Features of the Early Neonatal Period Course in Infants with Severe Birth Asphyxia

Introduction. Severe birth asphyxia, as one of the main causes of perinatal morbidity and mortality, presents a serious problem in neonatology.

Study Objective: To identify the characteristics of the early neonatal period and its outcome in full-term newborns with severe birth asphyxia.

Materials and Methods. A prospective single-center study was conducted. The main group consisted of 30 newborns who experienced severe birth asphyxia, and the control group for comparison of blood gases and acid-base balance comprised 60 newborns without asphyxia. Statistical processing of the results was carried out using the “Microsoft Excel 2016” application software package. The following were calculated: mean value (M), Standard deviation (SD), frequencies (%), and Student’s t-test. The critical significance level for testing statistical hypotheses was taken as 0.05.

Results. Maternal medical history and the course of the current pregnancy were analyzed. Predominantly endocrine pathology was identified, including gestational diabetes mellitus in 95% of cases and obesity of varying severity. Delivery was operative in 53% of cases. In 57% of cases, complications included the development of fetal distress. The condition of newborns at birth reflected severe hypoxia: average Apgar scores were 2.43±0.77 at one minute, 4.76±1.22 at five minutes, and 6.2±1.22 at ten minutes. Respiratory support was required for all patients: in the delivery room, invasive mechanical ventilation (MV) was used in 73%, and continuous positive airway pressure (CPAP) in 37%. This was followed by transfer to the Neonatal Intensive Care Unit (NICU), where ventilation duration reached 20 days in severe cases. Passive hypothermia was initiated in 70% of newborns, and therapeutic hypothermia in 33%, which aligns with current neuroprotection protocols and emphasizes the need for early intervention to minimize neurological deficits. Neurosonography revealed cerebral ischemia in 90% of infants, with cerebral edema in 47% and periventricular lesions in 60%, illustrating a direct link between asphyxia and cerebral complications and multi-organ dysfunction.

Conclusion. In the vast majority of newborns, the early neonatal period concluded with the development of cerebral ischemia, predominantly of moderate severity (grade II), with periventricular brain injury detected in a significant number of cases. Further study and analysis of newborns who experienced severe birth asphyxia are necessary to identify predictors of adverse neurological outcomes.

1. Apio G, Mbalinda SN, Alunyo JP, Okibure A, Makoko BT, McVoy M, Ayebare E. Birth asphyxia outcomes and associated factors among newborns admitted to a tertiary hospital in Eastern Uganda: A prospective cohort study. BMC Pregnancy Childbirth. 2025;25(1):487. doi: https://doi.org/10.1186/s12884-025-07603-2

2. Alemayehu T, Fati NM, Adlo AM, Deksisa A, Chirnet AT, Wakwoya EB, Negussie YM. Determinants of Birth Asphyxia Among Newborns at a Tertiary Care Hospital, Central Ethiopia: A Case-Control Study. Biomed Res Int. 2025;2025:5402567. doi: https://doi.org/10.1155/bmri/5402567

3. Panova M.S., Panchenko A.S., Mudrov V.A. New technologies for the diagnosis of hypoxic conditions in the term newborn. Transbaikalian Medical Bulletin. 2023;(2):89-102. (In Russ.) https://doi.org/10.52485/19986173_2023_2_89

4. Gizachew S, Wogie G, Getnet M, Lonsako AA. Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023. BMC Pediatr. 2024;24(1):142. doi: 10.1186/s12887-024-04627-z.

5. Yehouala SG, Tesfahun E, Dejene TM, Gebreegziabher ZA. Time to recovery of asphyxiated neonates and its’ predictors among newborns admitted to neonatal intensive care unit at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. BMC Public Health. 2024;24(1):2006. doi: 10.1186/s12889-024-19520-8

6. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010 ;86(6):329-38. doi: 10.1016/j.earlhumdev.2010.05.010.

7. Gedefaw GD, Abate AT, Worku DT, Ayenew ME, Daka DT. Length of hospital stay and its factor associated among neonates with perinatal asphyxia in the Northwest Amhara Region, Northwest Ethiopia 2023: a multicentre retrospective cross-sectional study. BMJ Open. 2025;15(2):e087995. doi: 10.1136/bmjopen-2024-087995.

8. Muralidharan O, Rehman S, Sihota D, Harrison L, Vaivada T, Bhutta ZA. Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence Synthesis. Neonatology. 2025;122(Suppl 1):84-105. Epub 2024. Erratum in: Neonatology. 2025;122(2):256. doi: https://doi.org/10.1159/000541862

9. Doğan Kocabıyık NN, Salihoğlu O. An Assessment of the Relationships Between Umbilical Cord Blood Gas Analysis, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) Scores, and Neonatal Outcomes. Cureus. 2024;16(6):e62362. doi: https://doi.org/10.7759/cureus.62362

10. Use and abuse of the Apgar score. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Pediatrics. 1996;98(1):141-2. PMID: 8668389.

11. Hypoxic ischemic encephalopathy of the newborn due to asphyxia during childbirth. Balashova E.N., Burov A.A., Gorev V.V., Gorelik K.D., and others, 2025; 6–28. http://neonatology.pro/wp-content/uploads/2021/12/draft_cr_hie_27122021.docx

12. Shilova N.А., Kharlamova N.V., Andreev A.V., Mezhinsky S.S., Panova I.A., Dudov P.R. Frequency of perinatal asphyxia and volume of provision of care to newborns in the delivery room. Neonatology: News, Opinions, Training. 2020; 8 (2): 47–53. DOI: 10.33029/2308-2402-2020-8-2-47-53 (in Russ.)