Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants.
Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) greater than or equal to 84, 3 had a GCI between 68 and 83 and 12 scored less than 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI less than 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay.
Shankaran
S
S
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Woldt
E
E
Koepke
T
T
Bedard
M P
MP
Nandyal
R
R
D000704:Analysis of Variance; D000886:Anthropometry; D001238:Asphyxia Neonatorum / Q000150:complications* / Q000401:mortality; D002493:Central Nervous System Diseases / Q000209:etiology*; D002675:Child, Preschool; D036861:Delivery, Obstetric; D002658:Developmental Disabilities / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis