title: Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy.
abstract: OBJECTIVE
  To identify the proportion of major organ system injury in cases of acute intrapartum asphyxia that result in neonatal encephalopathy.
  
  
  METHODS
  A prospectively maintained database was cross-referenced using medical record coding to identify diagnoses of acute intrapartum asphyxia, acute birth asphyxia, or neonatal encephalopathy over a 6-year period. An acute intrapartum asphyxial antecedent was validated with emphasis on excluding long-standing or chronic conditions where injury likely occurred before presentation. Injury pattern was evaluated using routinely available laboratory and imaging tests.
  
  
  RESULTS
  Forty-six cases of acute peripartum asphyxia sufficient to result in the diagnosis of neonatal encephalopathy were identified. Clinical central nervous system injury resulting in encephalopathy was present in 100% of cases as it was an entry criteria; of these, 49% had electroencephalogram and 40% had imaging studies diagnostic of acute injury. Liver injury based on elevated aspartate transaminase or alanine transaminase levels occurred in 80%. Heart injury, as defined by pressor or volume support beyond 2 hours of life or elevated cardiac enzymes, occurred in 78%. Renal injury, defined by an elevation of serum creatinine to greater than 1.0 mg/dL, persistent hematuria, persistent proteinuria, or clinical oliguria, occurred in 72%. An elevation in nucleated red blood cell counts exceeding 26 per 100 white blood cells occurred in 41%.
  
  
  CONCLUSIONS
  Using common diagnostic tests as markers of acute asphyxial injury, we noted that multiple organs suffer damage during an acute intrapartum asphyxial event sufficient to result in a neonatal encephalopathy.
authors.affiliation: Departments of Obstetrics and Gynecology, Galveston, Texas, USA. ghankins@utmb.edu
authors.forename: Gary D V
authors.initials: GD
authors.lastname: Hankins
authors.forename: Sophia
authors.initials: S
authors.lastname: Koen
authors.forename: Alfredo F
authors.initials: AF
authors.lastname: Gei
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Lopez
authors.forename: James W
authors.initials: JW
authors.lastname: Van Hook
authors.forename: Garland D
authors.initials: GD
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications*; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology*; D007231:Infant, Newborn; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology*; D011247:Pregnancy; D011446:Prospective Studies