Perinatal asphyxia of full-term newborns: from pathophysiology to long-term outcomes

Abstract

The fetal environment and circulatory patterns are very different from that of extrauterine life. The fetus evolved to thrive and grow in a relative hypoxemic environment adapted several mechanisms in response to changes in oxygen concentration in the blood to ensure optimal oxygen delivery to the brain and heart. However according to estimates of the World Health Organization in the world from 4 to 9 million newborns are born annually in a state of perinatal asphyxia. In economically underdeveloped countries, this indicator is higher than in developed countries, but in general, the frequency of perinatal asphyxia remains at a rather high level in the modern world. Perinatal asphyxia or hypoxic-ischemic encephalopathy, in newborns can cause multiple organ dysfunction in the neonatal period, severe diseases in the future, lead to disability and infant mortality. Perinatal asphyxia is characterized by a violation of gas exchange, which can lead to varying degrees of hypoxia, hypercapnia and acidosis, depending on the duration and degree of interruption of air flow, however, obstructed perinatal gas exchange does not have precise biochemical criteria. In addition, the exact mechanisms of pathophysiology of perinatal asphyxia have not been fully studied, as a result of which the “gold standard” of treatment remains an active area of research. The publication reflects modern views on the main stages of the pathogenesis of perinatal asphyxia, shows changes in blood circulation during delivery and the neonatal period, presents current data on emerging disorders in the newborn’s body against the background of hypoxic ischemic encephalopathy.