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Each year, an estimated 23% of the 3.5 million neonatal deaths that occur worldwide are the result of birth asphyxia. In the United States, preliminary 3.9 million children are born annually, with a reported infant mortality rate of 6.11 for the year 2011.1,2 This suggests that every year, among US children who reach 28 weeks’ gestation, over 26,000 die prior to their seventh day of life. A significant portion of those infants who succumb do so from birth asphyxia. Further, among children reaching term gestation, 2 to 3 per 1000 live term births suffer hypoxic ischemic encephalopathy (HIE), (0.3 per 1000 severe HIE). (Table 24-1) Up to 80% of infants who survive severe hypoxic-ischemic encephalopathy develop serious complications and 10% to 20% develop moderately serious disabilities. In addition, it is widely accepted that 10% of all newborns require some assistance to begin and maintain normal breathing and that 1% require aggressive resuscitation. Thus, using the national birth rate data, annually 400,000 newborns need some help during the perinatal period, 40,000 per year require expert assistance to reverse profound cardiorespiratory depression, and 1200 per year develop severe HIE. Although there is some evidence that therapeutic hypothermia is beneficial to term newborns with moderate to severe hypoxic ischemic encephalopathy, and that cooling decreases death without increasing major disability in survivors, this therapy is not available at all centers yet as further research is being compiled. (Table 24-2).
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