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Fotopoulos S, Mouchtouri A, Xanthou G, Lipsou N, Petrakou E, Xanthou M. Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections. Acta Paediatr 2005; 94:800-6. [PMID: 16188792 DOI: 10.1111/j.1651-2227.2005.tb01988.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The inflammatory response induced by perinatal infections and asphyxia is considered to participate in neonatal brain damage. Inflammatory responses are characterized by the expression of chemokines. Although chemokine levels have been investigated in healthy newborns, their role during neonatal pathological conditions has not been studied. The aim of our study was to examine chemokine serum levels in asphyxiated and infected neonates. METHODS Peripheral blood samples were obtained from perinatally asphyxiated and infected neonates during the first days of life and from neonates who developed nosocomial infections. Serum levels of interleukin-8 (IL-8), interferon-gamma-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha (MIP-1alpha), and regulated upon activation, normal T cells expressed and secreted (RANTES) were determined. RESULTS In perinatally asphyxiated neonates, IL-8 levels were significantly elevated on the 1st day of life. In perinatally infected neonates, IL-8 and IP-10 levels were significantly increased on the 1st day of life, while RANTES levels were significantly lower and remained so until the 4th day. In nosocomially infected neonates, IL-8, IP-10 and MIP-1alpha levels were significantly increased on diagnosis of infection. CONCLUSION The neonatal immune system is able to produce chemokines for the induction of an inflammatory response during perinatal asphyxia and perinatal or nosocomial infections. Blockade of inflammatory chemokines could possibly contribute to the prevention of brain damage.
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Türker G, Sarper N, Babaoğlu K, Gökalp AS, Duman C, Arisoy AE. Early prognostic significance of umbilical cord troponin I in critically ill newborns. Prospective study with a control group. J Perinat Med 2005; 33:54-9. [PMID: 15841615 DOI: 10.1515/jpm.2005.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To determine the value of cord blood cardiac troponin I levels (cTnl) as an early prognostic factor in critically ill newborns, and to compare cord cTnl levels with the prognostic value of the score for neonatal acute physiology (SNAP). METHODS Cord arterial samples were collected routinely for blood gas analysis, and cord venous samples for cTnl and cardiac-specific creatine kinase assay. The study group (n=109) comprised critically ill newborns who required mechanical ventilation. The control group (n = 96) comprised newborns who were either completely healthy (n = 48) or were followed in a level I neonatal care unit due to moderate-severity problems. RESULTS The critically ill newborns had significantly higher cTnl levels than control babies (median [min-max] 1.4 [0-13] vs. 0 [0-1.8] ng/mL, respectively; P<0.001). In critically ill newborns, non-survivors had significantly higher cTnl levels than survivors (median [min-max] 6.6 [1.3-13.0] vs. 1.3 [0-8.0] ng/mL, respectively; P<0.001). Receiver-operator curve analysis revealed that, compared with SNAP, cTnl was a more sensitive predictor of mortality in critically ill newborns (area under curve=0.96; 95% CI=0.90-1.02). CONCLUSION Significantly elevated cord cTnl may be a valuable predictor of mortality in critically ill newborns.
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Aly H, El Beshlawy A, Badrawi N, Mohsen L, Mansour E, Ramy N, Patel K. Thrombopoietin level is increased in the serum of asphyxiated neonates: a prospective controlled study. J Perinatol 2005; 25:320-4. [PMID: 15776003 DOI: 10.1038/sj.jp.7211287] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thrombopoietin (TPO) is a growth factor that controls platelet production. Despite the known association of chronic hypoxia and acute asphyxia with hematologic changes, TPO had not been studied in neonatal asphyxia. OBJECTIVE To assess TPO concentrations in the serum of asphyxiated and nonasphyxiated neonates, and examine any correlation with the severity of asphyxia. DESIGN/METHODS This prospective study was carried out on 32 asphyxiated neonates and 30 control subjects admitted at Cairo University Medical Center. Asphyxia was defined if two of the following were found: (1) Apgar score </=3 at 1 minute or </=6 at 5 minutes, (2) umbilical cord arterial pH </=7.2 combined with base deficit >/=-10 and (3) clinical evidence of perinatal asphyxia. Encephalopathy was classified clinically according to Sarnat's stages during the first day of life. Platelet count and TPO level (pg/ml) were measured at 1st, 3rd and 7th day of life. RESULTS : TPO measured on the first day of life did not differ between cases and controls (900.2+/-526.4 vs 726.6+/-441.9 pg/ml, p=0.2). It increased on the 3rd day of life and was significantly higher in asphyxiated infants compared to controls (1291.4+/-627.9 vs 885.5+/-400.3 pg/ml, respectively; p=0.004). This difference remained significant in a logistic regression model controlling for birth weight, sex and mode of delivery (regression coefficient=476.9+/-146.8; p=0.002). In asphyxiated infants (n=32), encephalopathy was classified as mild (n=17), moderate (n=10) and severe (n=5). TPO correlated with the degree of clinical severity on the 7th day of life (r=0.59, p=0.003). TPO did not differ between survivors (n=24) and nonsurvivors (n=8) within the asphyxia group (1197.1+/-596.8 vs 1613.1+/-605.9 pg/ml; p=0.09). Platelet counts correlated negatively with TPO measured on day 1 (r=-0.415; p=0.02), day 3 (r=-0.64; p=0.001) and day 7 (r=-0.562; p=0.007). CONCLUSIONS TPO increased and correlated with severity of asphyxia at 3 and 7 days of life. It correlated negatively with the platelet count at all times.
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Qin LN, Feng AH, Yang CH, Xing HY. [Clinical values of superoxide dismutase and malondialdehyde detection in cord blood of newborns with fetal distress]. ZHONGHUA FU CHAN KE ZA ZHI 2005; 40:312-4. [PMID: 15938780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To investigate the relations between intrauterine asphyxia and peroxidation and newborn hypoxic-ischemic encephalopathy (HIE). METHODS The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in cord blood of 60 newborns with intrauterine asphyxia during labor (which was divided into two groups, 39 cases with asphyxia in group I, and 21 cases with asphyxia in group II), and in 30 newborns without intrauterine asphyxia (control group) were determined. The levels of SOD and MDA in cord blood of newborns with HIE were compared with those in newborns without HIE. The incidence of HIE was estimated simultaneously. RESULTS (1) The levels of SOD were (12,896 +/- 247) U/g Hb in group I, (9846 +/- 268) U/g Hb in group II, (17,282 +/- 134) U/g Hb in control group, significantly lower in the former two groups compared with control group, while the level of SOD in group I was higher than that in group II (P < 0.01). There were nine cases with HIE in groups I and II (HIE group), the level of SOD in these cases was (7486 +/- 245) U/g Hb. There were 51 cases with non-HIE (non-HIE group), the level of SOD in this group was (13,878 +/- 257) U/g Hb. There was significant difference in the level of SOD between HIE and non-HIE groups (P < 0.01). Nineteen cases were in < 30 min group, and the levels of SOD was (17 411 +/- 324) U/g Hb. Twenty-six cases were in 30 - 120 min group, and the levels of SOD was (12,076 +/- 230) U/g Hb. Fifteen cases were in > 121 min group, and the levels of SOD was (9786 +/- 249) U/g Hb. (2) The levels of MDA were (6.3 +/- 0.4) micromol/L in group I, (8.6 +/- 1.5) micromol/L in group II, and (4.1 +/- 0.5) micromol/L in control group, significantly higher in the former two groups compared with control group (P < 0.01). The levels of MDA were (10.6 +/- 0.6) micromol/L in HIE group and (5.1 +/- 0.8) micromol/L in non-HIE group, with significant difference between the two groups (P < 0.01). The levels of MDA were (4.2 +/- 0.3) micromol/L in <or= 30 min group, (7.5 +/- 1.5) micromol/L in 31 - 120 min group and (8.9 +/- 1.5) micromol/L in >or= 121 min group respectively. (3) None of HIE cases were in <or= 30 min group, three cases in 31 - 120 min group, and six cases in >or= 121 min group. CONCLUSIONS The results indicate that the incidence of intrauterine asphyxia is closely related to peroxidation, and intrauterine asphyxia may be an important factor in pathogenesis of HIE. The levels of SOD and MDA in cord blood may be regarded as one of the early predictive indexes for HIE.
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Fugelseth D, Børke WB, Lenes K, Matthews I, Saugstad OD, Thaulow E. Restoration of cardiopulmonary function with 21% versus 100% oxygen after hypoxaemia in newborn pigs. Arch Dis Child Fetal Neonatal Ed 2005; 90:F229-34. [PMID: 15846013 PMCID: PMC1721882 DOI: 10.1136/adc.2004.056986] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the consequences of hypoxaemia and resuscitation with room air versus 100% O(2) on cardiac troponin I (cTnI), cardiac output (CO), and pulmonary artery pressure (PAP) in newborn pigs. DESIGN Twenty anaesthetised pigs (12-36 hours; 1.7-2.7 kg) were subjected to hypoxaemia by ventilation with 8% O(2). When mean arterial blood pressure fell to 15 mm Hg, or arterial base excess was < or = -20 mmol/l, resuscitation was performed with 21% (n = 10) or 100% (n = 10) O(2) for 30 minutes, then ventilation with 21% O(2) for 120 minutes. Blood was analysed for cTnI. Ultrasound examinations of CO and PAP (estimated from tricuspid regurgitation velocity (TR-Vmax)) were performed at baseline, during hypoxia, and at the start of and during reoxygenation. RESULTS cTnI increased from baseline to the end point (p<0.001), confirming a serious myocardial injury, with no differences between the 21% and 100% O(2) group (p = 0.12). TR-Vmax increased during the insult and returned towards baseline values during reoxygenation, with no differences between the groups (p = 0.11) or between cTnI concentrations (p = 0.31). An inverse relation was found between increasing age and TR-Vmax during hypoxaemia (p = 0.034). CO per kg body weight increased during the early phase of hypoxaemia (p<0.001), then decreased. Changes in CO per kg were mainly due to changes in heart rate, with no differences between the groups during reoxygenation (p = 0.298). CONCLUSION Hypoxaemia affects the myocardium and PAP. During this limited period of observation, reoxygenation with 100% O(2) showed no benefits compared with 21% O(2) in normalising myocardial function and PAP. The important issue may be resuscitation and reoxygenation without hyperoxygenation.
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Abstract
BACKGROUND The aim of this study is to determine carnitine levels in hypoxic-ischemiac neonates. METHODS Total and free carnitine levels were measured in 20 normal term neonates and 20 term neonates who were diagnosed as hypoxia-ischemia. RESULTS Both total carnitine levels (43.7 +/- 10.0 microg/dl vice 27.8 +/- 11.8 microg/dl, p<0.0001) and free carnitine levels (28.0 +/- 8.8 vice 13.2 +/- 6.8 microg/dl, p<0.0001) were lower in the hypoxic-ischemic group). Additionally acyl/total carnitine ratio was higher in the asphyxic group (0.33 +/- 0.20 vice 0.56 +/- 0.24, p<0.0001). CONCLUSIONS The findings of this study show that neonates with hypoxia-ischemia suffer carnitine deficiency.
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Ezgü FS, Atalay Y, Hasanoğlu A, Gücüyener K, Biberoğlu G, Koç E, Ergenekon E, Tümer L. Serum carnitine levels in newborns with perinatal asphyxia and relation to neurologic prognosis. Nutr Neurosci 2005; 7:351-6. [PMID: 15682932 DOI: 10.1080/10284150400017280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neonatal hypoxic encephalopathy is one of the major causes of permanent neurological sequel. This study was conducted to investigate serum total, free and acylcarnitine levels in asphyxiated newborns with or without encephalopathy. Serum total, free and acylcarnitine levels were investigated in 21 newborns with and seven asphyxiated newborns without signs of encephalopathy. The newborns with encephalopathy were further divided into grade 1, 2 and 3 encephalopathy groups. Serum total and acylcarnitine concentrations of the whole encephalopathy group were significantly lower than the non-encephalopathy group (p = 0.042 for both). Serum total and acylcarnitine concentrations of grade 3 encephalopathy group were significantly lower than the non-encephalopathy group (p = 0.014 and p = 0.040, respectively). No significant differences were noticed for free carnitine levels. Total carnitine levels were positively correlated with birth weight and 10th minute apgar score, whereas acylcarnitine levels were found to correlate with cord blood pH and free carnitine levels with birth weight. Cord blood pH, and total carnitine levels were found to be the most significant determinants of the neurological outcome at one year of age. It was emphasized that carnitine deficiency could occur in severely affected asphyxiated newborns and it is related to the outcome at one year of age.
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Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J. Usefulness of cardiac troponin T and echocardiography in the diagnosis of hypoxic myocardial injury of full-term neonates. Neonatology 2005; 88:19-23. [PMID: 15731551 DOI: 10.1159/000084067] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 11/23/2004] [Indexed: 12/19/2022]
Abstract
BACKGROUND Perinatal asphyxia constitutes a significant problem influencing neonatal mortality and morbidity. OBJECTIVES The aim of the present work was to provide evidence of the usefulness of cardiac troponin T (cTnT) and echocardiographic investigations in the diagnosis of heart damage in full-term infants after intrauterine hypoxia. MATERIAL AND METHODS The subjects were 39 asphyxiated and 44 term infants without fetal anoxia. Quantitative determinations of cTnT were performed between 12 and 24 h of life. Two-dimensional Doppler and color Doppler studies were performed at the bedside. We evaluated fractional shortening (FS), cardiac output (CO), cardiac index (CI), tricuspid (TI) and mitral (MI) insufficiency. RESULTS Asphyxiated infants presented increased cTnT (mean 0.141+/-0.226 vs. 0.087+/-0.111 ng/ml; p<0.01) and TI (38.5 vs. 11.4% of population; p<0.05) compared to healthy infants. CO, CI and FS remained in the same range. CONCLUSIONS We found cTnT to be the most useful among accessible diagnostic tools used in post-hypoxic heart damage in neonates. The data from our relatively small population study suggest a cTnT value of >0.1 ng/ml as a reliable marker of myocardial injury in neonates. Further study should be performed to generate a receiver-operator characteristic curve to discover what the cut-off level should be.
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Yoneda S, Ibara S, Kobayashi K, Kato E, Maruyama Y, Maruyama H, Sumida Y, Sunami R, Sakai M, Ikenoue T, Saito S. Low adjusted serum ionized calcium concentration shortly after birth predicts poor outcome in neonatal hypoxic-ischemic encephalopathy. J Obstet Gynaecol Res 2005; 31:57-64. [PMID: 15669994 DOI: 10.1111/j.1447-0756.2005.00241.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Hypoxic-ischemic reperfusion injury causes either necrosis or apoptosis, and the influx of ionized calcium into cells is the major cause of both types of cell death. The aim of this study was to investigate whether or not the serum ionized calcium concentration in neonates with hypoxic-ischemic encephalopathy (HIE) could be used to predict their outcome. METHODS Serum samples were obtained shortly after birth from 20 HIE neonates who had not urinated or received treatment with calcium. Serum ionized calcium concentrations were adjusted for pH using a correction formula. Twelve neonates without any disease were selected as a control. The results were compared between nine HIE neonates who made a full recovery, 11 who died or had neurologic deficits, and 12 normal neonates. RESULTS Considered together, the two HIE groups had lower serum ionized calcium concentrations (1.05 +/- 0.10 mmol/L) than the control group (1.22 +/- 0.07 mmol/L; P < 0.0001). Moreover, serum ionized calcium concentrations in the group with the poor outcome (0.99 +/- 0.07 mmol/L) were lower than those in the group that made a full recovery (1.13 +/- 0.06 mmol/L; P=0.0016). CONCLUSIONS The serum ionized calcium concentrations shortly after birth were significantly lower in neonates with HIE who had a poor outcome. Low concentrations may reflect multiple organ damage, particularly involving the brain.
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Abstract
This chapter aims to provide an overview of aspects of risk management as they might be applied to the practice of resuscitation of the newborn using general principles of risk management and specific standards where they apply. Section 1 considers the matter of hazard and risk and how they may be classified. Figures are presented to provide a clinical perspective on resuscitation with a discussion on the hierarchy of clinical risks operating upon the baby. Section 2 centres on a discussion of those aspects that operate to modify the risks to the baby during a resuscitation, including environmental considerations (location, clinical setting and equipment); staffing issues (establishment, competency, induction and training) and logistics (process, communication and documentation). Section 3 debates the place of cord gases in the context of the diagnosis of perinatal hypoxaemia.
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Di Iorio R, Marinoni E, Lituania M, Serra G, Letizia C, Cosmi EV, Gazzolo D. Adrenomedullin increases in term asphyxiated newborns developing intraventricular hemorrhage. Clin Biochem 2004; 37:1112-6. [PMID: 15589818 DOI: 10.1016/j.clinbiochem.2004.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Revised: 04/14/2004] [Accepted: 04/25/2004] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Adrenomedullin (AM) is a newly discovered vasodilator peptide that participates in the regulation of cerebral blood flow. The aim of this study was to investigate whether circulating AM was increased in infants with prenatal asphyxia who developed intraventricular hemorrhage (IVH). DESIGN AND METHOD : A case-control study was performed on 40 full-term asphyxiated newborns: 20 developed IVH (group A) and 20 did not (group B). Forty term healthy newborns represented the control group. Biochemical laboratory parameters, neurological patterns, cerebral ultrasound scanning, and Doppler velocimetry were assessed at 12 and 72 h from birth. Plasma AM concentration was measured at 12 h from birth by means of a specific RIA. RESULTS AM levels were significantly higher in group A (20.2 +/- 5.2 fmol/ml) than in group B (8.4 +/- 2.1 fmol/ml) or controls (9.3 +/- 2.6 fmol/ml). In asphyxiated newborns, AM concentration was correlated with middle cerebral artery PI value only in group B. CONCLUSIONS Increased concentration of AM at 12 h from birth in asphyxiated newborns who later developed IVH suggests that this peptide may participate in the loss of cerebral vascular autoregulation in response to hypoxia and could be useful to discriminate, among newborns at risk, those with an adverse neurological outcome.
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Ferns SJ, Bhat BV, Basu D. Value of nucleated red blood cells in predicting severity and outcome of perinatal asphyxia. INDIAN J PATHOL MICR 2004; 47:503-5. [PMID: 16295376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
The objective of the study was to assess nucleated red blood cell counts in cord blood in a group of asphyxiated infants, and to determine its predictive value for short-term outcome. A prospective case control study was undertaken on cord blood samples collected from fifty six term neonates with perinatal asphyxia and an equal number of normal appropriately matched controls for cord blood pH and nucleated RBC counts. Babies were followed up in nursery till discharge. Statistical analysis employed were ANOVA test, logistic and linear regression analysis. There was a significant increase in the number of nucleated red blood cells in cases as compared to controls. Low Apgar, cord blood pH and neonatal outcome correlated well with nucleated RBC counts. Nucleated red blood cell count at birth is a useful predictor of severity and short-term outcome of perinatal asphyxia.
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van Leuven K, Groenendaal F, Toet MC, Schobben AFAM, Bos SAJ, de Vries LS, Rademaker CMA. Midazolam and amplitude-integrated EEG in asphyxiated full-term neonates. Acta Paediatr 2004; 93:1221-7. [PMID: 15384888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM In the present, prospective study, the relation between the levels of midazolam, its two active metabolites--1-hydroxy-midazolam (OH-midazolam) and 1-hydroxy-midazolam-glucuronide (glu-midazolam)--and the aEEG were examined. PATIENTS AND METHODS Fifteen full-term neonates with seizures due to hypoxic-ischaemic encephalopathy admitted to our NICU were included. Midazolam (loading dose 0.05 mg/kg in 10 min, maintenance dose 0.15 mg/kg/h) was used as an add-on anti-convulsant after phenobarbital and lidocaine because of continuing seizures. Amplitude-integrated EEG background pattern was scored at the start of midazolam and at the time of blood sampling as continuous normal voltage (CNV), discontinuous normal voltage (DNV), burst suppression (BS), continuous low voltage (CLV) or flat trace (FT). Serum levels of midazolam, OH-midazolam and glu-midazolam were measured at least 8 h after the start with HPLC. RESULTS In 11/15 patients, seizures were abolished with the addition of midazolam. In the remaining patients, seizure frequency was reduced in one and unchanged in three. Amplitude-integrated EEG background pattern at the start of midazolam was CNV in two, DNV in six, BS in five and CLV in two. Moderate, temporary suppression of the aEEG background pattern lasting less than 2 h was seen in four neonates. Amplitude-integrated EEG at midazolam sampling was CNV in two, DNV in seven, CLV in two and FT in four. Serum levels of midazolam ranged from 0.10 to 1.76 mg/l, OH-midazolam from 0.05 to 0.28 mg/l and glu-midazolam from 0.85 to 4.36 mg/l. CONCLUSIONS A brief and moderate suppression of the aEEG background pattern immediately after midazolam was seen in four neonates for less than 2 h. Suppression at a later time point, i.e. after more than 8 h of midazolam infusion, was demonstrated almost exclusively in neonates with a poor background pattern, and therefore these patterns appear to be determined mainly by the severity of hypoxic-ischaemic encephalopathy.
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Celtik C, Acunaş B, Oner N, Pala O. Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy. Brain Dev 2004; 26:398-402. [PMID: 15275704 DOI: 10.1016/j.braindev.2003.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Revised: 12/24/2003] [Accepted: 12/24/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate serum concentrations of neuron-specific enolase (NSE) as a marker of the severity of hypoxic ischemic encephalopathy (HIE) and to elucidate the relation among the concentrations of NSE, grade of HIE and short-term outcome. Forty-three asphyxiated full-term newborn infants who developed symptoms and signs of HIE (Group 1) and 29 full-term newborn infants with meconium-stained amniotic fluid but with normal physical examination (Group 2) were studied with serial neurological examination, Denver developmental screening test (DDST), electroencephalogram and computerized cerebral tomography (CT) for neurological follow-up. Thirty healthy infants were selected as the control group. In the patient groups, two blood samples were taken to measure NSE levels, one between 4 and 48 h and the other 5-7 days after birth. Serum NSE levels were significantly higher in infants with HIE compared to those infants in Group 2 and control group. The mean serum concentrations of the second samples decreased in all groups studied but they were significantly higher in Group 1 compared to those in Group 2. Serum NSE concentrations of initial samples were significantly higher in patients with stage III HIE than in those with stages II and I. The sensitivity and specificity values of serum NSE as a predictor of HIE of moderate or severe degree (cut-off value 40.0 microg/l) were 79 and 70%, respectively, and as a predictor of poor outcome (cut-off value 45.4 microg/l) were calculated as 84 and 70%, respectively. The predictive capacity of serum NSE concentrations for poor outcome seems to be better than predicting HIE of moderate or severe degree. However, earlier and/or CSF samples may be required to establish serum NSE as an early marker for the application of neuroprotective strategies.
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Butterwegge M. [Fetal monitoring intra partum with cardiotocography and fetal blood sampling analysis and its possible influence on the C-section rate]. Z Geburtshilfe Neonatol 2004; 208:68-74. [PMID: 15112140 DOI: 10.1055/s-2004-818961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In times of rising c-section rates worldwide the obstetricians feel a big responsibility in avoiding a secondary c-section for non-reassuring fetal heart rate. No other experimental method has been established beside the gold standard (cardiotocography and fetal blood sampling) in daily routine until today. The two cases presented demonstrate the fallibility of the "gold standard" in predicting fetal asphyxia and why methodology with better positive predictive value is needed.
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Brucknerová I, Benedeková M, Pechán I, Franková E, Ujházy E, Dubovický M. Protection of newborn organism against effect of oxidative stress. Cent Eur J Public Health 2004; 12 Suppl:S18-20. [PMID: 15141966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The aim of the present study was to investigate influence of oxidative stress on newborn organism, in terms of the dynamics of malondialdehyde (MDA) concentration changes and of the activities of selected antioxidants in asphyxial newborns on the 1st and 5th day of life. METHOD In the group of 62 preterm and term asphyxial newborns, characterized by the presence of asphyxial criteria and admitted within 24 hours of life, the plasma concentration of MDA and level of total antioxidant status (TAS) were followed. RESULTS Dynamic changes of MDA signalized active process of lipoperoxidation (LP) and values of TAS were decreased in comparison with the capacity of adult patients.
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Moreno-Villares JM, Galiano-Segovia MJ. [Blood ammonia and transaminases in a term infant with perinatal asphyxia]. Rev Neurol 2004; 38:200. [PMID: 14752726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Vakrilova L, Kalaĭdzhieva M, Slŭncheva B, Emilova Z, Nikolov A, Metodieva V, Pramatarova T. [The significance of parameters of the acid-base status, blood gas and blood lactate level for the adequate resuscitation and prognosis in newborns with very low birth weight]. AKUSHERSTVO I GINEKOLOGIIA 2004; 43:25-31. [PMID: 15518281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED The aim of this prospective study was to optimize the resuscitation guidelines for VLBW and ELBW premature newborns, to improve their life prognosis and to minimize the permanent complications of the perinatal asphyxia. RESULTS The newborns were divided in 2 groups: main group--28 ELBW and 55 VLBW infants born from 01.10.01 to 30.06.02; and control group--52 ELBW and 78 VLBW infants, born in year 2000 in "Maichin dom". More intensive resuscitation was given to the VLBW newborns in the mean group--58% of them were intubated and ventilated in Delivery room (DR) infants compared with 40% from the controls. In the ELBW groups the rate of the assisted ventilation (AV) remains high (85% and 82%) but more often we insufflated Surfactant for prophylaxis of the RDS (71% compared with 52% in the controls). This, as well as the precisely monitoring of the early postnatal adaptation--pulsoxymetry, parameters of acid-base status (ABS) and homeostasis, resulted in significantly reduction of the mortality rate in ELBW infants from 46% to 18%. We found a reduction of the severe neurological injuries and high degree retinopathy of prematurity too. We evaluated the lactate values and the ABS parameters in blood from umbilical artery (u.a.) and from arterial blood 1 hour after birth. We found out that the low lactate levels in u.a. didn't correlate with the degree of the metabolic acidosis (pH and BE). Correlation between high lactate levels in u.a, low pH and BE were found predominantly in newborns with significant intrauterine retardation and chronic placental insufficiency. Levels > 5.0 mmol/l 1h after birth and the persistence of the metabolic acidosis despite an adequate resuscitation determinated in principle bad outcome and severe complications. CONCLUSIONS The adequate DR resuscitation under strict monitoring of the cardio-pulmonary adaptation and the prophylactic Surfactant application improve the survival rate and the prognosis of the ELBW newborns. The persistence of high lactate levels in combination with a metabolic acidosis and intrauterine retardation are bad prognostic criteria for outcome.
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Shah S, Tracy M, Smyth J. Postnatal lactate as an early predictor of short-term outcome after intrapartum asphyxia. J Perinatol 2004; 24:16-20. [PMID: 14726932 DOI: 10.1038/sj.jp.7211023] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN We retrospectively reviewed the records of 61 full-term neonates (> or =37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001. The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS The initial lactate levels were significantly higher (p=0.001) in neonates with moderate-to-severe HIE (mean+/-SD=11.09+/-4.6) as compared to those with mild or no HIE (mean+/-SD=7.1+/-4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5+/-mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.
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95
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Pereira DN, Procianoy RS. Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels. Acta Paediatr 2003; 92:339-45. [PMID: 12725550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
AIM To compare serum concentrations of thyroid hormones--T4, T3, free T4 (FT4) and reverse T3 (rT3)--and thyroid-stimulating hormone (TSH) found in the umbilical cord blood of term newborns with and without asphyxia and those found in their arterial blood collected between 18 and 24 h after birth. A further aim of the study was to assess the association between severity of hypoxic-ischemic encephalopathy and altered thyroid hormone and TSH levels, and between mortality and FT4 levels in the arterial blood of newborns between 18 and 24 h of life. METHODS A case-control study was carried out. The case group comprised 17 term newborns (Apgar score < or = 3 and < or = 5 at the first and fifth minutes; umbilical cord blood pH < or = 7.15) who required bag and mask ventilation for at least one minute immediately after birth. The control group consisted of 17 normal, term newborns (Apgar score > or = 8 and > or = 9 at the first and fifth minutes; umbilical cord blood pH > or = 7.2). Cord blood and arterial blood samples were collected immediately after birth and 18 to 24 h after birth, respectively, and were used in the blood gas analysis and to determine serum concentrations of T4, T3, FT4, rT3 and TSH by radioimmunoassay. All newborns were followed-up until hospital discharge or death. RESULTS Gestational age, birthweight, sex, size for gestational age, mode of delivery and skin color (white and non-white) were similar for both groups. No differences were found in mean levels of cord blood TSH, T4, T3 and FT4 between the groups. In the samples collected 18 to 24 h after birth, mean levels of TSH, T4, T3 and FT4 were significantly lower in the asphyxiated group than in the control group. Mean concentrations of arterial TSH, T4 and T3 between 18 and 24 h of life were lower than concentrations found in the cord blood analysis in asphyxiated newborns, but not in controls. In addition, asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy presented significantly lower mean levels of TSH, T4, T3 and FT4 than those of controls. None of the asphyxiated newborns with FT4 > or = 2.0 ng/dl died; 6 out of the 11 asphyxiated newborns with FT4 < 2.0 ng/dl died. CONCLUSIONS Serum concentrations of TSH, T4, T3 and FT4 are lower in asphyxiated newborns than in normal newborns between 18 and 24 h of life; this suggests central hypothyroidism secondary to asphyxia. Asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy present a greater involvement of the thyroid function and consequently a greater risk of death.
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96
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Nagdyman N, Grimmer I, Scholz T, Muller C, Obladen M. Predictive value of brain-specific proteins in serum for neurodevelopmental outcome after birth asphyxia. Pediatr Res 2003; 54:270-5. [PMID: 12736385 DOI: 10.1203/01.pdr.0000072518.98189.a0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain-specific proteins have been used to detect cerebral injury after birth asphyxia. Previous investigations suggest that serum protein S-100beta, brain-specific creatine kinase (CK-BB), and neuron-specific enolase (NSE) are capable of identifying patients with a risk of developing hypoxic-ischemic encephalopathy. Whether detection of elevated serum concentrations of these proteins reflects long-term neurodevelopmental impairment remains to be investigated. We examined serum protein S-100beta, NSE, and CK-BB at 2, 6, 12, and 24 h after birth in 29 asphyxiated infants and 20 control infants. Neurodevelopmental follow-up examinations were performed at 20 mo of age using the German revision of the Griffiths scales for developmental assessment. Elevated concentrations of serum protein S-100beta, NSE, and CK-BB within 24 h after asphyxia did not correlate with long-term neurodevelopmental delay. We conclude that serum protein S-100beta, NSE, and CK-BB, sampled on the first day of life, is of limited value in predicting severe brain damage after birth asphyxia.
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97
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Salonvaara M, Riikonen P, Kekomäki R, Vahtera E, Mahlamäki E, Halonen P, Heinonen K. Effects of gestational age and prenatal and perinatal events on the coagulation status in premature infants. Arch Dis Child Fetal Neonatal Ed 2003; 88:F319-23. [PMID: 12819166 PMCID: PMC1721592 DOI: 10.1136/fn.88.4.f319] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study prospectively the effects of prematurity and perinatal events on the coagulation status of premature infants. PATIENTS AND MAIN OUTCOME MEASURES Blood samples from premature infants born before 37 gestational weeks were taken for analysis of coagulation factors II, V, VII, and X and platelet count. RESULTS A total of 125 premature infants, 71 boys, were studied at the median postnatal age of 40 minutes (range 12-100). The lowest median activities of coagulation factors II, V, VII, and X and the platelet count were observed, as expected, in infants (n = 21) born at 24-27 weeks gestation. Twin B (n = 14) had lower median activities of coagulation factors II, V, VII, and X than twin A. Infants with evidence of mild asphyxia (Apgar score at 5 minutes < 7 or cord pH < 7.26) had significantly (p < 0.05) lower levels of coagulation factors II, V, VII, and X and platelet counts than infants without asphyxia. Infants who were small for gestational age (SGA) had significantly (p < 0.05) lower levels of coagulation factors V and VII and platelet counts than infants of appropriate size for gestational age. Other prenatal and perinatal variables examined (sex, maternal hypertension and/or pre-eclampsia, antenatal steroid use, mode of delivery, Apgar scores) did not show any significant associations with coagulation status, which may be explained by the small number of infants studied. CONCLUSIONS The data strongly suggest that there are distinct differences in specific coagulation tests in different patient populations, which could assist in the identification of extremely preterm, SGA, or asphyxiated preterm infants who may be susceptible to haemorrhagic problems perinatally.
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Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. Int J Gynaecol Obstet 2003; 81:267-71. [PMID: 12767568 DOI: 10.1016/s0020-7292(03)00124-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in cord blood of term non-asphyxiated newborns and to investigate variations in NRBC counts in perinatal asphyxia. METHODS A total of 75 cases were studied. Levels of NRBC per 100 WBC in umbilical venous blood were compared between 26 asphyxiated newborns (group I) and 49 non-asphyxiated newborns (group II). Correlation with neonatal outcome was also evaluated. RESULTS The mean (+/-S.D.) NRBC per 100 WBC level in umbilical blood of newborns in group I was 16.5+/-6.4, range 3-25; whereas that in group II was 8.6+/-7.01, range 1-26. This difference was statistically significant (P<0.001). A statistically significant negative correlation existed between NRBC level and markers of acute intrapartum asphyxia, Apgar score and umbilical arterial pH (r=-0.50, P<0.001 and r=-0.48, P<0.001, respectively). Positive correlation was demonstrated with evidence of chronic antepartum asphyxia, presence of pregnancy induced hypertension and intrauterine growth restriction (r=2.66, P=0.02). A high NRBC count in umbilical blood correlated with poor early neonatal outcome. CONCLUSIONS The level of NRBC per 100 WBC correlates both with acute as well as chronic antepartum asphyxia. Further, it can be used as a reliable index of early neonatal outcome.
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Matuszczak-Wleklak M, Szymankiewicz M. [Perinatal asphyxia, known topic, new diagnostic prospects--advisability of troponin T in perinatal medicine]. Ginekol Pol 2003; 74:487-93. [PMID: 12931457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Perinatal asphyxia is a major topic in neonatology. It has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. Hypoxia triggers compensatory mechanisms in the fetus and the newborn aimed to sustain adequate oxygen transport to the vital organs. Long periods of hypoxia and poor perfusion cause failure of mentioned compensative mechanisms and lead to irreversible damage in tissues. No clear-cut physiologic parameters exist which allow for an early identification of neonatal infants who are either at risk to develop brain damage or posthypoxic heart failure. In the above paper authors demonstrate new possibilities in diagnosis of perinatal asphyxia. They present cardiac troponin T, a thin filament contractile protein as a highly specific and sensitive marker of myocardial injury and hypoxia.
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100
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Xu YP, Zheng JY, Wang J. [Relationship among serum cortisol and insulin and blood glucose in the asphyxiated neonates]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2003; 32:253-6. [PMID: 12881876 DOI: 10.3785/j.issn.1008-9292.2003.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To explore the dynamic change of serum cortisol and insulin levels, and their relation with blood glucose concentration in asphyxiated neonates. METHODS The levels of serum cortisol and insulin at d1,d3 and d7 of birth were measured by radioimmunoassay and the concentration of blood glucose was measured with glucose oxidase method in 43 asphyxiated neonates. RESULTS The levels of serum cortisol at d 1, d 3 and d 7 of birth were gradually decreased (P<0.01). At d1, the incidence of hyperinsulism (>20 mIU/L) was 60.5%. The level of serum insulin reached normal level (<or=20 mIU/L) at d 3. At d 1, the level of serum cortisol was positively related with the level of blood glucose (r=0.432, P<0.01), the ratio of serum insulin and cortisol in hypoglycemia group (0.71+/-0.71) was significantly higher than that in normal blood glucose group (0.19+/-0.36, P<0.01). The incidence of hypoglycemia in hyperinsulism group was markedly higher than that in normal serum insulin group (P<0.05). CONCLUSION There are temporary hyperinsulism in asphyxiated neonates. Hypoglycemia in asphyxiated neonates is related with hyperinsulism and low serum cortisol level.
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