Article Text

CONFUSING ETIOLOGY OF THE NEONATAL ENCEPHALOPATHY
  1. E M Zisovska1,
  2. N P Pehcevska1,
  3. I B Martinovska1,
  4. L B Lazarevska2
  1. 1Neonatology Department, Clinic for Gynecology and Obstetrics, Skopje, Macedonia
  2. 2Institute for Health Protection, Skopje, Macedonia

Abstract

Neonatal hypoxic-ischemic encephalopathy (HIE) and perinatal asphyxia are used as synonyms, but perinatal brain injury may cause other fractors, like polycythaemia in the immediate neonatal period, producing symptoms mimicking HIE. The definition newborn encephalopathy was introduced for disturbed neurological function in fullterm infants. The aim of our study was to assess the neurological status of fullterm infants comparing newborns with polycythaemia and those experiencing some degree of birth asphyxia.

Material/Methods Newborns admitted to the Department for Neonatology-Clinic for Gynecology&Obstetrics in Skopje, Macedonia, during last three years. As polycythaemia was considered hematocrite >0,65; birth asphyxia-presence of fetal distress, metabolic acidosis and depression at birth (low Apgar score at 1,5 and 10 minutes). The neurological status graded by Sarnat&Sarnat, although there are some attempts to find better grading (Miller scoring system).

Results 10 235 liveborn term infants were cared and 194 (1,9%) had some degree of birth asphyxia; 243/10235 (2,4%) had haematocrit >0,65 and no determinants of perinatal asphyxia. The presence of HIE in asphyctic newborns was 85%, graded as mild 77,6%, moderate 18,8% and 3,6%5 severe. Neurological signs were found in 42/243 (17,28%) polycythaemic fullterm newborns graded as mild HIE, without seizures. A conclusion could be derived that confusion occur regarding neurological status in polycythaemic and asphyctic newborns, although polycythaemic very rare experience severe neurological impairment, so the difficulties in differential diagnosis may exist only in mild neurological disturbances. Thorough analysis and investigations are required in distinguishing the etiology of the encephalopathy in term of the early neurological prognosis of the newborns

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