Neonatal necrotizing enterocolitis

Neonatal Asphyxia (Neonatal asphyxia)

1) Disease Description (Causes and Symptoms)

• Summary of definition: A condition in which the systemic circulation of a fetus or newborn is not adequately maintained at any time before, during, or after delivery, impairing oxygen supply and carbon dioxide removal. If it persists for a prolonged period, it may cause multiple organ damage and brain injury.
• Main causes
  • Fetal-related: Intrauterine growth restriction (IUGR), prematurity or post-term birth, hemolytic disease of the fetus, meconium aspiration, etc.
  • Maternal-related: Gestational diabetes, eclampsia, hypotension or hypertension, bleeding, drug or alcohol intoxication, etc.
  • Delivery-related: Umbilical cord compression or prolapse, placental abruption or placenta previa, difficult labor, premature rupture of membranes, infection, etc.
• Pathophysiology (briefly): Due to hypoxia, blood flow is redistributed to central organs (the brain and heart), causing ischemia in peripheral organs (the kidneys, gastrointestinal tract, liver, lungs, etc.) → if persistent, systemic ischemic and hypoxic injury → metabolic acidosis, cellular injury, and organ dysfunction.
• Main clinical symptoms
  • Central nervous system: Altered consciousness, apnea or hypoventilation, decreased muscle strength, abnormal pupils, seizures
  • Respiratory system: Respiratory distress, respiratory failure, pulmonary hemorrhage, signs of meconium aspiration
  • Cardiovascular system: Hypotension, shock, arrhythmia
  • Renal and gastrointestinal systems: Oliguria, acute renal failure, necrotizing enterocolitis, etc.
  • Electrolyte and metabolic: Metabolic acidosis, hypoglycemia, electrolyte abnormalities, hypothermia

2) Treatment Methods

• Emergency initial treatment (highest priority)
  • Prompt resuscitation (airway management, ventilation [artificial respiration], chest compressions, medication administration, etc., according to neonatal resuscitation guidelines)
  • Maintain the airway and provide adequate oxygenation (avoid both hyperoxia and hypoxia)
  • Maintain circulation (inotropes if necessary), and correct fluid, electrolyte, and blood glucose abnormalities
• Intensive care
  • Multiorgan monitoring and supportive care in the neonatal intensive care unit (respiratory treatment and ventilator use if necessary)
  • Administration of anticonvulsants if seizures occur
  • Simultaneous treatment of electrolyte abnormalities, acidosis, hypoglycemia, and infection
  • Treatment specific to the affected organ in the event of multiorgan failure (such as hemodialysis)
• Therapeutic hypothermia
  • May be considered in term or near-term infants with moderate to severe hypoxic-ischemic encephalopathy who meet the indications
  • Treatment should begin as soon as possible (generally recommended within 6 hours after birth) / performed at a specialized center
  • The attending specialist must determine the eligible patients, method, contraindications, etc.
• Preventive and rehabilitative measures
  • Infection prevention, temperature maintenance, nutritional management, early physical therapy, and neurodevelopmental follow-up
• Precautions (points of caution, risk of complications, self-care)
  • Initial resuscitation is critical, and delays may result in a poor prognosis
  • Excessive oxygen (hyperoxia) or excessive mechanical ventilation may worsen brain injury (follow the specialist’s instructions regarding oxygen and ventilation targets)
  • Therapeutic hypothermia may be beneficial under specific conditions, but it is not applicable to all newborns (possible adverse effects and indications must be confirmed)
  • Long-term follow-up is necessary (evaluation of neurological sequelae, growth, and development)
  • At home, immediately visit a medical institution if emergency signs such as fever, hypothermia, sudden feeding difficulties, or seizures occur

3) Checkpoints Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • Birth records (delivery records), Apgar score, umbilical cord blood gas results (if available), and copies of test and imaging results (CT/MRI), electrocardiograms, and blood tests performed immediately after birth
  • A list of currently administered medications (including doses and administration times)
  • A log recording the newborn’s feeding, sleep, and breathing patterns (including seizure or apnea episodes)
  • Hospitalization and intensive care records, discharge summary, and immunization records
• Checkpoints before the outpatient visit
  • Check for recent fever, respiratory distress, or seizures
  • Record changes in urine output, bowel movements, and feeding volume
  • Sleep and wake patterns and developmental responses (eye contact, smiling, weaning-food and motor development)
• Example questions (recommended for the patient’s guardian to ask at the outpatient visit)
  • “Has there been any recent apnea or cyanosis? How often did it occur, and how long did it last?”
  • “Has the feeding volume or urine output decreased? What is the body temperature?”
  • “Has there been any recent behavior suggestive of seizures, such as sudden trembling or stiffening?”

4) Examples of General Questions to Ask the Doctor

• “What are the results and significance of the tests used to assess the extent of our child’s brain injury (brain MRI/ultrasound/EEG)?”
• “What is the expected prognosis, both short-term and long-term? What is the follow-up schedule?”
• “What are the main side effects of the prescribed medications, and how should they be managed?”
• “Was therapeutic hypothermia appropriate for our child, or is it likely to be needed in the future?”
• “To prepare for the possibility of developmental delay, which rehabilitation services (physical therapy, occupational therapy, speech therapy) should be started and when?”

5) Examples of Disease-Specific Questions

• “How do the umbilical artery blood gas values at birth (pH or base deficit) and the Apgar score predict our baby’s neurological prognosis?”
• “When is a brain MRI recommended, and how will the specific treatment and rehabilitation plan change depending on the results?”

Note: The information provided is general medical information, and the diagnosis and treatment of an individual patient may vary depending on the evaluation and test results of the attending pediatrician or neonatologist. If acute symptoms occur, such as persistent apnea, repeated seizures, acute respiratory distress, or cyanosis, immediately visit an emergency medical institution.