Gónzalez de Dios J, Moya M
Servicio de Pediatría, Hospital Universitario San Juan.
Rev Neurol. 1996 Jul;24(131):812-9.
Perinatal asphyxia, and its neurologic manifestations (hypoxic-ischemic encephalopathy) is the most important cause of brain injury and neurologic sequelae in full-term infants.
The aim of this study was to know the incidence of perinatal asphyxia, hypoxic-ischemic encephalopathy and neurologic sequelae in our full-term infants.
Prospective epidemiologic study of perinatal asphyxia in full-term infants born in Universitary Hospital San Juan (Alicante, Spain) between November 1991-February 1995. Perinatal asphxyia was graded as non severe (1-minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart rate patterns and/or meconiumstained amniotic fluid, and the need for immediate neonatal resuscitation) and severe (1-minute Apgar score < or = 3 and umbilical artery pH < 7.10). Hypoxic-ischemic encephalopathy was graded as mild, moderate and severe based on classification of Levene and Sarnat & Sarnat. Neurologic sequelae in 12-24 months follow-up was graded as mild, moderate and severe based on classification of Finer and Amiel-Tison.
During the study period there were 3.342 full-term, live births. Perinatal asphyxia developed in 156 (31 severe and 125 non-severe), with an incidence of 4.66 cases per 100 full-term newborns. Neurologic manifestations was present in 25.6% of 156 term infants with perinatal asphyxia: 40 cases of hypoxic-ischemic encephalopathy (mild in 30, moderate in 5 and severe in 5). The incidence of hypoxic-ischemic encephalopathy was 1.19 cases per 100 full-term infants. The asphyctic newborns were regularly assessed. Ten infants was lost to follow-up. The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 12-24 months, was 16.5%.
Despite the widespread use of the term perinatal asphyxia, there is little uniformity on the clinical definition of asphyxia, which makes comparison of incidence, treatment and outcome very difficult. The main epidemiologic differences in the studies of perinatal asphyxia and hypoxic-ischemic encephalopathy are due to little agreement on their definition. A consensus is necessary.
围产期窒息及其神经学表现（缺氧缺血性脑病）是足月儿脑损伤和神经后遗症的最重要原因。
本研究旨在了解我院足月儿围产期窒息、缺氧缺血性脑病及神经后遗症的发生率。
对1991年11月至1995年2月在西班牙阿利坎特圣胡安大学医院出生的足月儿围产期窒息进行前瞻性流行病学研究。围产期窒息分为非重度（1分钟阿氏评分≤6分和/或脐动脉血pH＜7.20，伴有异常胎心监护图形和/或羊水胎粪污染，且需要立即进行新生儿复苏）和重度（1分钟阿氏评分≤3分且脐动脉血pH＜7.10）。缺氧缺血性脑病根据Levene和Sarnat及Sarnat的分类法分为轻度、中度和重度。在12至24个月的随访中，神经后遗症根据Finer和Amiel-Tison的分类法分为轻度、中度和重度。
研究期间共出生3342例足月儿、活产儿。156例发生围产期窒息（31例重度，125例非重度），发生率为每100例足月儿中有4.66例。156例有围产期窒息的足月儿中，25.6%出现神经学表现：40例缺氧缺血性脑病（轻度30例，中度5例，重度5例）。缺氧缺血性脑病的发生率为每100例足月儿中有1.19例。对窒息新生儿进行了定期评估。10例失访。在至少随访12至24个月的115例窒息足月儿中，神经后遗症的发生率为16.5%。
尽管围产期窒息这一术语被广泛使用，但关于窒息的临床定义几乎没有统一标准，这使得发病率、治疗方法和治疗结果的比较变得非常困难。围产期窒息和缺氧缺血性脑病研究中的主要流行病学差异是由于对其定义缺乏共识。有必要达成共识。
