Newborn asphyxia

Disease Description (Causes and Symptoms)

• Definition: Neonatal asphyxia is a condition that occurs when systemic circulation in the fetus or newborn is not adequately maintained before, during, or after delivery, resulting in insufficient oxygen supply and impaired carbon dioxide removal. It may cause tissue hypoxia, acidosis, and multiple organ dysfunction.
• Main causes
  • Fetal factors: Intrauterine growth restriction (IUGR), prematurity or post-term birth, meconium aspiration, hemolytic disease, etc.
  • Maternal factors: Severe preeclampsia, diabetes, hypotension or hemorrhage, drug intoxication, etc.
  • Delivery-related factors: Umbilical cord compression or prolapse, placental abruption, placenta previa, difficult labor, effects of sedatives or analgesics, complications related to cesarean delivery, etc.
• Summary of pathophysiology: Initially, loss of spontaneous breathing (primary apnea) and metabolic imbalance occur, followed by reduced blood flow to the kidneys, liver, gastrointestinal tract, and other organs due to blood-flow redistribution → organ damage → if persistent, progression to brain and heart injury.
• Main symptoms
  • Immediate: Apnea or shallow breathing, bradycardia, cyanosis, hypotonia (decreased muscle tone), low Apgar score
  • Electrolyte and metabolic: Metabolic acidosis, hypoglycemia, electrolyte abnormalities
  • Organ-related symptoms: Respiratory failure/pulmonary hemorrhage, renal failure (oliguria), necrotizing enterocolitis, abnormal liver function
  • Neurological: Decreased consciousness, seizures, symptoms of hypoxic-ischemic encephalopathy (HIE)

Treatment Methods

• Initial emergency management (neonatal resuscitation, based on NRP guidelines)
  • Immediately maintain body temperature (keep the newborn warm) and secure the airway (clear removable secretions/meconium)
  • Perform positive pressure ventilation (PPV) — consider endotracheal intubation if breathing does not recover
  • If the heart rate is < 60 beats/minute, follow guidelines for chest compressions and epinephrine administration
  • If necessary, provide medications and fluids through intravenous/intraosseous access
  • Oxygen therapy should follow target oxygen saturation ranges recommended by minute of life, avoiding hyperoxia
• Intensive care (neonatal intensive care unit)
  • Mechanical ventilation, hemodynamic support (fluids, vasoactive agents), and correction of electrolyte and blood glucose abnormalities
  • Anticonvulsants in the event of seizures (e.g., phenobarbital)
  • Identify and treat the cause: testing and treatment for hemorrhage, infection, metabolic disease, etc.
  • Conservative or specialized treatment for renal, hepatic, and respiratory complications (such as hemodialysis) when necessary
• Special treatment
  • Therapeutic hypothermia: Recommended within 6 hours of onset whenever possible for term or near-term newborns (≥36 weeks) with moderate to severe hypoxic-ischemic encephalopathy. Confirmation of the hospital protocol, indications, and contraindications is necessary. It may improve neurological outcomes.
• Preventive and supportive care
  • Consider infection prevention and antibiotics (when infection is suspected)
  • Nutritional and fluid management, maintenance of body temperature, and coordination with rehabilitation and physical therapy
• Precautions (Points to note during treatment and self-care)
  • Avoid excessive oxygen administration (hyperoxia) and maintain the target oxygen saturation
  • Prompt specialized resuscitation and transfer to the intensive care unit are critical to the prognosis
  • Infection control and monitoring of body temperature, blood glucose, and electrolytes are essential during treatment and recovery
  • After discharge, ongoing neurodevelopmental follow-up and early intervention (physical therapy, occupational therapy, etc.) are recommended

Checklist Before an Outpatient Visit (Including Items to Prepare and Sample Questions)

• Items/information to bring
  • Birth records: Apgar scores (1 minute and 5 minutes), umbilical cord blood gas results (if available), and whether resuscitation was performed during delivery and its details (positive pressure ventilation, intubation, chest compressions, medications)
  • Neonatal intensive care unit records (admission records, treatments, test results, imaging findings [brain ultrasound/MRI, etc.])
  • Current medications and nutrition (breast milk/formula), urination and bowel movement frequency, feeding ability, and weight changes
  • Records of seizures, breathing difficulty, or color changes (cyanosis)
• Checklist before the outpatient visit
  • Record recent weight, feeding volume, and feeding frequency
  • Check for symptoms suggestive of seizures (tremors, unresponsiveness, abnormal eye movements) and prepare imaging/EEG results, if available
  • Vaccination history and future vaccination schedule
• Sample questions (during rounds or an outpatient visit with the doctor)
  • Regarding the condition: "What is my baby’s current neurological status?" "When will follow-up imaging (brain MRI/ultrasound) be performed?"
  • Treatment and management: "Does my baby meet the indications for therapeutic hypothermia? If it has already been performed, what are the possible side effects?"
  • Follow-up and prognosis: "What is the long-term developmental prognosis? When should rehabilitation begin?"

Examples of General Questions to Ask the Doctor

• What are the expected effects and possible side effects of this medication (or treatment)?
• What is the extent of our baby’s neurological prognosis (such as the risk of developmental delay or cerebral palsy)?
• What is the schedule for future follow-up tests (EEG, brain MRI, developmental assessments), and which areas should be monitored most closely?
• What warning signs should we observe at home (seizures, refusal to feed, lethargy, etc.)?
• Are there any guidelines for feeding and nutritional management after discharge or for simple rehabilitation at home (positioning and exercises)?

Examples of Disease-Specific Questions

• Regarding therapeutic hypothermia
  • "Does our baby meet the eligibility criteria for therapeutic hypothermia? If it cannot be performed, what other alternatives are available?"
  • "What complications may occur after hypothermia treatment (such as bleeding, infection, or blood pressure changes), and how are they monitored?"
• Regarding neurodevelopment and follow-up
  • "What changes on the brain MRI should we watch for carefully? What additional tests are needed to predict the prognosis?"
  • "During long-term follow-up, when should early intervention (physical and occupational therapy, speech therapy) be started, and what are its goals?"

(Note: The information above was compiled based on neonatal resuscitation guidelines (NRP) and neonatal intensive care standards. Treatment and prognosis for individual patients vary depending on the clinical situation and test results, so consultation with the treating medical team should take priority.)