MULTIPLE ORGAN INVOLVEMENT IN PERINATAL ASPHYXIA

Objectives: (1) To evaluate the frequency and spectrum of severity of multisystem dysfunction after perinatal asphyxia and (2) to analyze th e relationship between the clinical and biochemical markers of perinat al asphyxia and multiorgan involvement. Study design: Seventy-two cons ecutive term newborn infants with perinatal asphyxia were studied pros pectively. Systematic neurologic, renal, pulmonary, cardiac, and gastr ointestinal evaluations were performed. Involvement of each organ was classified as moderate or severe. Results: Involvement of one or more organs occurred in 82% of the infants; the central nervous system (CNS ) was most frequently involved (72%). Severe CNS Injury (7 infants) al ways occurred with involvement of other organs, although moderate CNS involvement was isolated in 14 infants. Renal involvement occurred in 42%, pulmonary in 26%, cardiac in 29%, and gastrointestinal in 29% of the infants; 15% neonates had renal failure and 19% had respiratory fa ilure. The Apgar scores at 1 and 5 minutes were the only perinatal fac tors related to the number of organs involved and the severity of invo lvement; the Apgar score at 5 minutes had the stronger independent ass ociation. No relationship of organ dysfunction was found with the umbi lical cord arterial blood pH, meconium-stained amniotic fluid, umbilic al cord abnormalities, presentation, or type of delivery. Conclusions: Our findings indicate that the Apgar score at 5 minutes, in infants w ho have other criteria for asphyxia, is the perinatal marker that may best identify infants at risk of organ dysfunction.