Asfixia perinatal: relación entre afectación cardiovascular, neurológica y multisistémica

espanolObjetivo: Conocer el perfil epidemiologico de los neonatos a termino con asfixia perinatal; relacionarlo con la existencia y el grado de encefalopatia hipoxico-isquemica (EHI); valorar la frecuencia de afectacion cardiovascular (ACV) y relacionarla con la afectacion neurologica y extraneurologica; determinar la relacion entre ACV y factores etiopatogenicos de la asfixia. Material y metodos: Estudio retrospectivo de los pacientes que cumplieron criterios de asfixia perinatal entre enero de 2000 y diciembre de 2004. Resultados: Se incluyeron 295 pacientes. Un 39% cumplia criterios de EHI: leve 23,1%; moderada 8,8% y grave 7,1%. La afectacion pulmonar se dio en un 35,9%, la renal en un 18%, presentaron hipocalcemia un 18,6%, trombopenia un 13,9% y coagulopatia un 21,4%. Un 14,2% de los pacientes presentaron ACV cierta (alteracion enzimatica y/o ecocardiografica con shock y/o hipotension arterial), y un 15,6% ACV probable (solo hipotension arterial y/o shock). La existencia de ACV se relaciona con la presencia de EHI y, por consiguiente, con alteraciones en el electroencefalograma y de neuroimagen. Asimismo, la existencia de ACV aumenta la presencia de afectacion extraneurologica. Tambien se constata que los pacientes con ACV presentan mas frecuentemente acidosis al ingreso y acidosis metabolica persistente durante su evolucion. Conclusiones: La ACV se correlaciona con la existencia y la gravedad de las manifestaciones neurologicas y con la afectacion de otros organos y sistemas, en especial con la acidosis metabolica persistente. EnglishObjective: The aim of this study is to review epidemiological data concerning asphyxia in full-term newborn infants and the relationship between this data and the existence and severity of hypoxic-ischemic encephalopathy (HIE). The authors also evaluate the incidence of cardiovascular involvement (CVI) and the relationship between this condition and neurological and extraneurological involvement. A third objective was to determine the relationship between cardiovascular involvement and the etiological and pathological factors of asphyxia. Materials and methods: A retrospective review of all the asphyxiated term neonates born between January 2000 and December 2004. Results: A total of 295 patients were included. Thirty-nine percent were diagnosed as having HIE: mild, 23.1%; moderate 8.8%; and severe, 7.1%. Pulmonary involvement was detected in 35.9% of the patients, renal involvement in 18%, hypocalcemia in 18.6% of cases; thrombocytopenia in 13.9% and coagulopathy in 21.4%. Forty-two patients had "proven" CVI (abnormal enzyme levels and/or echocardiographic findings in patients with hypotension and/or shock) and 46 had "possible" CVI (only hypotension and/or shock). CVI is associated with the presence of HIE and, consequently, with abnormal electroencephalographic and neuroimaging findings. Moreover, CVI increases the prevalence of extraneurological involvement. It was also observed that, in patients with CVI, there is a higher incidence of acidosis at admission and persistent metabolic acidosis throughout the course of the disease. Conclusions: CVI correlates with the existence and severity of neurological and extraneurological involvement, and especially with persistent metabolic acidosis.