Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.@*METHODS@#A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.@*RESULTS@#Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.@*CONCLUSIONS@#The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

Factores asociados con bajo puntaje de Apgar en la maternidad del Centro Hospitalario Pereira Rossell / Factors associated with low Apgar score in the maternity of Pereira Rossell Hospital / Fatores associados com baixa pontuação de Apgar na maternidade do Centro Hospitalar Pereira Rossell

Introducción: La depresión neonatal es una de las causas más frecuentes de ingreso de recién nacidos a unidades especializadas de atención neonatal. La asfixia perinatal es una de las causas de bajo puntaje de Apgar, siendo uno de los criterios clínicos para su diagnóstico. Los principales factores de riesgo vinculados con bajos puntajes de Apgar pueden ser maternos (edad, patologías obstétricas, nivel socioeconómico, adicciones, etc.), del trabajo de parto y parto o, alteraciones fetales. Objetivos: Determinar los factores perinatales asociados a la baja puntuación de Apgar a los 5 minutos. Diseño: Estudio retrospectivo de casos y controles en los años 2015 y 2016. Institución: Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. Participantes: Se incluyeron todos los recién nacidos término con Apgar a los 5 minutos menor o igual a 5. Resultados: Hubo un total de 12.528 nacimientos de recién nacidos vivos de término en el HM. 34 casos de recién nacidos con Apgar a los 5 minutos menor o igual a 5. Esto corresponde al 0,27% de la población. No se identificaron diferencias estadísticamente significativas en cuanto a los principales factores asociados a asfixia perinatal. Conclusiones: En el análisis de esta población, la mayoría de los factores analizados no se asocia con los casos de Apgar a los 5 minutos menor o igual a 5 (depresión neonatal moderada-severa), por lo que la mayoría de estos casos pueden no ser evitables.

Introduction: Neonatal depression is one of the most frequent causes of admission of newborns to specialized units of neonatal care. Perinatal asphyxia is one of the causes of low Apgar score, and it is one of the clinical criteria for its diagnosis. Main risk factors associated with low Apgar scores can be maternal (age, obstetric pathologies, socioeconomic level, addictions, etc.), of labor and delivery or, fetal alterations. Objective: To determine the perinatal factors associated with the low Apgar score at 5 minutes. Design: Retrospective study of cases and controls in 2015 and 2016. Institution: Maternity, Women Hospital, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. Patients: We included all term newborns with Apgar at 5 minutes less than or equal to 5. Results: There was a total of 12,528 births of term full-term newborns in the HM. 34 cases of newborns with Apgar at 5 minutes less than or equal to 5. This corresponds to 0.27% of the population. No statistically significant differences were identified regarding the main factors associated with perinatal asphyxia. Conclusions: In the analysis of this population, most of the analyzed factors are not associated with cases of Apgar at 5 minutes less than or equal to 5 (moderate-severe neonatal depression), so that most of these cases may not be avoidable.

Introdução: A depressão neonatal é uma das causas mais freqüentes de internação de recém-nascidos em unidades especializadas de atenção neonatal. A asfixia perinatal é uma das causas do baixo índice de Apgar, sendo um dos critérios clínicos para o seu diagnóstico. Os principais fatores de risco associados aos baixos escores de Apgar podem ser maternos (idade, patologias obstétricas, nível socioeconômico, dependências, etc.), de trabalho de parto e parto, ou alterações fetais. Objetivos: Determine os fatores perinatais asociados ao baixo índice de Apgar aos 5 minutos. Design: Estudo retrospectivo de casos e controles nos anos de 2015 e 2016. Instituição: Hospital da Mulher, Centro Hospitalar Pereira Rossell, Montevidéu, Uruguai. Participantes: Todos os recém-nascidos a termo com Apgar a 5 minutos menor ou igual a 5 foram incluídos. Houve um total de 12.528 nascidos vivos a termo no MB. 34 casos de recém-nascidos com Apgar a 5 minutos menor ou igual a 5. Isso corresponde a 0,27% da população. Não foram identificadas diferenças estatisticamente significantes quanto aos principais fatores associados à asfixia perinatal. Conclusões: Na análise dessa população, a maioria dos fatores analisados não está associada aos casos de Apgar em 5 minutos menor ou igual a 5 (depressão neonatal moderada a grave), de modo que a maioria desses casos pode não ser evitável.

Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011 / Factores de riesgo asociados con el desarrollo de asfixia perinatal en neonatos en el Hospital Universitario del Valle, Cali, Colombia, 2010-2011

Abstract Introduction: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. Objective: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Materials and methods: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Results: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Resumen Introducción: La asfixia perinatal constituye una de las principales causas de morbilidad y mortalidad perinatal en el mundo, tiene factores de riesgo modificables y genera altos costos para los sistemas de salud. Objetivo: Determinar los factores de riesgo asociados al desarrollo de asfixia perinatal en recién nacidos en el Hospital Universitario del Valle, Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio de casos incidentes y controles concurrentes. Los casos se definieron como neonatos con asfixia perinatal moderada a grave, de edad de gestación mayor o igual a 36 semanas, que requirieron reanimación avanzada y presentaron, al menos, una de las siguientes condiciones: alteraciones neurológicas tempranas, falla orgánica múltiple o aparición de un evento centinela. Los controles se definieron como neonatos sin diagnóstico de asfixia, nacidos hasta con una semana de diferencia con respecto al caso y de edad de gestación comparable. Se excluyeron los pacientes con malformaciones congénitas mayores y síndromes. Resultados: Se estudiaron 56 casos y 168 controles. El desprendimiento prematuro de la placenta (odds ratio, OR=41,09; IC95% 4,61-366,56), un trabajo de parto con fase expulsiva prolongada (OR=31,76; IC95% 8,33-121,19), no usar oxitocina (OR=2,57; IC95% 1,08-6,13) y ser madre soltera (OR=2,56; IC95% 1,21-5,41) fueron factores de riesgo para el desarrollo de asfixia perinatal en la población bajo estudio. En las madres de los casos se encontraron dificultades sociales en mayor proporción. Conclusiones: Se recomienda un control adecuado y una vigilancia apropiada del trabajo de parto, hacer un estricto partograma, y una búsqueda activa, de manera que cada mujer embarazada tenga un adecuado control prenatal y reciba apoyo social.

Asphyxie périnatale du nouveau-né à terme : facteurs de risque et pronostic au Centre National Hospitalier et Universitaire (CNHU­HKM) de Cotonou

Introduction: Dans les pays en développement l'asphyxie périnatale constitue l'une des principales causes de décès néonataux. La plupart des facteurs de risque associés peuvent être prévenus. L'objectif de cette étude était d'étudier les facteurs de risque associés à l'asphyxie périnatale, et le pronostic des nouveau-nés ayant présenté une asphyxie dans l'unité de néonatologie du CNHU-HKM de Cotonou.Patients et méthodes : Il s'agissait d'une étude cas-témoin réalisée du 1er avril au 31 août 2015. Les données de 64 nouveau-nés à terme ayant présenté une asphyxie ont été comparées à celles de 128 nouveau-nés à terme sans asphyxie. Résultats : La prévalence était de 4,5%. Les facteurs associés à l'asphyxie étaient la présence d'une affection au cours de la grossesse (p= 0,004 OR 7,05 [1,84 ­ 26,96]), le long travail d'accouchement(p= 0,041 OR 3,09 [1,04 ­ 9,16]), la rupture prématurée des membranes (p=0,002 OR 17,51[2,93 104,56]), le liquide amniotique teinté et/ou fétide (p<0,001 OR 137,18 [29,18 - 651,03]). L'évaluation des nouveau-nés les 24 premières heures avait noté une encéphalopathie anoxo-ischémique : grade 1 (36%) ; grade 2 (45%) ; grade 3 (19%) selon la classification de Sarnat. A la 48ème heure une encéphalopathie anoxo-ischémique était présente chez 87,5% des nouveau-nés (n= 56). Elle était de grade 2 et de grade 3 dans 46,3% des cas. Le taux de décès des nouveau-nés étaient de 26,6%. Conclusion : Le dépistage systématique des facteurs de risque avec mesures correctrices conséquentes permettraient d'optimiser la prise en charge des nouveau-nés

Hipotermia en recíen nacidos con asfixia perinatal / Hypothermia in newborns with perinatal asphyxia

Se ha demostrado que la hipotermia controlada puede reducir la muerte o discapacidad grave, la mortalidad y los trastornos del neurodesarrollo en recién nacidos que han sufrido asfixia perinatal. Con el objetivo de implementar la realización de hipotermia se analizó su aplicación en 10 recién nacidos de término que cumplieron con criterios de inclusión en dos centros neonatales de Montevideo en un período de dos años. Se alcanzó la temperatura objetivo (33,5°C) en las primeras 6 horas de vida de los pacientes y se mantuvo en ese rango durante 72 horas en 7/10 pacientes. En 8/10 pacientes se utilizó un gorro con agua fría circulante y en 2/10 placas de gel congelado para el enfriamiento encefálico directo y de todo el cuerpo en forma indirecta. Tres pacientes se retiraron del protocolo luego de 48 horas de hipotermia por alteraciones de la coagulación, bradicardia mantenida y paro cardiorrespiratorio, respectivamente. El recalentamiento se logró en todos los casos en seis horas sin alteraciones. El 60% de los pacientes presentaron convulsiones durante su internación y el 100% recibieron fenobarbital. En el grupo analizado se produjeron dos muertes, uno de ellos próximo a la supresión de la terapia y otro en la evolución alejada. De manera complementaria se presentó la caracterización del impacto de la hipoxia severa y de la inducción de hipotermia sobre las variables más relevantes en un modelo de cerdo recién nacido. Se concluye que el desarrollo de hipotermia controlada es una estrategia terapéutica posible y segura, que brinda una oportunidad a los pacientes que han sufrido asfixia perinatal

Short term Neurodevelopmental outcome of asphyxiated newborns at tertiary care unit

To find out the short term neurodevelopmental outcome of asphyxiated newborns. Cross-sectional study using prospective data. Neonatal unit of Children's Hospital, Lahore from August, 2000 to July, 2001. We included 150 cases of birth asphyxia and survivors were followed till the age of six months and neurodevelopmental status was assessed by Denver developmental screening test II [DDST-II]. Severity of asphyxia was categorized as no encephalopathy, three different stages of HIE. During follow up visits, normal to delayed developmental status was expected. Infants were divided into two groups. Group A included neonates without HIE and group B with encephlopathy. Among group B, newborns developmental delay was found in 9 neonates and 48 neonates died while in group A neonates there was no child who had developmental delay and only six newborns died.[P value<0.05] There were 117 [78%] males, 35 mothers [23%] had antenatal visits to trained medical professionals. Majority of mothers [76%] had their visits to non doctor personnel like midwives, lady health visitors or nurse. Majority [61%] of study population were home delivered, 24% at private clinics and maternity homes while only 14% came from hospitals. Different stages of HIE have strong correlation with the outcome of these neonates. More effort and resources should be directed to this preventable community problem

Risk factor analysis in asphyxiated newborns and their outcome in relation to stage of hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy [HIE] is one of the common causes of neonatal mortality and long term sequale. The incidence is reported at 2-9/1000 live births. To find out the frequency of risk factors in asphyxiated newborns and outcome of these newborns in relation to the stage of hypoxic ischemic encephalopathy in hospital setting. Prospective descriptive study. This study was conducted in the Neonatology Unit of the Department of Paediatrics Unit-II, King Edward Medical University/Mayo hospital, Lahore, over a period of six months from April 01, 2006, to September 30, 2006. All the asphyxiated babies admitted during study period were included in study. Babies having congenital anomalies were excluded. The mothers were interviewed by using a pre-tested structured questionnaire. Out of 449 total admissions in study period, 227[51%] babies were asphyxiated. Eighty five [37%] newborns had stage I HIE, 39% had stage II and 24% had stage III HIE. One hundred and sixty four [73%] were full term. Majority of the newborns were male [60%]. One hundred and thirteen [49%] newborns were between 1.5 and 2.5kg. One hundred and thirty four [59%] babies delivered normally while seventy four [33%] were delivered by caesarian section. Hundred and sixty seven [74%] newborns were referred from government hospitals. Most of the deliveries [80%] were conducted by doctors. Majority of the mothers [48%] were below 25 years of age, 34% mothers were primigravida and 33% mothers received general anesthesia during labor. One hundred and sixty five [73%] babies had cephalic presentation. None of the deliveries were attended by a paediatrician in any of the cases. Maternal hypertension was found in 53 [23%] mothers, gestational diabetes in 9 [4%], hypoxia in 6 [3%], anemia in 31 [14%], toxemia in 19 [8%], pelvic abnormality in 30 [13%] and antepartum hemorrhage in 14 [6%]. No mother was found to be smoker. Eight [4%] babies had cord around the neck during delivery. One hundred and ten [48%] newborns were brought to the neonatal unit within one hour of delivery. Majority 21% of HIE I remained admitted in neonatology unit for less than 24 hours while 27[12%] of babies of HIE III died within 24 hour of admission. Among the factors studied, gestational age, weight, mode of delivery, birth attendant, sedation during labor and late arrival in neonatal unit were found to be significant with p value of < 0.05. HIE is caused by the risk factors that may be antepartum, intrapartum or postpartum. Monitoring for the known risk factors of asphyxia, proper training of primary birth attendants and improvement in neonatal resuscitation services can minimize the incidence of HIE

Jeune thoracic dystrophy with right sided diaphragmatic hernia.

Jeune thoracic dystrophy is a rare autosomal recessive chondrodysplasia, first described by Jeune et al in 1955. Early death is usually the consequence of asphyxia with or without pneumonia. Here is reported a newborn with Jeune thoracic dystrophy and a right-sided diaphragmatic hernia.

Factores que influyen en el apgar bajo al nacer, en el Hospital América Arias de la Habana, Cuba, 2000 / Factors associated to the low Apgar at birth in the America Arias de la Habana Hospital

Objetivo: Identificar los factores perinatales y maternos que influyen en el Apgar bajo al nacer. Material y método: Análisis retrospectivo y descriptivo de algunos antecedentes clínicos en 87 neonatos con Apgar < 7 puntos al minuto y 5º minuto de vida. Resultados: Las patologías asociadas fueron: hipertensión arterial crónica 20 por ciento, asma bronquial 15 por ciento e infección urinaria 15 por ciento; 55 por ciento de las pacientes no presentaban patologías. De los recién nacidos: el 16,1 por ciento eran de pretérmino y 14,9 por ciento de postérmino; 18,4 por ciento de bajo peso al nacer y 10,3 por ciento de macrosómicos. Al minuto de vida 49 recién nacidos estaban moderadamente deprimidos y 38 severamente deprimidos; a los 5 minutos 6 neonatos aún estaban severamente deprimidos y 30 moderadamente. Conclusiones: La depresión neonatal manifestada como Apgar <7 se relaciona con la prematurez, la postmadurez y patologías maternas que pueden alterar el intercambio gaseoso materno fetal. Especialmente en estos casos se debe mantener un control estricto de la frecuencia cardiaca fetal intraparto y disponer de neonatólogo en la sala de partos para efectuar un adecuado tratamiento de la asfixia perinatal.

Severe perinatal asphyxia: Incidence, risk factors and short-term outcome in a regional hospital in Oman

This study was aimed to document the incidence, risk factors and short-term outcome of severe perinatal asphyxia in a regional referral hospital in Oman. Of the 7487 babies delivered in our hospital during a 3-years period [1999-2001], 61 [8.2 per thousand] suffered severe perinatal asphyxia. Twentyone other severely asphyxiated babies, delivered elsewhere, were referred to us for care. The identified risk factors in all these 82 babies comprised mainly of complications of labour or delivery [in 53 babies, 66%], low birth weight [in 24 babies, 29%] and maternal disease [17 instances, 21%]. Some babies had multiple risk factors Eighteen [22%] of the babies died, 15 [18%] survived but with residual neurodeficit, while 49 [60%] survived apparently intact. Predictors of an adverse outcome included an Apgar score of zero at one minute, or less than 4 at 5 minutes, low birth weight, and cerebral oedema of haemorrhage. Infants of primiparous mothers also fared poorly. We conclude that perinatal asphyxia is still a significant problem in our practice area. Many of the risk factors are potentially preventable. But attainment of that goal requires sustained health education, continuing improvements in the health services, and a change in societal attitude, especially in terms of reproductive demands on women

Cardiac abnormalities in birth asphyxia.

Cardiac abnormalities in birth asphyxia were first recognised in 1970s. These include (i) transient tricuspid regurgitation which is the commonest cause of a systolic murmur in a newborn and tends to disappear without any treatment unless it is associated with transient myocardial ischemia or primary pulmonary hypertension of the new born (ii) transient mitral regurgitation which is much less common and is often a part of transient myocardial ischemia, at times with reduced left ventricular function and therefore, requires treatment in the form of inotropic and ventilatory support, (iii) transient myocardial ischemia (TMI) of the newborn. This should be suspected in any baby with asphyxia, respiratory distress and poor pulses especially if a murmur is audible. It is of five types (A to E) according to Rowe's classification. Type B is the most severe with respiratory distress, congestive heart failure and shock. Echocardiography helps to rule out critical left ventricular obstructive lesions like hypoplastic left heart syndrome or critical aortic stenosis. ECG is very important for diagnosis of TMI, and may show changes ranging from T wave inversion in one lead to a classical segmental infarction pattern with abnormal q waves. CPK-MB may rise and echocardiogram shows impaired left ventricular function, mitral and/or tricuspid regurgitation, and at times, wall motion abnormalities of left ventricle. Ejection fraction is often depressed and is a useful marker of severity and prognosis. Treatment includes fluid restriction, inotropic support, diuretics and ventilatory resistance if required, (v) persistent pulmonary hypertension of the new born (PPHN). Persistent hypoxia sometimes results in persistence of constricted fetal pulmonary vascular bed causing pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale. This causes respiratory distress and cyanosis (sometimes differential). Clinical examination also reveals evidence of pulmonary arterial hypertension and right ventricular failure with systolic murmur of tricuspid and, at times, mitral regurgitation. Treatment consists of oxygen and general care for mild cases, ventilatory support, ECMO and nitric oxide for severe cases. Cardiac abnormalities in asphyxiated neonates are often underdiagnosed and require a high index of suspicion. ECG and Echo help in early recognition and hence better management of these cases.

Displasia torácica asfixiante (síndrome de Jeune): relato de dois casos em irmãos / Asphyxiating thoracic dystrophy (Jeune syndrome): report of two cases in brothers

A displasia torácica asfixiante (DTA) ou síndrome de Jeune é uma condiçäo rara de herança autossômica recessiva e prognóstico geralmente ruim, pelo rápido desenvolvimento de insuficiência respiratória restritiva. A fisiopatologia se baseia em um distúrbio da ossificaçäo endocondral, com reduçäo das dimensöes da caixa torácica, baixa estatura com membros curtos, e alteraçöes pélvicas e falangeanas. Pode haver associaçäo com alteraçöes renais e hepáticas, evoluindo para insuficiência renal progressiva nos casos em que a deformidade torácica näo for o fator limitante da sobrevida. Neste artigo descrevemos dois casos familiares de DTA e relatamos uma breve revisäo bibliográfica do assunto, destacando a importância do diagnóstico precoce, que permite antecipar a evoluçäo clínica, bem como evitar o óbito precoce, pelo emprego de novas técnicas de expansäo da caixa torácica

Fatores de risco para asfixia neonatal em recém-nascidos com peso acima de 1000 gramas / Risk factors for neonatal asphyxia in neonates weighing more than 1000 grams

Objetivo: Avaliar alguns fatores de risco para asfixia neonatal em recém-nascidos vivos com peso acima de 1000 gramas. Métodos: De uma populaçäo de 13.385 partos consecutivos, no período de janeiro de 1991 a dezembro de 1994, foram comparados 135 recém-nascidos com asfixia neonatal e 135 sem a doença, num estudo caso-controle emparelhado pelo peso, no Serviço de Neonatologia do Departamento de Pediatria da Unicamp. A análise estatística foi bivariada e múltipla por regressäo logística, calculando-se a razäo de chance (O.R.) com intervalo de confiança de 95 por cento. Resultados: Na análise bivariada, as variáveis associadas com a asfixia foram descolamento prematuro de placenta [O.R. = 8.00(1.07 - 353,4)], parto cesárea [O.R. = 4,88(2,25 - 12,08)], rotura prolongada de membranas [O.R. = 4,33 (1,19 - 23,71)], líquido amniótico meconial, hemorrágico ou purulento [O.R. = 9,00(3,58 - 29,03)], oligoâmnio ou poliidrâminio [O.R. = 5,00(1,88 - 16,76), uso de anestesia [O.R. = 2,56 (1,41 - 4,89)] e anestesia geral [O.R. = 14,00 (2,13 - 598,8)], sexo masculino O.R. = 2,06 (1,12 - 3,92)] e idade gestacional abaixo de 37 semanas [O.R. = 3,29 (1,37 - 9,07). Após a análise múltipla, o líquido amniótico näo claro, a anestesia, o oligoâmnio ou polidrâmnio permaneceram como fatores de risco independentes para asfixia, enquanto o número de consultas de pré-natal maior que seis apareceu como fator protetor. Conclusöes: A asfixia neonatal associa-se a eventos clínicos obstétricos, perinatais e neonatais; assim combinar esforços para prover cuidado pré-natal adequado, ótima atençäo ao parto e nascimento e cuidado intensivo neonatal poderia reduzir significativamente a morbidade e mortalidade neonatal pela doença

Distrés respiratorio del recién nacido: ¿ha pensado en el síndrome de pulmón inmaduro? / Neonatal respiratory distress: had you think in the immature lung syndrome?

Los problemas respiratorios del recién nacido tanto de término como de pretérmino son una causa frecuente de morbimortalidad y por lo tanto de hospitalización. Frente a un recién nacido con dificultad respiratoria el pediatra realiza un análisis para determinar la etiología considerando antecedentes maternos, edad gestacional, examen del paciente y resultados de estudios de laboratorio y por imágenes. Actualmente la enfermedad de membrana hialina se ha hecho menos frecuente debido al uso profiláctico de corticoides y a la administración de surfactante exógeno, ya sea previniendo la patología o como tratamiento. Como causa de origen respiratorio existe también la taquipnea transitoria y el síndrome de pulmón inmaduro que se describe a continuación