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Elizabeta ZISOVSKA

PERINATAL ASPHYXIA AS POTENTIAL SOURCE OF CHILDREN WITH DEVELOPMENTAL PSYCHO-MOTOR DIFFICULTIES

Besides the great improvement of aostetrics and neanatal intensive care, certain percentage of new born children suffer from perinatal asphyxia (PA) and that is one of the first reasons for hypoxic and ischemic brain damage which leads to neuro-developing handicap. In order to show how strong is the correaltion between PA and permanent sequele, an early, precise and prompt diagnosis of asphyxia and its influence on neonatal brain  is neccessary.

This study presents answers to the following issues.

1.       Which parameters define precisely the perinatal asphyxia?

2.       How great is the PA incidence on our material?

3.       What is the percentage of postasphyxic encephalopathy (PAE) in the group of asphyxic new born children?

4.       Which of these children bear high risk for developmental psycho-motor difficulties?

Material

The new born children delivered on time  in  the Clinic of Gyneacology  and Obstetrics.

Methods

1.       Early diagnosis of PA according to the score consisted of high specific, sensitivity and positive and predictive value

2.       Consequent neurological check-ups and PAE cathegori-zation for seven days

3.       Ultrasound examination of CNS through big fontanelle

4.       Lab analyses

Results

5.639 successive new born children delivered on time were examined. The included scouring system covers APGAR score at the 5th minute, cardiotocographic record, base deficit in ABS, meconium around the amniotic water. According to this system, 81 child passed the PA , i.e., 14,3/ 1.000 new born children delivered on time. Out of them, 54 have signs of PAE (9,5/1000 new born children delivered on time), i.e., 66,6% of all asphyxia new born children. Classification has been made according to the PAE grade: 34 children survived the first grade (62,9%), 11 children survived the second grade (20,4%) and 9 new born children survived the third grade (16,7%). According to data in literature and long year studies of this issue, the children from the group who passed the second and the third grade of PAE have the risk of neurodeveloping changes and disorders, i.e., that risk is 3,5/1000 children born on time and they should be recorded and permanently observed.