Introduction
Clinical manifestations of this case depends on the severity and degree of hypoxic.
They include:
- Ischaemic encephalopathy), inability to cry or suck, global
- hypotonia and poor activity or global hypertonia with brisk deep tendon reflexes, shock, poor temperature regulation, paralytic ileus, respiratory distress, bleeding tendencies, seizures, oliguria
Management
Management is largely anticipatory.
Serial monitoring of parameters such as:
- oxygen saturation via pulse oximetry, random blood glucose, serum electrolytes, urea and creatinine, serum calcium, serum
troponin, serum aspartate aminotransferase, serum alanine aminotransferase should be
done where facilities are available. - Derangements should be appropriately corrected according to standard protocols:
- Prophylactic phenobarbitone by slow intravenous administration (even in the absence of seizures) 10-15mg/kg loading dose and maintained with 2.5mg/kg 12 hourly till neurologic functions are
restored. - Seizures should be managed with slow intravenous phenobarbitone (loading dose of 15mg/kg over 15-20 minutes to be maintained with 2.5mg/kg 12 hourly. The dose should be tailed off over many days after serial neurologic physical examination and electroencephalography have consistently shown normal parameters.
- Fluid restriction in the management of perinatal asphyxia is no longer favored because of the existing risks of renal insufficiency coupled with the uncertain risk of the Syndrome of Inappropriate ADH Secretion. Efforts should be to prevent over-hydration rather than fluid restriction. Administer the exact daily maintenance fluid requirement.
- Apnea should be managed with frequent airway clearing and ventilation by bag and mask.
- Nil per os should be maintained until peristalsis is present and respiratory rate is normal. Feeding should be instituted even when the sucking reflex is still depressed with the use of expressed breast milk administered via a nasogastric tube. The volume of milk to be administered will depend on the daily maintenance fluid requirement.
Outcome.
- The persistence of abnormal cry, abnormal motor functions and primitive reflexes beyond the first week of life highly suggests severe cerebral damage.
- The risk of long term neurologic deficits has been shown to be minimized with the use of interventions such as magnesium sulphate and selective cerebral cooling.