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

@entity1 @entity8455 @entity4670 @entity5869 @entity1503 @entity519 @entity880 @entity1729 @entity14853 @entity74
Per-partum @entity519 is a frequent situation facing the pediatrician in the maternity ward. The question is to decide which @entity1 require care in a specialized unit. If transfer is decided, the @entity1 must be referred to an appropriate pediatric unit (intensive care or neonatal unit). Cases of severe @entity519 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), @entity1503 or first hour blood tests (cord pH<7, base deficit 12, cord or blood @entity880 9 mmol/l). Obstetrical circumstances which led to per-partum @entity519 must be well identified because those interrupting placental flow ( @entity5869 , @entity14853 ) suggest prudence is necessary even if the @entity1 appears to have recovered well. All @entity4670 ( @entity8455 , prematurity, @entity1729 ) increase the risk of rapid decompensation and may argue for hospitalization. Likewise, if even minimal signs of neurological, respiratory or @entity74 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 @entity519 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.
