth asphyxia. Conclusion The asphyxiated neonates had hyponatremia, hypocalcemia, hyperkalemia, raised serum urea, and creatinine and correlated with the severity of birth asphyxia. Prolonged labor and meconium-stained liquor were the most attributable factor for the severe degree of birth asphyxia. Effective neonatal resuscitation and quick correction of electrolyte imbalances will help in the reduction of neonatal mortality and long-term neurological sequelae.

Perinatal outcome and need of care for term asphyxiated newborns without moderate or severe hypoxic‐ischemic encephalopathy

“…Hypoglycaemia occurring in asphyxiated newborns is known to be closely associated with their long‐term neurological outcome, 22 and it is known that asphyxiated newborns represent a vulnerable population with risk of early hypoglycaemia 19 . Apart from hypoglycaemia, electrolyte disturbances such as hyponatremia or hypocalcaemia occurred, which is consistent with anomalies described in previous studies 23,24 25 it seems important to monitor the ionogram of this fragile population.…”

“…19 Apart from hypoglycaemia, electrolyte disturbances such as hyponatremia or hypocalcaemia occurred, which is consistent with anomalies described in previous studies. 23,24 Knowing that electrolyte disturbances can increase the risk of seizures, 25 it seems important to monitor the ionogram of this fragile population. The frequency and severity of biological anomalies is known to be associated with the severity of HIE, 14 but organ dysfunction among asphyxiated newborns without moderate or severe HIE can occur, as described in our study.…”

Hospital-Based Prevalence, Electroencephalogram (EEG), and Neuroimaging Correlation in Seizures Among Children in Odisha, India

“…We try to find out the single most investigation needed to yield the highest correlation with seizure, as the data regarding this is lacking in developing countries like India. Children with seizures must get a proper diagnosis at the earliest for better management and a good prognosis [ 5 ]. This prospective observational study was conducted to investigate the socio-demographic profile, clinical characteristics, hospital-based prevalence, and correlation of EEG and neuroimaging in children under 15 years with seizures in Odisha state.…”

The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia

“…MSAF and bloody amniotic fluid were found to be independent risk factors associated with birth asphyxia. 1,3,39,40 Bhatia et al indicated that free radicals were increased in the presence of MSAF and suggested that neonates with MSAF suffer from hypoxia regardless of the Apgar at birth. 41 Also, bloody amniotic fluid was associated with higher rates of placental abruption.…”