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.
Subject(s)
Asphyxia Neonatorum/etiology , Asphyxia , Asphyxia Neonatorum/epidemiology , Colombia , Gestational Age , Humans , Infant, Newborn , Prenatal Care/statistics & numerical data , Risk FactorsABSTRACT
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.
Subject(s)
Humans , Infant, Newborn , Asphyxia , Asphyxia Neonatorum/etiology , Prenatal Care/statistics & numerical data , Asphyxia Neonatorum/epidemiology , Risk Factors , Gestational Age , ColombiaABSTRACT
El misoprostol, un análogo sintético de la prostaglandina E1, se ha asociado a un aumento en el riesgo de ocurrencia del síndrome de Moebius (parálisis congénita del VII par craneal que puede estar asociada a compromiso de otros pares craneales o incluso de otros sistemas) y defectos de las extremidades de tipo transversal-terminal en embarazos en que las madres utilizan este medicamento durante el primer trimestre de gestación. Se ha propuesto la perturbación vascular como mecanismo teratogénico del misoprostol. La asociación VACTERL es la coocurrencia estadísticamente no aleatoria de defectos vertebrales, anomalías vasculares, atresia anal, anomalías cardíacas, fístula traqueoesofágica con atresia esofágica, displasia renal y radial y anomalías de las extremidades diferentes a las radiales. No existe evidencia de una causa unificadora de la coocurrencia de las malformaciones VACTERL, por lo que esta condición se sigue denominando asociación y no síndrome. Se presenta el caso de una niña recién nacida con asociación VACTERL y síndrome de Moebius asociados a exposición prenatal a misoprostol en el primer trimestre del embarazo y, dado el mecanismo teratogénico del misoprostol, se propone un origen vascular de la asociación VACTERL.
Misoprostol, a synthetic analogue of prostaglandin E1, has been associated with an increased risk of occurrence of the Moebius syndrome (congenital paralysis of the seventh cranial nerve that may be associated with involvement of other cranial nerves or of other systems) and crossterminal limb defects in pregnancies in which mothers used this drug during the first trimester of pregnancy. Vascular disruption has been proposed as a teratogenic mechanism of misoprostol. The VACTERL association is the statistically non-random co-occurrence of vertebral defects, vascular anomalies, anal atresia, cardiac abnormalities, tracheo-esophageal fistula with esophageal atresia, radial and renal dysplasia, and other limb anomalies. There is no evidence for a unifying cause for the co-occurrence of VACTERL malformations, so this condition is still called an association and not a syndrome. We report the case of a newborn girl with VACTERL association and Moebius syndrome associated with prenatal exposure to misoprostol in the first trimester of pregnancy. Given the teratogenic mechanism of misoprostol, we propose a vascular origin for VACTERL association.