DIAGNOSIS OF SEVERE BIRTH ASPHYXIA AND EARLY PREDICTION OF NEONATAL NEUROLOGICAL OUTCOME IN TERM ASPHYXIATED NEWBORNS

Ten indicators available during the first two hours of life, such as c linical criteria of neonatal distress and postnatal arterial blood gas es, -ere compared with the neonatal neurological course in sixty full term newborns with significant birth asphyxia in order to test their v alue for the diagnosis and the short-tem prognosis of severe birth asp hyxia. Birth asphyxia was defined as severe when it was followed by sy mptoms of moderate or severe post-asphyxial encephalopathy. We calcula ted 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 ba se deficit at thirty minutes of life were found to be the best criteri a for the diagnosis of severe birth asphyxia, but lacked positive pred ictive value. The best predictive tool for the short-term neurological prognosis of birth asphyxia was a single score established at 30 minu tes of life and based on the evaluation of consciousness, respiration and neonatal reflexes. Some aspects of the pathophysiology of birth as phyxia and the rationale for treatment of post-agphyxial metabolic aci dosis are discussed.