520: Neonatal organ system injury in acute birth asphyxia sufficient to result in permanent brain injury

Abstract

RESULT IN PERMANENT BRAIN INJURY JEFFREY PHELAN, LISA KORST, GILBERT MARTIN, Citrus Valley Medical Center, OB/Gyn, City of Industry, California, USC Keck School of Medicine, OB/GYN, Los Angeles, California, Citrus Valley Medical Center, Neonatology, West Covina, California OBJECTIVE: To determine the prevalence of major organ dysfunction among neonates with acute intrapartum asphyxia that resulted in permanent brain injury. STUDY DESIGN: Fetuses with a sudden, rapid and sustained deterioration from a previously reactive FHR pattern were identified in a registry of singleton term brain damaged neonates. All neonates without the requisite FHR pattern were excluded because their brain injury was considered non-acute. Neonatal organ injury was determined using available laboratory tests. As all the neonates had permanent brain injury, central nervous system injury was not considered an organ injury. Hematologic injury was not defined. Organ system injury was defined separately for each organ as follows: Renal-serum creatinine 1.0 mg/dl or oliguria [ 1.0 cc/kg/hr]; Hepatic-Elevation of SGOT or SGPT 100 U/L or LDH 600 U/L; Cardiac-pressors for support or CPK 400 U/L or abnormal echocardiogram; Pulmonary: ventilator support; Gastrointestinal: gasless abdomen on x-ray. RESULTS: One hundred fourteen cases of acute asphyxia sufficient to result in permanent brain injury were identified. Of the 114 cases, 18 cases were excluded due to insufficient data,yielding 96 cases for further examination. Of these 96 cases, 72 (75%) had an hypoxic sentinel event: uterine rupture alone-12 (17%) or with expulsion-38 (53%) or other-22 (30%). The prevalence of organ dysfunction was as follows: Pulmonary-87/90 [97%];Renal-77/90 [86%]; Cardiac-51/94[54%]; Hepatic-30/54 [56%]; Gastrointestinal-17/47 [36%]. The number of organs affected were as follows: 0-None; 1-(15%); 2-29 (30%); 3-36 (38%); 4-16 (17%). CONCLUSION: Using common diagnostic tests, we determined that multiple organs suffer damage during an acute intrapartum asphyxial event sufficient to result in permanent neonatal brain injury.