morphine and Asphyxia-Neonatorum

Meconium stained amniotic fluid (MSAF) is common and associated with meconium aspiration syndrome (MAS). Other consequences of meconium passage before birth are less well understood.. We reviewed the literature for original papers reporting on outcomes associated with MSAF.. Among preterm infants MSAF is more prevalent than previously believed and is associated with higher neonatal morbidity. Intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS. No compelling evidence supported an association between MSAF and increased neurological impairment, including early seizure activity.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetus; Humans; Infant, Newborn; Infant, Premature; Meconium; Meconium Aspiration Syndrome; Otitis Media; Pregnancy; Seizures; Sepsis

Topics: Amniotic Fluid; Asphyxia Neonatorum; Extraembryonic Membranes; Female; Fetal Blood; Fetal Monitoring; Humans; Infant, Newborn; Labor Onset; Labor, Obstetric; Meconium; Oxytocin; Pregnancy

This report focuses on the relationship of placental pathology to unfavorable pregnancy outcome. Relevant literature is cited and data from the author's investigations are reported and tabulated. The reader will find detailed information on placental lesions that have not been completely investigated or discussed previously. Particular considerations include placental meconium staining, edema, acute and chronic intrauterine infections, placental fetal vasculopathy with fetal nucleated red blood cells, and chorangiosis or other placental dysmaturity. These pathologic changes often signify the pathogenesis of cerebral palsy and other developmental disorders. Almost 90% of neurodevelopmental disorders are initiated before the intrapartum period. Prenatal asphyxia or severe chronic fetal hypoxia are probably present therein. Most investigations of these afflictions are invalid because they do not include placental study with well-designed epidemiologic methods. The pathologic placental findings that are most strongly associated with perinatal asphyxia include chronic ischemic changes, fetal nucleated red blood cells, intravillous hemorrhage, fetal fibrin vascular intimal cushions, meconium staining, and placental intervillous fibrin. Chorioamnionitis is a pathologic entity rather than a clinical syndrome as defined by obstetricians. When it causes severe prematurity, chorioamnionitis is also associated with cerebral palsy.

Topics: Asphyxia Neonatorum; Chorioamnionitis; Edema; Erythrocytes; Female; Fetal Diseases; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy; Pregnancy Outcome; Specimen Handling

In this article, the authors examine whether indicators commonly used to recognized birth asphyxia are specific to asphyxial states, and whether these allow recognition of a severity of asphyxia sufficient to pose a risk of irreversible brain injury. Characteristics recognizable within the first hours after birth are focused on because these characteristics will be of most use in clinical decisions regarding use of potential new therapies for asphyxia.

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Biomarkers; Blood Gas Analysis; Brain Diseases; Causality; Cerebral Palsy; Decision Making; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Predictive Value of Tests; Pregnancy; Pulmonary Gas Exchange; Severity of Illness Index

Thirty-four infants who had a diagnosis of severe persistent pulmonary hypertension of the newborn at birth (alveolar-arterial oxygen difference greater than 600) were treated without paralysis or hyperventilation to induce alkalosis. All survived. Twenty-seven of these 34 eligible infants (79%) underwent neurologic, intelligence, and audiologic testing between 10 months and 6 years of age. Children who were younger than 1 year of age at the initial hearing test were retested after they reached 2 years of age. The average IQ was within the normal range (mean = 96.23). None had sensorineural hearing loss. Severe neurologic abnormalities were seen in 4 children, 3 of whom had been severely asphyxiated at birth (determined by biochemical criteria). Mild neurologic abnormalities were observed in 5 children. Two infants had bronchopulmonary dysplasia because they required supplemental oxygen for 29 and 66 days, respectively, and had abnormal chest roentgenograms; 1 patient takes intermittent doses of albuterol (Ventolin) and neither currently requires supplemental oxygen. This study of 27 infants with severe persistent pulmonary hypertension of the newborn suggests that conservative management without induced alkalosis or respiratory paralysis is accompanied by no sensorineural hearing loss and a good neurologic outcome.

Topics: Apgar Score; Asphyxia Neonatorum; Carbon Dioxide; Child; Child Development; Child, Preschool; Female; Follow-Up Studies; Hearing; Humans; Infant; Infant, Newborn; Intelligence; Male; Meconium; Oxygen; Oxygen Inhalation Therapy; Persistent Fetal Circulation Syndrome; Positive-Pressure Respiration; Psychomotor Performance; Time Factors; Treatment Outcome

Meconium-stained amniotic fluid occurs in approximately 12% of live births. In approximately one third of these infants meconium is present below the vocal cords. However, meconium aspiration syndrome develops in only 2 of every 1000 live-born infants. Ninety-five percent of infants with inhaled meconium clear the lungs spontaneously. Recent investigations have suggested that a reexamination of our assumptions about the etiology of meconium aspiration syndrome is in order. Several authors have provided evidence that support the hypothesis that it is not the inhaled meconium which produces the primary pathologic condition of meconium aspiration syndrome but rather it is fetal asphyxia that is the etiologic agent. Asphyxia in utero produces pulmonary vasospasm and hyperreactivity of the pulmonary vessels. With severe asphyxia the fetal lungs undergo pulmonary vascular damage with pulmonary hypertension. The damaged lungs are then unable to clear the meconium. In the most severe cases there is right-to-left shunting and persistent fetal circulation with subsequent fetal death. The incidence of meconium aspiration may thus be essentially unaffected by current obstetric and pediatric interventions at birth. For the asphyxiated or distressed infant we recommend suctioning at birth and tracheal intubation. In the healthy fetus observation may be sufficient.

Topics: Asphyxia Neonatorum; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Respiratory Insufficiency; Syndrome

There are conflicting opinions about the significance of 5 perinatal findings felt to be indicators of asphyxia (meconium staining of the amniotic fluid, abnormal fetal heart rate patterns, acidotic fetal scalp blood gases, low Apgar scores, and acidotic cord blood gases). A review of the literature was undertaken to determine the strength of association of each of these findings with adverse outcomes. Although all studies contained methodological problems, these indicators were found to have strong associations with one or more adverse outcomes such as perinatal death, low Apgar scores or cerebral palsy. The strength of the association (relative risk) was found to vary inversely with the prevalence of the outcome.

Topics: Acidosis; Apgar Score; Asphyxia Neonatorum; Fetal Blood; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Meconium; Prognosis; Risk

Perinatal asphyxia may occur prior to or at the time of birth, leading to hypoxia and acidosis with persistence of the fetal circulatory pattern. Resuscitation facilitates transition to the adult circulatory pattern by restoring normal oxygenation, ventilation, and perfusion. Assessment of the degree of asphyxia should utilize the Apgar score, and resuscitation should proceed in a stepwise fashion to an extent determined by the degree of depression. Aspects of resuscitation unique to the newborn are reviewed, in addition to situations requiring specific intervention.

Topics: Anesthesia, Obstetrical; Apgar Score; Asphyxia Neonatorum; Female; Heart Rate; Humans; Infant, Newborn; Inhalation; Meconium; Pregnancy; Resuscitation

Topics: Acid-Base Equilibrium; Apgar Score; Asphyxia Neonatorum; Atropine; Bicarbonates; Blood Transfusion; Calcium Gluconate; Epinephrine; Female; Fetal Blood; Fetal Organ Maturity; Glucose; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intubation, Intratracheal; Isoproterenol; Lung; Meconium; Narcotic Antagonists; Pregnancy; Resuscitation; Sodium Bicarbonate

Topics: Asphyxia Neonatorum; Blood Viscosity; Female; Fetal Growth Retardation; Humans; Hyperglycemia; Hypocalcemia; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Patient Care Team; Pneumonia, Aspiration; Pregnancy; Prognosis

Topics: Acid-Base Equilibrium; Acidosis; Asphyxia Neonatorum; Blood Circulation; Blood Glucose; Body Temperature Regulation; Calcium; Central Nervous System Diseases; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Meconium; Oxygen Consumption; Pneumonia, Aspiration

Topics: Asphyxia Neonatorum; Delivery, Obstetric; Epinephrine; Female; Humans; Infant, Newborn; Infant, Premature; Intubation, Intratracheal; Meconium; Oxygen; Plasma Substitutes; Positive-Pressure Respiration; Pregnancy; Respiration, Artificial; Shock, Hemorrhagic; Suction

Topics: Animals; Animals, Newborn; Asphyxia Neonatorum; Birth Order; Carbon Dioxide; Delivery, Obstetric; Environmental Exposure; Female; Fetal Death; Fetus; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant, Newborn; Lactates; Meconium; Obstetric Labor Complications; Oxygen; Pregnancy; Respiration; Stress, Physiological; Swine; Swine Diseases; Temperature; Umbilical Cord

Topics: Asphyxia Neonatorum; Humans; Infant, Newborn; Inhalation; Meconium; Respiratory Distress Syndrome, Newborn; Therapeutic Irrigation; Trachea

Topics: Acidosis; Animals; Animals, Newborn; Asphyxia Neonatorum; Bacterial Infections; Cerebral Hemorrhage; Erythroblastosis, Fetal; Female; Fetal Diseases; Hepatitis, Animal; Horse Diseases; Horses; Humans; Hypoglycemia; Hypoxia; Infant, Newborn; Meconium; Nephritis; Pregnancy; Respiratory Insufficiency; Seizures; Syndrome; Virus Diseases

Topics: Amniotic Fluid; Asphyxia Neonatorum; Estriol; Female; Fetal Death; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant Mortality; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnanediol; United Kingdom

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Free Radicals; Humans; Hypoxanthine; Hypoxia-Ischemia, Brain; Infant, Newborn; Labor, Obstetric; Malondialdehyde; Meconium; Pregnancy; Xanthine

Cord blood pH, lactate, hypoxanthine, and erythropoietin levels have all been used as markers of either acute or chronic asphyxia. We sought to determine whether these index values were significantly different in infants with or without meconium-stained amniotic fluid.. Fifty-six pregnant women in spontaneous labor at term were divided into two groups on the basis of the presence or absence of meconium-stained amniotic fluid. All meconium-stained fluid was centrifuged, and the volume percentage of particulate matter (i.e., meconium) was recorded. Umbilical artery blood and mixed arterial and venous cord blood were obtained at each delivery. Lactate, hypoxanthine, and erythropoietin levels were measured. Statistical analysis included Student t test and rank sum statistics where appropriate. Normal and Spearman correlation coefficients were also used.. There were no significant differences in mean umbilical artery pH (7.26 +/- 0.06 vs 7.25 +/- 0.10), lactate levels (32.8 +/- 10 mg/dl vs 30.4 +/- 14.2 mg/dl), and hypoxanthine levels (13.4 +/- 6.7 mumol/L vs 14.0 +/- 6.0 mumol/L) in newborns with meconium (n = 28) compared with controls (n = 28). Erythropoietin levels were significantly greater in newborns with meconium (median 39.5 mIU/ml vs 26.8 mIU/ml, p = 0.039). There was no correlation between the amount of particulate matter and any marker of asphyxia.. There was no correlation between markers of acute asphyxia (i.e., umbilical artery blood pH, lactate, or hypoxanthine) and meconium. However, erythropoietin levels were significantly elevated in newborns with meconium-stained amniotic fluid. This latter marker may better correlate with chronic asphyxia.

Topics: Acute Disease; Adolescent; Adult; Amniotic Fluid; Asphyxia Neonatorum; Biomarkers; Chronic Disease; Erythropoietin; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Hypoxanthines; Infant, Newborn; Lactates; Meconium

The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia.. A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI.. There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups.. Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Topics: Amniotic Fluid; Asphyxia; Asphyxia Neonatorum; Ethiopia; Female; Hospitals; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Meconium Aspiration Syndrome; Neonatal Sepsis; Pregnancy; Pregnancy Complications; Prospective Studies

Meconium-stained amniotic fluid is considered as the bad predictor of fetal outcome having significant perinatal morbidity and mortality. This study aimed to compare immediate fetal outcomes in meconium-stained amniotic fluid and clear amniotic fluid.. Hospital-based comparative observational study was conducted from a total of 204 women admitted in labour room at a tertiary level hospital. Among them, 102 were cases with meconium-stained amniotic fluid, and 102 were comparison groups with clear amniotic fluid. Fetal outcome was compared between these two groups.. The study findings revealed that majority (74.5%) in the study group had cesarean section as compared to 14.7% in the comparative group. More than one-fourth (26.5%) of the newborns in the study group had moderate to severe birth asphyxia, needed resuscitation (25.5%) and neonatal intensive care unit admission (25.5%) as compared to 3.9% from the comparative group. Maternal age (COR=0.34, 95%CI=0.15-0.81), color of amniotic fluid (COR=0.11; 95%CI=0.04-0.33), meconium consistency (COR=0.27; 95%CI=0.17-0.43), and mode of delivery (COR=0.36; 95%CI=0.17-0.79) were associated with birth asphyxia in bivariate analysis. Maternal age (AOR=2.66; 95%CI=1.04-6.81) and color of amniotic fluid (AOR=11.50; 95%CI=2.97-44.56) were associated with birth asphyxia in the multivariate analysis.. Meconium-stained amniotic fluid was associated with increased frequency of cesarean section and adverse fetal outcome with birth asphyxia being the major complications compared with clear amniotic fluid. Predictors of birth asphyxia were maternal age and color of amniotic fluid.

Topics: Amniotic Fluid; Asphyxia; Asphyxia Neonatorum; Cesarean Section; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Nepal; Pregnancy; Pregnancy Complications

More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies.. Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI.. The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI.. The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.

Topics: Adolescent; Adult; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Cross-Sectional Studies; Ethiopia; Female; Fetal Membranes, Premature Rupture; Hospitals, General; Humans; Infant, Newborn; Labor Presentation; Live Birth; Male; Meconium; Perinatal Death; Photoperiod; Pregnancy; Prevalence; Risk Factors; Time Factors; Vacuum Extraction, Obstetrical; Young Adult

To determine the perinatal outcome of labouring mothers with meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid at teaching referral hospital in urban Ethiopia.. A prospective cohort study was conducted among labouring mothers with meconium-stained amniotic fluid from July 1 to December 30, 2019. Data was collected with pretested structured questionnaires. A Chi-square test used to check statistical associations between variables. Those variables with a p-value of less than 0.05 were selected for cross-tabulation and binary logistic regression. P-value set at 0.05, and 95% CI was used to determine the significance of the association. Relative risk was used to determine the strength and direction of the association.. Among 438 participants, there where 75(52.1%) primigravida in a stained fluid group compared to112 (38.5%) of the non-stained fluid group. Labour was induced in 25 (17.4%) of the stained fluid group compared to 25(8.6%) of a non-stained fluid group and has a statistically significant association with meconium staining. The stained fluid group was twice more likely to undergo operative delivery compared with a non-stained fluid group. There were more low Apgar scores at birth (36.8% versus 13.2%), birth asphyxias (9% versus 2.4%), neonatal sepsis (1% versus 5.6%), neonatal death (1% versus 9%), and increased admissions to neonatal intensive care unit (6.2% versus 21.5%) among the meconium-stained group as compared to the non-stained group. Meconium aspiration syndrome was seen in 9(6.3%) of the stained fluid group.. Meconium-stained amniotic fluid is associated with increased frequency of operative delivery, birth asphyxia, neonatal sepsis, and neonatal intensive care unit admissions compared to clear amniotic fluid.

Topics: Adult; Amnion; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Ethiopia; Female; Hospitals; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Labor, Obstetric; Male; Meconium; Meconium Aspiration Syndrome; Mothers; Parturition; Pregnancy; Pregnancy Complications; Prospective Studies; Referral and Consultation; Young Adult

To validate established neonatal neutrophil reference ranges (RRs) and determine the utility of serial measurements of neutrophil values in the first 24 hours to predict the absence of neonatal early-onset sepsis (EOS).. Retrospective study of 2073 admissions to the neonatal intensive care unit (2009-2011). Neonates were classified as blood culture-positive, proven EOS (n = 9), blood culture-negative but clinically suspect EOS (n = 292), and not infected (n = 1292). Neutrophil values from 745 not-infected neonates without perinatal complications were selected to validate RR distributions. Positive and negative predictive values were calculated; area under receiver operating characteristic curves (AUCs) were constructed to predict the presence or absence of EOS. Neutrophil value scores were established to determine whether serial neutrophil values predict the absence of EOS.. Seventy-seven percent of admissions to the neonatal intensive care unit were evaluated for EOS: 9 (0.56%) had proven EOS with positive blood culture ≤ 37 hours; 18% had clinically suspect EOS. Neutropenia occurred in preterm neonates, and nonspecific neutrophilia was common in uninfected neonates. The distribution of neutrophil values differed significantly between study groups. The specificity for absolute total immature neutrophils and immature to total neutrophil proportions was 91% and 94%, respectively, with negative predictive value of 99% for proven and 78% for proven plus suspect EOS. Absolute total immature neutrophils and immature to total neutrophil proportions had the best predictability for EOS >6 hours postnatal with an AUC ∼ 0.8. Neutrophil value scores predicted the absence of EOS with AUC of 0.9 and 0.81 for proven and proven plus suspect EOS, respectively.. Age-dependent neutrophil RRs remain valid. Serial neutrophil values at 0, 12, and 24 hours plus blood culture and clinical evaluation can be used to discontinue antimicrobial therapy at 36-48 hours.

Topics: Apgar Score; Asphyxia Neonatorum; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meconium; Neutrophils; Predictive Value of Tests; Pregnancy; Reference Values; Resuscitation; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Sepsis

The purpose of this study was to determine risk factors that are associated with hypoxic ischemic encephalopathy (HIE).. This was a case-control study that included newborn infants with HIE who were admitted to the hospital between January 2001 and December 2008. Two control newborn infants were chosen for each case. Logistic regression and classification and regression tree (CART) analysis that compared control infants and cases with grade 1 HIE and control infants and cases with grades 2 and 3 HIE was performed.. Two hundred thirty-seven cases (newborn infants with grade 1 encephalopathy, 155; newborn infants with grade 2 encephalopathy, 61; newborn infants with grade 3 encephalopathy, 21) and 489 control infants were included. Variables that were associated independently with HIE included higher grade meconium, growth restriction, large head circumference, oligohydramnios, male sex, fetal bradycardia, maternal pyrexia and increased uterine contractility. CART analysis ranked high-grade meconium, oligohydramnios, and the presence of obstetric complications as the most discriminating variables and defined distinct risk groups with HIE rates that ranged from 0-86%.. CART analysis provides information to help identify the time at which intervention in labor may be of benefit.

Topics: Asphyxia Neonatorum; Case-Control Studies; Female; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Logistic Models; Male; Meconium; Obstetric Labor Complications; Odds Ratio; Oligohydramnios; Pregnancy; Risk Factors

Neonatal asphyxia may have severe consequences in term newborns. Our purpose was to identify possible risk factors of severe acidosis during pregnancy and labor.. In a case-control study from January 2003 to December 2008 in three university perinatal centers (two French and one Canadian hospitals), we analyzed 226 women with term pregnancies complicated by severe neonatal acidosis (umbilical artery pH less than 7.00). Cases were individually matched with controls with a normal acid-base status (pH 7.15 or greater) paired by parity. Groups were compared for differences in maternal, obstetric, and fetal characteristics. Univariable and logistic conditional regression were used to identify possible risk factors.. Among 46,722 births after 22 weeks, 6,572 preterm births and 829 stillbirths or terminations of pregnancy were excluded. From the 39,321 live term births, 5.30% of pH values were unavailable. Severe acidosis complicated 0.63% of 37,235 term structurally normal pregnancies. By using multivariate conditional regression, maternal age 35 years or older (35.0% compared with 15.5%; odds ratio [OR] 5.58, 95% confidence interval [CI] 2.51-12.40), prior neonatal death (3.5% compared with 0%), prior cesarean delivery (24.7% compared with 6.6%; OR 4.08, 95% CI 1.71-9.72) even after excluding cases of uterine rupture, general anesthesia (8.4 compared with 0.9%; OR 8.04, 95% CI 1.26-50.60), thick meconium (6.4% compared with 2.8%; OR 5.81, 95% CI 1.72-19.66), uterine rupture (4.4% compared with 0%), and abnormal fetal heart rate (66.1% compared with 19.8%; OR 8.77, 95% CI 3.72-20.78) were independent risk factors of severe neonatal acidosis.. Prior cesarean delivery, maternal age 35 years or older, prior neonatal death, general anesthesia, thick meconium, uterine rupture, and abnormal fetal heart rate are independent risk factors of severe neonatal acidosis.. II.

Topics: Acidosis; Adult; Anesthesia, General; Apgar Score; Asphyxia Neonatorum; Case-Control Studies; Cesarean Section; Female; Heart Rate, Fetal; Humans; Infant Mortality; Infant, Newborn; Male; Meconium; Pregnancy; Risk Factors; Severity of Illness Index; Uterine Rupture

The effects of meconium-stained amniotic fluid (MSAF) on cord blood vascular endothelial growth factor (VEGF) levels have not been explored. The aim of this study was to verify whether MSAF influences cord blood VEGF levels in healthy term neonates and we can use cord blood VEGF levels in infants with MSAF as an indicator of fetal distress.. Using an enzyme-linked immunosorbent assay double sandwich method, plasma VEGF levels were determined in 18 healthy term neonates with MSAF and in 16 healthy term neonates without MSAF.. VEGF plasma levels were not significantly different between healthy term neonates with or without MSAF.. Intrauterine meconium passage could not affect VEGF levels on cord blood in term newborn infants and VEGF level may not be used as an indicator of fetal distress in infants with MSAF.

Topics: Amniotic Fluid; Asphyxia Neonatorum; Biomarkers; Diagnosis, Differential; Fetal Blood; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Vascular Endothelial Growth Factor A

Modern medical practice has changed dramatically during the past decades because of improved technology. Still, fetal surveillance during labor is relatively unchanged since 1960 s when fetal heart rate monitoring (FHR) became standard practice. Newborn infants are still suffering from birth asphyxia and in severe cases leading to hypoxic ischemic encephalopathy (HIE) which sometimes results in permanent neurological damage. The incidence of birth asphyxia and HIE in Iceland is unknown and so are the risk factors for severe asphyxia. The objective of this study was to assess the incidence, obstetric risk factors and the sequela of severe asphyxia at Landspitali university hospital (LSH).. All term infants born at LSH from 1.1.1997- 31.12.2001 with birth asphyxia, defined as five minute Apgar score %lt;6, were included in the study (n=127). Clinical information were collected retrospectively from maternal records on maternal diseases during pregnancy, cardiotocogram (CTG), type of birth, the presence of meconium and operative delivery rates. Information was also collected regarding birth asphyxia and HIE in the neonatal period.. The incidence of birth asphyxia was 9.4/1000 live term births during the study period, with increasing incidence during the three last years. The incidence of HIE was 1.4/ 1,000 live term births. Severe maternal diseases during pregnancy were not a significant risk factor for asphyxia. The amniotic fluid was meconium stained in fifty percent of cases and the umbilical cord was wrapped around the fetal neck in 41% of cases. Abnormal CTG tracing was observed in 66% of cases in the study group and in 79% of the HIE cases. Operative deliveries were significantly more common in the study cohort compared with other deliveries at LSH at the same time: ventouse delivery 22% vs 6.8% (p<0,001), forceps delivery 6.3% vs 1,03% (p<0,001), emergency cesarean section 19.7% vs 11.4% ( p=0,008).. The incidence of birth asphyxia is higher in LSH compared with the incidence found in other studies. Signs of fetal distress on CTG and delivery with operative interventions are common. With current available methods to detect intrapartum asphyxia there is a poor correlation with CTG and the development of HIE after severe asphyxia. The presence of severe maternal diseases does not correlate with increased incidence of asphyxia, presumably due to increased surveillance of these pregnancies and a lower treshold for intervention during delivery. In low risk pregnancies there is a lack of appropriate methods with high sensitivity and specificity to detect intrapartum asphyxia.

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Cardiotocography; Delivery, Obstetric; Female; Heart Rate, Fetal; Humans; Hypoxia-Ischemia, Brain; Iceland; Incidence; Infant, Newborn; Meconium; Obstetric Labor Complications; Odds Ratio; Pregnancy; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index

ACOG states meconium stained amniotic fluid (MSAF) as one of the historical indicators of perinatal asphyxia. Thick meconium along with other indicators is used to identify babies with severe intrapartum asphyxia. Lactate creatinine ratio (L:C ratio) of 0.64 or higher in first passed urine of babies suffering severe intrapartum asphyxia has been shown to predict Hypoxic Ischaemic Encephalopathy (HIE). Literature review shows that meconium is passed in distress and thin meconium results from mixing and dilution over time, which may be hours to days. Thin meconium may thus be used as an indicator of antepartum asphyxia. We tested L:C ratios in a group of babies born through thin and thick meconium, and for comparison, in a group of babies without meconium at birth.. 86 consecutive newborns, 36 to 42 weeks of gestation, with meconium staining of liquor, were recruited for the study. 52 voided urine within 6 hours of birth; of these 27 had thick meconium and 25 had thin meconium at birth. 42 others, who did not have meconium or any other signs of asphyxia at birth provided controls. Lactate and creatinine levels in urine were tested by standard enzymatic methods in the three groups.. Lactate values are highest in the thin MSAF group followed by the thick MSAF and controls. Creatinine was lowest in the thin MSAF, followed by thick MSAF and controls. Normal babies had an average L:C ratio of 0.13 (+/- 0.09). L:C ratio was more among thin MSAF babies (4.3 +/- 11.94) than thick MSAF babies (0.35 +/- 0.35). Median L:C ratio was also higher in the thin MSAF group. Variation in the values of these parameters is observed to be high in the thin MSAF group as compared to other groups. L:C ratio was above the cutoff of 0.64 of Huang et al in 40% of those with thin meconium. 2 of these developed signs of HIE with convulsions (HIE Sarnat and Sarnat Stage II) during hospital stay. One had L:C Ratio of 93 and the other of 58.6. A smaller proportion (20%) of those with thick meconium had levels above the cutoff and 2 developed HIE and convulsions with L:C ratio of 1.25 and 1.1 respectively.. In evolving a cutoff of L:C ratios that would be highly sensitive and specific (0.64), Huang et al studied it in a series of babies with severe intrapartum asphyxia. Our study shows that the specificity may not be as good if babies born through thin meconium are also included. L:C ratios are much higher in babies with thin meconium. It may be that meconium alone is not a good indicator of asphyxia and the risk of HIE. However, if the presence of meconium implies asphyxia then perhaps a higher cut-off than 0.64 is needed. L:C ratios should be tested in a larger sample that includes babies with thin meconium, before L:C ratios can be applied universally.

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Creatinine; Female; Gestational Age; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Lactic Acid; Male; Meconium; Sensitivity and Specificity

Topics: Air; Amniotic Fluid; Animals; Asphyxia Neonatorum; Cardiomyopathies; Contraindications; Disease Susceptibility; Dose-Response Relationship, Drug; Europe; Humans; Hypoxia; Infant, Newborn; Kidney Diseases; Meconium; Models, Animal; Muscle Hypotonia; Neoplasms; Oxygen; Oxygen Inhalation Therapy; Practice Guidelines as Topic; Resuscitation; United States

Clinical diagnosis of acute foetal distress (AFD) is based on several parameters such as abnormal foetal heart rate (FHR) pattern and/or meconium liquid staining (MLS). Standards for cord blood (CB) banking indicate that AFD should be considered as exclusion criteria for CB collection, but precise guidelines on how to proceed with CB collection in the presence of AFD signs during labour are not available. We evaluated whether the presence of FHR abnormality and/or MLS during labour 1) reduced the CB collection activity; 2) were associated with the infant's acidaemia or asphyxia and 3) deteriorated the biological characteristics of CB units. Thirty-three units of CB were evaluated for biological parameters, gas values and newborn's Apgar score. The results were compared with a control group of 33 consecutive units previously banked. No differences were observed between the two groups and all but one newborn showed normal Apgar score and absence of metabolic acidaemia. The results showed that 1) AFD reduced the CB collection activity by 10% each year; 2) the majority of CB units collected in the presence of abnormal FHR and/or meconium have biological characteristics eligible for banking; 3) FHR alterations or meconium in the presence of normal gas analysis do not represent certain diagnosis of AFD.

Topics: Apgar Score; Asphyxia Neonatorum; Blood Donors; Blood Preservation; Blood Specimen Collection; Contraindications; Cryopreservation; Donor Selection; Female; Fetal Blood; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Outcome

This study was undertaken to examine the roles of clinical risk scoring, electronic fetal heart rate monitoring, and fetal blood gas and acid-base assessment in the prediction and prevention of intrapartum fetal asphyxia in term pregnancies.. The outcomes of 166 term pregnancies with biochemically confirmed fetal asphyxia (umbilical artery base deficit at delivery, >12 mmol/L) were examined. This population included 83 pregnancies delivered abdominally matched with 83 pregnancies delivered vaginally. Antepartum and intrapartum clinical risk factors and neonatal complications were documented. Fetal assessments included fetal heart rate patterns in the fetal heart rate record and fetal capillary blood gas and acid-base assessments. Fetal asphyxia was classified as mild, moderate, or severe on the basis of umbilical artery base deficit (cutoff >12 mmol/L) and neonatal encephalopathy and other organ system complications.. Fetal asphyxial exposures were as follows: mild, 140; moderate, 22; and severe, 4. Intervention and delivery during the first or second stage of labor occurred in 98 of the 166 pregnancies. Predictive fetal heart rate patterns were the primary indication leading to intervention and delivery during the first or second stage of labor. Clinical risk factors when present were secondary indications in the clinical decision to intervene. Fetal blood gas and acid-base assessment was a useful supplementary test in 41 pregnancies. Intervention and delivery may have prevented the progression of mild asphyxia in 78 pregnancies and may have modified the degree of moderate or severe asphyxia in 20 pregnancies.. Although fetal heart rate patterns will not discriminate all asphyxial exposures, continuous fetal heart rate monitoring supplemented by fetal blood gas and acid-base assessment can be a useful fetal assessment paradigm for intrapartum fetal asphyxia. Such an assessment paradigm will not prevent all cases of moderate or severe fetal asphyxia. However, prediction and diagnosis with intervention and delivery during the first or second stage of labor could prevent the progression of mild asphyxia to moderate or severe asphyxia in some cases.

Topics: Acid-Base Imbalance; Amniotic Fluid; Asphyxia Neonatorum; Capillaries; Carbon Dioxide; Female; Fetal Blood; Fetal Monitoring; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium; Oxygen; Pregnancy; Risk Factors; Umbilical Arteries

The delivery room management of infants born through meconium stained amniotic fluid (MSAF) remains controversial. The aim of this prospective study was to evaluate maternal and neonatal characteristics of MSAF infants and the incidence of meconium aspiration syndrome (MAS) in routine delivery room management which reserved selective intubation for depressed/asphyxiated babies. Between October 1993 and September 1997, a consecutive sample of 3745 full-term infants was analyzed. Of these, 361 were MSAF infants. No significant difference in maternal age, parity, gestational age, sex, low 1 and 5 minute Apgar scores, metabolic acidemia, or need for endotracheal intubation was found between MSAF and non-MSAF infants. Only one of the MSAF infants (0.28%), who needed intubation, developed MAS. Identification of postterm pregnancy and prenatal asphyxia is the best prevention of MAS.

Topics: Adult; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Gestational Age; Humans; Infant, Newborn; Intubation, Intratracheal; Male; Meconium; Meconium Aspiration Syndrome; Prospective Studies

Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use.. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconium-stained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative.. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n=36), FHRT abnormalities and MSAF (n=20), MSAF only (n=23), abruptio placentae (n=6), intubation in the DR (n=44), intubation in the neonatal intensive care unit (n=22), chest compressions (n=2), 5-minute Apgar scores of 5 or less (n=21), umbilical cord arterial pH of 7.00 or less (n=21), and base deficits of -14 mEq/L or more negative (n=19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds rations (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%.. A combination of high-risk postnatal markers, specifically, a low 5-minute Apgar score and intubation in the DR in association with severe fetal acidemia, facilitates the identification within the first hour of life of term infants at highest risk for developing seizures secondary to perinatal asphyxia.

Topics: Abruptio Placentae; Acid-Base Imbalance; Adrenergic Agonists; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Brain Ischemia; Cardiopulmonary Resuscitation; Cerebral Palsy; Epinephrine; Female; Fetal Blood; Forecasting; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Hypoxia, Brain; Infant, Newborn; Intensive Care, Neonatal; Intubation, Intratracheal; Meconium; Positive-Pressure Respiration; Pregnancy; Prospective Studies; Risk Factors; Seizures

Our purpose was to evaluate the outcomes of pregnancies complicated by a multiple (double, triple, or quadruple) nuchal cord entanglement.. Computerized data from our University Hospital perinatal database were reviewed between 1990 and 1994. Only singleton, vertex, and term pregnancies undergoing labor were analyzed. Patients with active perinatal complications were eliminated to reduce bias. Pregnancies with infants with either a single or no nuchal cord entanglement served as comparison groups. A comparison of frequencies in the three groups was by chi 2 testing and a comparison of means by a two-tailed Student t test and analysis of variance.. Of the 8565 deliveries, the frequency of two or more cord entanglements at delivery was 3.8%. Compared with a single or no cord entanglement, pregnancies with a multiple entanglement were more likely to exhibit an abnormal fetal heart rate pattern during advanced labor (p < 0.001) and to require low or midforceps application (p < 0.001). The study infants were also more likely to have meconium (p = 0.013), a low 1-minute Apgar score (p < 0.001), and an umbilical artery pH < or = 7.10 (odds ratio 2.2, p = 0.013) than the controls. Rates of abruptio placentae, cesarean delivery, and 5-minute Apgar scores < 7 were no more common in the multiple entanglement than the control groups.. A multiple nuchal cord entanglement was associated with a greater risk of meconium, an abnormal fetal heart rate pattern during advanced labor, the need for operative vaginal delivery, and mild umbilical artery acidosis at birth; however, there was no added risk of an adverse neonatal outcome.

Topics: Acidosis, Respiratory; Adolescent; Adult; Analysis of Variance; Asphyxia Neonatorum; Chi-Square Distribution; Female; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Umbilical Arteries; Umbilical Cord

Our purpose was to determine the effects of labor and fetal hypoxia on the levels of insulin-like growth factor binding protein-1 in the maternal and fetal circulation.. Serum levels of insulin-like growth factor binding protein-1 were determined in maternal and umbilical blood at delivery in two groups. The first group included 43 vaginal deliveries and 23 elective cesarean sections. The second group consisted of 44 women; in 24 the liquor was meconium stained and in 20 it was clear.. Levels of insulin-like growth factor binding protein-1 in the neonate were lower in deliveries occurring before onset of labor (p < 0.001), Mann-Whitney U test) and higher in cases with severe meconium staining (p = 0.01). There were no differences in maternal levels of insulin-like growth factor binding protein-1 between subjects in labor and not in labor or those with or without meconium staining.. The process of labor leads to an increase in fetal levels of insulin-like growth factor binding protein-1. This increase may well be associated with the relative fetal stress that occurs during labor. This suggestion is supported by the finding of the highest levels in labors in which there was thick staining of the liquor.

Topics: Adolescent; Adult; Amniotic Fluid; Asphyxia Neonatorum; Carrier Proteins; Cesarean Section; Delivery, Obstetric; Female; Fetal Blood; Humans; Infant, Newborn; Insulin-Like Growth Factor Binding Protein 1; Insulin-Like Growth Factor I; Labor, Obstetric; Male; Meconium; Pregnancy; Somatomedins

A total of 3472 deliveries were studied over a year to evaluate (i) the importance of thin meconium stained liquor (MSL) in the causation of meconium aspiration syndrome (MAS), and (ii) the efficacy of intrapartum plus endotracheal suction at birth in the prevention of MAS due to thin meconium. Two hundred and ninety four (8.5%) of deliveries had meconium stained liquor of which thin MSL was present in 101. MAS occurred in 98 babies. Thin MSL was responsible for 19.4% of cases of MAS. Inspite of intrapartum suction, a high proportion (55-78%) of infants had meconium in the trachea, though thin meconium was found in the trachea significantly less often than thick meconium. Combined intrapartum and endotracheal suction reduced the incidence of MAS due to thin meconium from 26% to 16%. MAS due to thin meconium occurred in asphyxiated as well as vigorous babies inspite of combined suction. Thin meconium accounts for a significant proportion of deliveries with MSL and causes a considerable number of cases of MAS. To prevent meconium aspiration syndrome caused by thin meconium, all neonates born through thin MSL, whether they are asphyxiated or not should undergo intrapartum suction followed by immediate endotracheal suction at birth.

Topics: Asphyxia Neonatorum; Delivery, Obstetric; Female; Humans; Incidence; Infant Care; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Mouth; Nasopharynx; Pneumonia, Aspiration; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn; Suction; Trachea

The Neonatal Resuscitation Programme, sponsored by the Canadian Heart and Stroke Foundation and by the American Heart Association, is a structured learning package and workshop for all individuals who provide resuscitation for newborns. The emphasis is on rapid, decisive action using algorithms based on clearly stated criteria. This CME article serves as an introduction to the NRP and discusses some of the new guidelines regarding concurrent ventilation and chest compressions, tracheal suction for meconium and the use of medications. The author encourages readers who find this article helpful to register in an accredited NRP course to receive the extensive illustrated textbook and to benefit from the "hands-on" nature of the workshop.

Topics: Asphyxia Neonatorum; Body Temperature; Cyanosis; Education, Medical, Continuing; Epinephrine; Heart Rate; Humans; Infant, Newborn; Intubation, Intratracheal; Laryngoscopy; Masks; Meconium; Naloxone; Plasma Substitutes; Positive-Pressure Respiration; Practice Guidelines as Topic; Respiration; Respiration, Artificial; Resuscitation; Suction

Several authors had reported high blood volumes (BV) and Low placental residual blood volumes (PRBV) in hypoxic human newborns, and also in asphyxiated experimentally animals. Those findings could be explained by and exaggerated intrauterine placental transfusion, ante or intrapartum. The authors had observed high cord blood and 24-48 hs. hematocrits in meconium-stained amniotic fluid (MSAF) and/or low 1 minute Apgar score newborns (Nb), despite early cord clamping. Sometimes, by delaying cord clamping up to 1 minute, those hematocrits had a tendency to decrease, instead of increasing. In view of that, it was decided to measure BV in a small group of similar type of Nb's with Evans blue (T-1824) and to practice in some of them a delayed cord clamping, but elevating the infant above the introitus (DECC). The BV values obtained were a little higher than the ones from the literature, being the most elevated in Nb's with MSAF and the lowest from cesarean. Also, the early cord clamping babies had higher BV than the DECC. All the MSAF Nb's had low plasmatic BV. BV was positively related to Birth Weight and the Hematocrit, and inversely to the Apgar score and the cord blood pH. Unexpectedly, delayed cord clamping was only slightly related to Red Cell BV, not to BV. MSAF constitutes 10% of all deliveries and delayed cord clamping has to be re-evaluated, because it offers a good chance for those babies of developing a normal BV or Hct's.

Topics: Asphyxia Neonatorum; Blood Volume; Constriction; Female; Hematocrit; Humans; Infant, Newborn; Male; Meconium; Polycythemia; Time Factors

Determination of the percent by volume of the solid component of meconium (the "meconiumcrit") provides a more objective method of characterizing the type of meconium. In a study of 106 women with meconium-stained amniotic fluid, 61 (58%) had thin meconium, 36 (34%) had moderate meconium, and nine (8%) had thick meconium. There was no correlation between the type of meconium and newborn acidemia (umbilical artery pH, less than 7.20)--13%, 19%, and 11%, respectively. None of the newborns with either thin or thick meconium had 1-minute Apgar scores of less than or equal to 3 and only two with moderate meconium had such Apgar scores; none had an Apgar score of less than or equal to 3 at 5 minutes. None of the newborns with thin or moderate meconium had meconium aspiration syndrome, although two of nine infants with thick meconium did have meconium aspiration syndrome. All newborns subsequently did well and left the hospital in good condition. There would appear to be no correlation between the consistency of meconium and recently reported criteria for defining birth asphyxia.

Topics: Apgar Score; Asphyxia Neonatorum; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome

Analyses were undertaken to determine the causes of cerebral palsy in a prospective study of 43,437 full-term children. Presumed causes were found for about 71% of the 34 quadriplegic and 40% of the 116 nonquadriplegic patients with cerebral palsy. Risk estimates based on predictive models, adjusted for multiple factors, suggest that 53% of the quadriplegic patients with cerebral palsy could be attributed to congenital disorders, 14% to birth asphyxia, and 8% to other identified disorders. Thirty-five percent of the nonquadriplegic patients with cerebral palsy could be attributed to congenital disorders and 6% to other disorders. In the victims of cerebral palsy, characteristic consequences of birth asphyxia were more often the result of nonasphyxial disorders. These included meconium in the amniotic fluid, low 10-minute Apgar scores, neonatal apnea spells, seizures, persisting neurologic abnormalities, and slow head growth after birth.

Topics: Aged; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Central Nervous System Diseases; Cerebral Palsy; Child; Confidence Intervals; Congenital Abnormalities; Humans; Infant; Infant, Newborn; Meconium; Prospective Studies; Risk Factors

Chronically meconium-stained fetuses may ultimately suffer cerebral palsy and other devastation. The mechanism is unknown. Innocuous pregnancy complications may cause some fetuses to discharge meconium, which may become hazardous, independently of aspiration. We herein report previously undescribed, meconium-induced umbilical and placental vascular necrosis. To investigate whether meconium causes vasocontraction, we tested umbilical vein tissue with an isometric transducer connected to a polygraph. The specimens were suspended in a 30-mL organ bath with Krebs solution (pH, 7.4; temperature, 37 degrees C; under aeration with 95% O2 and 5% CO2). We exposed the tissue to meconium and compared meconium-induced vasocontraction with that induced by Krebs solution and 10(-5) molar serotonin. Meconium maximally produced 62.9% of serotonin-induced vasocontraction. Krebs solution and boiled meconium did not produce vasocontraction. We hypothesize that meconium may cause placental and umbilical cord vasocontraction, cerebral and other fetal hypoperfusion, and major poor outcome.

Topics: Asphyxia Neonatorum; Cerebral Palsy; Cerebrovascular Circulation; Female; Humans; Hypoxia, Brain; Infant, Newborn; Ischemia; Meconium; Meconium Aspiration Syndrome; Muscle, Smooth, Vascular; Placenta; Pregnancy; Pregnancy Outcome; Risk Factors; Vasoconstriction

Of 323 pregnancies with meconium-stained amniotic fluid at 36-42 weeks' gestation, 68 (21%) had a pH less than 7.20 in umbilical arterial blood, 21 (7%) had a pH less than 7.15, and only three newborns (0.9%) had true metabolic acidemia. At birth, of the 74 newborns with normal electronic fetal heart rate (FHR) tracings, eight (11%) had an umbilical arterial pH less than 7.20. There was a significantly higher frequency of acidemia (defined as pH less than 7.20) in newborns with both baseline and periodic FHR abnormalities. Although there was a significant difference (P less than .05) in the frequency of meconium found below the cords in these neonates with an umbilical artery pH less than 7.20 compared with those with values exceeding 7.20, there was no significant difference in the frequency of clinical meconium aspiration syndrome. We conclude that meconium-stained amniotic fluid correlates poorly with infant condition at birth as reflected by umbilical cord acid-base measurements.

Topics: Acid-Base Imbalance; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetal Blood; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy

Neonatal neurological morbidity was studied in relation to Apgar score, meconium stained amniotic fluid and acidaemia at birth in 247 small-for-gestational age (SGA) maturely born infants. SGA infants, and especially the severely SGA infants and those born abdominally, showed higher rates of neurological morbidity, acidaemia and meconium stained amniotic fluid than appropriate-for-gestational age (AGA) controls. The examined indicators of asphyxia at birth showed slightly higher correlation coefficients with the 'neonatal neurological optimality score' (NNOS) in SGA, than in AGA term infants, but the percentage of explained variance was low, except in the 23 infants born abdominally. In this group poor neurological outcome was restricted to the 14 infants who showed signs of fetal hypoxaemia diagnosed by decelerative fetal heart rate (FHR) patterns. In 11 of them, FHR decelerations occurred antepartum. These FHR abnormalities appear to be better predictors for the neonatal neurological outcome than indicators of asphyxia at birth.

Topics: Apgar Score; Asphyxia Neonatorum; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Nervous System Diseases

The pattern of arginine vasopressin (AVP) secretion in the immediate neonatal period is unclear. Plasma concentrations of AVP are reflected by its urinary excretion, thus providing a noninvasive method for studying the pattern of AVP release in the neonate. In these studies, we determined the pattern of urinary AVP excretion (microU/mg creatinine) during the first 2-4 days after birth in 78 neonates, 53 of whom had various prenatal and/or neonatal complications. In well term (n = 12) and preterm (n = 13) infants mean urinary AVP excretion decreased gradually during the first 24-36 h after birth. Although term and preterm infants with perinatal asphyxia had highest initial levels of urinary AVP (greater than 200 microU/mg creatinine) and a significant negative correlation with the 1-min Apgar score was obtained, their pattern of excretion was similar to respective controls. After delivery, elevated values for urinary AVP excretion were found among infants with neonatal courses complicated by intracranial hemorrhage, hypoxic encephalopathy, and pneumothorax. Urine osmolality did not correlate linearly with urinary AVP levels, but rather attained a maximum value of approximately 400 mosmol/kg at urinary AVP levels less than 200 microU/mg creatinine and then plateaued. It is concluded that the decrease in urinary AVP excretion observed soon after birth generally reflects diminution of the hypersecretion of AVP during parturition; neonates with evidence of intrapartum asphyxia initially have increased urinary AVP excretion; however, the pattern of excretion is similar to normal infants. During the neonatal period insults such as pneumothorax and intracranial hemorrhage may cause hypersecretion of this hormone.

Topics: Amniotic Fluid; Apgar Score; Arginine Vasopressin; Asphyxia Neonatorum; Cerebral Hemorrhage; Creatinine; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Male; Meconium; Osmolar Concentration; Pneumothorax; Time Factors

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Humans; Infant, Newborn; Male; Meconium; Pneumonia, Aspiration; Pregnancy; Respiratory Insufficiency; Syndrome

Topics: Asphyxia Neonatorum; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Infections; Meconium; Pneumonia, Aspiration; Surgical Procedures, Operative; Thyroid Gland; Thyroid Hormones; Thyrotropin; Thyroxine; Thyroxine-Binding Proteins; Triiodothyronine; Triiodothyronine, Reverse

Topics: Amniotic Fluid; Asphyxia Neonatorum; Cardiomegaly; Female; Humans; Infant, Newborn; Inhalation; Male; Meconium; Suction

Topics: Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Growth Retardation; Glucose; Hematologic Diseases; Hemorrhage; Humans; Hypoglycemia; Hypothermia; Infant Care; Infant Food; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Lung Diseases; Meconium; Pregnancy; Respiratory Distress Syndrome, Newborn; Terminology as Topic; Water-Electrolyte Balance

The experienced obstetrician knows that depressed neonates do not always herald their coming, and that the potential liability for failure to intervene promptly is great. It is imperative that all personnel involved in the delivery and care of newborns be familiar with these principles of newborn resuscitation.

Topics: Acidosis; Animals; Animals, Newborn; Apgar Score; Asphyxia Neonatorum; Central Nervous System; Emergencies; Female; Glycolysis; Heart Rate; Humans; Infant, Newborn; Infant, Premature; Macaca mulatta; Meconium; Pregnancy; Respiration, Artificial; Resuscitation; Risk

Patients with perinatal asphyxia from a total population of 15,216 births were studied prospectively. A total of 76 newborn infants achieved the criteria for inclusion. These were distributed in three populations: 53 (73%) without acute renal failure (ARF); 17 (22%) with ARF of prerenal type; 6, (8%) with ARF of renal type. Incidence of several perinatal factors were compared (gestational age, birth weight, meconial amniotic fluid, cord and/or placental disturbances, type of delivery, APGAR Score, and resuscitation). Authors observed that in the group of preterm infants, ARF is present, always was of renal type. In the population with ARF of renal type perinatal asphyxia was clinically worse: greatest frequency of meconial amniotic fluid (p less than 0,025) and worse response to resuscitation with a lower increment in the APGAR Score between one and five minutes (p less than 0.005).

Topics: Acute Kidney Injury; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Birth Weight; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Prospective Studies

The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.

Topics: Airway Obstruction; Apgar Score; Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Distress; Fetal Hypoxia; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Pregnancy; Pregnancy Complications; Respiratory Distress Syndrome, Newborn; Resuscitation

Obstetric literature deals with meconium stained amniotic fluid (AF) in various ways when judging it as an indicator of fetal distress. This evidently reflects the difficulty of finding overt relations between measurable alterations in the condition of the fetus or of the newborn infant and the amount of meconium passed into the AF. Nor is the moment predictable by means of fetal monitoring when meconium is passed. Discussing these problems in the light of the consecutive course of events resulting finally in meconium aspiration some of the discrepancies can be explained without difficulty. Considering also the kinetics of formation and excretion of AF the distinction of 3 variants of meconium aspiration syndrome is possible: 1. late meconium aspiration syndrome in non-asphyctic infants, 2. late meconium aspiration syndrome in asphyctic infants, 3. "connatal" meconium aspiration syndrome.

Topics: Amniotic Fluid; Asphyxia Neonatorum; Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Kinetics; Meconium; Respiration; Syndrome

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetal Hypoxia; Fetus; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Postmature; Infant, Premature; Meconium; Pregnancy

There are contradictory descriptions in the literature about the methods as well as the sequence of clearing the upper respiratory tract of new-born babies. In order to clarify this problem anatomical, physiological and pathophysiological aspects of the fetal and neonatal respiratory system are described. Intrauterine asphyxia can lead to aspiration of amniotic fluid (containing meconium, squamous epithelium, lanugo hair). During delivery the fetal airway is cleared by compression of the thorax. Through suction of the mouth, throat and nose--in exactly this defined sequence--before birth of the thorax, aspiration of potentially damaging material can be prevented. The particular problem associated with meconium-steined amniotic fluid is described.

Topics: Amniotic Fluid; Asphyxia Neonatorum; Humans; Infant, Newborn; Meconium; Methods; Pneumonia, Aspiration; Respiratory Physiological Phenomena; Suction

Topics: Acid-Base Equilibrium; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Birth Weight; Female; Gestational Age; Humans; Infant, Newborn; Larynx; Meconium; Pregnancy; Prognosis; Suction

Topics: Asphyxia Neonatorum; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukocyte Count; Meconium; Pneumonia, Aspiration

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Humans; Infant, Newborn; Meconium; Pregnancy; Suction; Therapeutic Irrigation

Topics: ABO Blood-Group System; Asphyxia Neonatorum; Blood Group Incompatibility; Family Practice; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Internship and Residency; Meconium; Nurseries, Hospital; Pneumothorax; Risk; Vitamin K Deficiency Bleeding

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Fetal Distress; Fetal Monitoring; Fetus; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy

Topics: Asphyxia Neonatorum; Female; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Male; Massachusetts; Meconium; Mediastinal Emphysema; Pneumonia, Aspiration; Pneumopericardium; Pneumothorax; Pulmonary Emphysema; Respiration, Artificial; Respiratory Function Tests; Retrospective Studies

Hypoxia in newborn infants is becoming much easier to prevent, detect and treat. Nevertheless the successful management of potentially hypoxic fetuses and newborn infants remains the major challenge to all physicians concerned with perinatal care. What is at stake is not only that sick infants should survive, but equally or more importantly that the survivors should be normal children. Recent follow-up studies show that this aim can, with few exceptions, now be achieved (Stewart and Reynolds, 1974; Davies and Stewart, 1975; Durbin et al, 1976).

Topics: Apnea; Asphyxia Neonatorum; Blood Circulation; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Lung Diseases; Meconium; Pneumothorax; Pulmonary Edema; Pulmonary Surfactants; Respiration; Vitamin K Deficiency Bleeding

A variety of common situations result in asphyxia of the newborn. The infant may be born in secondary or terminal asphyxia. The infant at greatest risk of neurologic sequelae is the low birth weight infant with a low five-minute Apgar score. Personnel must be trained and the delivery room must be properly equipped for successful resuscitation. For example, a radiant warmer is essential. Meconiumstained infants require special care. Meconium must be removed from the airway. The list of postasphyxial complications is formidable.

Topics: Animals; Apgar Score; Asphyxia Neonatorum; Haplorhini; Hemodynamics; Humans; Infant, Low Birth Weight; Infant, Newborn; Meconium; Resuscitation; Risk

Effective resuscitation of the newborn requires knowledge of the cause of depression. Four major causes are trauma, asphyxia, medication, and malformation. More than one of these may contribute to depression in a single infant. The first principles of resuscitation are to avoid cooling the infant and to establish an airway. Infants with an Apgar score of 3 to 4 at one minute usually need bag-and-mask ventilation, while those with scores of 0 to 2 require immediate ventilation, preferably by means of endotracheal intubation. Severely depressed infants may also require chemical resuscitation and closed cardiac massage. Fetal depression caused by narcotic analgesics given to the mother can be reversed with the use of naloxone hydrochloride (Narcan). Infants asphyxiated on the basis of malformations may benefit from expeditious diagnostic and therapeutic procedures performed in the delivery room.

Topics: Apnea; Asphyxia Neonatorum; Congenital Abnormalities; Delivery, Obstetric; Female; Fetus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intubation, Intratracheal; Maternal-Fetal Exchange; Meconium; Pregnancy; Resuscitation; Suction; Wounds and Injuries

Topics: Asphyxia; Asphyxia Neonatorum; Blood Glucose; Blood Viscosity; Brain Diseases; Female; Fetal Diseases; Fetal Growth Retardation; Humans; Hypocalcemia; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Kidney Diseases; Meconium; Polycythemia; Pregnancy; Prognosis; Syndrome

Topics: Adult; Asphyxia Neonatorum; Female; Fetal Diseases; Fetal Hypoxia; Humans; Infant, Newborn; Inhalation; Meconium; Pregnancy; Prenatal Care; Subarachnoid Hemorrhage

Topics: Airway Obstruction; Asphyxia Neonatorum; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Resuscitation

Topics: Amniotic Fluid; Asphyxia Neonatorum; Birth Weight; Cholestasis; Female; Fetal Death; Follow-Up Studies; Gestational Age; Hepatitis A; Humans; Infant, Newborn; Infant, Newborn, Diseases; Jaundice; Male; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pruritus; Recurrence

Topics: Amniotic Fluid; Anesthesia, Epidural; Anesthesia, Obstetrical; Asphyxia Neonatorum; Caudate Nucleus; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Heart Rate; Humans; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Pregnancy; Pregnancy Complications; Prognosis; Radiography; Respiratory Distress Syndrome, Newborn

Topics: Apgar Score; Asphyxia Neonatorum; Birth Weight; Carbon Dioxide; Cardiac Catheterization; Cyanosis; Diagnosis, Differential; Female; Follow-Up Studies; Gestational Age; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Obstetric Labor Complications; Oxygen; Partial Pressure; Pregnancy; Pulmonary Artery; Radiography

Topics: Anthropometry; Asphyxia Neonatorum; Birth Weight; Child Development; Congenital Abnormalities; Emaciation; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Nails; Neurologic Manifestations; Organ Size; Pregnancy; Pregnancy, Prolonged; Sleep Wake Disorders; Social Behavior; Thumb; Umbilical Cord

Topics: Asphyxia Neonatorum; Brain Damage, Chronic; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Pneumonia; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Tetanus

Topics: Asphyxia Neonatorum; Female; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Oxygen Inhalation Therapy; Pregnancy; Respiratory Distress Syndrome, Newborn

Topics: Adult; Asphyxia Neonatorum; Birth Injuries; Body Weight; Brain Damage, Chronic; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Heart; Gestational Age; Heart Rate; Humans; Hypertension; Infant, Newborn; Labor Presentation; Labor, Obstetric; Maternal Age; Meconium; Parity; Pregnancy; Prospective Studies; Respiration

Topics: Asphyxia Neonatorum; Brain; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Lung; Male; Meconium; Pneumonia, Aspiration

Topics: Amniotic Fluid; Amobarbital; Animals; Asphyxia Neonatorum; Atropine; Female; Fetal Diseases; Fetus; Humans; Infant, Newborn; Inhalation; Meconium; Morphine; Pentobarbital; Pregnancy; Rabbits; Respiration; Scopolamine; Sheep

Topics: Asphyxia Neonatorum; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Pneumonia; Pneumothorax; Respiratory System Abnormalities; Respiratory Tract Diseases

Topics: Amnion; Asphyxia Neonatorum; Female; Germany, East; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Methods; Physical Examination; Pregnancy

Topics: Acidosis; Amniotic Fluid; Asphyxia; Asphyxia Neonatorum; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Diseases; Hemoglobinometry; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Serum Albumin, Radio-Iodinated; Spectrophotometry; Tromethamine

Topics: Amniotic Fluid; Asphyxia Neonatorum; Endoscopy; Female; Fetal Heart; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Methods; Pregnancy

Topics: Amniotic Fluid; Asphyxia Neonatorum; Blood Circulation; Classification; Female; Fetal Death; Fetal Distress; Fetal Heart; Fetal Hemoglobin; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Metabolism; Pathology; Placenta; Pregnancy

Topics: Asphyxia Neonatorum; Boston; Child; Fatty Liver; Hospitals; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pyridoxine

Topics: Asphyxia Neonatorum; Blood Chemical Analysis; Female; Fetal Diseases; Fetal Heart; Fetus; Heart Rate; Humans; Infant, Newborn; Labor Presentation; Meconium; Oximetry; Pregnancy

Topics: Asphyxia Neonatorum; Bradycardia; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Fetal Distress; Fetal Heart; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy

Topics: Amniotic Fluid; Asphyxia Neonatorum; Biomarkers; Fetal Hypoxia; Humans; Infant, Newborn; Meconium; Staining and Labeling

Topics: Amniotic Fluid; Asphyxia Neonatorum; Humans; Hypoxia; Infant, Newborn; Meconium; Physical Examination; Staining and Labeling