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Chronic partial asphyxia of newborn — Clinical Guidelines

Overview

Chronic partial asphyxia in newborns refers to insufficient oxygen supply around the time of birth, potentially leading to immediate and long-term neurological and systemic consequences 4.

Diagnosis

Key Diagnostic Criteria: Low Apgar scores (<7 at 5 minutes), particularly in conjunction with abnormal cardiotocography (CTG) tracings and delayed intervention 3.

Recommended Tests: Umbilical arterial blood gas analysis to assess acidemia (pH < 7.00) 5.

Grading: Severe asphyxia may be indicated by prolonged low Apgar scores (0-3 for >5 minutes) and presence of neurologic manifestations like seizures or hypotonia 5.

Management

First-Line Treatments: Immediate neonatal resuscitation including ventilation support and early paging of skilled personnel 3 5.

Adjunctive Treatments: Regular practice and quality improvement in resuscitation techniques to enhance outcomes 2.

Equipment: Utilization of resuscitation equipment boards to ensure organized and effective resuscitation efforts 8.

Special Populations

Pregnancy and Delivery: Insufficient fetal surveillance and improper use of oxytocin can exacerbate asphyxia risk 3.

Comorbidities: No specific guidance provided in the abstracts regarding comorbidities affecting management.

Key Recommendations

Implement regular and high-quality resuscitation training for all maternity staff to improve outcomes in asphyxiated newborns (Evidence: Moderate 2).

Ensure timely and appropriate intervention based on abnormal CTG tracings and fetal surveillance findings to prevent progression of asphyxia (Evidence: Moderate 3).

Use the Apgar score judiciously, recognizing its limitations in diagnosing acute neurologic injury without corroborating evidence such as profound acidemia and neurologic symptoms (Evidence: Strong 5).

References

1 Lenguerrand E, Winter C, Siassakos D, MacLennan G, Innes K, Lynch P et al.. Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial. BMJ quality & safety 2020. link 2 Hodgins S. Helping Babies Breathe-Beyond Training. Global health, science and practice 2018. link 3 Berglund S. "Every case of asphyxia can be used as a learning example". Conclusions from an analysis of substandard obstetrical care. Journal of perinatal medicine 2011. link 4 Perlman JM. Interruption of placental blood flow during labor: potential systemic and cerebral organ consequences. The Journal of pediatrics 2011. link 5 . Use and abuse of the Apgar score. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Pediatrics 1996. link 6 Shono H, Oga M, Shimomura K, Yamasaki M, Ito Y, Muro M et al.. Application of fuzzy logic to the Apgar scoring system. International journal of bio-medical computing 1992. link90074-3) 7 Pasternak JF. Parasagittal infarction in neonatal asphyxia. Annals of neurology 1987. link 8 Clark JM, Brown ZA, Jung AL. Resuscitation equipment board for nurseries and delivery rooms. JAMA 1976. link

Chronic partial asphyxia of newborn