Shock of birth evaluation of neurologic status of term newborn in the first 48 hours of life

Riesgo, Rudimar Dos Santos; Rotta, Alexandre Tellechea; Rotta, Newra Tellechea

doi:10.1590/S0004-282X1996000300001

Abstracts

The shock of birth is a transient depression of muscle tone and deep tendon reflexes seen in newborn babies shortly after birth. We evaluated the shock of birth in a sample of 313 consecutive term newborns at 4, 24 and 48 hours of life. We correlated neurologic findings on examination with maternal, obstetric and perinatal data. Special attention was given to the relationship between the mode of delivery and shock of birth. Of the maternal data, factors associated with the shock of birth were obstetric gestational age, previous gestations, abortions or previous vaginal deliveries. Presence of stained amniotic fluid at birth was associated with the shock of birth. There was also a correlation between shock of birth and newborn sex, birth weight, thoracic circumference and the Battaglia and Lubchenco classification. The shock of birth lasted less than 24 hours in 70% of the newborns and less than 48 hours in 84.3%. We conclude that the mode of delivery, vaginal or cesarean section, did not influence the shock of birth. We also established the duration and factors associated with this phenomenon.

shock of birth; neurologic examination; term newborn

O choque do nascimento é uma depressão temporária do tono muscular e reflexos em recém-nascidos. Nós o avaliamos em uma amostra de 313 recém-nascidos a termo, de partos consecutivos, examinados com 4,24 e 48 horas de vida. Correlacionamos os achados do exame neurológico com dados maternos, do parto e do recém-nascido, com ênfase na relação entre o tipo de parto e o choque do nascimento. Dentre os dados maternos, estiveram associados com o choque do nascimento: idade gestacional obstétrica, gestações, abortamentos e partos vaginais prévios. O único dado do parto que esteve associado foi a presença de líquido amniótico não claro. Sexo, peso ao nascimento, perímetro torácico e classificação de Battaglia & Lubchenco foram os dados do recém-nascido que estiveram associados com o evento. O choque do nascimento durou menos de 24 horas em 70% dos recém-nascidos e até 48 horas em 84,3% deles. Concluímos que o tipo de parto, se vaginal ou cesáreo, não exerce influência no choque do nascimento. Também estabelecemos sua duração e os fatores que estão associados com este fenômeno.

choque do nascimento; exame neurológico; recém-nascido a termo

Shock of birth evaluation of neurologic status of term newborn in the first 48 hours of life

Choque do nascimento: avaliação do vigor neurológico do recém-nascido a termo nas primeiras 48 horas de vida

Rudimar dos Santos Riesgo^I; Alexandre Tellechea Rotta^II; Newra Tellechea Rotta^III

^IDivision of Neurology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, Brazil. M.D., Child Neurologist, Master in Pediatrics

^IIDivision of Neurology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, Brazil. M.D., Pediatrician, The Children's Hospital of Buffalo

^IIIDivision of Neurology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, Brazil. M.D., Ph.D., Child Neurologist, Associate Professor of Neurology at UFRGS

ABSTRACT

The shock of birth is a transient depression of muscle tone and deep tendon reflexes seen in newborn babies shortly after birth. We evaluated the shock of birth in a sample of 313 consecutive term newborns at 4, 24 and 48 hours of life. We correlated neurologic findings on examination with maternal, obstetric and perinatal data. Special attention was given to the relationship between the mode of delivery and shock of birth. Of the maternal data, factors associated with the shock of birth were obstetric gestational age, previous gestations, abortions or previous vaginal deliveries. Presence of stained amniotic fluid at birth was associated with the shock of birth. There was also a correlation between shock of birth and newborn sex, birth weight, thoracic circumference and the Battaglia and Lubchenco classification. The shock of birth lasted less than 24 hours in 70% of the newborns and less than 48 hours in 84.3%. We conclude that the mode of delivery, vaginal or cesarean section, did not influence the shock of birth. We also established the duration and factors associated with this phenomenon.

Key words: shock of birth, neurologic examination, term newborn.

RESUMO

O choque do nascimento é uma depressão temporária do tono muscular e reflexos em recém-nascidos. Nós o avaliamos em uma amostra de 313 recém-nascidos a termo, de partos consecutivos, examinados com 4,24 e 48 horas de vida. Correlacionamos os achados do exame neurológico com dados maternos, do parto e do recém-nascido, com ênfase na relação entre o tipo de parto e o choque do nascimento. Dentre os dados maternos, estiveram associados com o choque do nascimento: idade gestacional obstétrica, gestações, abortamentos e partos vaginais prévios. O único dado do parto que esteve associado foi a presença de líquido amniótico não claro. Sexo, peso ao nascimento, perímetro torácico e classificação de Battaglia & Lubchenco foram os dados do recém-nascido que estiveram associados com o evento. O choque do nascimento durou menos de 24 horas em 70% dos recém-nascidos e até 48 horas em 84,3% deles. Concluímos que o tipo de parto, se vaginal ou cesáreo, não exerce influência no choque do nascimento. Também estabelecemos sua duração e os fatores que estão associados com este fenômeno.

Palavras-chave: choque do nascimento, exame neurológico, recém-nascido a termo.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 26-março-1996.

Dr. Rudimar dos Santos Riesgo - Rua São Vicente 513/704 - 90630-180 Porto Alegre RS - Brasil.

1. Abboud TK, Artal R, Henriksen EH, Earl S. Effects of spinal anesthesia on maternal circulating catecholamines. Am J Obst Gynecol 1982;142:252-254.
2. Abrol P, Kapoor R, Gathwala G, Tiwari S, Tiwari AD. Neonatal behavior in full-term small-for-date. Indian Pediatr 1994;31:785-789.
3. Amiel-Tison C. Neurologic disorders in neonates associated with abnormalities of pregnancy and birth. Curr Probl Pediatr 1973;3:3-37.
4. Amiel-Tison C, Barrier G, Shnider SM, Levin son G, Hughes SC, Stefani SJ. A new neurologic and adaptative capacity score system for evaluating obstetric medication in full-term newborns. Anesthesiology 1982;56:340-350.
5. Barton MD, Killam AP, Meschia G. Reponse of ovine uterine blood flow to epinephrine and norepinephrine. Proc Soc Exp Biol Med 1974;145:996-1003.
6. Battaglia PC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. Pediatrics 1967;71:159-163.
7. Brazelton TB. Effect of prenatal drugs on the behavior of the neonate. Am J Psychiatry 1970;126:1261-1266.
8. Brazelton TB. Neonatal behavioural assessment scale. In Spastics International Medical Publications. Clinics in development medicine. London: Heinemann, 1973.
9. Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978;93:120-122.
10. Desmond MM, Franklin RR, Vallbona C, Hill RM, Plumb R, Arnold D, Watts J. The clinical behavior of the neonatal patient: the standard baby. Am J Dis Child 1961;102:732-733.
11. Diament AJ. Contribuição para a sistematização do exame neurológico de crianças normais no primeiro ano de vida. Tese de Doutorado, Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1967.
12. Diament AJ. Introdução à semiologia neurológica infantil. In Diament AJ, Cypel S. Neurologia Infantil-Lefèvre. Ed 2. São Paulo: Atheneu, 1989: 1-4.
13. Diament AJ, Gherpelli JLD. Exame neurológico do recém-nascido. In Vaz FAC. Problemas neurológicos do recém-nascido. São Paulo: Sarvier, 1985:29-58.
14. Dixhoorn MJ, Visser GHA, Huisjes HJ, Fidler V, Touwen BCL. The relation between umbilical pH values and neonatal neurological morbity in full-term appropriate-for-date infants. Early Hum Dev 1985; 11:32-42.
15. Escardó F, Coriat LF. Development of postural and tonic patterns in the newborn infant. Pediatr Clin North Am 1960;7:511-525.
16. Fenton A, Steer CM. Fetal distress. Am J Obst Gynecol 1962; 83:354-362.
17. Irested L, Langercrantz H, HjemadhI P, Hagnevik H. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obst Gynecol 1982;142:1004-1010.
18. Jones CM, Greiss FC. The effect of labor on maternal and fetal circulating catecholamines. Am J Obst Gynecol 1982;144:149-153.
19. Koenigsberger MR. Judgement of fetal age: neurologic examination. Pediatr Clin North Am 1966; 13:823-833.
20. Korner AF. Individual differences at birth: implications for early experience and later development. Am J Orthopsychiat 1971;41:608-619.
21. Korner AF. Sex differences in newborns with special reference to differences in the organization of oral behavior. J Child Psychol Psychiat 1973;14:19-29.
22. Kuhnert BR, Harrison MJ, Linn PL, Kuhnert PM. Effects of maternal epidural anesthesia on neonatal behavior. Anesth Analg 1984;63:301-308.
23. Low JA. Fetal acid-base status and outcome. In Hill A, Volpe JJ. Fetal neurology. New York: Raven Press, 1989:195-217.
24. Low JA, Pancham SR, Worthing ton D, Boston RW. Acid-base, lactate, and pyruvate characteristics of the normal obstetric patient and fetus during the intrapartum period. Am J Obst Gynecol 1974; 120:862-867.
25. Maekawa K, Ochiai Y. Electromyographic studies on flexor hypertonia of the extremities of newborn infants. Dev Med Child Neurol 1975;17:440-446.
26. Mingeot R, Herbaut M. The functional status of the newborn infnat. Am J Obst Gynecol 1973; 115:1138-1144.
27. Miura E. Assistência ao recém-nascido na sala de parto. In Miura E. Neonatologia: princípios e prática. Porto Alegre: Artes Médicas, 1991:53-56.
28. Nelson N. O início da respiração. In Avery GB. Neonatologia. Ed.2. Schvartsman S (tradutor). Rio de Janeiro: Medsi, 1984:148-170.
29. Otamiri G, Finnstrom O, Leijon I, Rydén G, Selbing A. Neurological condition of large-for-gestational age infants during the newborn period. Acta Paediatr Scand 1988;77:647-652.
30. Rotta NT. Problemas neurológicos do recém-nascido: o exame neurológico. In Miura E. Neonatologia: princípios e prática. Porto Alegre: Artes Médicas, 1991:305-307.
31. Scanlon JW. How is the baby? the Apgar score revisited. Clin Pediatr 1973;12:61-63.
32. Scanlon JW, Brown WV, Weiss JB, Alper MH. Neurobehavioural reponses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974;40:121-128.
33. Simion F, Dondi M, Ferlini I, Valenza E, Zanco F. Influence of the delivery on neonatal competence. Pediatr Med Chir 1992;14:29-32.
34. Touwen BCL, Huisjes HJ, Van-der-Zee ADJ, Eedengurg MECB, Smrkovsky M, Olinga AA. Obstetrical condition and neurological morbity: an analysis with the help of the optimally concept. Early Hum Dev 1980;4:207-228.
35. Zuspan FP, Cibils LA, Pose SV. Myometrical and cardiovascular reponses to alterations in plasma epinephrine and norepinephrine. Am J Obst Gynecol 1962,84:841-851.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
Sept 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abboud TK, Artal R, Henriksen EH, Earl S. Effects of spinal anesthesia on maternal circulating catecholamines. Am J Obst Gynecol 1982;142:252-254.

[2] 2. Abrol P, Kapoor R, Gathwala G, Tiwari S, Tiwari AD. Neonatal behavior in full-term small-for-date. Indian Pediatr 1994;31:785-789.

[3] 3. Amiel-Tison C. Neurologic disorders in neonates associated with abnormalities of pregnancy and birth. Curr Probl Pediatr 1973;3:3-37.

[4] 4. Amiel-Tison C, Barrier G, Shnider SM, Levin son G, Hughes SC, Stefani SJ. A new neurologic and adaptative capacity score system for evaluating obstetric medication in full-term newborns. Anesthesiology 1982;56:340-350.

[5] 5. Barton MD, Killam AP, Meschia G. Reponse of ovine uterine blood flow to epinephrine and norepinephrine. Proc Soc Exp Biol Med 1974;145:996-1003.

[6] 6. Battaglia PC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. Pediatrics 1967;71:159-163.

[7] 7. Brazelton TB. Effect of prenatal drugs on the behavior of the neonate. Am J Psychiatry 1970;126:1261-1266.

[8] 8. Brazelton TB. Neonatal behavioural assessment scale. In Spastics International Medical Publications. Clinics in development medicine. London: Heinemann, 1973.

[9] 9. Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978;93:120-122.

[10] 10. Desmond MM, Franklin RR, Vallbona C, Hill RM, Plumb R, Arnold D, Watts J. The clinical behavior of the neonatal patient: the standard baby. Am J Dis Child 1961;102:732-733.

[11] 11. Diament AJ. Contribuição para a sistematização do exame neurológico de crianças normais no primeiro ano de vida. Tese de Doutorado, Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1967.

[12] 12. Diament AJ. Introdução à semiologia neurológica infantil. In Diament AJ, Cypel S. Neurologia Infantil-Lefèvre. Ed 2. São Paulo: Atheneu, 1989: 1-4.

[13] 13. Diament AJ, Gherpelli JLD. Exame neurológico do recém-nascido. In Vaz FAC. Problemas neurológicos do recém-nascido. São Paulo: Sarvier, 1985:29-58.

[14] 14. Dixhoorn MJ, Visser GHA, Huisjes HJ, Fidler V, Touwen BCL. The relation between umbilical pH values and neonatal neurological morbity in full-term appropriate-for-date infants. Early Hum Dev 1985; 11:32-42.

[15] 15. Escardó F, Coriat LF. Development of postural and tonic patterns in the newborn infant. Pediatr Clin North Am 1960;7:511-525.

[16] 16. Fenton A, Steer CM. Fetal distress. Am J Obst Gynecol 1962; 83:354-362.

[17] 17. Irested L, Langercrantz H, HjemadhI P, Hagnevik H. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obst Gynecol 1982;142:1004-1010.

[18] 18. Jones CM, Greiss FC. The effect of labor on maternal and fetal circulating catecholamines. Am J Obst Gynecol 1982;144:149-153.

[19] 19. Koenigsberger MR. Judgement of fetal age: neurologic examination. Pediatr Clin North Am 1966; 13:823-833.

[20] 20. Korner AF. Individual differences at birth: implications for early experience and later development. Am J Orthopsychiat 1971;41:608-619.

[21] 21. Korner AF. Sex differences in newborns with special reference to differences in the organization of oral behavior. J Child Psychol Psychiat 1973;14:19-29.

[22] 22. Kuhnert BR, Harrison MJ, Linn PL, Kuhnert PM. Effects of maternal epidural anesthesia on neonatal behavior. Anesth Analg 1984;63:301-308.

[23] 23. Low JA. Fetal acid-base status and outcome. In Hill A, Volpe JJ. Fetal neurology. New York: Raven Press, 1989:195-217.

[24] 24. Low JA, Pancham SR, Worthing ton D, Boston RW. Acid-base, lactate, and pyruvate characteristics of the normal obstetric patient and fetus during the intrapartum period. Am J Obst Gynecol 1974; 120:862-867.

[25] 25. Maekawa K, Ochiai Y. Electromyographic studies on flexor hypertonia of the extremities of newborn infants. Dev Med Child Neurol 1975;17:440-446.

[26] 26. Mingeot R, Herbaut M. The functional status of the newborn infnat. Am J Obst Gynecol 1973; 115:1138-1144.

[27] 27. Miura E. Assistência ao recém-nascido na sala de parto. In Miura E. Neonatologia: princípios e prática. Porto Alegre: Artes Médicas, 1991:53-56.

[28] 28. Nelson N. O início da respiração. In Avery GB. Neonatologia. Ed.2. Schvartsman S (tradutor). Rio de Janeiro: Medsi, 1984:148-170.

[29] 29. Otamiri G, Finnstrom O, Leijon I, Rydén G, Selbing A. Neurological condition of large-for-gestational age infants during the newborn period. Acta Paediatr Scand 1988;77:647-652.

[30] 30. Rotta NT. Problemas neurológicos do recém-nascido: o exame neurológico. In Miura E. Neonatologia: princípios e prática. Porto Alegre: Artes Médicas, 1991:305-307.

[31] 31. Scanlon JW. How is the baby? the Apgar score revisited. Clin Pediatr 1973;12:61-63.

[32] 32. Scanlon JW, Brown WV, Weiss JB, Alper MH. Neurobehavioural reponses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974;40:121-128.

[33] 33. Simion F, Dondi M, Ferlini I, Valenza E, Zanco F. Influence of the delivery on neonatal competence. Pediatr Med Chir 1992;14:29-32.

[34] 34. Touwen BCL, Huisjes HJ, Van-der-Zee ADJ, Eedengurg MECB, Smrkovsky M, Olinga AA. Obstetrical condition and neurological morbity: an analysis with the help of the optimally concept. Early Hum Dev 1980;4:207-228.

[35] 35. Zuspan FP, Cibils LA, Pose SV. Myometrical and cardiovascular reponses to alterations in plasma epinephrine and norepinephrine. Am J Obst Gynecol 1962,84:841-851.