Monday, March 7, 2011

Perinatal Asphyxia Postasfixic Syndrome

Perinatal Asphyxia

* Introduction
* Clinical Forms
Antepartum diagnosis *
* Changes postpartum laboratory
* Positive Diagnosis
* Postasfixic Syndrome
* Treatment
* Evolution and prognosis
back Postasfixic Syndrome
Complications include asphyxiation syndrome postasfixic.
The brain is manifested by focal or multifocal cortical necrosis, microinfarcte brain, selective neuronal necrosis, and necrosis in the nuclei or basal ganglia talamici, hypoxic-ischemic encephalopathy which has a spectrum of clinical manifestations of severe environmental disturbances expressed by tone, reflexes, irregular breathing, tonic-clonic seizures. Severely affected children may show progressive deterioration of brain function with prolonged apnea and coma.
At the level of transient myocardial ischemia occurs cardiovascular clinical signs of progressive respiratory distress at birth, congestive heart failure. Clinical signs: central cyanosis, tachypnea, pulmonary rales, discrete hepatosplenomegaly. Is characteristic systolic murmur on the left of the sternum. In developing severe forms systemic hypotension and increased central venous pressure. In critical states can occur rapidly progressive shock expressed by weak pulse in the extremities, capillary Recolor for over three seconds, the importance of hepatomegaly, pulmonary rales, gallop rhythm. Radiograph reveals cardiomegaly. Electrocardiography showed ischemic changes. Echocardiography, Doppler echocardiography reveals tricuspid and mitral regurgitation.
In the respiratory complications include: - Increased pulmonary resistance; - Pulmonary hemorrhage, usually massive, correlated with clotting disorders; - Congestive heart failure secondary pulmonary edema; - Inhibition of surfactant secretion by persistent acidemia with hyaline membrane disease installation, - Meconium aspiration.
Renal complications can be: acute tubular necrosis, cortical necrosis and / or bone marrow, acute renal vein thrombosis. Initial failure is prerenala and usually resolves within 4-5 days after postasfixic syndrome occurs if prompt, or turn in proteinuria and renal failure with myoglobinuria. The newborn may oligoanurie a period of 24 hours, rarely after 24 hours. Persistent oliguria over this period is accompanied by multiple injuries organic. Monitoring non-protein nitrogen, urea and creatinine, serum Na and K, the concentration of urinary Na and K are exploring what we will confirm ARF
Liver Complications include: Outbreaks of hepatic necrosis, hepatic disorders of enzymatic processes, coagulation factor deficiencies vitamin-K dependent, non-reversible by treatment with vitamin K.
Haematological complications manifested by: poliglobulie, anemia, disseminated vascular coagulation phenomena (CID).
Gastrointestinal complications, which is distinguished by intestinal ischemia may be complicated by ulcerative-necrotic enterocolitis.
Thermoregulatory disorders include hypoxia, which has inhibitory action on thermoregulatory centers, making it difficult to adapt to external thermal environment of these infants (hyperthermia, especially hypothermia).

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