Intrapartum Asphyxiated Newborns Without Fetal Heart Rate and Cord Blood Gases Abnormalities: Two Case Reports of Shoulder Dystocia to Reflect Upon

Gina Ancora,Fabrizio Sandri,Claudio Meloni,Silvia Soffritti,Emanuela Ferretti

doi:10.3389/fped.2020.570332

Abstract

Our report covers two cases of severe hypoxic-ischemic encephalopathy in newborns whose birth was complicated by shoulder dystocia. In both cases, there were inconsistencies observed among cardiotocographic traces, baby's clinical conditions at birth, and umbilical cord blood gases. Namely, normal cardiotocographic monitoring and cord pH > 7, in spite of the fact that the newborns were severely depressed at birth and their blood gases evaluated within 1 h from birth showed a severe metabolic acidosis. Moreover, one of the two newborns displayed moderately low hemoglobin levels. Metabolic and infectious causes were ruled out. Both newborns developed severe hypoxic-ischemic encephalopathy and received therapeutic hypothermia for 72 h. Both survived, one with a severe dystonic cerebral palsy whereas the other developed only a mild developmental delay in language. Cardiac asystole theory could explain these two cases, reinforcing the need for specific resuscitation guidelines for infants experiencing a birth complicated by shoulder dystocia.

Highlights

Shoulder dystocia is a severe condition capable of posing a risk to the health of the newborn by increasing the odds of perinatal asphyxia, hypoxic-ischemic encephalopathy, perinatal mortality, and brachial plexus paralysis [1].Asphyxia following shoulder dystocia is sometimes very severe, and perinatal mortality has been reported in spite of a remarkably short head-body delivery interval [2]
Inconsistencies can be detected among neonatal clinical status, cardiotocographic findings, and cord blood gases values [3,4,5], possibly increasing litigation between healthcare professionals and parents
We report two cases of infants whose birth was complicated by shoulder dystocia, who were severely depressed at birth despite the lack of fetal heart rate (FHR) anomalies during labor or umbilical-cord gas anomalies at birth, and despite appropriate obstetric and neonatological care; reinforcing the soundness of the cardiac asystole hypothesis in these cases [3]

Summary

INTRODUCTION

Shoulder dystocia is a severe condition capable of posing a risk to the health of the newborn by increasing the odds of perinatal asphyxia, hypoxic-ischemic encephalopathy, perinatal mortality, and brachial plexus paralysis [1]. Asphyxia following shoulder dystocia is sometimes very severe, and perinatal mortality has been reported in spite of a remarkably short head-body delivery interval [2]. In these dramatic circumstances, inconsistencies can be detected among neonatal clinical status, cardiotocographic findings, and cord blood gases values [3,4,5], possibly increasing litigation between healthcare professionals and parents. The baby showed severe hypotonia and passive hypothermia was started at about 10 min of life. He was transferred to the neonatal intensive care unit (NICU), mechanically ventilated with a fraction of inspired oxygen (FiO2) 0.3. At the 2-years followup, the baby showed severe dystonic cerebral palsy and neurosensorial deficits

DISCUSSION

CONCLUSIONS

ETHICS STATEMENT