Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.

Automatic identification of stimulation activities during newborn resuscitation using ECG and accelerometer signals

BACKGROUND AND OBJECTIVE

Early neonatal death is a worldwide challenge with 1 million newborn deaths every year. The primary cause of these deaths are complications during labour and birth asphyxia. The majority of these newborns could have been saved with adequate resuscitation at birth. Newborn resuscitation guidelines recommend immediate drying, stimulation, suctioning if indicated, and ventilation of non-breathing newborns. A system that will automatically detect and extract time periods where different resuscitation activities are performed, would be highly beneficial to evaluate what resuscitation activities that are improving the state of the newborn, and if current guidelines are good and if they are followed. The potential effects of especially stimulation are not very well documented as it has been difficult to investigate through observations. In this paper the main objective is to identify stimulation activities, regardless if the state of the newborn is changed or not, and produce timelines of the resuscitation episode with the identified stimulations.

METHODS

Data is collected by utilizing a new heart rate device, NeoBeat, with dry-electrode ECG and accelerometer sensors placed on the abdomen of the newborn. We propose a method, NBstim, based on time domain and frequency domain features from the accelerometer signals and ECG signals from NeoBeat, to detect time periods of stimulation. NBstim use causal features from a gliding window of the signals, thus it can potentially be used in future realtime systems. A high performing feature subset is found using feature selection. System performance is computed using a leave-one-out cross-validation and compared with manual annotations.

RESULTS

The system achieves an overall accuracy of 90.3% when identifying regions with stimulation activities.

CONCLUSION

The performance indicates that the proposed NBstim, used with signals from the NeoBeat can be used to determine when stimulation is performed. The provided activity timelines, in combination with the status of the newborn, for example the heart rate, at different time points, can be studied further to investigate both the time spent and the effect of different newborn resuscitation parameters.

Implementation of the Perinatal Death Surveillance and Response guidelines: Lessons from annual health system strengthening interventions in the Rwenzori Sub-Region, Western Uganda

Aim

To determine the health facility-based perinatal mortality rate, its causes and avoidable factors using the perinatal mortality surveillance and response guidelines.

Design

This was an action study conducted in one of the districts in Western Uganda from 1 January-31 December 2019.

Methods

A total of 20 perinatal death cases were recruited consecutively. Data were collected using a Ministry of Health Perinatal Death Surveillance and Response (PDSR) questionnaire containing questions on pregnancy, delivery and immediate postnatal care. We used descriptive statistics to describe key data elements.

Results

We found a health facility-based perinatal mortality rate of 17.3 deaths per 1,000 live births. Birth asphyxia was the most common cause of perinatal deaths. Seven, three and ten mothers delayed seeking, reaching and receiving appropriate health care, respectively.

A Comparative Study of Craniosonogram and CT scan of Brain in CNS Complication of Perinatal Asphyxia

Pereinatal asphyxia is one of the most important complications related with the process of birth and this complications affect not only the brain but also many other organs. The purpose of this cross sectional study is to compare the role of craniosonogram and CT scan of the brain to delineate the cerebral pathology in respondent of preterm and term infant and to assess the Kappa test for agreement. This study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of July 2015 to June 2017. A total number of 40 neonates clinically diagnosed as perinatal asphyxia referred for Craniosonogram and Computed tomography (CT) were included in this study. The test of agreement of USG in detection of neonatal cerebral pathology was calculated. Male to female ratio was 1:1.4. More than half (55.0%) patients were preterm age. The mean birth weight was found 2.3±0.6 kg and mean age was 22.7±12.7 days. Fifty five percent respondent mothers had antenatal check up and 27% had anemia, 11% had premature rupture of membrane, 9% had multiple pregnancy and 7% patient had hypertension. Cerebral pathology was found 28 and 31 cases by Craniosonogram and CT scan respectively. Germinal matrix hemorrhage/IVH (Intra ventricular hemorrhage) found 7(17.5%) in USG and 4(10.0%) in CT scan. Hypoxic ischaemic changes with mild ventriculomegaly observed 5(12.5%) in USG and 7(17.5%) in CT scan. Hypoxic ischaemic change found 4(10.0%) in USG and 5(12.5%) in CT scan. In USG evaluation of 28 patients having cerebral pathology & 16(72.7%) had in preterm group and 12(66.7%) in term group. In CT scan of brain 31 patients with cerebral pathology & 15(37.5%) in preterm group and 16(40.0%) in term group. CT scan found cerebral pathology 77.5% (31/40) cases and USG found 70.0% (28/40), with Kappa value was 0.551, which indicates that fair agreement between USG and CT scan for detection of cerebral pathology in respondent. Craniosonogram is a useful method in all neonates specially preterm to see the CNS complication of perinatal asphyxia.

Activity Recognition From Newborn Resuscitation Videos

OBJECTIVE

Birth asphyxia is one of the leading causes of neonatal deaths. A key for survival is performing immediate and continuous quality newborn resuscitation. A dataset of recorded signals during newborn resuscitation, including videos, has been collected in Haydom, Tanzania, and the aim is to analyze the treatment and its effect on the newborn outcome. An important step is to generate timelines of relevant resuscitation activities, including ventilation, stimulation, suction, etc., during the resuscitation episodes.

METHODS

We propose a two-step deep neural network system, ORAA-net, utilizing low-quality video recordings of resuscitation episodes to do activity recognition during newborn resuscitation. The first step is to detect and track relevant objects using Convolutional Neural Networks (CNN) and post-processing, and the second step is to analyze the proposed activity regions from step 1 to do activity recognition using 3D CNNs.

RESULTS

The system recognized the activities newborn uncovered, stimulation, ventilation and suction with a mean precision of 77.67%, a mean recall of 77,64%, and a mean accuracy of 92.40%. Moreover, the accuracy of the estimated number of Health Care Providers (HCPs) present during the resuscitation episodes was 68.32%.

CONCLUSION

The results indicate that the proposed CNN-based two-step ORAA-net could be used for object detection and activity recognition in noisy low-quality newborn resuscitation videos.

SIGNIFICANCE

A thorough analysis of the effect the different resuscitation activities have on the newborn outcome could potentially allow us to optimize treatment guidelines, training, debriefing, and local quality improvement in newborn resuscitation.

Crystallographic investigation of urine in newborn with renal disturbance due to asphyxia

OBJECTIVE

The aim is to increase the efficiency of diagnosis of renal injury in neonates with asphyxia by identifying of structural markers according to research facies of urine in newborns of different gestational ages.

PATIENTS AND METHODS

Materials and methods: The study involved 150 full-term with signs of kidney damage due to asphyxia: 75 babies with severe asphyxia, and 75 children with moderate asphyxia and 100 preterm infants: 50 children with severe asphyxia and 50 children with moderate. Comparison groups: group 1 consisted of 20 full-term infants, group 2 which included 20 preterm neonates. Material for the study - morning portion of urine, which was collected at 8-10 a.m. on 1-2 and 7-8 days of life.

RESULTS

Results: morphological picture of facies of newborns with asphyxia depends on the severity of pathological changes in the urine (proteinuria) and urine output. Structure of facies in babies with renal distorbance due to severe asphyxia indicates a significant loss of organic and mineral substances in the urine. The width of the peripheral zone facies, the amount of solid particles transferred depends on the severity of asphyxia, the difference in morphology facies is maintained even at the end of the early neonatal period.

CONCLUSION

Conclusions: Analysis of dried drops of urine in infants with renal impairment on the background of asphyxia can be used as one of the criteria for assessing kidney function and have prognostic value.

A longitudinal 1H-NMR metabolomics analysis of urine from newborns with hypoxic-ischemic encephalopathy undergoing hypothermia therapy. Clinical and medical legal insights

Perinatal asphyxia is an event affecting around four million newborns worldwide. The 0.5 to 2 per 1000 of full term asphyxiated newborns suffer from hypoxic-ischemic encephalopathy (HIE), which is a frequent cause of death or severe disability and, as consequence, the most common birth injury claim for obstetrics, gynaecologists, and paediatricians. Perinatal asphyxia results from a compromised gas exchange that leads to hypoxemia, hypercapnia, and metabolic acidosis. In this work, we applied a metabolomics approach to investigate the metabolic profiles of urine samples collected from full term asphyxiated newborns with HIE undergoing therapeutic hypothermia (TH), with the aim of identifying a pattern of metabolites associated with HIE and to follow their modifications over time. Urine samples were collected from 10 HIE newborns at birth, during hypothermia (48 hours), at the end of the therapeutic treatment (72 hours), at 1 month of life, and compared with a matched control population of 16 healthy full term newborns. The metabolic profiles were investigated by 1H NMR spectroscopy coupled with multivariate statistical methods such as principal component analysis and orthogonal partial least square discriminant analysis. Multivariate analysis indicated significant differences between the urine samples of HIE and healthy newborns at birth. The altered metabolic patterns, mainly originated from the depletion of cellular energy and homeostasis, seem to constitute a characteristic of perinatal asphyxia. The HIE urine metabolome changes over time reflected either the effects of TH and the physiological growth of the newborns. Of interest, the urine metabolic profiles of the HIE non-surviving babies, characterized by the increased excretion of lactate, resulted significantly different from the rest of HIE population.

Clinical Profile and Biochemical Abnormalities of Neonatal Seizure at NICU of a Tertiary Care Hospital

Seizures are most common neurological emergency in the neonatal period and present as a diagnostic and therapeutic challenge to clinicians worldwide. This prospective observational study was conducted in the Neonatal Intensive Care Unit of Mymensingh Medical College Hospital from January 2015 to March 2015. Total 318 patients were enrolled in the study who presented with convulsion. Most of the patients were term (72.95%) and birth weight was normal (77.3%). Around 75% patients were delivered at home. Most common causes of convulsion were Perinatal Asphyxia (78%) followed by Septicemia, Hypoglycemia and Meningitis in order of frequency. Commonest type of seizure was subtle seizure (45.5%). Most of the patients recovered completely (73%) and 8.4% patients died due to complications.

Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia

The clinical evidence of neurological menifestations associated with asphyxia is described as hypoxic ischaemic encephalopathy (HIE). A variety of metabolic problems are present in asphyxiated newborns including hypoglycemia, hypocalcemia, hypomagnesemia and others metabolic abnormalities. Some of these biochemical disturbances may trigger seizure or potentiate further brain damage. This cross sectional case-control study was done in Mymensingh Medical College Hospital, to identify the association of hypoglycemia, hypocalcemia, hypomagnesemia in neonates with perinatal asphyxia. Study period was six months. Sample size was 60. Among total sample 30 term asphyxiated newborns of <24 hours age were case and equal number term healthy newborns <24 hours age were control. The main clinical presentations were delayed cry after birth along with respiratory distress, convulsion and absence of cry in asphyxiated newborns. Major physical findings were cyanosis, convulsion and tachypnoea in asphyxiated group. The mean value of serum calcium level was significantly lower in asphyxiated newborns (7.37 ± 0.10mg/dl) than control value (8.04±0.09mg/dl). Hypocalcemia was found among 23.33% babies in case group. On the contrary, hypocalcemia was found in single baby among control group. The mean value of serum magnesium was significantly lower in asphyxiated newborns (1.83 ± 0.04mg/dl) than control value (1.96 ± 0.05mg/dl). Hypomagnesemia was found among 3(10%) newborns but none was found among control group. Hypoglycemia was found in 7(23.33%) cases though the mean value of blood glucose was higher in case group (5.72 ± 0.62mmol/l) than control group (4.87 ± 0.15mmol/l) difference was not statistically significant. Combined hypoglycemia, hypocalcemia and hypomagnesemia were found in 1(3.33%) case; combined hypoglycemia and hypocalcemia were found in 2(6.67%) cases; and combined hypocalcemia and hypomagnesemia were found in 1(3.33%) case. During the study period, 3(10.0%) cases were expired but no death occurred among control group. This study shows isolated or combined hypoglycemia, hypocalcemia, hypomagnesemia are frequently found in newborns with perinatal asphyxia. So, it is necessary to monitor blood glucose, serum calcium and also serum magnesium among asphyxiated newborns for proper management.

Hyperbaric oxygenation promotes neural stem cell proliferation and protects the learning and memory ability in neonatal hypoxic-ischemic brain damage

The aim of our study was to evaluate whether hyperbaric oxygenation (HBO) was an effective therapy for neonatal hypoxic ischemic brain damage (HIBD). Seven-day-old rat pups were divided into 3 groups: sham, hypoxia-ischemia (HI) control and HI-HBO group. HBO was administered for HI rats daily. The pathologic changes in brain tissues were observed by hematoxylin-eosin (H-E) staining. The immunohistochemical staining was applied to detect the Nestin and 5-bromo-2-deoxyuridine (BrdU) positive cells in hippocampal dentate gyrus region. The learning and memory function of rats was examined by Morris water maze. The HI rats showed obvious pathologic changes accompanied by levels decreasing and disorder arrangement of pyramidal cells, glial cells proliferation in postoperative, and nerve nuclei broken, while pathologic changes of rats in sham group was approximate to that in the HI + HBO group that was opposite to the HI group. Compared with the sham group, the Nestin and BrdU positive cells in HBO + HI group at different time points increased significantly (P < 0.01). Learning and memory function of rats in HI group was poor compared with the sham/HI + HBO group (P < 0.01), while that in HI + HBO group was approximate to that in sham group (P > 0.05). HBO treatment improved the learning and memory ability of the HI rats. HBO therapy may be effective for neonatal HIBD treatment.

Development of children at risk for adverse outcomes participating in early intervention in developing countries: a randomized controlled trial

BACKGROUND

Previous research has indicated positive effects of early developmental intervention (EDI) on the development of children in developing countries. Few studies, however, have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation. Also, birth asphyxia as a risk condition has not been well studied. To address these limitations, we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India, Pakistan, and Zambia.

METHODS

Children with and without birth asphyxia were randomized to EDI or control intervention, which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months. Development was assessed in 376 children at ages 12, 24, and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition.

RESULTS

Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities, regardless of risk condition, maternal resources, child gender, or country. Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities, but were not statistically different between intervention conditions. Developmental differences were observed first at 36 months of age.

CONCLUSION

Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions. EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty.

[Analysis of mortality rate and causes of death among children under 5 years old in Beijing from 2003 to 2012]

OBJECTIVE

To understand the age-specific and cause-specific mortality rate among children under 5 years old in Beijing from 2003 to 2012.

METHODS

Death surveillance data of children under the age of 5 were obtained from Beijing children mortality surveillance network from 2003 to 2012. Neonatal mortality rate (NMR), infant mortality rate (IMR), under 5-year old children mortality rate (U5MR) and the leading cause of death for under 5-year old children in urban, suburbs, and outer suburbs in Beijing were analyzed.

RESULTS

The NMR, IMR and U5MR in Beijing were 2.08 (253/121 747), 3.11 (379/121 747) and 3.57 (435/121 747) per 1000 live births in 2012, respectively, which declined 54.88%, 50.24% and 54.75% compared with the level in 2003 respectively. The children mortality rates showed a decreasing trend in urban, suburb, and outer suburbs during 2003 and 2012 (NMR was decreased from 0.53%, 0.42%, and 0.48% in 2003 to 0.20%, 0.19%, and 0.23% in 2012; IMR was decreased from 0.73%, 0.58%, and 0.63% in 2003 to 0.30%, 0.29%, and 0.35% in 2012; U5MR was decreased from 0.90%, 0.72%, and 0.82% to 0.33%, 0.34%, and 0.39% in 2012, P < 0.01). There was a steady decline in the U5MR due to congenital heart disease, birth asphyxia, premature birth or low birth weight and traffic accident in Beijing from 2003 to 2012. The mortality rate of congenital heart disease declined from 140.63 to 41.89 per 100 000 live births, birth asphyxia declined from 109.38 to 59.96 per 100 000 live births, premature birth or low birth weight declined from 85.94 to 52.57 per 100 000 live births, traffic accident declined from 26.04 to 6.57 per 100 000 live births (P < 0.01). The mortality rate of congenital heart disease declined remarkably from 216.56 to 52.47, from 119.75 to 23.50, and from 134.58 to 63.11 per 100 000 live births in urban, suburb, and outer suburbs(P < 0.01). Six of the top 8 leading causes of death among children under 5 years old declined remarkably in rural areas. They were congenital heart disease, birth asphyxia, premature birth or low birth weight, traffic accident, drowning, and septicemia, and the mortality rate of them declined from 134.58 to 63.11, from 127.85 to 65.54, from 100.94 to 60.69, from 33.65 to 12.14, from 33.65 to 0.00, and from 26.92 to 4.85 per 100 000 live births, respectively (P < 0.05). There was no drowning death case in rural areas in recent 4 years. The top 5 leading causes of death among children under 5 years old in Beijing in 2012 were birth asphyxia, premature birth or low birth weight, congenital heart disease, pneumonia, and accidental suffocation. The mortality rate of these top 5 leading causes were 59.96, 52.57, 41.89, 24.64, and 15.61 per 100 000 live births in 2012.

CONCLUSION

From 2003 to 2012, the NMR, IMR, U5MR and mortality rate of congenital heart disease declined remarkably in urban, suburb, and outer suburb areas in Beijing. There was a decrease trend for the six of the top 8 leading causes of death among children under 5 years old. The mortality rate of drowning dropped markedly in outer suburbs.

Maternal and perinatal risk factors for childhood cancer: record linkage study

OBJECTIVE

To investigate maternal and perinatal risk factors for childhood cancer.

STUDY DESIGN

Case-control analysis of linked records from the Aberdeen Maternity and Neonatal Databank with the Scottish Cancer Registry and the General Registry of Births and Deaths in Scotland was carried out.

SETTING

Aberdeen, Scotland.

PARTICIPANTS

Cases (n=176) comprised children diagnosed with cancer under 15 years or recorded as having died of cancer. Four controls per case were matched by age and gender.

RISK FACTORS TESTED

Maternal age, body mass index, social class, marital status and smoking as well as pre-eclampsia, antepartum haemorrhage and previous miscarriage, gestational age, birth weight and Apgar scores were compared between groups to test for association with cancer. ORs with 95% CIs were calculated using conditional logistic regression in univariable and multivariable models.

RESULTS

Of the maternal characteristics tested, mother's age at delivery (cases mean 28.9 (SD 5.6) years vs controls mean 30.2 (SD 4.6), p=0.002) and smoking status (38.6% smokers among cases, 29.7% among controls, p=0.034) were found to be different between groups. Of the perinatal factors tested, low Apgar score at 5 min (adjusted OR (AOR) 4.59, 95% CI 1.52 to 13.87) and delivery by caesarean section (AOR 1.95, 95% CI 1.30 to 2.92) showed statistically significant associations with childhood cancer in the multivariable model.

CONCLUSIONS

Younger maternal age, maternal smoking, delivery by caesarean section and low Apgar score at 5 min were independently associated with increased risk of childhood cancer. These general findings should be interpreted with caution as this study did not have the power to detect any association with individual diagnostic categories of childhood cancer.

Childhood outcomes after hypothermia for neonatal encephalopathy

BACKGROUND

We previously reported early results of a randomized trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy showing a significant reduction in the rate of death or moderate or severe disability at 18 to 22 months of age. Long-term outcomes are now available.

METHODS

In the original trial, we assigned infants with moderate or severe encephalopathy to usual care (the control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (the hypothermia group). We evaluated cognitive, attention and executive, and visuospatial function; neurologic outcomes; and physical and psychosocial health among participants at 6 to 7 years of age. The primary outcome of the present analyses was death or an IQ score below 70.

RESULTS

Of the 208 trial participants, primary outcome data were available for 190. Of the 97 children in the hypothermia group and the 93 children in the control group, death or an IQ score below 70 occurred in 46 (47%) and 58 (62%), respectively (P=0.06); death occurred in 27 (28%) and 41 (44%) (P=0.04); and death or severe disability occurred in 38 (41%) and 53 (60%) (P=0.03). Other outcome data were available for the 122 surviving children, 70 in the hypothermia group and 52 in the control group. Moderate or severe disability occurred in 24 of 69 children (35%) and 19 of 50 children (38%), respectively (P=0.87). Attention-executive dysfunction occurred in 4% and 13%, respectively, of children receiving hypothermia and those receiving usual care (P=0.19), and visuospatial dysfunction occurred in 4% and 3% (P=0.80).

CONCLUSIONS

The rate of the combined end point of death or an IQ score of less than 70 at 6 to 7 years of age was lower among children undergoing whole-body hypothermia than among those undergoing usual care, but the differences were not significant. However, hypothermia resulted in lower death rates and did not increase rates of severe disability among survivors. (Funded by the National Institutes of Health and the Eunice Kennedy Shriver NICHD Neonatal Research Network; ClinicalTrials.gov number, NCT00005772.).

Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria

OBJECTIVES

The study aimed at identifying the risk factors for neonatal septicaemia in Zaria.

PATIENTS AND METHODS

Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05.

RESULTS

A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078).

CONCLUSION

The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.

The acceptability among lay persons and health professionals of actively ending the lives of damaged newborns

BACKGROUND

Euthanasia is performed on occasion, even on newborns, but is highly controversial, and it is prohibited by law and condemned by medical ethics in most countries.

AIM

To characterise and compare the judgments of lay persons, nurses, and physicians of the acceptability of actively ending the life of a damaged newborn.

METHODS

Convenience samples of 237 lay persons, 214 nurses, and 76 physicians in the south of France rated the acceptability on a scale of 0-10 of giving a lethal injection in 54 scenarios composed of all combinations of 4 within-subject factors: gestational age of 6, 7, or 9 months; 3 levels of severity of either perinatal asphyxia or of genetic disease; attitude of the parents about prolonging care unknown, favourable, or unfavourable; and decision made individually by the physician or collectively by the medical team. Overall ratings were subjected to cluster analysis and each cluster to analysis of variance and graphic representation.

RESULTS

Lay persons (mean acceptability rating 4.29) were significantly more favourable to euthanasia than nurses (2.84), p < .005, or physicians (2.12), p < .005. Five clusters were found with different judgment rules, i.e., how the information was integrated. More physicians (30 per cent) than nurses (14 per cent), p < .01, or lay persons (11 per cent), p < .01, rated euthanasia as never, under any condition, acceptable. Most, however, asserted that it was increasingly acceptable as the factors combined to favour it, especially when the parents desired to stop treatment. More physicians (45 per cent) and nurses (46 per cent) than lay persons (21 per cent), p < .01, used a complex conjunctive rule (level of parent's attitude x level of severity of damage x consultation with team or not) rather than a simple additive rule.

CONCLUSIONS

Unlike law and medical ethics, most of the lay persons, nurses, and physicians judged the acceptability of euthanasia as a function of the circumstances. Most health professionals combined the factors in a conjunctive (multiplicative), rather than additive, fashion in accordance with legislation for adults in The Netherlands and elsewhere that requires a set of criteria to be fulfilled before it is legitimate to end a patient's life.

[Role of Omi/HtrA2 in renal tubular cells apoptosis induced by post asphyxial serum of neonate]

OBJECTIVE

To investigate the mechanism of inducing apoptosis of Omi/HtrA2 in renal tubular cells with post asphyxial serum of neonate.

METHODS

Human renal proximal tubular cell line HK-2 cell was used as target cell. They were divided into three groups: control group, asphyxia group and Ucf-101 (Omi/HtrA2 special inhibitor) treated group. The challenge concentration of serum obtained from neonates 24 hours after asphyxia was 20%, and the treatment concentration of Ucf-101 was 10 mumol/L. The Omi/HtrA2 translocation in renal tubular cells was observed with confocal microscopy, and the rate of apoptosis was detected with flow cytometer.

RESULTS

It was found that Omi/HtrA2 was translocated into cytoplasm in asphyxia group, and the rate of Omi/HtrA2 translocation in HK-2 cells of asphyxia group was significantly increased [(28.1+/-3.6)% vs. (9.4+/-2.1)%, P<0.01]. Compared with the control group, after being treated with post asphyxial serum, the rate of apoptosis of HK-2 cells in asphyxia group was significantly increased [(36.3+/-4.4)% vs.(12.4+/-2.9)%, P<0.01]. Compared with asphyxia group, the rate of apoptosis in HK-2 cells in Ucf-101 treated group was significantly decreased [(27.0+/-3.9)% vs.(36.3+/-4.4)%, P<0.01].

CONCLUSION

These experimental data demonstrates that post asphyxial serum of neonate can induce apoptosis of HK-2 cells, and translocation of Omi/HtrA2 from mitochondria into cytoplasm may play an important role in its intracellular signal transduction mechanism in induction of apoptosis.