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World J Clin Pediatr. Feb 8, 2016; 5(1): 67-74
Published online Feb 8, 2016. doi: 10.5409/wjcp.v5.i1.67
Short and long term prognosis in perinatal asphyxia: An update
Caroline E Ahearne, Geraldine B Boylan, Deirdre M Murray
Caroline E Ahearne, Geraldine B Boylan, Deirdre M Murray, Department of Paediatrics and Child Health, University College Cork, Cork T12 YN60, Ireland
Caroline E Ahearne, Geraldine B Boylan, Deirdre M Murray, Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre), University College Cork, Cork T12 YN60, Ireland
Author contributions: Ahearne CE aided in the literature review, and contributed to the text and preparation of the manuscript; Boylan GB contributed to the manuscript and edited final content; Murray DM wrote and edited the manuscript.
Supported by The Health Research Board CSA/2012/40; and a Science Foundation Ireland Research Centre Award (INFANT - 12/RC/2272).
Conflict-of-interest statement: There is no conflict of interest associated with either of the authors who contributed to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Deirdre Murray, Department of Paediatrics and Child Health, University College Cork, Western Rd, Cork T12 YN60, Ireland. d.murray@ucc.ie
Telephone: +353-21-4205023
Received: July 31, 2015
Peer-review started: August 3, 2015
First decision: October 13, 2015
Revised: November 18, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: February 8, 2016
Abstract

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.

Keywords: Perinatal asphyxia, Neurological outcome, Hypoxic ischaemic encephalopathy, Cerebral palsy, Cognitive outcome

Core tip: Perinatal asphyxia is a significant cause of acquired brain injury occurring in the neonatal period. A reliable early marker for predicting injury severity and sequelae remains elusive. The advent of therapeutic hypothermia as an effective neuroprotective intervention has changed the prognosis for affected infants. In this review we summarise what is known about the short and long term outcome for infants with perinatal asphyxia in the pre- and post-cooling era. We also describe currently available early indicators of outcome and introduce the exciting field of emerging novel biomarkers, both chemical and physiological.