Classification of Low et al for Intrapartum Fetal Asphyxia Based on Neonatal Findings

The presence of certain findings in a neonate can indicate the level of asphyxia experienced during the intrapartum period.

Key defining characteristics: metabolic acidosis at delivery, as indicated by an umbilical artery base deficit (negative base excess) > 12 mmol/L

Parameters during the first 5 days after delivery:

(1) encephalopathy

(2) cardiovascular, respiratory and/or renal complications

Organ	Minor Complication	Moderate Complication	Severe Complication
central nervous system	irritability, jitteriness	profound lethargy or abnormal tone	coma, or abnormal tone and seizures
cardiovascular	bradycardia or tachycardia	hypotension or hypertension	abnormal ECG or echocardiographic findings
respiratory	supplementary oxygen required	continuous positive airway pressure, or ventilation required for < 24 hours	mechanical ventilation required for >= 24 hours
renal	hematuria	elevated serum creatinine > 100 µmol/L (> 1.13 mg/dL)	anuria, or oliguria

where:

• Bradycardia indicates pulse <= 100 beats per minute; tachycardia a pulse >= 180 beats per minute.

• Blood pressure changes were based on the 95% confidence limits for blood pressure in neonates.

• Oliguria occurs when urine output is < 1 mL per kg per hour.

Encephalopathy	Complications in Other Organs	Classification of Asphyxia
none	none	none
minor	minor	mild
moderate	minor to moderate	moderate
severe	minor to severe	severe

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