SIMÕES, Maria da Conceição Ribeiro [1]
NETO, Daniel Carlos [2]
SIMÕES, Maria da Conceição Ribeiro; NETO, Daniel Carlos. Neonatal Anoxia and Neurologic Sequelae: clinical case report. Multidisciplinary Core scientific journal of knowledge. Year 1. Vol. 9. pp 799-802. October/November 2016. ISSN. 2448-0959
INTRODUCTION
The Neonatal Anoxia is a condition of deprivation or decreased oxygen supply to the brain, and can evolve to Hypoxic-ischemic Encephalopathy (HIE) affecting mainly infants and pre-term and term, at extreme levels increases the statistics of deaths.
Despite repeated scientific studies and literary reviews, yet there is no stating specific criteria for diagnosis of neonatal Anoxia.
The EHI is the clinical manifestation more addressed in the literature. However, the low specificity of the findings prevents a precise diagnosis, need early neonatal history analysis.
The aim of this work was, from the clinical case, perform a careful investigation of the neonatal history with the goal of finishing the etiologic causes of EHI.
CASE REPORT
K.D.O. M, 09 years old, performed once, at the age of five, behavior in certain degree of abnormality compared to others in the same age group.
In 20.10.2011, K.D.O.M., with 5 years and 4 months of age, had its abnormality compounded, with stages of aggression, being diagnosed by professional as having Severe Encephalopathy and chronic, Moderate Mental retardation, Global Development Disorder and Hyperactivity with attention deficit.
Considering the lack of evidence that triggers this postpartum traumatic sequel, the neurological examination of neonatal history, only to justify brain injury.
Therefore, the mother B.L.O., 27 years old, resident of Boa Vista/RR, secundigesta, with gestation fetus only within the parameters of normal and regular prenatal monitoring. A: 8/24/2005 DPP: 5/22/2006. The 37th week ultrasound showed a fetus with cephalic presentation, fetal heart tones and rhythmic (144 bpm), placenta with further deployment. The mother denied infections, diabetes and hypertension, was regularised vaccine portfolio, having been admitted to the State Hospital Childrens our Lady of Nazareth on the day 6/13/2006 to 23:54 hours. Blood typing HR (+).
The partogram, patient presented pélvicade 4 cm dilation to 7:00 hours 6/14/2006 day. To 9:15 hours, showed 5 cm dilated; at this same time the amniotomy to rupture it, which presented scant presence of meconium; the attending physician has prescribed SG 5% 500 ml + 1 amp of Oxytocin, 8 drops/min EV; Plašil + 50% Glucose, 1 ampoule every EV slow; bed rest and moist 2 l O2/min. The mother has evolved with pelvic dilatation of 6 cm to 10:15 hours, 8 cm at 11:00 hours and 9 cm to 12:00 hours.
The birth occurred at 13:35 hours on the same day by vaginally, with prolonged and expulsive thick meconium. RN the term, male, weighing from 4,335 g, 56 cm long, cephalic perimeter of 37 cm, chest perimeter of 36 cm. Blood type and Rh factor of the Neonate: (-). The RN was born depressed, showing Apgar 6 to the first minute and Apgar 9 the fifth minute. Resuscitation maneuvers were held and tracheal suction, plus use of mask for ventilation and inhaled O2; the ligature of the umbilical cord in under a minute. To 22:00 hours 6/14/2006 the RN was Ruddy, reactive, with good suction, this evacuation and decreased urine output. In the account of the day 6/15/2006 the RN was active, reactive, with reflexes and good breast sucking; both received hospital discharge.
DISCUSSION
As ventilated, given the existence of scientific studies inconclusive about the causes of neonatal anoxia, the bias of the present report takes into consideration the evidence from the perinatal and neonatal history, conducting a joint analysis of the associated evaluation criteria during labour and birth.
One of the criteria analyzed during labour is the presence of thick meconium in the amniotic fluid.
Although the literature does not allow to affirm that the isolated presence of meconium has relation to the prognosis of late abnormality, it is indisputable that at least considered marker of maturity (MILLER et. Al., 1975; MEIS et. Al., 1978). Another criterion to be parsed is the Apgar score in the first minute with score 6 (six).
Although studies do not constitute a security profile in relate the Apgar and the existence or absence of neurologic sequelae, dare we disagree in this case because, even though in the 5th minute Apgar was 9, the score of the first minute was preceded by the presence of thick meconium, which wouldn't be so early to generate sequels of a possible suffocation.
Finally, although controversial in obstetrics, the expulsive extended period, decreases the supply of placental blood to the fetal nervous system and may lead to serious and irreversible neurological damage.
CONCLUSION
On all points presented in this work, it is concluded that despite the diagnosis of Severe and chronic Encephalopathy have occurred belatedly, his cause may originate during labour, preceeded by a set of events, which is handled by the literature as being unspecified.
However, evidence even if isolated, should not be discarded, do, might be enough to signal that the earlier for the diagnosis and intervention in changes that could lead to neurological sequelae, the smaller the impact in the future.
Finally, this study demonstrates the need for increasing investments in studies that have as their goal the identification of risk factors before, during and after childbirth as a way to reduce the diversity of diagnostic criteria used, which is not always conducive to the prevention of neonatal Anoxia and its sequels in the future.
BIBLIOGRAPHIC REFERENCE
Brazil. Ministry of health. Attention to newborn health: a guide for health professionals. Secretariat for health care. Department of Programmatic and strategic Actions. Brasília: Ministry of health, 2011. 6 4. : il. -(Series a. Technical standards and Manuals)
CORRÊA, r. r. m. et al. With changes of the placenta and variations of the Apgar score. Brazilian Journal of maternal and child health. Recife: v. 6, n. 2, p. 239-243, Apr/jun. 2006.
M.c. Espinheira, m. Gerrard, g. Rocha, b. Guedes and h. Guimarães. Meconial aspiration syndrome – experience of a tertiary centre. Rev Pneumol Port. 2011; 17 (2): 71-76
MEIS, P.J.; HALL III, M.; MARSHALL, J.R.; HOBEL, C.J. -Meconium passage: a new classification for risk assesment during labor. Am. J. Obstet. Gynecol., 131:509-13, 1978.
MILLER F.C.; SACKS, D.A.; YEH, S-Y.; PAUL, R. H; SCHIFRIN, B.S.; MARTIN Jr., C.B.; HON, E.H. -Significance of mecomium during labor. Am. J. Obstet. Gynecol., 122:573-80, 1975.
SARNAT HB, Sarnat MS. Neonatal encephalopathy following fetal distress: the clinical and electroencephalographic study. ARC Neurol. 1976; 33:696-705.
[1] Doctor. Specialist in Gynecology and obstetrics, master and PhD in health sciences by UNB. Supervisor of medical residency in Gynecology and obstetrics, the Base Hospital Dr. Ary Pinheiro/Porto Velho-RO and coordinator of medical studies of the Faculdades Integradas Aparício oak.
[2] Lawyer. Specialist in medical law and health; Degree in medicine. Executive MBA in health. PhD in public health.
