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Perinatal asphyxia — Clinical Guidelines

Overview

Perinatal asphyxia refers to a condition where a newborn experiences significant interruption of oxygen supply around the time of birth, leading to potential multi-organ dysfunction and severe neurological consequences, including neonatal encephalopathy 2 5 18.

Diagnosis

Clinical signs include Apgar scores <7 at 5 minutes, metabolic acidosis, and neurological abnormalities 4 18.

Recommended tests involve blood gas analysis, cranial ultrasound, and MRI for brain injury assessment 4 18.

Grading systems often use Sarnat staging for neonatal encephalopathy severity 4.

Management

First-line treatment includes immediate resuscitation efforts, including ventilation support 18.

Therapeutic hypothermia (cooling to 33.5°C for 72 hours) is recommended for neonates meeting specific criteria 19 (Evidence: Strong).

Adjunctive treatments may include monitoring for and managing multi-organ dysfunction, though specific pharmacological interventions like prophylactic theophylline show mixed efficacy 13 (Evidence: Moderate).

Special Populations

Pregnancy: Limited direct evidence; focus on prevention and antenatal care 18.

Pediatrics: Neonatal management strategies apply, with emphasis on long-term neurological follow-up 2 18.

Comorbidities: No specific guidance provided in abstracts; general principles of supportive care apply 18.

Key Recommendations

Implement therapeutic hypothermia for neonates with perinatal asphyxia meeting specific criteria to improve neurological outcomes (Evidence: Strong) 19.

Provide comprehensive bereavement care training for healthcare professionals to enhance support for bereaved parents (Evidence: Moderate) 7 14.

Utilize cold cots and facilitate parental bonding time post-perinatal loss to improve psychological outcomes for parents (Evidence: Moderate) 17.

Enhance multidisciplinary team training in perinatal bereavement care to address the psychological impact on both parents and healthcare providers (Evidence: Expert opinion) 6 16.

References

1 Zhu Y, Zhang Q, Zhang Y, Zhao Q, Zhang A. Factors Influencing Bereavement Care Competence in Midwifery Students: Regression and QCA Analysis. Nursing open 2026. link 2 Demirel N, Unal S, Durukan M, Celik İH, Bas AY. Multi-organ dysfunction in infants with acidosis at birth in the absence of moderate to severe hypoxic ischemic encephalopathy. Early human development 2023. link 3 Martínez-García E, Lara-Rodríguez H, Álvarez-Serrano MA, González-García A, Martín-Salvador A, Gázquez-López M et al.. Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain. Midwifery 2023. link 4 Herbert D, Young K, Pietrusińska M, MacBeth A. The mental health impact of perinatal loss: A systematic review and meta-analysis. Journal of affective disorders 2022. link 5 Iribarren I, Hilario E, Álvarez A, Alonso-Alconada D. Neonatal multiple organ failure after perinatal asphyxia. Anales de pediatria 2022. link 6 Aggarwal N, Moatti Z. "Getting it right when it goes wrong - Effective bereavement care requires training of the whole maternity team". Best practice & research. Clinical obstetrics & gynaecology 2022. link 7 Qian J, Sun S, Wang M, Liu L, Yu X. Effectiveness of the implementation of a perinatal bereavement care training programme on nurses and midwives: protocol for a mixed-method study. BMJ open 2022. link 8 Qian J, Cai W, Sun S, Wang M, Yu X. Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study. Nurse education today 2022. link 9 Roberts LR, Sarpy NL, Peters J, Nick JM, Tamares S. Bereavement care immediately after perinatal loss in health care facilities: a scoping review protocol. JBI evidence synthesis 2022. link 10 Boyle FM, Horey D, Dean JH, Lohan A, Middleton P, Flenady V. Perinatal bereavement care during COVID-19 in Australian maternity settings. Journal of perinatal medicine 2022. link 11 Power A, Atkinson S, Noonan M. "Stranger in a mask" midwives' experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: A qualitative descriptive study. Midwifery 2022. link 12 Zhuang S, Ma X, Xiao G, Zhao Y, Hou J, Wang Y. Clinical practice guidelines for perinatal bereavement care: A systematic quality appraisal using AGREE II instrument. Journal of pediatric nursing 2022. link 13 Bellos I, Pandita A, Yachha M. Effectiveness of theophylline administration in neonates with perinatal asphyxia: a meta-analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2021. link 14 Leitao S, Helps A, Cotter R, O'Donoghue K. Development and evaluation of TEARDROP - a perinatal bereavement care training programme for healthcare professionals. Midwifery 2021. link 15 Paraíso Pueyo E, González Alonso AV, Botigué T, Masot O, Escobar-Bravo MÁ, Lavedán Santamaría A. Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review. International nursing review 2021. link 16 Qian J, Sun S, Wu M, Liu L, Yaping S, Yu X. Preparing nurses and midwives to provide perinatal bereavement care: A systematic scoping review. Nurse education today 2021. link 17 Smith P, Vasileiou K, Jordan A. Healthcare professionals' perceptions and experiences of using a cold cot following the loss of a baby: a qualitative study in maternity and neonatal units in the UK. BMC pregnancy and childbirth 2020. link 18 Usman F, Imam A, Farouk ZL, Dayyabu AL. Newborn Mortality in Sub-Saharan Africa: Why is Perinatal Asphyxia Still a Major Cause?. Annals of global health 2019. link 19 Üner IL, Johansen T, Dahle J, Persson M, Stiris T, Andresen JH. Therapeutic hypothermia and N-PASS; results from implementation in a level 3 NICU. Early human development 2019. link 20 Steen SE. Raising the bar: development of a perinatal bereavement programme. International journal of palliative nursing 2019. link 21 Wool C, Catlin A. Perinatal bereavement and palliative care offered throughout the healthcare system. Annals of palliative medicine 2019. link 22 Hutti MH, Limbo R. Using Theory to Inform and Guide Perinatal Bereavement Care. MCN. The American journal of maternal child nursing 2019. link 23 Doherty J, Cullen S, Casey B, Lloyd B, Sheehy L, Brosnan M et al.. Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives. Midwifery 2018. link 24 Aiyelaagbe E, Scott RE, Holmes V, Lane E, Heazell AEP. Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2017. link 25 Domingues AP, Belo A, Moura P, Vieira DN. Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 2015. link 26 Domingues AP, Moura P, Vieira DN. Lessons from a decade of technical-scientific opinions in obstetrical litigation. Journal of forensic and legal medicine 2014. link 27 Côté-Arsenault D, Schwartz K, Krowchuk H, McCoy TP. Evidence-based intervention with women pregnant after perinatal loss. MCN. The American journal of maternal child nursing 2014. link 28 Miller LH, Lindley LC, Mixer SJ, Fornehed ML, Niederhauser VP. Developing a perinatal memory-making program at a children's hospital. MCN. The American journal of maternal child nursing 2014. link 29 Friedrichs JB, Kobler K, Roose RE, Meyer C, Schmitz N, Kavanaugh K. Combining regional expertise to form a bereavement support alliance. MCN. The American journal of maternal child nursing 2014. link 30 Lathrop A, VandeVusse L. Continuity and change in mothers' narratives of perinatal hospice. The Journal of perinatal & neonatal nursing 2011. link 31 Chan MF, Lou FL, Cao FL, Li P, Liu L, Wu LH. Investigating factors associated with nurses' attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong. Journal of clinical nursing 2009. link 32 Chan MF, Lou FL, Arthur DG, Cao FL, Wu LH, Li P et al.. Investigating factors associate to nurses' attitudes towards perinatal bereavement care. Journal of clinical nursing 2008. link 33 Tarcan A, Tiker F, Güvenir H, Gürakan B. Hepatic involvement in perinatal asphyxia. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2007. link 34 Carter BS, Haverkamp AD, Merenstein GB. The definition of acute perinatal asphyxia. Clinics in perinatology 1993. link 35 Graham SB. When babies die: death and the education of obstetrical residents. Medical teacher 1991. link

Perinatal asphyxia