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May 1989, Vol 143, No. 5 >
Article | May 1989

Acute Systemic Organ Injury in Term Infants After Asphyxia FREE

J. M. Perlman, MD; E. D. Tack, MD; T. Martin, MD; G. Shackelford, MD; E. Amon, MD
[+] Author Affiliations

Accepted for publication December 21, 1988.

Reprint requests to Children's Hospital, Division of Newborn Medicine, 400 S Kingshighway, St Louis, MO 63110 (Dr Perlman).


Am J Dis Child. 1989;143(5):617-620. doi:10.1001/archpedi.1989.02150170119037.
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References
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• The systemic manifestations of "asphyxia" were evaluated prospectively in 35 consecutively intubated term newborn infants. The following systemic organ injuries were identified most often: (1) renal, ie, oliguria less than 1 mL/kg per hour for at least 24 hours (40%), an elevated urinary β-2-microglobulin concentration (57%), azotemia (11%), and an elevated serum creatinine level (17%); (2) central nervous system, ie, hypoxic-ischemic encephalopathy (including seizures) (31%) or an abnormal cranial ultrasound scan, ie, diffuse parenchymal echogenicity, slitlike ventricles, and poor visualization of the sulci, and/or intracranial hemorrhage (26%); (3) cardiovascular, ie, an abnormal echocardiogram (25%) or abnormal electrocardiogram (11%); (4) pulmonary complications, including persistent pulmonary hypertension (23%); and (5) gastrointestinal complications, which were rare. Traditional markers of fetal distress were not related to the frequency and/or distribution of systemic organ injury. An important implication of this study relates to the recognition of the extent and distribution of organ injury in the "asphyxiated" infant.

(AJDC. 1989;143:617-620)

REFERENCES

1 +
Behrman RE, Lees MH, Petersen EH, Lannoy CW, Seeds AE.  Distribution of the circulation in the normal and asphyxiated fetal primate . Am J Obstet Gynecol . 1970;;180:956-961.
2 +
Cohn EH, Sack SEJ, Heymann MA, Rudolph AM.  Cardiovascular responses to hypoxemia and acidemia in fetal lambs . Am J Obstet Gynecol . 1974;;120:817-824.
3 +
Rudolph AM:  The fetal circulation and its response to stress . J Dev Physiol . 1984;;6:11-16.
4 +
Sexson WR, Sexson SB, Rawson JE, Brann AW.  The multisystem involvement of the asphyxiated newborn . Pediatr Res . 1976;;10:432. Abstract.
5 +
Dubowitz L, Dubowitz V, Goldberg C.  Clinical assessment of gestational age in the newborn infant . J Pediatr . 1970;;77:1-5.
6 +
Cole JW, Portman RJ, Lim Y, Perlman JM, Robson AM.  Urinary B2-microglobulin in full term newborns: evidence for proximal tubular dysfunction in infants with meconium-stained amniotic fluid . Pediatrics . 1985;;76:958-964.
7 +
Tack ED, Perlman JM, Robson AM.  Renal injury in sick newborn infants: a prospective evaluation utilizing urinary B2-microglobulin concentrations . Pediatrics . 1988;;81:432-440.
8 +
Volpe JJ: Neurology of the Newborn . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1987;.
9 +
Siegel MJ, Shackelford GD, Perlman JM, Fulling GE.  Hypoxic-ischemic encephalopathy in term infants: diagnosis and prognosis evaluated by ultrasound . Radiology . 1984;;152:395-399.
10 +
Sahn DJ, DeMaria AN, Kisslo J, Weyman A.  Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements . Circulation . 1978;; 58:1072-1083.
11 +
Johnson GL, Breart GL, Gewitz MH, et al.  Echocardiographic characteristics of premature infants with patent ductus arteriosus . Pediatrics . 1983;;72:864-871.
12 +
Hirschfeld S, Meyer R, Schwartz DC, Korfhagen J, Kaplan S.  Measurement of right and left ventricular systolic time intervals by echocardiography . Circulation . 1975;;51:304-309.
13 +
Spodick DH, Ball HE, Pigott VM.  Effects of recording speed on precision of time-based polycardiographic measurements . Br Heart J . 1978;; 40:13441348.
14 +
Goldberg SJ, Allen HD, Sahn DJ. Pediatric and Adolescent Echocardiography: A Handbook . Chicago, Ill: Year Book Medical Publishers Inc; 1980;.
15 +
Goldberg SJ, Allen HD, Marx GR, Flynn C. Doppler Echocardiography . Philadelphia, Pa: Lea & Febiger; 1985;.
16 +
Leibman J.  Electrocardiography . In: Moss AJ, Adams FH, Emmanouilides GG, eds. Electrocardiography in Heart Disease in Infants, Children, and Adolescents . 2nd ed. Baltimore, Md: Williams & Wilkins; 1977;.
17 +
Fox WW, Duara S.  Persistent pulmonary hypertension in the neonate: diagnosis and management . J Pediatr . 1983;;103:505-514.
18 +
Walsh MC, Kliegman RM.  Necrotizing enterocolitis: treatment based on staging criteria . Pediatr Clin North Am . 1986;;33:179-201.
19 +
Dauber IM, Krauss AN, Symchych PS, Auld PAM.  Renal failure following perinatal anoxia . J Pediatr . 1976;;88:851-855.
20 +
Stark H, Geiger R.  Renal tubular dysfunction following vascular accidents of the kidneys in the newborn period . J Pediatr . 1973;;83:933-940
21 +
Stites DP, Pawlak LL, Carr MC, Fudenberg HH, Poulik MD.  Ontogeny of beta-2-microglobulin synthesis in the human fetus . Dev Comp Immunol . 1978;;2:185-192.
22 +
Takieddine F, Tabbara M, Hall P, Sokol RJ, King KC.  Fetal renal maturation: studies on urinary B2-microglobulin in the neonate . Acta Obstet Gynecol Scand . 1983;;62:311-314.
23 +
Aperia A, Broberger O, Elinder G, Herin P, Zetterstrom R.  Postnatal development of renal function in pre-term and full-term infants . Acta Pediatr Scand . 1981;;70:183-187.
24 +
Assadi FK, John EG, Justice P, Fornell L.  Beta-2-microglobulin clearance in neonates: index of tubular maturation . Kidney Int . 1985;;28: 153-157.
25 +
Aperia A, Broberger O.  Beta-2-microglobulin, an indicator of renal tubular maturation and dysfunction in the newborn . Acta Pediatr Scand . 1979;; 68:669-676.
26 +
Nelson KB, Ellenberg JH.  Neonatal signs as predictors of cerebral palsy . Pediatrics . 1979;; 64:225-232.
27 +
Perlman JM, Tack ED.  Renal injury in the asphyxiated newborn infant: relationship to neurological outcome . J Pediatr . 1988;;113:875-879.
28 +
Bucciarelli RL, Nelson RM, Egan EA, Eitzman DV, Gessner IH.  Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborns . Pediatrics . 1977;;59:330-337.
29 +
Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouilides G.  Cardiogenic shock associated with perinatal asphyxia in preterm infants . J Pediatr . 1980;;96:705-710.
30 +
Donnelly WH, Bucciarelli RL, Nelson RM.  Ischemic papillary muscle necrosis in stressed new-born infants . J Pediatr . 1980;;96:295-300.
31 +
Finley JP, Howman-Giles RB, Gilday DL, Bloom KR, Rowe RD.  Transient myocardial ischemia of the newborn infant demonstrated by thallium myocardial imaging . J Pediatr . 1979;; 94:263-270.
32 +
Rein AJ, Sanders SP, Colan SD, Parness IA, Epstein M.  Left ventricular mechanics in the normal newborn . Circulation . 1987;;76:1029-1036.
33 +
Sykes GS, Molloy PM, Johnson P, Wei G, Ashworth F, Stirrat GM.  Do Apgar scores indicate asphyxia? Lancet . 1982;;1:494-496.
34 +
Silverman F, Suidan J, Wasserman J, Antoine C, Young BK.  The Apgar score: is it enough? Obstet Gynecol . 1985;;66:331-336.
35 +
Goldenberg RL, Huddleston JF, Nelson KG.  Apgar scores and umbilical arterial pH in preterm newborn infants . Am J Obstet Gynecol . 1984;; 149:651-655.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Behrman RE, Lees MH, Petersen EH, Lannoy CW, Seeds AE.  Distribution of the circulation in the normal and asphyxiated fetal primate . Am J Obstet Gynecol . 1970;;180:956-961.
2 +
Cohn EH, Sack SEJ, Heymann MA, Rudolph AM.  Cardiovascular responses to hypoxemia and acidemia in fetal lambs . Am J Obstet Gynecol . 1974;;120:817-824.
3 +
Rudolph AM:  The fetal circulation and its response to stress . J Dev Physiol . 1984;;6:11-16.
4 +
Sexson WR, Sexson SB, Rawson JE, Brann AW.  The multisystem involvement of the asphyxiated newborn . Pediatr Res . 1976;;10:432. Abstract.
5 +
Dubowitz L, Dubowitz V, Goldberg C.  Clinical assessment of gestational age in the newborn infant . J Pediatr . 1970;;77:1-5.
6 +
Cole JW, Portman RJ, Lim Y, Perlman JM, Robson AM.  Urinary B2-microglobulin in full term newborns: evidence for proximal tubular dysfunction in infants with meconium-stained amniotic fluid . Pediatrics . 1985;;76:958-964.
7 +
Tack ED, Perlman JM, Robson AM.  Renal injury in sick newborn infants: a prospective evaluation utilizing urinary B2-microglobulin concentrations . Pediatrics . 1988;;81:432-440.
8 +
Volpe JJ: Neurology of the Newborn . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1987;.
9 +
Siegel MJ, Shackelford GD, Perlman JM, Fulling GE.  Hypoxic-ischemic encephalopathy in term infants: diagnosis and prognosis evaluated by ultrasound . Radiology . 1984;;152:395-399.
10 +
Sahn DJ, DeMaria AN, Kisslo J, Weyman A.  Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements . Circulation . 1978;; 58:1072-1083.
11 +
Johnson GL, Breart GL, Gewitz MH, et al.  Echocardiographic characteristics of premature infants with patent ductus arteriosus . Pediatrics . 1983;;72:864-871.
12 +
Hirschfeld S, Meyer R, Schwartz DC, Korfhagen J, Kaplan S.  Measurement of right and left ventricular systolic time intervals by echocardiography . Circulation . 1975;;51:304-309.
13 +
Spodick DH, Ball HE, Pigott VM.  Effects of recording speed on precision of time-based polycardiographic measurements . Br Heart J . 1978;; 40:13441348.
14 +
Goldberg SJ, Allen HD, Sahn DJ. Pediatric and Adolescent Echocardiography: A Handbook . Chicago, Ill: Year Book Medical Publishers Inc; 1980;.
15 +
Goldberg SJ, Allen HD, Marx GR, Flynn C. Doppler Echocardiography . Philadelphia, Pa: Lea & Febiger; 1985;.
16 +
Leibman J.  Electrocardiography . In: Moss AJ, Adams FH, Emmanouilides GG, eds. Electrocardiography in Heart Disease in Infants, Children, and Adolescents . 2nd ed. Baltimore, Md: Williams & Wilkins; 1977;.
17 +
Fox WW, Duara S.  Persistent pulmonary hypertension in the neonate: diagnosis and management . J Pediatr . 1983;;103:505-514.
18 +
Walsh MC, Kliegman RM.  Necrotizing enterocolitis: treatment based on staging criteria . Pediatr Clin North Am . 1986;;33:179-201.
19 +
Dauber IM, Krauss AN, Symchych PS, Auld PAM.  Renal failure following perinatal anoxia . J Pediatr . 1976;;88:851-855.
20 +
Stark H, Geiger R.  Renal tubular dysfunction following vascular accidents of the kidneys in the newborn period . J Pediatr . 1973;;83:933-940
21 +
Stites DP, Pawlak LL, Carr MC, Fudenberg HH, Poulik MD.  Ontogeny of beta-2-microglobulin synthesis in the human fetus . Dev Comp Immunol . 1978;;2:185-192.
22 +
Takieddine F, Tabbara M, Hall P, Sokol RJ, King KC.  Fetal renal maturation: studies on urinary B2-microglobulin in the neonate . Acta Obstet Gynecol Scand . 1983;;62:311-314.
23 +
Aperia A, Broberger O, Elinder G, Herin P, Zetterstrom R.  Postnatal development of renal function in pre-term and full-term infants . Acta Pediatr Scand . 1981;;70:183-187.
24 +
Assadi FK, John EG, Justice P, Fornell L.  Beta-2-microglobulin clearance in neonates: index of tubular maturation . Kidney Int . 1985;;28: 153-157.
25 +
Aperia A, Broberger O.  Beta-2-microglobulin, an indicator of renal tubular maturation and dysfunction in the newborn . Acta Pediatr Scand . 1979;; 68:669-676.
26 +
Nelson KB, Ellenberg JH.  Neonatal signs as predictors of cerebral palsy . Pediatrics . 1979;; 64:225-232.
27 +
Perlman JM, Tack ED.  Renal injury in the asphyxiated newborn infant: relationship to neurological outcome . J Pediatr . 1988;;113:875-879.
28 +
Bucciarelli RL, Nelson RM, Egan EA, Eitzman DV, Gessner IH.  Transient tricuspid insufficiency of the newborn: a form of myocardial dysfunction in stressed newborns . Pediatrics . 1977;;59:330-337.
29 +
Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouilides G.  Cardiogenic shock associated with perinatal asphyxia in preterm infants . J Pediatr . 1980;;96:705-710.
30 +
Donnelly WH, Bucciarelli RL, Nelson RM.  Ischemic papillary muscle necrosis in stressed new-born infants . J Pediatr . 1980;;96:295-300.
31 +
Finley JP, Howman-Giles RB, Gilday DL, Bloom KR, Rowe RD.  Transient myocardial ischemia of the newborn infant demonstrated by thallium myocardial imaging . J Pediatr . 1979;; 94:263-270.
32 +
Rein AJ, Sanders SP, Colan SD, Parness IA, Epstein M.  Left ventricular mechanics in the normal newborn . Circulation . 1987;;76:1029-1036.
33 +
Sykes GS, Molloy PM, Johnson P, Wei G, Ashworth F, Stirrat GM.  Do Apgar scores indicate asphyxia? Lancet . 1982;;1:494-496.
34 +
Silverman F, Suidan J, Wasserman J, Antoine C, Young BK.  The Apgar score: is it enough? Obstet Gynecol . 1985;;66:331-336.
35 +
Goldenberg RL, Huddleston JF, Nelson KG.  Apgar scores and umbilical arterial pH in preterm newborn infants . Am J Obstet Gynecol . 1984;; 149:651-655.

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