Neonatal Intensive Care Department, Trousseau University Hospital, APHP, Paris, France.
Department of Obstetrics and Gynaecology, FHU PREMA, Trousseau University Hospital, Paris, France.
Acta Paediatr. 2022 Mar;111(3):576-583. doi: 10.1111/apa.16199. Epub 2021 Dec 3.
Birth asphyxia can lead to organ dysfunction, varying from isolated biological acidosis to hypoxic-ischemic encephalopathy (HIE). Pathophysiology of moderate or severe HIE is now well known and guidelines exist regarding the care required in this situation. However, for newborns without moderate or severe HIE, no consensus is available. Our objective was to describe the immediate neonatal consequences and need for care of asphyxiated newborns without moderate or severe HIE.
Multicentre retrospective study from January 2015 to December 2017 in two academic centres, including neonates ≥37 gestational weeks with pathological foetal acidemia (umbilical arterial pH<7.00 and/or lactate≥10 mmol/L).
Among 18 550 births, 161 (0.9%) had pathological foetal acidemia. 142 (88.0%) were not diagnosed with moderate or severe HIE. Among them, 82 (58.0%) were hospitalised. 13 (9.0%) had respiratory failure and required nutritional support. 100 (70.0%) underwent blood sampling, which showed at least one biological anomaly in 66 (66.0%) of cases.
Newborns born with pathological foetal acidemia without the occurrence of moderate or severe HIE had metabolic disorders and could need organ support. A prospective study describing this vulnerable population would help to establish consensus guidelines for the management of this population.
出生窒息可导致器官功能障碍，从孤立的生物酸中毒到缺氧缺血性脑病（HIE）不等。中度或重度 HIE 的病理生理学现在已经很清楚，并且针对这种情况的护理指南已经存在。然而，对于没有中度或重度 HIE 的新生儿，尚无共识。我们的目的是描述无中度或重度 HIE 的窒息新生儿的即刻新生儿后果和护理需求。
这是一项 2015 年 1 月至 2017 年 12 月在两个学术中心进行的多中心回顾性研究，纳入≥37 孕周且有病理胎儿酸中毒（脐动脉 pH<7.00 和/或乳酸≥10mmol/L）的新生儿。
在 18550 例分娩中，有 161 例（0.9%）存在病理胎儿酸中毒。其中 142 例（88.0%）未诊断为中度或重度 HIE。在这 142 例中，82 例（58.0%）住院。其中 13 例（9.0%）有呼吸衰竭，需要营养支持。100 例（70.0%）进行了血液取样，其中 66 例（66.0%）至少存在一种生物学异常。
出生时伴有病理胎儿酸中毒但未发生中度或重度 HIE 的新生儿存在代谢紊乱，可能需要器官支持。描述这一脆弱人群的前瞻性研究将有助于为该人群的管理制定共识指南。
