Perinatal asphyxia
Asfixia perinatal
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García, D. A., Romero, H., & Colmenares, A. E. (2013). Perinatal asphyxia. Journal of Medicine and Surgery Repertoire, 22(1), 28–37. https://doi.org/10.31260/RepertMedCir.v22.n1.2013.845
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Abstract
A literature review on perinatal asphyxia was conducted for no consensos definition exists. The current definition based on its pathophysiology cannot be applied in clinical practice, where various criteria, such as: alterations in fetal heart rate, meconium in the amniotic fluid, metabolic acidosis, low Apgar seores and clinical signs of post asphyxiation cerebral lesion, have been described. The definition specified by the American College of Obstetrics and Gynecology (ACOG) and its pediatric peer association (AAP) was analyzed and adopted. Post asphyxiation complications in new borns were reviewed. Relevant management was discussed considering the high incidence of this condition in developing countries and the new therapies which lead to mitigate injuries caused by perinatal asphyxia
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References
1 González de DJ. [Definition of perinatal asphyxia in medica! literature: the need of a consensus]. Rev Neurol. 2002 Oct 1;35(7):628-34.
2 McGuire W. Perinatal asphyxia. Clin Evid (Online). 2007 Nov 7;2007
3 Hill A, Volpe JJ. Perinatal asphyxia: clinical aspects. Clin Perinatol. 1989 Jun;16(2):435-57.
4 Levene ML, Kornberg J, Williams TH. The incidence and severity of post-as phyxial encephalopathy in full-term infants. Early Hum Dev. 1985 May;11(1):21- 6.
5 Delivoria-Papadopoulos M, Marro PJ. Biochemical basis of hypoxic-Ischemic encephalopathy. NeoReviews. 2010 Apr 1;l 1(4):el84-el 93.
6 Jonsson M, Norden SL, Hanson U. Analysis of malpractice claims with a focus on oxytocin use in labour. Acta Obste! Gynecol Scand. 2007;86(3):315-9.
7 Berglund S, Grunewald C, Pcttcrsson H, Cnattingius S. Risk factors for asphyx ia associated with substandard care during labor. Acta Obstet Gynecol Scand. 2010;89(1):39-48.
8 Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998 Dec 5;317(7172):1549-53.
9 Milsom I, Ladfors L, Thiringer K, Niklasson A, Odeback A, Thornberg E. In fluence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. Acta Obste! Gynecol Scand. 2002 Oct;81(10):909-l 7.
10 Gorovenko NG, Rossokha Zl, Podolskaya SV, Pokhylko VI, Lundberg GA. The role of genetic determinan! in the development of severe perinatal asphyxia. Tsi tol Genet. 20 lO Sep;44(5):4l-6.
11 Blickstein 1, Green T. Umbilical cord blood gases. Clin Perinatol. 2007 Sep;34(3):45l-9.
12 Wayenberg JL. Threshold ofmetabolicacidosis associated withneonatal encepha lopathy in the term newbom. J Matero Fetal Neonatal Med. 2005 Dec;18(6):381-5.
13 Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newbom complications. Am J Obste! Gynecol. 1997 Dec;177(6):139 J-4.
14 [Multicenter clinical study on umbilical cord arterial blood gas param eters for diagnosis of neonatal asphyxia]. Zhonghua Er Ke Za Zhi. 2010 Sep;48(9):668-73.
15 Gazzolo D, Abella R, Marinoni E, di IR, Li VG, Galvano F, et al. New markers of neonatal neurology. J Matem Fetal Neonatal Med. 2009;22 Suppl 3:57-61.
16 Rarnaswamy V, Horton J, Vandermeer B, Buscemi N, Miller S, Yager J. Sys tematic review of biomarkers of brain injury in term neonatal encephalopathy. Pediatr Neurol 2009 Mar;40(3):2l 5-26. Routsi C, Stamataki E, Nanas S, Psachoulia C, Stathopoulos A, Koroneos A, et al. Increased levels of serum SI00B protein in criticallyill patientswithout brain injury. Shock. 2006 Jul;26(1):20-4.
18 Monda) N, Bhat BV, Banupriya C, Koner BC. Oxidative stress in perinatal as phyxia in relation to outcome. lndian J Pediatr. 20!0 May;77(5):515-7.
19 Martin-Ancel A, Garcia-Alix A, Gaya F, Cabanas F, Burgueros M, Quero J. Mul tiple organ involvement in perinatal asphyxia. J Pediatr. 1995 Nov;l27(5):786- 93.
20 Shah P, Riphagen S, Beyene J, Perlman M.Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F152-F155.
21 Linnik MD, Zobrist RH, Hatfield MD. Evidencesupportinga role for programmed cell death in focal cerebral ischemia in rats. Stroke. 1993 Dec;24(12):2002-8.
22 Zanelli SA, Numagami Y, McGowan JE, Mishra OP, Delivoria-Papadopoulos M. NMDA receptor-mediated calcium influx in cerebral cortical synaptosomes of the hypoxic guinea pig fetus.Neurochem Res. 1999 Mar;24(3):437-46.
23 Huang Z, Huang PL, Panahian N, Dalkara T, Fishman MC, Moskowitz MA. Effects of cerebral ischemia in mice deficient in neuronal nitric oxide synthase. Science. 1994 Sep 23;265(5180):1883-5.
24 Nicholson DW, Thornberry NA. Caspases: killer proteases. Trends Biochem Sci. 1997 Aug;22(8):299-306.
25 Jajoo D, Kumar A, Shankar R, Bhargava V. Effect of birth asphyxia on serum calcium levels in neonates. lndian J Pediatr. 1995 Jul;62(4):455-9.
26 Basu P, Som S, Das H, Choudhuri N. Electrolyte status in birth asphyxia. Indian J Pediatr. 2010 Mar;77(3):259-62.
27 Aggarwal R, Upadhyay M, Deora. ri AK, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2001 Oct;68(10):973-5.
28 Simovic AM, Knezevic J, Igrutinovic Z, Stojanovic N, Kocic S. [Cardiac tropo nin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury]. Vojnosanit Pregl. 2009 Nov;66(11):881-6.
29 Lin LX, Mao QH, Zhang ZL, An CX, Kang XG. [Plasma levels of N-terminal pro-brain natriuretic peptide and glycogen phosphorylase isoenzyme BB in neo nates with asphyxia complicated by myocardial injury]. Zhongguo Dang Dai Er Ke Za Zhi.2010 Apr;l 2(4):252-5.
30 Rajakumar PS, Vishnu BB, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Electrocardiographic and echocardiographic changes in perinatal asphyxia. lndian J Pediatr. 2009 Mar;76(3):261-4.
31 Rowe RD, Hoffman T. Transient myocardial ischemia of the newbom infant: a form of severe cardiorespiratory distress in full-term infants. J Pediatr. 1972 Aug;81(2):243-50.
32 Lapointe A, Barrington KJ. Pulrnonary hypertension and the asphyxiated new bom.J Pediatr.2011 Feb;l 58(2 Suppl):el 9-e24.
33 Leone TA, Finer NN. Shock: a common consequence of neonatal asphyxia. J Pediatr. 2011 Feb;l58(2 Suppl):e9-12.
34 Tarcan A, Tiker F, Guvenir H, Gurakan B. Hepatic involvement in perinatal as phyxia.J Matern Fetal Neonatal Med. 2007 May;20(5):407-10.
35 Fischler B, Pettersson M, Hjem A, Nemeth A. Association between low Apgar score and neonatal cholestasis. Acta Paediatr.2004 Mar;93(3):368-7 l.
36 Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia.J Pedia tr.2011 Feb;I58(2 Suppl):e29-e33.
37 Gupta BD, Sbarma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. lndian Pediatr. 2005 Sep;42(9):928-34.
38 Chevalier RL, Campbell F, Brenbridge AN.Prognostic factors in neonatal acute renal failure.Pediatrics. 1984 Aug;74(2):265-72.
39 Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr. 2011;31(2):129-34.
40 Moake JL. Haemolytic-uraemic syndrome: basic science. Lancet. 1994 Feb 12;343(8894):393-7.
41 Biran V, Fau S, Jama! T, Veinberg F, Renolleau S, Gold F, et al. Perinatal as phyxia may present with features of neonatal atypical hemolytic uremic syndro me. Pediatr Nephrol. 2007 Dec;22(12):2129-32.
42 Levi M, de JE, Meijers J. Toe diagnosis of disseminated intravascular coagula tion. Blood Rev.2002 Dec;16(4):217-23.
43 Salhab WA, Wyckoff MH, Laptook AR, Perlman JM. Inicial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics. 2004 Aug;114(2):361-6.
44 Basu P, Som S, Choudhuri N, Das H.Contribution of the blood glucose leve! in perinatal asphyxia. Eur J Pediatr. 2009 Jul;168(7):833-8.
45 Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al.Whole-body hypothermia for neonates with hypoxic-ischemic encepha lopathy. N Engl J Med. 2005 Oct 13;353(15):1574-84.
46 Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol.1999 Sep;l6(5):384-7.
47 van BF, Shadid M, Moison_RM, Dorrepaal CA, Fontijn J, Monteiro L, et al. Effect of allopurinol on postasphyxial free radical formation, cerebral hemody narnics, and electrical brain activity.Pediatrics. 1998 Feb;l 01(2):185-93.
48 Levene MI, Gibson NA, Fenton AC, Papathoma E, Bamett D. The use of a calcium-channel blocker, nicardipine, for severely asphyxiated newbom infants. Dev Med Child Neurol. 1990 Jul;32(7):567-74.
49 Donn SM, Goldstein GW, Schork MA. Neonatal hypoxic-ischemic encephalo pathy: current management practices. J Perinatol. 1988;8(1):49-52.
50 Hunt R, Osbom D. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatalasphyxia.Cochrane Database Syst Rev. 2002;(3):CD003484.
51 Ichiba H, Tamai H, Negishi H, Ueda T, Kim TJ, Sumida Y, et al.Randomized controlled tria! of magnesium sulfate infusion for severe birth asphyxia.Pediatr Int. 2002 Oct;44(5):505-9.
52 Davis PO, Tan A, O'Donnell CP, Schulze A.Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet 2004 Oct 9;364(9442):1329-33.
53 Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Car diopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S909-S919.
54 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS.How many child deaths can we prevent this year? Lancet. 2003 Jul 5;362(9377):65-71.
55 Stuart A, Otterblad OP, Kallen K. Apgar seores at 5 minutes after birth in relation to school performance at 16 years of age. Obstet Gynecol.2011 Aug;l 18(2 Pt 1):201-8.
56 WESTIN B, MILLER JA, Jr., NYBERG R, WEDENBERG E. Neonatal as phyxia pallida treated with hypothermia alone or with hypothermia and transfu sion of oxygenated blood. Surgery.1959 May;45(5):868-79.
57 Shah PS. Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med. 201O Oct;15(5):238-46. Nelson KB, Chang T, Ghadini A.Comment and reply on: Neonatal asphyxia and forensic medicine. J Matero Fetal Neonatal Med.201I Apr;24(4):652-3.
59 Locatelli A, lncerti M, Ghidini A, Greco M, Villa E, Paterlini G. Factors associ ated with umbilical artery acidemia in term infants with low Apgar seores at 5 min. Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):146-50.
2 McGuire W. Perinatal asphyxia. Clin Evid (Online). 2007 Nov 7;2007
3 Hill A, Volpe JJ. Perinatal asphyxia: clinical aspects. Clin Perinatol. 1989 Jun;16(2):435-57.
4 Levene ML, Kornberg J, Williams TH. The incidence and severity of post-as phyxial encephalopathy in full-term infants. Early Hum Dev. 1985 May;11(1):21- 6.
5 Delivoria-Papadopoulos M, Marro PJ. Biochemical basis of hypoxic-Ischemic encephalopathy. NeoReviews. 2010 Apr 1;l 1(4):el84-el 93.
6 Jonsson M, Norden SL, Hanson U. Analysis of malpractice claims with a focus on oxytocin use in labour. Acta Obste! Gynecol Scand. 2007;86(3):315-9.
7 Berglund S, Grunewald C, Pcttcrsson H, Cnattingius S. Risk factors for asphyx ia associated with substandard care during labor. Acta Obstet Gynecol Scand. 2010;89(1):39-48.
8 Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998 Dec 5;317(7172):1549-53.
9 Milsom I, Ladfors L, Thiringer K, Niklasson A, Odeback A, Thornberg E. In fluence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. Acta Obste! Gynecol Scand. 2002 Oct;81(10):909-l 7.
10 Gorovenko NG, Rossokha Zl, Podolskaya SV, Pokhylko VI, Lundberg GA. The role of genetic determinan! in the development of severe perinatal asphyxia. Tsi tol Genet. 20 lO Sep;44(5):4l-6.
11 Blickstein 1, Green T. Umbilical cord blood gases. Clin Perinatol. 2007 Sep;34(3):45l-9.
12 Wayenberg JL. Threshold ofmetabolicacidosis associated withneonatal encepha lopathy in the term newbom. J Matero Fetal Neonatal Med. 2005 Dec;18(6):381-5.
13 Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newbom complications. Am J Obste! Gynecol. 1997 Dec;177(6):139 J-4.
14 [Multicenter clinical study on umbilical cord arterial blood gas param eters for diagnosis of neonatal asphyxia]. Zhonghua Er Ke Za Zhi. 2010 Sep;48(9):668-73.
15 Gazzolo D, Abella R, Marinoni E, di IR, Li VG, Galvano F, et al. New markers of neonatal neurology. J Matem Fetal Neonatal Med. 2009;22 Suppl 3:57-61.
16 Rarnaswamy V, Horton J, Vandermeer B, Buscemi N, Miller S, Yager J. Sys tematic review of biomarkers of brain injury in term neonatal encephalopathy. Pediatr Neurol 2009 Mar;40(3):2l 5-26. Routsi C, Stamataki E, Nanas S, Psachoulia C, Stathopoulos A, Koroneos A, et al. Increased levels of serum SI00B protein in criticallyill patientswithout brain injury. Shock. 2006 Jul;26(1):20-4.
18 Monda) N, Bhat BV, Banupriya C, Koner BC. Oxidative stress in perinatal as phyxia in relation to outcome. lndian J Pediatr. 20!0 May;77(5):515-7.
19 Martin-Ancel A, Garcia-Alix A, Gaya F, Cabanas F, Burgueros M, Quero J. Mul tiple organ involvement in perinatal asphyxia. J Pediatr. 1995 Nov;l27(5):786- 93.
20 Shah P, Riphagen S, Beyene J, Perlman M.Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F152-F155.
21 Linnik MD, Zobrist RH, Hatfield MD. Evidencesupportinga role for programmed cell death in focal cerebral ischemia in rats. Stroke. 1993 Dec;24(12):2002-8.
22 Zanelli SA, Numagami Y, McGowan JE, Mishra OP, Delivoria-Papadopoulos M. NMDA receptor-mediated calcium influx in cerebral cortical synaptosomes of the hypoxic guinea pig fetus.Neurochem Res. 1999 Mar;24(3):437-46.
23 Huang Z, Huang PL, Panahian N, Dalkara T, Fishman MC, Moskowitz MA. Effects of cerebral ischemia in mice deficient in neuronal nitric oxide synthase. Science. 1994 Sep 23;265(5180):1883-5.
24 Nicholson DW, Thornberry NA. Caspases: killer proteases. Trends Biochem Sci. 1997 Aug;22(8):299-306.
25 Jajoo D, Kumar A, Shankar R, Bhargava V. Effect of birth asphyxia on serum calcium levels in neonates. lndian J Pediatr. 1995 Jul;62(4):455-9.
26 Basu P, Som S, Das H, Choudhuri N. Electrolyte status in birth asphyxia. Indian J Pediatr. 2010 Mar;77(3):259-62.
27 Aggarwal R, Upadhyay M, Deora. ri AK, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2001 Oct;68(10):973-5.
28 Simovic AM, Knezevic J, Igrutinovic Z, Stojanovic N, Kocic S. [Cardiac tropo nin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury]. Vojnosanit Pregl. 2009 Nov;66(11):881-6.
29 Lin LX, Mao QH, Zhang ZL, An CX, Kang XG. [Plasma levels of N-terminal pro-brain natriuretic peptide and glycogen phosphorylase isoenzyme BB in neo nates with asphyxia complicated by myocardial injury]. Zhongguo Dang Dai Er Ke Za Zhi.2010 Apr;l 2(4):252-5.
30 Rajakumar PS, Vishnu BB, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Electrocardiographic and echocardiographic changes in perinatal asphyxia. lndian J Pediatr. 2009 Mar;76(3):261-4.
31 Rowe RD, Hoffman T. Transient myocardial ischemia of the newbom infant: a form of severe cardiorespiratory distress in full-term infants. J Pediatr. 1972 Aug;81(2):243-50.
32 Lapointe A, Barrington KJ. Pulrnonary hypertension and the asphyxiated new bom.J Pediatr.2011 Feb;l 58(2 Suppl):el 9-e24.
33 Leone TA, Finer NN. Shock: a common consequence of neonatal asphyxia. J Pediatr. 2011 Feb;l58(2 Suppl):e9-12.
34 Tarcan A, Tiker F, Guvenir H, Gurakan B. Hepatic involvement in perinatal as phyxia.J Matern Fetal Neonatal Med. 2007 May;20(5):407-10.
35 Fischler B, Pettersson M, Hjem A, Nemeth A. Association between low Apgar score and neonatal cholestasis. Acta Paediatr.2004 Mar;93(3):368-7 l.
36 Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia.J Pedia tr.2011 Feb;I58(2 Suppl):e29-e33.
37 Gupta BD, Sbarma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. lndian Pediatr. 2005 Sep;42(9):928-34.
38 Chevalier RL, Campbell F, Brenbridge AN.Prognostic factors in neonatal acute renal failure.Pediatrics. 1984 Aug;74(2):265-72.
39 Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr. 2011;31(2):129-34.
40 Moake JL. Haemolytic-uraemic syndrome: basic science. Lancet. 1994 Feb 12;343(8894):393-7.
41 Biran V, Fau S, Jama! T, Veinberg F, Renolleau S, Gold F, et al. Perinatal as phyxia may present with features of neonatal atypical hemolytic uremic syndro me. Pediatr Nephrol. 2007 Dec;22(12):2129-32.
42 Levi M, de JE, Meijers J. Toe diagnosis of disseminated intravascular coagula tion. Blood Rev.2002 Dec;16(4):217-23.
43 Salhab WA, Wyckoff MH, Laptook AR, Perlman JM. Inicial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics. 2004 Aug;114(2):361-6.
44 Basu P, Som S, Choudhuri N, Das H.Contribution of the blood glucose leve! in perinatal asphyxia. Eur J Pediatr. 2009 Jul;168(7):833-8.
45 Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al.Whole-body hypothermia for neonates with hypoxic-ischemic encepha lopathy. N Engl J Med. 2005 Oct 13;353(15):1574-84.
46 Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol.1999 Sep;l6(5):384-7.
47 van BF, Shadid M, Moison_RM, Dorrepaal CA, Fontijn J, Monteiro L, et al. Effect of allopurinol on postasphyxial free radical formation, cerebral hemody narnics, and electrical brain activity.Pediatrics. 1998 Feb;l 01(2):185-93.
48 Levene MI, Gibson NA, Fenton AC, Papathoma E, Bamett D. The use of a calcium-channel blocker, nicardipine, for severely asphyxiated newbom infants. Dev Med Child Neurol. 1990 Jul;32(7):567-74.
49 Donn SM, Goldstein GW, Schork MA. Neonatal hypoxic-ischemic encephalo pathy: current management practices. J Perinatol. 1988;8(1):49-52.
50 Hunt R, Osbom D. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatalasphyxia.Cochrane Database Syst Rev. 2002;(3):CD003484.
51 Ichiba H, Tamai H, Negishi H, Ueda T, Kim TJ, Sumida Y, et al.Randomized controlled tria! of magnesium sulfate infusion for severe birth asphyxia.Pediatr Int. 2002 Oct;44(5):505-9.
52 Davis PO, Tan A, O'Donnell CP, Schulze A.Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet 2004 Oct 9;364(9442):1329-33.
53 Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Car diopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S909-S919.
54 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS.How many child deaths can we prevent this year? Lancet. 2003 Jul 5;362(9377):65-71.
55 Stuart A, Otterblad OP, Kallen K. Apgar seores at 5 minutes after birth in relation to school performance at 16 years of age. Obstet Gynecol.2011 Aug;l 18(2 Pt 1):201-8.
56 WESTIN B, MILLER JA, Jr., NYBERG R, WEDENBERG E. Neonatal as phyxia pallida treated with hypothermia alone or with hypothermia and transfu sion of oxygenated blood. Surgery.1959 May;45(5):868-79.
57 Shah PS. Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med. 201O Oct;15(5):238-46. Nelson KB, Chang T, Ghadini A.Comment and reply on: Neonatal asphyxia and forensic medicine. J Matero Fetal Neonatal Med.201I Apr;24(4):652-3.
59 Locatelli A, lncerti M, Ghidini A, Greco M, Villa E, Paterlini G. Factors associ ated with umbilical artery acidemia in term infants with low Apgar seores at 5 min. Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):146-50.