[Clinical and prognostic value of cardiovascular symptoms in perinatal asphyxia]. / Importancia clínica y pronóstica de las manifestaciones cardiovasculares en la asfixia perinatal.

OBJECTIVE: The myocardium, while selected as a preferred organ for perfusion in the asphyxiated fetus or newborn, nevertheless may suffer damage. The objectives of this study were: (1) to analyze the frequency and type of cardiovascular (CV) manifestations in perinatal asphyxia (PA); (2) to evaluate the perinatal differences in asphyxiated term infants with and without CV involvement; and (3) to know the importance of CV manifestations in relationship to neurological sequelae in PA. PATIENTS AND METHODS: One hundred and fifty-six consecutive asphyxiated full-term newborns were studied prospectively. During the neonatal period, systematic CV evaluations, including clinical examination, heart rate and blood pressure monitoring, and complementary procedures (chest X-rays, electrocardiograms and echocardiograms), were performed on every infant with PA. Those with CV involvement were classified into two groups: "minor" (dysrhythmias and mild hypotension) and "major" (transient tricuspid insufficiency, myocardial ischemia, cardiogenic and/or hypovolemic shock). CV involvement was analyzed with regard to severity of PA, hypoxic-ischemic encephalopathy (based on the classification of Levene) and neurologic sequelae after a follow-up period of at least 12-months (based on the classification of Finer and Amiel-Tison). RESULTS: CV manifestations were observed in 31 (19.8%) of the infants and classified as minor in 27 cases (mainly mild hypotension and bradycardia) and major in 4. CV involvement was found significantly more frequently in asphyxiated newborns with severe PA (p < 0.001) and those with neurological and other extraneurological manifestations (p < 0.001). In relation to neurologic sequelae at follow-up, the only significant extraneurologic involvement in PA was CV involvement (univariant analysis by Cox's regression; RR = 3.96, CI95% = 1.50-10.45). CONCLUSIONS: A significant association was found between CV manifestations and all of the neurological and extraneurological dysfunctions in PA, based on the severity of the hypoxic-ischemic lesion. The incidence of severe CV damage is low, although less severe manifestations may be frequent (mainly mild hypotension and bradycardia). The results of this study indicate the need for CV assessment in asphyxiated term newborn infants based on its clinical and prognostic value in relationship to neurological sequelae.