Comprehensive Multidisciplinary Management and Long-Term Care Approaches for Newborns with Birth Asphyxia: Clinical Guidelines for Healthcare Professionals

Abdulaziz saleh ahmad alghamdi; Fatimah Nassir Ahmad   Alshrif; MOHAMMED YAHYA SHARAHILI; Fahad Mousa Wasili; SULTAN MOUSA J WASILI; munirah  Abdullah ibrahim Namazi; Eman Ahmed Yahya Modawi; MARWA ALI ALKHAWAJA; ABDULLAH YACOUB ALTURKI; TAHANI HUWAYDI ALDHAFEERI

doi:10.64483/jmph-71

Authors

Abdulaziz saleh ahmad alghamdi Kingdom of Saudi Arabia, Imam Abdulrahman Alfaisal Hospital , Emergency Medical Services
Fatimah Nassir Ahmad Alshrif Kingdom of Saudi Arabia, Ayash Primary Health Care, Nursing technician
MOHAMMED YAHYA SHARAHILI Kingdom of Saudi Arabia, King Abdullah bin Abdulaziz University Hospital
Fahad Mousa Wasili Kingdom of Saudi Arabia, King Fahad hospital
SULTAN MOUSA J WASILI Kingdom of Saudi Arabia, Abuareash General Hospital
munirah Abdullah ibrahim Namazi Kingdom of Saudi Arabia, Prince Mohammed bin Nasser Hospital , Nursing specialist
Eman Ahmed Yahya Modawi Kingdom of Saudi Arabia, Prince Mohammed bin Nasser Hospital
MARWA ALI ALKHAWAJA Kingdom of Saudi Arabia, King Faisal General Hospital
ABDULLAH YACOUB ALTURKI Kingdom of Saudi Arabia, Cluster 2 Riyadh Consultant family medicine
TAHANI HUWAYDI ALDHAFEERI Kingdom of Saudi Arabia, King khalid general hospital

DOI:

https://doi.org/10.64483/jmph-71

Keywords:

Birth asphyxia, hypoxic–ischemic encephalopathy, neonatal care, multidisciplinary team, neonatal rehabilitation, pediatric neurology

Abstract

Background: Birth asphyxia is a major contributor to neonatal morbidity and mortality worldwide, frequently resulting in hypoxic–ischemic encephalopathy (HIE) and multi-organ dysfunction. Optimal management requires timely diagnosis, acute intervention, and coordinated multidisciplinary care to minimize adverse outcomes.

Aim: To highlight the essential role of multidisciplinary consultations in the clinical management and long-term rehabilitation of newborns affected by birth asphyxia.

Methods: This review synthesizes current evidence and clinical guidelines on postnatal consultation strategies for infants with birth asphyxia. The focus is on the integration of neonatology, pediatric subspecialties, and allied health services to ensure comprehensive, individualized care. Literature from peer-reviewed journals and established neonatal protocols was critically analyzed.

Results: Effective management necessitates early involvement of a neonatologist for stabilization and ongoing monitoring. Pediatric neurologists provide assessment for neurological injury, particularly HIE. Cardiologists and nephrologists manage cardiac and renal complications, while pulmonologists address respiratory dysfunction. In complex cases with multi-organ involvement, pediatric intensivists or palliative care specialists are essential. Developmental pediatricians, along with physical and occupational therapists, play a crucial role in early rehabilitation and long-term developmental support. Early, coordinated intervention enhances recovery potential and reduces long-term disability.

Conclusion: A multidisciplinary consultation framework is critical for optimizing outcomes in birth asphyxia. Early, coordinated, and ongoing involvement of diverse specialties ensures comprehensive management from acute care through long-term follow-up.

References

Sugiura-Ogasawara M, Ebara T, Yamada Y, Shoji N, Matsuki T, Kano H, Kurihara T, Omori T, Tomizawa M, Miyata M, Kamijima M, Saitoh S., Japan Environment, Children’s Study (JECS) Group. Adverse pregnancy and perinatal outcome in patients with recurrent pregnancy loss: Multiple imputation analyses with propensity score adjustment applied to a large-scale birth cohort of the Japan Environment and Children's Study. Am J Reprod Immunol. 2019 Jan;81(1):e13072.

Hakobyan M, Dijkman KP, Laroche S, Naulaers G, Rijken M, Steiner K, van Straaten HLM, Swarte RMC, Ter Horst HJ, Zecic A, Zonnenberg IA, Groenendaal F. Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis. Neonatology. 2019;115(2):127-133.

Viaroli F, Cheung PY, O'Reilly M, Polglase GR, Pichler G, Schmölzer GM. Reducing Brain Injury of Preterm Infants in the Delivery Room. Front Pediatr. 2018;6:290.

Enweronu-Laryea CC, Andoh HD, Frimpong-Barfi A, Asenso-Boadi FM. Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana. PLoS One. 2018;13(10):e0204410.

Kapaya H, Williams R, Elton G, Anumba D. Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study. J Pregnancy. 2018;2018:2195965.

Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr. 2015 Apr;169(4):397-403.

Victor S, Rocha-Ferreira E, Rahim A, Hagberg H, Edwards D. New possibilities for neuroprotection in neonatal hypoxic-ischemic encephalopathy. Eur J Pediatr. 2022 Mar;181(3):875-887.

Odd D, Heep A, Luyt K, Draycott T. Hypoxic-ischemic brain injury: Planned delivery before intrapartum events. J Neonatal Perinatal Med. 2017;10(4):347-353.

Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm Hypoxic-Ischemic Encephalopathy. Front Pediatr. 2016;4:114.

Tadesse AW, Muluneh MD, Aychiluhm SB, Mare KU, Wagaw GB. Determinants of birth asphyxia among preterm newborns in Ethiopia: a systematic review and meta-analysis of observational studies protocol. Syst Rev. 2022 Feb 19;11(1):30.

Goldenberg RL, Dhaded S, Saleem S, Goudar SS, Tikmani SS, Trotta M, Hwang Jackson K, Guruprasad G, Kulkarni V, Kumar S, Uddin Z, Reza S, Raza J, Yasmin H, Yogeshkumar S, Somannavar MS, Aceituno A, Parlberg L, Silver RM, McClure EM., PURPOSe Study Group. Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG. 2022 Nov;129(12):1993-2000.

Garfinkle J, Wintermark P, Shevell MI, Oskoui M. Children born at 32 to 35 weeks with birth asphyxia and later cerebral palsy are different from those born after 35 weeks. J Perinatol. 2017 Aug;37(8):963-968.

Imai K, de Vries LS, Alderliesten T, Wagenaar N, van der Aa NE, Lequin MH, Benders MJNL, van Haastert IC, Groenendaal F. MRI Changes in the Thalamus and Basal Ganglia of Full-Term Neonates with Perinatal Asphyxia. Neonatology. 2018;114(3):253-260.

Salas J, Tekes A, Hwang M, Northington FJ, Huisman TAGM. Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time. Neonatology. 2018;114(3):185-197.

Alsaleem M, Zeinali LI, Mathew B, Kumar VHS. Glucose Levels during the First 24 Hours following Perinatal Hypoxia. Am J Perinatol. 2021 Apr;38(5):490-496.

Li Y, Wisnowski JL, Chalak L, Mathur AM, McKinstry RC, Licona G, Mayock DE, Chang T, Van Meurs KP, Wu TW, Ahmad KA, Cornet MC, Rao R, Scheffler A, Wu YW. Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury. Pediatr Res. 2022 Dec;92(6):1731-1736.

Sakr M, Shah M, Balasundaram P. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 25, 2024. Neonatal Therapeutic Hypothermia.

Alsaleem M, Hpa N, Kumar VHS. Stridor in infants with hypoxic-ischemic encephalopathy and whole body hypothermia: A case series. J Neonatal Perinatal Med. 2020;13(4):463-468.

Kebaya LMN, Kiruja J, Maina M, Kimani S, Kerubo C, McArthur A, Munn Z, Ayieko P. Basic newborn resuscitation guidelines for healthcare providers in Maragua District Hospital: a best practice implementation project. JBI Database System Rev Implement Rep. 2018 Jul;16(7):1564-1581.

Simon LV, Shah M, Bragg BN. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 19, 2024. APGAR Score.

Oliveira V, Singhvi DP, Montaldo P, Lally PJ, Mendoza J, Manerkar S, Shankaran S, Thayyil S. Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F388-F390.

Alsaleem M, Saadeh L, Elberson V, Kumar VHS. Subcutaneous fat necrosis, a rare but serious side effect of hypoxic-ischemic encephalopathy and whole-body hypothermia. J Perinat Med. 2019 Nov 26;47(9):986-990.

Pappas A, Shankaran S, Laptook AR, Langer JC, Bara R, Ehrenkranz RA, Goldberg RN, Das A, Higgins RD, Tyson JE, Walsh MC., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Hypocarbia and adverse outcome in neonatal hypoxic-ischemic encephalopathy. J Pediatr. 2011 May;158(5):752-758.e1.

Klinger G, Beyene J, Shah P, Perlman M. Do hyperoxaemia and hypocapnia add to the risk of brain injury after intrapartum asphyxia? Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F49-52.

McGowan JE, Perlman JM. Glucose management during and after intensive delivery room resuscitation. Clin Perinatol. 2006 Mar;33(1):183-96, x.

Riley C, Spies LA, Prater L, Garner SL. Improving Neonatal Outcomes Through Global Professional Development. Adv Neonatal Care. 2019 Feb;19(1):56-64.

Yates N, Gunn AJ, Bennet L, Dhillon SK, Davidson JO. Preventing Brain Injury in the Preterm Infant-Current Controversies and Potential Therapies. Int J Mol Sci. 2021 Feb 07;22(4)

Wu YW, Monsell SE, Glass HC, Wisnowski JL, Mathur AM, McKinstry RC, Bluml S, Gonzalez FF, Comstock BA, Heagerty PJ, Juul SE. How well does neonatal neuroimaging correlate with neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy? Pediatr Res. 2023 Sep;94(3):1018-1025.

Ambalavanan N, Shankaran S, Laptook AR, Carper BA, Das A, Carlo WA, Cotten CM, Duncan AF, Higgins RD., EUNICE KENNEDY SHRIVER NICHD NEONATAL RESEARCH NETWORK. Early Determination of Prognosis in Neonatal Moderate or Severe Hypoxic-Ischemic Encephalopathy. Pediatrics. 2021 Jun;147(6)

Ambalavanan N, Carlo WA, Shankaran S, Bann CM, Emrich SL, Higgins RD, Tyson JE, O'Shea TM, Laptook AR, Ehrenkranz RA, Donovan EF, Walsh MC, Goldberg RN, Das A., National Institute of Child Health and Human Development Neonatal Research Network. Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy. Pediatrics. 2006 Nov;118(5):2084-93.

Gazzolo D, Marinoni E, Di Iorio R, Bruschettini M, Kornacka M, Lituania M, Majewska U, Serra G, Michetti F. Urinary S100B protein measurements: A tool for the early identification of hypoxic-ischemic encephalopathy in asphyxiated full-term infants. Crit Care Med. 2004 Jan;32(1):131-6.

Gillam-Krakauer M, Shah M, Gowen Jr CW. Birth asphyxia. InStatPearls [Internet] 2024 Oct 5. StatPearls Publishing.