جستجوی مقالات مرتبط با کلیدواژه « asphyxia » در نشریات گروه « پزشکی »

 We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.

 This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) born at Al-Zahra Hospital in Rasht, Iran. We collected the cord blood samples for CK level and NRBC at birth. The clinical stage of Sarnat indicated the severity of HIE. Data were analyzed in the two groups using IBM SPSS Statistics for Windows, version 22.

 The case group had a higher NRBC count (P=0.001). The CK level was significantly different between the two groups and was higher in the case group than in the control group (P= 0.002). Results demonstrated a significant association between NRBC count and the occurrence of HIE in neonates with asphyxia (P = 0.021). Besides, a positive correlation was found between HIE and CK levels in the case group (r = 0.7, P=0.001).

According to our results, NRBC count and umbilical cord CK level measurement are valuable predictors of asphyxia and HIE in neonates. In addition, measuring these parameters may help clinicians for faster diagnosis and better management.

To demonstrate that birth asphyxia is a risk factor of in vitro Fertilization in Cameroon. A retrospective cohort study was conducted at the pediatric department of the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction (HCRAESHR) in Yaoundé. Every newborn, from in vitrofertilization (exposed group) and spontaneous conception (non-exposed group) after a single pregnancy was included and those from multiple pregnancies were excluded. Each group contained 100 newborns that were matched according to the mode of delivery. The data collection lasted 8 months. For that, the birth medical records of the newborns were used and data were reported on individual questionnaires. The absence of cry at birth, an Apgar score<7 at the 5th minute of life, and the concept of neonatal resuscitation including at least the mask ventilation, were the three criteria measured for considering a newborn as having birth asphyxia. A p-value≤0.05 signed the statistical significance of all our results. The mean maternal age was 40.55 ± 8.35 years in exposed group against 35.72 ± 5.01 years in non-exposed group (p = 0.000). The birth asphyxia was significantly predominant in exposed group (35% and 11% respectively, p = 0.000), in comparison to non- exposed group. Exposed group had 3.85 times higher risk to have birth asphyxia compared to non-exposed group (p = 0.001) while controlling for confounding factors (maternal age, maternal hypertension, prematurity and the sex of the baby.                                                                                                                          This study clearly established that in vitro fertilization can cause birth asphyxia.

Fingers’ swan neck deformity is an uncommon sign in neonates. This deformity has much pathology in adults such as prolonged rheumatoid diseases, tearing or weakness of ligaments or increased spasticity of muscles. In this article we report on a neonate case of swan neck deformity and discuss the possible disorders which have possibly caused this deformity. Our infant is a known case of asphyxia so we are also going to discuss that swan necks may be a complication or a comorbidity of asphyxia.

Our infant is a two month-old male preterm newborn, hospitalized due to seizures. The infant has a history of intrauterine growth retardation and perinatal asphyxia. On physical examination the patient was hypotonic and reflexes were decreased and there was a deformity on the hands which is very similar to swan neck deformity seen in adults. We requested different paraclinical modalities such as electroencephalogram, electromyography and nerve conduction velocity, computed tomography to rule out different possible diagnoses for the deformity (e.g., Ehlers Danlos syndrome, leukocyte adhesion deficiency). According to the results of the investigations, no reason was found for this deformity in the infant, and it seems that this deformity is one of the complications of asphyxia or has occurred in association with it.

Swan neck deformity is a very rare finding on neonates. It was observed in a newborn with perinatal asphyxia, and different commonly known causes of this deformity were ruled out in this newborn. Therefore, in our opinion, this deformity can possibly be one of the late manifestations of asphyxia in a newborn.

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of mortality and morbidity in neonates. Head cooling is considered the standard treatment that reduces mortality and morbidity by decreasing the adverse effects of the disease. Some medicines having neuroprotective properties may be beneficial in treating HIE.

We aimed to evaluate the effect of erythropoietin (EPO) on short-time outcomes in newborns with HIE.

This study was conducted on 62 newborns with moderate to severe HIE hospitalized in Fatemieh Hospital, affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, from 2019 to 2020. Eighteen patients who received head cooling plus 1000 IU/kg/d EPO were considered the intervention group and compared with 44 neonates who received only head cooling alone. Short-term outcomes, including length of stay (LOS), thrombocytopenia, seizure, need for mechanical ventilation, multiple anticonvulsant drugs, and in-hospital mortality, were compared between the groups using SPSS version 22.

The mean LOS was 21.2 ± 9.6 and 21.5 ± 12.3 days (P = 0.927), thrombocytopenia occurred in 27.8% and 34.1% (P = 0.629), and 84.1% - 88.9% of newborns required mechanical ventilation (P = 1.0). The seizure was observed in 93.2 -94.4% of newborns (P = 0.29), and multiple anti-seizure drugs were required in 35.3% and 48.9% of EPO and control groups retrospectively (P = 0.66). The mortality rate was significantly different between the EPO and control groups (11.1% vs 44%; P = 0.02).

High-dose EPO can reduce the mortality rate of neonates with HIE when used in addition to head cooling compared to head cooling alone.

Hypoxia-ischemia-induced brain injury is a major cause of acute mortality and chronic neurological disability in infants and children. Imaging plays a vital role in diagnosing and treating hypoxicischemic encephalopathy (HIE) and as an adjunct to acute conditions and provides valuable information on long-term prognosis.

Our study was prospective with 50 neonates aged 34 weeks and older with HIE. Cerebral ultrasound and MRI were performed on the infants, and the pattern of lesions was recorded. A pediatric neurologist examined the infants, and their developmental status was assessed and recorded with electroencephalography (EEG) findings.
The data were analyzed.

The sonography pattern was normal in 26 (76.5%) term neonates, and also, the PVL pattern was observed in 10 term neonates. The incidence of observing an edema pattern (17.6%) was significantly different between the term and pre-term infants (P-value = 0.001). MRI findings were normal in 20 (58.8%) term neonates and 11 premature neonates. However, the PVL pattern was observed in MRI performed in six term neonates (6.6%). The watershed pattern (17%) showed that these differences were significant between the term and pre-term infants (P-value = 0/001).

Normal sonography was significantly higher in neonates with normal neurodevelopment than in patients with normal MRI and EEG findings but with poor neurodevelopment. Also, the probability of having normal MRI results was lower in neonates with moderate to severe asphyxia compared to ultrasound and EEG.

Natural delivery is distressing, and the mother’s anxiety in this condition can have negative impacts on the fetus, mother, and the delivery process. Hence, many women tend to use pharmacological or nonpharmacological methods for reduction of labor stress and anxiety. The aim was to assess the effect of supportive care and acupressure during labor on the mother’s anxiety level and arterial oxygen pressure of the umbilical cord of infants.

This performed on 150 pregnant women were randomly assigned to two interventions and a control group in the delivery ward of the selected educational center of Shiraz University of Medical Sciences (Shoushtari Hospital) in Iran. Mothers’ anxiety scores before (beginning of the active stage of labor) and after intervention (the end of the first stage of labor) were measured using Spielberger’s questionnaire. Then, infants’ cord blood samples for arterial blood gas and hematologic analyses were sent to the hospital’s laboratory. After all, the data with SPSS version 16 and using Pearson’s correlation coefficient, one‑way ANOVA, were analyzed.

The mean of anxiety score in the control group was 21.1% and in the supportive group and the acupressure group, respectively, decreased by 37.5% and 34.8%, respectively (P < 0.001). The mean of PO2 was also reported in the maternal supportive, acupressure, and control groups, 40.4 ± 8.8, 27.4 ± 2.8, and 18.1 ± 3.7, respectively. Additionally, a significant correlation was found between mothers’ anxiety scores after the intervention and the mean of PO2 (P = 0.014).

The supportive care and acupressure at BL32 acupoint reduced mothers’ anxiety and consequently improved fetal oxygenation. Therefore, these methods are recommended to be used during labor for improving birth outcomes.

Lung involvement is a common presentation of Hydatid disease in children. In addition, giant Hydatid cyst is common in children due to parenchymal elasticity of their lungs. In this study, we presented a case of giant Hydatid cyst that was ruptured following trauma through car accident and lung drowning with Hydatid fluid in a 5-year-old boy.

Our patient was a 5-year-old boy who was injured in a car accident. He had full signs and symptoms of obvious respiratory failure. Based on chest X-ray, the primary diagnosis was congenital pulmonary cyst, so a chest tube was placed for decompression. By evaluation of the chest CT-scan, we detected a communicating rupture of Hydatid cyst. Despite full conservative treatment, patient’s condition was exacerbated. Therefore, we decided to perform surgical intervention for removing the pressure of the cyst on lung. The patient’s condition did not improve. Unfortunately, the patient had cardiac arrest, cardiopulmonary resuscitation was not successful and we lost the patient.

Chest trauma is common in traumatic patients and pleural effusion, empyema, and pneumothorax may occur for a variety of reasons. Various factors can cause these symptoms, and among all the possible causes, the physician should consider the possibility of a ruptured Hydatid cyst following trauma to the lung as one of the differential diagnoses, especially in endemic areas with higher prevalence of Hydatid disease. In the present case, cyst rupture and subsequent drowning and asphyxia with cyst fluid were the main causes of mortality.

Death by hanging is a vital health hazard worldwide; it is classified as violent mechanical deaths resulting from asphyxia. The manner of death in hanging is suicide in the majority of the cases, and accidental hanging is less common, and homicidal hanging is still less common. The study was aimed towards analyzing sociodemographic patterns, precipitating factors for committing hanging at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India.

A retrospective study was conducted at the mortuary of VIMS, Ballari, Karnataka, India. From January 01, 2016, to December 31, 2020, 356 alleged hanging cases were brought to the mortuary for postmortem examination, and the cause of death was attributed to hanging. The necessary data were collected with the help of history, inquest reports, meticulous postmortem examination, etc. The results were obtained after tabulating and data analyzed with a cross-sectional study.

Of 356 cases of hanging, the majority of the cases were in the age group of 31-40 years (140 patients; i.e., 39.32%). Male preponderance was detected in 235(66%) cases, and most victims have married 199(56%) subjects. Concerning seasonal variation, we noted that the maximum number of suicides by hanging was reported in July to September 141(39.60%). Out of 356 hanging cases, 178(50%) were employed. The predisposing factor was Chronic illness in 136(38.20 %) cases, followed by financial stress and psychological problems in 120(33.70%) and 50(14.04%) cases, respectively. Most of the victims belonged to the Hindu religion, 290(82%) cases. Moreover, 320(90%) of cases had no suicide note.

Hanging is challenging to prevent due to numerous concomitant factors, but psychological counseling, economic support, and education can reduce the incidence of hanging.

Asphyxia may lead to serious complications, among which acute kidney injury (AKI) is the most common. Early diagnosis of AKI can help prevent impaired acid-base, fluid, and electrolyte balance that may lead to life-threatening complications. This study aimed to evaluate the effect of kidney injury molecule-1 (KIM-1) and cystatin-C in the early diagnosis of AKI among asphyxiated neonates.

This case-control study was conducted on 45 asphyxiated neonates, 24 of whom were in the control group and 23 cases were in the case group. Creatinine (Cr), KIM-1, and cystatin-C were measured for participants within 8 h and 4 days after birth and compared between case and control groups.

The mean level of Cr-Standardized KIM-1 measured within 8 h and 4 days after birth was significantly higher in the case group, compared to the control group (P-value<0.05). The mean level of Cr-Standardized cysteine, only 4 days after birth, was significantly higher in the case group, compared to the control group (P-value<0.05). A receiver operating characteristic (ROC) curve analysis demonstrated that between the two biomarkers with two measurements, the KIM-1 Cr-Standardized within 4 days had the highest area under the curve (AUC) (0.751, 95% CI: 0.597-0.905). Moreover, the results of ROC curve analysis showed that Cr-Standardized KIM-1 within 4 days after birth with a critical value of >0.67 ng/ml allowed to predict kidney failure in newborns with 57.1 % sensitivity and 86.4 % specificity.

The findings of the present study show that high-specificity KIM-1 is a good biomarker for the early detection of acute renal failure in asphyxiated infants; however, similar expectations cannot exist with regards to cystatin-C for at least the first 8 h after birth.

Subcutaneous fat necrosis is a rare form of adipose tissue inflammation in neonates that results from certain predisposing factors such as asphyxia at birth.

This report introduces a male neonate born at 38 weeks gestation with hypoxic-ischemic encephalopathy. The patient presented with an extensive erythematous skin lesion and subcutaneous nodules on the back and shoulders at four days of life. The baby had severe hypertriglyceridemia (834 mg/dl) after developing the lesion, which raised the diagnostic suspicion of subcutaneous fat necrosis. The hypertriglyceridemia resolved Over the next four and six months (82, 75 mg /dl, respectively). He had no other neurologic or metabolic abnormalities associated with subcutaneous fat necrosis.

Although subcutaneous fat necrosis is self-limited and has a benign course, it can be associated with severe hypertriglyceridemia requiring careful investigation and monitoring.

Despite advances in perinatal care, perinatal asphyxia (PA) remains one of the most important causes of mortality and morbidity at birth. Asphyxia is associated with the dysfunction of different organs of the body. Therefore, this study aimed to investigate the urinary biomarker of beta-2 microglobulin in neonates with asphyxia.

This case-control study was performed on neonates admitted to the Neonatal Intensive Care Unit of AL Zahra and Shahid Beheshti hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during 2017-18. On the second day of birth, beta-2 microglobulin was measured in urine samples using the enzyme-linked immunosorbent assay technique.

The mean level of beta-2 microglobulin in the group with asphyxia (9.91±6.16) was significantly higher than that in the control group (3.83±4.03) (P=0.001). Moreover, analysis of beta-2 microglobulin level in the group with asphyxia showed that the mean serum level of neonates with acute renal failure (13.14±6.27) was significantly higher than that in newborns without acute renal failure (6.68±4.24) (P=0.02).

The results of our study suggest that the beta-2 microglobulin level can be evaluated as a marker of neonatal asphyxia. Furthermore, its level was significantly associated with acute kidney injury. It is suggested that further studies be conducted with a larger sample size.

Asphyxia is a medical situation resulting from the deprivation of oxygen to a newborn lasting long enough during the birth process to cause physical harm, especially to the brain. Human umbilical cord blood (UCB) is a well-established source of hematopoietic stem/progenitor cells (HSPCs) for allogeneic stem cell transplantation. A low level of O2 in neonates with asphyxia during labor can affect proliferation and differentiation of stem cells in cord blood.

The quality and colony-forming ability of hematopoietic stem cells in the cord blood of neonates with severe asphyxia with Apgar score 3-5or need to cardiac pulmonary resuscitation 5 min after delivery were compared with the group with normal Apgar score. Thereafter, hematopoietic stem cells were isolated, and cells were cultured in an enriched media (MethoCult H4435) special for HSPCs for 7 days to assess the growth and colony formation.

Based on the results, there was a significant difference in the number of colonies of RBC (P=0.0016) and WBC precursor (P=0.006), in a plate with 104 cord blood hematopoietic stem cells in newborns exposed to hypoxemia during labor.

Umbilical cord blood is valuable for its content of stem cells. Severe hypoxia in the perinatal period does not negatively affect the viability of UCB-derived HSPCs to grow and form colonies. Furthermore, it was found that transient severe asphyxia does not exert negative effects on the banking quality of HSPCs for likely problems in the future.

Perinatal asphyxia/ischemia is an interruption in the availability of oxygen supply to the myocardium. We sought to assess myocardial function among asphyxiated and non-asphyxiated neonates using echocardiography.
 
The present case-control study was undertaken at the neonatal intensive care unit (NICU) of a tertiary care hospital. Neonates with asphyxia who were admitted to the NICU were included in the study. The diagnosis of asphyxia was established on the basis of the APGAR score at 1 and 5 minutes. Myocardial function was assessed in terms of serum cardiac troponin I (CTnI) and different echocardiographic parameters such as M-Mode, Doppler flow parameters, and tissue Doppler imaging.
 
Thirty asphyxiated (the case group) and 30 non-asphyxiated (the control group) term neonates were enrolled in the study. The asphyxia group had significantly lower (P < 0.001) 1- and 5-minute APGAR scores than the controls. The asphyxia group had a higher serum CTnI value. The differences between the 2 groups concerning M-Mode parameters in the first 12 hours of life were statistically significant (P < 0.001). The case and control groups were also statistically significantly different regarding left atrial pressure at 48 hours following birth, calculated as a ratio of E/e’ (P < 0.001). The differences between the 2 study groups at 24 hours after birth as regards tissue Doppler parameters, including left ventricular ejection time and left ventricular Tei index, were also statistically significant (P < 0.001). The case and control groups also showed statistically meaningful differences concerning right ventricular ejection period/ ejection time at 24 hours after birth (P < 0.002).
 
It can be concluded that the myocardial function assessment using CTnI and different echocardiographic techniques is the most sensitive and specific method in the detection of ischemic cardiac injury in asphyxiated newborns. (Iranian Heart Journal 2021; 22(1): 91-99)

Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications.

In this cohort with two-year follow up study with availability sampling 196 term asphyxic infants were involved during 2009 to 2018. A researcher designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1β(IL-1β), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student T test, Chi-square, ROC curve, and regression models.

IL-6, IL-1β, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in prediction of complications of asphyxia was found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1β were associated with increased unfavorable outcomes.

Combinations of: IL-1β + IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6 + HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.

In order to determine the prognosis of neonates, it is recommended to use umbilical gas analysis in all high-risk pregnancies. However, utilizing umbilical gas analysis and Apgar score together is very helpful for determining the mortality rate confidence interval. Therefore, in this study, we investigated the application of umbilical gas analysis in assessing the prognosis of infants. This cross-sectional study was conducted in Hakim Hospital of Neyshabur, Iran during 2017-2018 with 100 subjects in each group of control and test. Blood samples were collected from the umbilical vein of all neonates. The data were compared between the two groups by the t-test and Mann-Whitney test using the SPSS software version 18 at the significance level of P ≤ 0.05. Our findings demonstrated that both hospitalization and the need for resuscitation had significant relationships with pH and base excess (BE) in the case and control groups (P<0.05). Moreover, 52.7% of the subjects in the intervention group and 47.3% of the participants in the control group were born through cesarean section. Therefore, the two groups were not significantly different regarding the route of delivery (P>0.05) According to the results of this study, a positive relationship was found between the neonatal prognosis and umbilical vein blood gas. Consequently, we can determine neonatal prognosis based on umbilical vein blood gas.

As there are different views on the effects of aminophylline on neonatal renal function, we intended to observe the effects of aminophylline on renal dysfunction in neonates with prenatal asphyxia.

This randomized trial was conducted in the Obstetrics and Gynecology Hospital, Tehran, Iran, from June 2016 to May 2017, in neonates with moderate to severe asphyxia during birth. Fifty-six neonates were divided randomly into two groups. The intervention group received one dose of 5mg/kg slow intravenous aminophylline injection and the placebo group received 2 mL/kg of intravenous 10% solution of dextrose saline during the first hour of life. They were monitored and compared for renal functional indices, electrolytes, and complications of asphyxia during the three days of life.

The mean of Cr (37.9 ± 8.8 vs 38.5 ± 9.4 and 20.8 ± 4.8 vs 30.1 ± 5.2 μmol/L), GFR (21.55 ± 4.7 vs 20.25 ± 4.4 and 30.8 ± 7.1 vs 20.1 ± 6.5 mL/minute/1.73 m2), Na (135.1 ± 12.4 vs134.5 ± 11.2 and 128.9 ± 11.5 vs 134.2 ± 10.9 mEq/L), and urine output (98.2 ± 25 vs 96.8 ± 23 and 148.7 ± 35 vs 108.8 ± 20 cc) were in the aminophylline treated and placebo group on the 1st and 3rd days, respectively. The mean difference of Cr (-9.3 (-8.9; -9.7) μmol/L); (P = 0.02), GFR (10.7 (10.1; 11.3) mL/minute/1.73 m2) (P = 0.009), Na (-5.3 (-5.9; -4.7) mEq/L) (P = 0.002), and urine volume (39.9 (24.9; 54.9) cc) (P = 0.001) presented statistically significant differences on the third day between the intervention and placebo group.

Aminophylline was effective in preventing renal dysfunction in neonates with asphyxia. Neonates who received aminophylline indicated a significant improvement in GFR and urine output on the first day of life.the formula is not displayed correctly!

Neonatal mortality remains a public health concern in developing countries such as Burkina Faso. Improving the survival rate of newborns requires a good knowledge of the current situation. This study aimed at determining the risk factors for neonatal mortality in the Neonatology Department of Saint Camille Hospital of Ouagadougou (HOSCO - Hôpital Saint Camille de Ouagadougou).

This was a retrospective, descriptive and analytical study that included all newborns hospitalized in the neonatology department, at St Camille Hospital, in Burkina Faso from January 1 to December 31, 2017. Total of 710 records of hospitalized newborns in 2017 were analyzed. Among them our study focused on cases of death.

The neonatology department registered 246 deaths out of 710 hospitalizations, representing a mortality rate of 34.6%, of whom 194 (78.8%) were preterm infants and 52 (11.2%) were term newborns. Among the deceased newborns, 88% had a low birth weight and the sex ratio was 0.8. November was the most fatal period (12.6%). Prematurity and respiratory distress were the main reasons for referral. Prematurity (76.4%), asphyxia (51.2%) and neonatal infection (27.2%) were the top 3 diagnoses at admission. The leading cause of death was respiratory distress (89.8%). All the newborns have been hospitalized within 24 hours of life and the average time to death in the unit was 3 days and 54% of deaths occurred within 72 hours of hospitalization.

Mortality rate is higher among preterm infants while it is relatively low among full-term newborns in our facility. Prematurity, asphyxia and neonatal infection remain the main risk factors associated with neonatal mortality.

Neonatal mortality had not changed significantly in the last decade in African countries particularly in Nigeria; however, under-five mortality had reduced significantly. Nigeria with a quarter of maternal and under-five mortality is among ten countries with the highest neonatal mortality. Previous studies had shown patterns of newborn morbidity and mortality; however, no study has been conducted in this regard recently. The present study aimed to ascertain the current patterns of newborn morbidity and mortality. A retrospective review of records of all newborn admissions over a period of one year was carried out. Extracted data include age, gender, diagnosis on admission outcome, and cause of mortality. The frequency of morbidity and outcome variables were analyzed and then calculated. The major reason for admission was jaundice 29.6% followed by asphyxia 25%, sepsis 16.1%, and prematurity 9%. The neonatal mortality rate was 12.5% with more than half of the deaths occurring within 24 hours and almost all within 72 hours. Causes of death were asphyxia 58.2%, jaundice 16.4%, sepsis 10 .4%, and prematurity 3%. More than half of the neonates with asphyxia were likely to die within 24 hours. Asphyxia, jaundice, sepsis, and prematurity were the major causes of morbidity. In addition, asphyxia is still a major cause of preventable death in newborns in Nigeria.