Asphyxia and Developmental Outcome in High Risk Infants

By Dukovska, Valentina; Sofijanova, Aspazija et al. | The Journal of Special Education and Rehabilitation, January 1, 2010 | Go to article overview

Asphyxia and Developmental Outcome in High Risk Infants


Dukovska, Valentina, Sofijanova, Aspazija, Duma, Filip, Juzevski, Zhivko, The Journal of Special Education and Rehabilitation


Abstract

Asphyxia is a risk factor that is very often related to neuro-developmental issues in high risk infants and equally affects preterm and term infants, however its outcome on the developed brain differs from the outcome on the preterm brain.

In preterm infants, asphyxia usually exerts a hemorrhagic or ischaemic event and periventricular leukomalacia.

In term infants, asphyxia leads to cerebral edema and atrophy of the brain, which may later lead to hypoxic ischaemic encephalopathy (HIE).

The number of term infants with HIE who have survived is lower than those of preterm infants, while the percentage of term infants with HIE who have neuro-developmental issues is higher.

Preemies face more problems in their motor development as a result of the brain damage, while term infants suffer from encephalopathy and their cognitive abilities are more affected.

We have conducted a study about the effects that asphyxia has on the developmental outcomes in high risk infants. In our study, we did a longitudinal developmental follow-up of 30 high risk infants and an evaluation of their developmental outcome using the Griffiths Mental Development Scales, from the 4th month of life until the end of the 36th month. First, we found that high risk infants had a much lower developmental outcome than the control group during the trial. Finally, we found that asphyxia makes a difference in the developmental outcome of preterm infants without asphyxia who have a very low birth weight, the preterm infants with asphyxia, and the term infants with HIE-II.

Key words: asphyxia, HIE, high risk infants, Griffiths Developmental Scales, developmental outcome

(ProQuest: ... denotes formula omitted.)

Introduction

Asphyxia is a commonly used clinical term that is related to ischaemia (local deficiency of blood supply) and hypoxia (deficiency in the amount of oxygen).

Initially, Virginia Apgar introduced a scoring system, which now carries her name, to assess an infant one minute after birth (Apgar score, 1953). Today, this assessment is conducted five minutes after birth. The assessment refers to the afterbirth condition the child is in (1).

According to the NH&MRC report of the Healthcare Committee Expert on Perinatal Morbidity, asphyxia is a neonatal condition with the following symptoms:

* Reduction of oxygen flow that leads to acidosis

* Functional problems in two organs as a result of acute asphyxia (2).

Asphyxia leads to a lower Apgar score. The developmental outcome in high risk infants is related to an Apgar score ≤3 in the 5th minute after birth or ≤5. More and more studies reveal that the Apgar score does not show the duration of suffering of the infant and has a low correlation with the infantfs developmental outcome (3).

Causes of asphyxia are related to pregnancy, the birth, and the time right after birth (4, 5).

Hypoxic-ischaemic encephalopathy Postasphyctic encephalopathy

The transferal from brain hypoxia-ischaemia to hypoxic-ischaemic encephalopathy (HIE) is a clinical manifestation.

Postasphyctic encephalopathy - HIE is closely related to later neuro-developmental issues and is not always in good correlation with the Apgar score. Because HIE can be analyzed in a retrospective way, more researchers use it as an index of developmental outcome, "HIE represents an abnormal brain function, a brain damage as a result of deficiency in the blood (ischaemia) and oxygen (hypoxia) supply" (1, 3).

The HIE affected infants have neurological symptoms and show signs of more than two afflicted organs. As a result of brain damage, especially the effects of HIE, permanent injury of brain tissue, cerebral paralysis (CP), epilepsy, and mental retardation can occur.

Asphyxia in preemies can cause hemorrhaging and damage to the brain structure, such as thalamus, hypothalamus, and others. (6)

In term infants HIE is divided into three levels. …

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