Newborn jaundice

Disease Description (Causes and Symptoms)

• Definition summary: Neonatal asphyxia is a condition in which, regardless of the cause before, during, or after delivery, systemic circulation in the fetus or newborn is insufficient, resulting in inadequate oxygen supply and carbon dioxide removal. If it persists, it may cause multiple organ damage and hypoxic-ischemic encephalopathy (HIE).
• Main causes
  • Fetal factors: intrauterine growth restriction, post-term birth or prematurity, hemolytic disease of the newborn, polyhydramnios or meconium aspiration, etc.
  • Maternal factors: gestational diabetes, eclampsia (pregnancy-induced hypertension), low or high blood pressure, hemorrhage, medications (alcohol, psychoactive drugs, etc.)
  • Delivery-related factors: premature rupture of membranes, difficult labor, umbilical cord compression or prolapse, placenta previa or placental abruption, problems related to cesarean delivery, obstetric sedatives or analgesics, etc.
• Pathophysiology (brief summary): Initially, recovery may be possible after primary apnea with stimulation and oxygen. If treatment is delayed, it progresses to secondary apnea and low cardiac output. Blood flow is preferentially redistributed to the brain and heart, but over time ischemia and metabolic disturbances (acidosis, hypoglycemia, etc.) occur in all organs.
• Representative symptoms
  • Immediate: apnea or shallow breathing, decreased heart rate, cyanosis, low Apgar score
  • Systemic: decreased consciousness or seizures (central nervous system), respiratory distress or respiratory failure, shock, hypotension or arrhythmia, oliguria or renal failure, necrotizing enterocolitis, etc.
• Findings helpful for diagnosis: low Apgar score (especially at 5 and 10 minutes), severe metabolic acidosis in umbilical arterial blood gas analysis (low pH, high base deficit), abnormal fetal heart rate tracing (during labor), the newborn’s clinical presentation, and other causes that can be ruled out.

Treatment

• Emergency care (delivery room/immediately)
  • Neonatal resuscitation (as recommended by the Neonatal Resuscitation Program): airway management → positive-pressure ventilation (or intubation) → chest compressions (based on heart rate) → medication (epinephrine) and fluid replacement if necessary.
  • When using oxygen, avoid hyperoxia (prolonged high concentrations) and adjust to the target oxygen saturation appropriate for the infant’s age.
• Intensive care (NICU)
  • Respiratory care: mechanical ventilation or continuous positive airway pressure (maintaining lung function and managing pulmonary hemorrhage or meconium aspiration)
  • Circulation: fluids, vasoactive agents (inotropes), and treatment of shock or arrhythmia
  • Metabolic and electrolyte correction: correction of hypoglycemia, acidemia, hypo- or hypernatremia, hypocalcemia, etc.
  • Seizure management: use of anticonvulsants (e.g., phenytoin, phenobarbital, etc.) with EEG monitoring
  • Administration of antibiotics if infection is suspected (timely treatment during the golden window)
  • Temperature management: maintain an appropriate temperature. As a selective therapy, therapeutic hypothermia is used to improve neurological outcomes in term or near-term newborns (≥36 weeks) who meet the criteria and have moderate to severe hypoxic-ischemic encephalopathy, when started within 6 hours of onset — it is not indicated for every patient and is performed according to specialist-center criteria.
• Tests and monitoring
  • Continuous electrocardiography, oxygen saturation, and blood pressure monitoring; blood gas, blood glucose, electrolyte, liver function, and kidney function tests; EEG (or amplitude-integrated EEG); brain imaging (MRI is important for prognostic evaluation); ultrasound, etc.
• Rehabilitation and follow-up care
  • If HIE is suspected, plan long-term neurodevelopmental follow-up and early rehabilitation, including physical, occupational, and speech therapy.
• Precautions (during treatment and self-care)
  • Immediate resuscitation is essential; avoid hyperoxia, overheating, and excessive fluid volume.
  • Therapeutic hypothermia should be performed according to specialized guidelines, taking indications, contraindications, and adverse effects (such as the risk of bleeding, arrhythmia, and infection) into account.
  • Frequent follow-up is needed after discharge because of developmental delay, seizures, feeding problems, and other issues.

Checklist Before an Outpatient Visit (Examples of Items to Bring and Records to Prepare)

• Items to bring
  • Birth records: Apgar scores (at 1, 5, and 10 minutes), umbilical (arterial) blood gas results (if available), and a summary of the delivery process (including abnormal findings during labor)
  • Newborn medical records/discharge summary (including intensive care treatment and procedures or medications administered)
  • List of current medications (including dosage and frequency)
  • Copies of records, if available, showing whether seizures occurred, their frequency and onset, and the results of imaging tests (MRI or ultrasound) and EEG
  • Records of feeding, bowel movements, urination, sleep patterns, and weight changes
• Symptom change records (examples by site)
  • Whether apnea, cyanosis, or respiratory distress recurs; breast milk (formula) intake and whether vomiting occurs; changes in crying; changes in muscle tone; and seizure characteristics (start/end time and body part affected), etc.

Examples of General Questions to Ask the Doctor

• “Is neonatal asphyxia definitely present in our baby’s condition? What is the basis for the diagnosis?”
• “Please explain what the Apgar score and umbilical blood gas results mean for the prognosis.”
• “What are the goals and expected effects of the treatment currently recommended? What are the expected adverse effects?”
• “What are the indications for therapeutic hypothermia (or mechanical ventilation or anticonvulsants), and what is the basis for applying it?”
• “What symptoms (or developmental milestones) should we monitor after discharge? What is the schedule for follow-up tests?”
• “What range of long-term outcomes can be expected regarding neurodevelopment and motor and cognitive function?”

Examples of Disease-Specific Questions

• “What were the umbilical artery pH and base deficit values at birth? What do these values mean for the prognosis?”
• “Please explain whether our baby meets the indications for therapeutic hypothermia, and if it is applied, when it should be started, what benefits are expected, and what possible complications (e.g., bleeding, infection, or electrocardiographic abnormalities) may occur.”

(If necessary, bringing the relevant test results, discharge summary, and imaging findings to the appointment can allow for more specific and personalized consultation.)