[TREATMENT OF SEVERE INTRAPATUM ASPHYXIA.]

THE AIM: Estimate of efficiency of newborns with severe birth asphyxia treatment using systemic therapeutic hypothermia. MATERIALS AND METHODS: a retrospective open-controlled clinical research with a resolution of the Ethics;Committee performed in 33 neonates born in asphyxia and treated at the NICU All newborns due to the presence of indications, overall controlled hypothermia was conducted according to the approved protocol, using the apparatus Allon 2001". RESULTS: The neurological status at admission: Sarnat II was detected in 60.6% (20) children; Sarnat III was detected in 39.4% (13) children. The correlation ofApgar scores with the most severe hypoxic ischemic encephalopathy. Pupillary reflexes admission absent in 48.5% (16) newborns. Convulsions within first hours of lfe were observed in 57.6% (19) newborns. Convulsions within I day of life were observed in 81.8 % (27) newborns. The correlation of the amniotic infection (AI) and meconium aspiration syndrome (MAS) treatment using high-frequency mechanical ventilation (p<0,05) and prolongation of mechanical ventilation for more than 5 days (p<0,01). At the beginning of systemic hypothermia fraction of inspired oxygen (FiO2), mean airway pressure (MAP), respiratory rate (RR) were down to the 12th hour of life and reaches a minimum at the end of the third day. These trends have been observed in children with MAS. The correlation of the use of high-frequency mechanical ventilation using high doses ofcardiotonics and the transition to the infusion of epinephrine or norepinephrine (p <0.01).There were no deaths in the studying group. CONCLUSIONS: 1. Reliable predictor of the clinical outcomes severity of hypoxic-ischemic encephalopathy (HIE) by the end of the first month lf is the presence of convulsions within the first hour of lf (p<0. 03). 2. When comparing the evaluation on Apgar scale with the data of acid-base balance and severity of HIE a significant correlation between the estimation at the first minute is I point and at the fifth minute 3 point and more severe pH shift, base deficiency, hyperlactatacidosis and severe HIE. 3. MAS and AI are the most frequent accompanying diseases that complicates the severity of newborn status causing prolonged artificial ventilation and the infusion ofcardiotonics. 4. There is a decrease in all parameters of artficial lung ventilation to the twelfth hour life in early systemic hypothermia and reached minimum by the end of the third day.