PERINATAL ASPHYXIA- WHERE WE ARE TODAY?

Abstract

Perinatal asphyxia is the result of interruption of blood flow and gas exchange to the fetus in the perinatal period, and if it is significant, it may trigger a cascade of neuronal injury leading to neonatal encephalopathy and long-term damage. The World Health Organization (WHO) estimates around 3% of 120 million newborns every year in developing countries suffering from perinatal asphyxia, and some 900.000 of these newborns die each year. Hypoxic-ischaemic encephalopathy (HIE) is a major acute neurologic manifestation of perinatal asphyxia, and in severe HIE the mortality rate is reportedly up to 25-50%. Most deaths occur in the first week of life due to multiple organ failure or redirection of care. There has been significant research progress in perinatal asphyxia and consecuent HIE over the last two decades, and many new molecular mechanisms have been identified. Although a different parameters have been used to predict or define perinatal asphyxia no single marker of perinatal asphyxia has shown good predictive efficiency in the early assessment of perinatal asphyxia and its complications. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these newborns is more important than ever, as hypotermia is a time sensitive intervention, with a very narrow therapeutic window. So, we need to strive to effective, reliable and cheep markers to enable early identifications of newborns at risk of short or long term injury.