Intrauterine Asphyxia: Clinical Implications for Providers of Intrapartum Care

Jenifer Fahey, CNM, MSN, MPH; Tekoa L. King, CNM, MPH

Disclosures

J Midwifery Womens Health. 2005;50(6):498-506. 

In This Article

Neonatal Encephalopathy, Hypoxic-Ischemic Encepalopathy, and Cerebral Palsy

Neonatal encephalopathy is "a clinically-defined syndrome of disturbed neurologic function" that is seen in the first days of life of a term or near-term infant, and is manifested by "difficulty with initiating and maintaining respirations, depression of tone and reflexes, subnormal level of consciousness, and often, seizures."[11] Neonatal encephalopathy that results from systemic hypoxemia and decreased cerebral perfusion leading to ischemia is termed hypoxic-ischemic encephalopathy. Neonatal encephalopathies, including hypoxic-ischemic encephalopathies, can have multiple etiologies, including metabolic disease, infection, drug exposure, trauma, genetic disorders, nervous system anomalies, and intrapartum asphyxia.[12] Findings in near-term and term infants with hypoxic-ischemic encephalopathy include delay of spontaneous respirations at birth, seizures, altered level of consciousness, altered tone, decreased spontaneous movement, irregular respirations, apnea, poor or absent Moro's reflex, abnormal cry and suck, altered papillary responses, and stupor that develop in the first 72 hours after birth.[13] Long-term morbidity and/or mortality after hypoxic-ischemic encephalopathy depends on the extent and severity of the injury. However, not all hypoxic-ischemic encephalopathy results in permanent neurologic damage such as cerebral palsy.

Cerebral palsy is a term used to describe chronic, nonprogressive disorders appearing early in life, in which the defining symptoms are abnormal control of movement and posture.[14] Cerebral palsy results from abnormal development of or damage to the regions of the brain that control posture and movement. Cerebral palsy types are classified by the number of limbs involved (e.g., hemiplegia, quadriplegia, or hemiparesis) and the type of movement disorder (e.g., spastic, athetoid/dyskinetic, akinetic, ataxic, or mixed). The incidence of cerebral palsy in the United States is approximately 1.0 to 2.3 per 1000 births.[15]

Research suggests that spastic quadriplegia, and less often, dyskinetic cerebral palsy, are the only types of cerebral palsy associated with hypoxic intrapartum events but that neither of these types of cerebral palsy are specific to intrapartum asphyxia.[16,17] However, hemiplegic cerebral palsy, spastic diplegia, and ataxia are not associated with intrapartum asphyxia in term infants.[18]

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