Abstract

BIRTH ASPHYXIA, RESPIRTORY DISTRESS SYNDRAME

Dr. Nadia Riyadh Maaroof*, Dr. Azeez Abed Bihaadh Alyakoobi and Dr. Deman Hunar Najeeb

ABSTRACT

„Birth asphyxia‟ is a term that generates anxiety for most birth attendants. Not only does it contribute to a large number of neonatal deaths and long-term disabilities in children worldwide, but it can have a long lasting impact on the careers of the obstetricians and midwives concerned. Obstetric claims related to mishaps during labour, leading to birth asphyxia and long-term neurological damage to the newborn, are associated with enormous costs of financial compensation for families who have to suffer the emotional distress and care for a possibly life-long handicapped child. Recent advances in obstetrics, neonatology and radiology have enabled health care professionals to –prevent some of the cases of birth asphyxia, improve its management with the aim to limit damage/disability and correctly assess the prognosis for long-term neurological development of the child. There is evidence that therapeutic hypothermia is beneficial in term and late preterm newborns with hypoxic ischaemic encephalopathy, and reduces mortality without increasing major disability in survivors. Hypothermia should be instituted in term and late preterm infants with moderate to severe hypoxic ischaemic encephalopathy if identified before six hours of age. From an obstetric point of view - accurate intrapartum fetal monitoring based on national guidelines, good communication and evidence based management hold the key to successful outcomes and avoidance of adverse events. RDS is caused by developmental insufficiency of surfactant production and structural immaturity of the lungs. The incidence is therefore inversely related to the gestational age and RDS remains the leading cause of death in premature infants. The lack of surfactant, which is produced in type II pneumocytes from 24 weeks‟ gestation, leads to a reduction in lung compliance. The alveoli tend to collapse, giving rise to atelectasis and a reduced functional residual capacity. Apart from prematurity, several factors contribute to the development of RDS. The risk of developing RDS is markedly reduced with the administration of antenatal steroids and prophylactic surfactant.

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