[Orientation after peripartum asphyxia in the maternity ward: which infants should be transferred to pediatric care units?].

Per-partum anoxia is a frequent situation facing the pediatrician in the maternity ward. The question is to decide which infants require care in a specialized unit. If transfer is decided, the infant must be referred to an appropriate pediatric unit (intensive care or neonatal unit). Cases of severe anoxia are exceptional. Intermediary situations are however much more frequent and raise difficult evaluation problems due to the lack of any specific test. The pediatrician must rely on a combination of elements from the clinical presentation, the medical history, the clinical course, and laboratory tests. Different elements suggest a prudent approach with referral to a pediatric unit. These elements include: imperfect clinical recovery (5-min Agpar <7), major intensive care at delivery (intubation, ventilation, vasoactive agents), anomalies in the cord blood or first hour blood tests (cord pH<7, base deficit 12, cord or blood lactate 9 mmol/l). Obstetrical circumstances which led to per-partum anoxia must be well identified because those interrupting placental flow (abruptio placenta, uterine rupture) suggest prudence is necessary even if the infant appears to have recovered well. All neonatal disorders (macrosomia, prematurity, infection, respiratory distress) increase the risk of rapid decompensation and may argue for hospitalization. Likewise, if even minimal signs of neurological, respiratory or hemodynamic disorders are present from birth to two hours, surveillance in a specialized unit is required, the level depending on local facilities. Certain situations nevertheless always require referral to a pediatric intensive care unit: use of vasoactive drugs, respiratory distress, abnormal neurological exam, poor recovery (5-min Agpar <4).Finally, it must be remembered that per-partum anoxia is rarely predictable and can occur any at any time of day or night. The pediatrician must also train other delivery room personnel, including the midwives, in intensive care techniques.