Nursing Care and Clinical Management of Birth Asphyxia-An Updated Review
Abstract
Background: Perinatal asphyxia remains a major contributor to neonatal mortality and long-term neurodevelopmental disability worldwide. It results from impaired oxygen delivery and blood flow during the peripartum period, leading to multisystem organ injury, particularly the brain. Hypoxic ischemic encephalopathy (HIE) represents the most severe neurological consequence and poses significant challenges for neonatal care teams.
Aim: This review aimed to provide an updated overview of the etiology, pathophysiology, clinical presentation, evaluation, and nursing-focused management strategies for perinatal asphyxia and hypoxic ischemic encephalopathy, with emphasis on evidence-based interventions that improve neonatal outcomes.
Methods: A narrative literature review approach was used, synthesizing current evidence from clinical guidelines, epidemiological data, and peer-reviewed studies addressing perinatal asphyxia and HIE. Key areas reviewed included epidemiology, mechanisms of brain injury, clinical staging, diagnostic evaluation, therapeutic hypothermia, supportive management, and multidisciplinary care roles.
Results: Perinatal asphyxia arises from complex maternal, placental, uterine, and fetal factors and is most commonly intrapartum. Neurological injury follows a biphasic pattern involving primary energy failure and delayed secondary neuronal damage. Therapeutic hypothermia initiated within six hours of birth significantly reduces mortality and long-term disability in eligible term and near-term infants with moderate to severe HIE. Supportive management, including respiratory, cardiovascular, metabolic, and neurological care, remains essential for all affected neonates. Early recognition, accurate staging, and continuous monitoring are critical to optimizing outcomes.
Conclusion: Perinatal asphyxia requires prompt diagnosis, structured neurological assessment, and comprehensive supportive care. Therapeutic hypothermia represents a cornerstone intervention for eligible infants, while skilled nursing and interdisciplinary collaboration are fundamental to improving survival and neurodevelopmental outcomes.
Full text article
References
Sugiura-Ogasawara M, Ebara T, Yamada Y, Shoji N, Matsuki T, Kano H, Kurihara T, Omori T, Tomizawa M, Miyata M, Kamijima M, Saitoh S., Japan Environment, Children’s Study (JECS) Group. Adverse pregnancy and perinatal outcome in patients with recurrent pregnancy loss: Multiple imputation analyses with propensity score adjustment applied to a large-scale birth cohort of the Japan Environment and Children's Study. Am J Reprod Immunol. 2019 Jan;81(1):e13072.
Hakobyan M, Dijkman KP, Laroche S, Naulaers G, Rijken M, Steiner K, van Straaten HLM, Swarte RMC, Ter Horst HJ, Zecic A, Zonnenberg IA, Groenendaal F. Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis. Neonatology. 2019;115(2):127-133.
Viaroli F, Cheung PY, O'Reilly M, Polglase GR, Pichler G, Schmölzer GM. Reducing Brain Injury of Preterm Infants in the Delivery Room. Front Pediatr. 2018;6:290.
Enweronu-Laryea CC, Andoh HD, Frimpong-Barfi A, Asenso-Boadi FM. Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana. PLoS One. 2018;13(10):e0204410.
Kapaya H, Williams R, Elton G, Anumba D. Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study. J Pregnancy. 2018;2018:2195965.
Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr. 2015 Apr;169(4):397-403.
Victor S, Rocha-Ferreira E, Rahim A, Hagberg H, Edwards D. New possibilities for neuroprotection in neonatal hypoxic-ischemic encephalopathy. Eur J Pediatr. 2022 Mar;181(3):875-887.
Odd D, Heep A, Luyt K, Draycott T. Hypoxic-ischemic brain injury: Planned delivery before intrapartum events. J Neonatal Perinatal Med. 2017;10(4):347-353.
Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm Hypoxic-Ischemic Encephalopathy. Front Pediatr. 2016;4:114.
Tadesse AW, Muluneh MD, Aychiluhm SB, Mare KU, Wagaw GB. Determinants of birth asphyxia among preterm newborns in Ethiopia: a systematic review and meta-analysis of observational studies protocol. Syst Rev. 2022 Feb 19;11(1):30.
Goldenberg RL, Dhaded S, Saleem S, Goudar SS, Tikmani SS, Trotta M, Hwang Jackson K, Guruprasad G, Kulkarni V, Kumar S, Uddin Z, Reza S, Raza J, Yasmin H, Yogeshkumar S, Somannavar MS, Aceituno A, Parlberg L, Silver RM, McClure EM., PURPOSe Study Group. Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG. 2022 Nov;129(12):1993-2000.
Garfinkle J, Wintermark P, Shevell MI, Oskoui M. Children born at 32 to 35 weeks with birth asphyxia and later cerebral palsy are different from those born after 35 weeks. J Perinatol. 2017 Aug;37(8):963-968.
Imai K, de Vries LS, Alderliesten T, Wagenaar N, van der Aa NE, Lequin MH, Benders MJNL, van Haastert IC, Groenendaal F. MRI Changes in the Thalamus and Basal Ganglia of Full-Term Neonates with Perinatal Asphyxia. Neonatology. 2018;114(3):253-260.
Salas J, Tekes A, Hwang M, Northington FJ, Huisman TAGM. Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time. Neonatology. 2018;114(3):185-197.
Alsaleem M, Zeinali LI, Mathew B, Kumar VHS. Glucose Levels during the First 24 Hours following Perinatal Hypoxia. Am J Perinatol. 2021 Apr;38(5):490-496.
Li Y, Wisnowski JL, Chalak L, Mathur AM, McKinstry RC, Licona G, Mayock DE, Chang T, Van Meurs KP, Wu TW, Ahmad KA, Cornet MC, Rao R, Scheffler A, Wu YW. Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury. Pediatr Res. 2022 Dec;92(6):1731-1736.
Sakr M, Shah M, Balasundaram P. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 25, 2024. Neonatal Therapeutic Hypothermia.
Alsaleem M, Hpa N, Kumar VHS. Stridor in infants with hypoxic-ischemic encephalopathy and whole body hypothermia: A case series. J Neonatal Perinatal Med. 2020;13(4):463-468.
Kebaya LMN, Kiruja J, Maina M, Kimani S, Kerubo C, McArthur A, Munn Z, Ayieko P. Basic newborn resuscitation guidelines for healthcare providers in Maragua District Hospital: a best practice implementation project. JBI Database System Rev Implement Rep. 2018 Jul;16(7):1564-1581.
Simon LV, Shah M, Bragg BN. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 19, 2024. APGAR Score.
Oliveira V, Singhvi DP, Montaldo P, Lally PJ, Mendoza J, Manerkar S, Shankaran S, Thayyil S. Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F388-F390.
Alsaleem M, Saadeh L, Elberson V, Kumar VHS. Subcutaneous fat necrosis, a rare but serious side effect of hypoxic-ischemic encephalopathy and whole-body hypothermia. J Perinat Med. 2019 Nov 26;47(9):986-990.
Pappas A, Shankaran S, Laptook AR, Langer JC, Bara R, Ehrenkranz RA, Goldberg RN, Das A, Higgins RD, Tyson JE, Walsh MC., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Hypocarbia and adverse outcome in neonatal hypoxic-ischemic encephalopathy. J Pediatr. 2011 May;158(5):752-758.e1.
Klinger G, Beyene J, Shah P, Perlman M. Do hyperoxaemia and hypocapnia add to the risk of brain injury after intrapartum asphyxia? Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F49-52.
McGowan JE, Perlman JM. Glucose management during and after intensive delivery room resuscitation. Clin Perinatol. 2006 Mar;33(1):183-96, x.
Riley C, Spies LA, Prater L, Garner SL. Improving Neonatal Outcomes Through Global Professional Development. Adv Neonatal Care. 2019 Feb;19(1):56-64.
Yates N, Gunn AJ, Bennet L, Dhillon SK, Davidson JO. Preventing Brain Injury in the Preterm Infant-Current Controversies and Potential Therapies. Int J Mol Sci. 2021 Feb 07;22(4)
Wu YW, Monsell SE, Glass HC, Wisnowski JL, Mathur AM, McKinstry RC, Bluml S, Gonzalez FF, Comstock BA, Heagerty PJ, Juul SE. How well does neonatal neuroimaging correlate with neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy? Pediatr Res. 2023 Sep;94(3):1018-1025.
Ambalavanan N, Shankaran S, Laptook AR, Carper BA, Das A, Carlo WA, Cotten CM, Duncan AF, Higgins RD., EUNICE KENNEDY SHRIVER NICHD NEONATAL RESEARCH NETWORK. Early Determination of Prognosis in Neonatal Moderate or Severe Hypoxic-Ischemic Encephalopathy. Pediatrics. 2021 Jun;147(6)
Ambalavanan N, Carlo WA, Shankaran S, Bann CM, Emrich SL, Higgins RD, Tyson JE, O'Shea TM, Laptook AR, Ehrenkranz RA, Donovan EF, Walsh MC, Goldberg RN, Das A., National Institute of Child Health and Human Development Neonatal Research Network. Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy. Pediatrics. 2006 Nov;118(5):2084-93.
Gazzolo D, Marinoni E, Di Iorio R, Bruschettini M, Kornacka M, Lituania M, Majewska U, Serra G, Michetti F. Urinary S100B protein measurements: A tool for the early identification of hypoxic-ischemic encephalopathy in asphyxiated full-term infants. Crit Care Med. 2004 Jan;32(1):131-6.
Authors
Copyright (c) 2024 Abdullah Hadi Al Kathere, Amal Ali Ahmed Hakami, Reda Mohammed Ashwi, Rayed Mubarak Saad Alotaibi, Majed Nafe Mogaees Almutairi, Khulud Saud Alowayni, Mohammed Raja Dughaybish Alsharari, Wedad Eid Rashed Alkhaldi, Rasheed Mohammed Talaq Alotaibi, Salma Hasan Bahari, Ameera Mabrook Allugmaine, Sami Mohammad Salhazemi, Mawada Mohammed Alshammari, Naifah Enad Quaid Al-Enezi
This work is licensed under a Creative Commons Attribution 4.0 International License.