Long-term prognosis of asphyctic neonates from an intensive care unit: intrauterine retarded infants at high risk of cerebral palsy.

The surviving asphyctic infants born during the three-year period 1977 to 1979 and admitted to the regional neonatal intensive care unit were prospectively followed up to 2 and 4 years of age. According to outcome the children were divided into three subgroups: 1 who did not show any consequence of asphyxia; 2 who showed syndromes classified as cerebral palsy; 3 whose psychomotor functions were found to be retarded. The cerebral palsy group mainly consisted of children who were born with a weight deficit after 37 weeks gestation. Only 4 out of the 15 children were premature and among them only 1 was of very low birth weight. Thus, dysmaturity was the main somatic characteristic of the severely handicapped children. In addition to intrauterine growth retardation, the high rate of congenital anomalies was a further feature of the cerebral palsy group. Gestational complications (toxaemia, haemorrhage, threatening abortion or premature delivery), as well as the distortions of the most important biochemical variables (pH, calcium, bilirubins and glucose level) either in themselves or in combination had a similar incidence in the three subgroups. Among postnatal conditions, only the incidence of convulsions seemed to be important prognostically. On the basis of the great difference in outcome it is concluded that there is no simple relationship between asphyxia and eventual handicap. There are certainly some other noxious factors (e.g., dysmaturity, congenital anomalies, etc.) associated with, or related to asphyxia which can be of great aetiological significance.