Question

A term newborn was born via emergency cesarean section in the setting of fetal bradycardia. The baby was limp and bradycardic at birth and was intubated at 6 minutes after birth for persistent apnea. The cord blood gas demonstrates a severe metabolic acidosis, and the physical examination is consistent with hypoxic-ischemic encephalopathy (HIE). Which of the following is the most appropriate intervention for this newborn?

a. Admit the newborn to a center with capability to perform therapeutic hypothermia.
b. Maintain a body temperature >38˚C to avoid cold stress after resuscitation.
c. Initiate formula feeding promptly to avoid electrolyte abnormalities.
d. Administer 100% oxygen and sodium bicarbonate to prevent pulmonary hypertension.

Answer 1

The most appropriate intervention for a term newborn with fetal bradycardia, severe metabolic acidosis, and signs of hypoxic-ischemic encephalopathy (HIE) is to admit the baby to a center capable of performing therapeutic hypothermia, as it can improve neurological outcomes.

Step-by-step explanation:

A term newborn was born via emergency cesarean section in the setting of fetal bradycardia. Following birth, the baby was limp and bradycardic, and was intubated at 6 minutes for persistent apnea. The presence of severe metabolic acidosis in the cord blood gas and physical examination findings consistent with hypoxic-ischemic encephalopathy (HIE) indicates that the most appropriate intervention for this newborn is therapeutic hypothermia. Therapeutic hypothermia is a treatment modality that has been shown to improve neurological outcomes in neonates with HIE by slowing metabolic processes and reducing the production of toxic substances that follow ischemic injury.

Maintaining a higher body temperature, initiating formula feeding immediately, or administering 100% oxygen with sodium bicarbonate are not recommended interventions for HIE. In fact, overly warm temperatures should be avoided, as they can exacerbate metabolic demand and oxygen consumption, potentially worsening brain injury. Early formula feeding could stress an already compromised system and does not address the neurological insult present in HIE. While managing oxygenation is important, 100% oxygen should be used with caution to avoid oxygen toxicity and oxidative stress, and sodium bicarbonate use for resuscitation is not recommended due to lack of evidence for efficacy and potential for harm.