Wayenberg J L, Vermeylen D, Bormans J, Magrez P, Müller M F, Pardou A
Department of Paediatrics, Hôpital Français, Reine Elisabeth, Brussels, Belgium.
J Perinat Med. 1994;22(2):129-36. doi: 10.1515/jpme.1994.22.2.129.
Ten indicators available during the first two hours of life, such as clinical criteria of neonatal distress and postnatal arterial blood gases, were compared with the neonatal neurological course in sixty full term newborns with significant birth asphyxia in order to test their value for the diagnosis and the short-term prognosis of severe birth asphyxia. Birth asphyxia was defined as severe when it was followed by symptoms of moderate or severe post-asphyxial encephalopathy. We calculated a sensitivity lower than fifty percent for clinical criteria such as delay in establishing regular respiration and Apgar scores. It was clear that normal delay in establishing regular respiration and normal Apgar scores do not exclude severe birth asphyxia. Arterial pH and base deficit at thirty minutes of life were found to be the best criteria for the diagnosis of severe birth asphyxia, but lacked positive predictive value. The best predictive tool for the short-term neurological prognosis of birth asphyxia was a single score established at 30 minutes of life and based on the evaluation of consciousness, respiration and neonatal reflexes. Some aspects of the pathophysiology of birth asphyxia and the rationale for treatment of post-asphyxial metabolic acidosis are discussed.
为了检验出生时严重窒息的诊断价值和短期预后，研究人员对60例足月且出生时严重窒息的新生儿出生后两小时内可得的10项指标，如新生儿窘迫的临床标准和出生后动脉血气，与新生儿神经学病程进行了比较。当出生窒息后出现中度或重度窒息后脑病症状时，被定义为严重窒息。对于诸如建立规律呼吸延迟和阿氏评分等临床标准，我们计算出其敏感性低于50%。显然，建立规律呼吸的正常延迟和正常的阿氏评分并不能排除严重出生窒息。出生30分钟时的动脉pH值和碱缺失被认为是诊断严重出生窒息的最佳标准，但缺乏阳性预测价值。出生窒息短期神经学预后的最佳预测工具是出生30分钟时基于意识、呼吸和新生儿反射评估建立的单一评分。本文还讨论了出生窒息病理生理学的一些方面以及窒息后代谢性酸中毒的治疗原理。
