جستجوی مقالات مرتبط با کلیدواژه "hypoxic-ischemic encephalopathy" در نشریات گروه "پزشکی"

Neonatal Hypoxic-Ischemic Encephalopathy (HIE) remains a major cause of neonatal morbidity and mortality. Neonates are at a significantly high risk of vitamin D deficiency. Maternal and neonatal vitamin D deficiency is associated with multiple neonatal diseases including HIE. This study aims to explore the possible association between maternal and neonatal 25-hydroxy vitamin D (25-OHD) levels and HIE in full-term infants and it attempts to find whether there is any relationship between vitamin D level and the clinical severity of HIE. This case-control study included 25 full-term neonates with HIE and their mothers along with 25 healthy neonates and their mothers. The level of serum (25-OHD) of the infants and their mothers was measured in the first 6 postnatal hours of the infants by isotope dilution ultra-performance liquid chromatography-tandem mass spectrometry. The severity of HIE was assessed depending on the clinical scoring system. Neonatal and maternal levels (25-OHD) were significantly lower in the study group compared with those of the control group. Neonatal (25-OHD) levels were significantly lower with increasing severity of HIE (p=0.005), but they did not follow the same order in the maternal (25-OHD) levels (p=0.96); i.e., a negative correlation was detected between neonatal (25-OHD) level and severity of HIE (r = − 0.66, P < 0.001). A positive correlation was found between neonatal and maternal (25-OHD) levels in the study group (r = 0.697, P < 0.001). Lower maternal and neonatal vitamin D levels were associated with HIE in full-term infants and the level of vitamin D was inversely associated with the clinical severity of HIE. Further studies are needed to examine the causal relationship between vitamin D deficiency and HIE in neonates.

 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.

We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia.

We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF.

Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37–40) weeks and 3245 (2715–3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1–5) and 6 (4–7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r, P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001).

Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of long-term neurological disabilities among children. Various types of cellular stress stimuli, including oxidative stress, inflammation, and hypoxia, induce heme oxygenase-1 (HO-1) enzyme for different kinds of tissues. The purpose of this study was to evaluate the plasma level of HO-1 enzyme in neonatal HIE patients and to determine the relationship between HO-1 enzyme level and clinical severity of HIE. In this case-control study, the plasma level of HO-1 enzyme was measured through sandwich ELISA in 28 newborns with a proven diagnosis of HIE and 31 healthy full-term newborns admitted to Bentolhoda Hospital, Bojnourd, Iran. Newborns with HIE were classified according to the Sarnat staging to mild, moderate, and severe HIE. Maternal and neonatal data were recorded in checklists and compared between the two groups. The mean plasma level of HO-1 enzyme in HIE patients was significantly higher than that in the control group (104.0 ± 4.01 and 91.63± 2.67 pg/ml, respectively, P=0.011). We also found that plasma HO-1 levels were significantly higher in severe neonatal HIE patients compared to mild and moderate neonatal HIE patients (121.0 ± 8.48Vs. 91.23 ± 3.35 and 105.5 ± 5.76, P ˂ 0.001). Our findings suggested that HO-1enzyme may be associated with the pathophysiology and clinical severity of neonatal HIE. We suggest further research on the correlation of plasma level of HO-1 enzyme at birth with the multi-organ dysfunction and abnormal neurodevelopmental outcomes in full-term newborns with HIE.

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.

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.

Perinatal asphyxia is the main cause of neurodevelopmental sequelae and perinatal death. Caspase-3 is a major enzyme associated with apoptosis and increases in hypoxic-ischemic events. There is still no reliable biomarker to predict the severity and outcome of an asphyxial event. In this regard, this study aimed to determine the caspase-3 level and its role as an outcome predictor in perinatal asphyxia.
This paired-group observational analytical cross-sectional study lasted from September 2016 to February 2017. In total, 50 neonates were included in the research and Caspase-3 levels were examined at two different times. Student’s t-test and logistic regression analysis were used for statistical analysis. There were 23 neonates (46%) with hypoxic-ischemic encephalopathy (HIE) and an increase in Caspase-3 level by 0.3135 points from the first to the second examination (t=6.555; P<0.0001). Results of this study showed a significant correlation between the caspase-3 level and mortality in neonates with HIE during both the initial (RR=2.33; P=0.014) and subsequent examinations (RR=2.25; P=0.015).
There is a significant increase in Caspase-3 levels in infants who suffer from perinatal asphyxia which can predict mortality in neonates with HIE.

Early diagnosis is considered as a priority for prevention and treatment of asphyxia-related complications. The main aim of the present study was to evaluate the prognostic value of interleukin-6 (IL-6) and hypoxic ischemic encephalopathy grade in prediction mortality and developmental status of neonates affected by prenatal asphyxia.

The cohort study was conducted on 38 term asphyxiated infants at Ghaem hospital, Mashhad, Iran, during 2013-2017. The HIE grade and serum IL-6 levels were determined at the time of birth. The developmental status was determined using the Denver II test at the end of two-year follow-up.

HIE grade 3 resulted in 83% mortality rate and developmental delay in all the survivors. The average IL-6 level was 2.7 ng/ml in the control group (not affected HIE) which increased up to 29, 175 and 136 ng/ml in those with HIE grades 1, 2 and 3, respectively. Roc curve analysis revealed the cut-off levels 24 pg/ml to predict the developmental delay with sensitivity and specificity of 96 and 92%, respectively.

The IL-6 level and HIE grade are the potential prognostic biomarkers for determination of mortality and morbidity rate in the asphyxiated neonates

Background:

 Neuroglobin is a member of the globin family that reversibly binds oxygen and increases oxygen delivery to brain. It also protects brain in hypoxemic or state levels, and so, decreases brain insult. We aimed to evaluate whether neuroglobin can be considered a neuroprotective in neonates with hypoxic-ischemic encephalopathy (HIE) by measuring its serum level in such cases.

This is a prospective case – control study that was conducted in Minia University Children’s hospital, El-Minya, Egypt on 30 term neonates who were diagnosed to have hypoxic–ischemic encephalopathy and another 30 apparently healthy term neonates as a control group. For both cases and controls, detailed history, clinical examination and serum neuroglobin level were done, while arterial blood gases, serum electrolytes, liver function, renal function tests, CBC, CRP, and CT- brain were done for cases only.

The results showed that serum neuroglobin levels were significantly higher in cases with hypoxic-ischemic encephalopathy than control group (p < 0.001). In this study, serum neuroglobin levels were higher (p < 0.001). We observed a weak negative correlation between serum neuroglobin level and Apgar score at one minute in studied cases with HIE. Also, we found that presence of both brain edema and hemorrhage in CT brain in cases with HIE was associated with a high mean serum neuroglobin level, than in either finding alone (p < 0.001).

Conclusion :

Neuroglobin could be considered as a neuroprotective in neonatal cases with hypoxic ischemic encephalopathy and this may be considered in the future potential therapeutic options in such cases.

Tramadol is a synthetic analgesic with two mechanisms. The opioid and non-opioid mechanisms are responsible for tramadol side effects. Non-opioid side effects of tramadol are due to the reuptake inhibitions of serotonin and norepinephrine. Some of the side effects include anaphylactoid reactions, CNS depression, hypoglycemia, hypotension, respiratory depression, seizures, and serotonin syndrome. Seizure may happen in therapeutic doses. If the frequency of tramadol seizures increases, ischemic brain injury and hypoxic-ischemic encephalopathy can be induced.

We report a young man with a history of tramadol abuse that was admitted with status epilepticus in Imam Reza hospital in Mashhad, Iran. Due to his altered mental status, he was intubated and antiepileptic agents were prescribed. He was transferred to ICU. After regaining consciousness, he was extubated and with the prescription of rehabilitation support he was discharged.

Tramadol is a synthetic analgesic agent with less potential for dependence. It is important to mention that the overdose of this drug is common. This drug has two mechanisms. This paper reports a case that developed generalized tonic clonic seizures due to tramadol and hypoxic ischemic encephalopathy. With adequate treatment and supportive care, patient’s mental status improves and he/she can be discharged.

Birth asphyxia is considered as one of the biggest challenges faced by perinatal care experts. According to the WHO, in 2005, one‑fourth of infant mortality cases occurred due to birth asphyxia. This study is a retrospective study done on the newborn population with gestational ages of 36 weeks or higher during the years 2013, 2014, and 2015 to fnd the relationship between the number of birth asphyxia cases and the years. As a secondary objective, the relationship between the mode of delivery and the cases of birth asphyxia were investigated using logistic regression test. The inclusion criteria consisted of three cases, namely, gestational age of 36 weeks or higher, 5 min Apgar of <5, and umbilical cord pH of <7.1. The exclusion criteria involved hydrops fetalis, cyanotic heart disease, chromosomal abnormality, and congenital infections. From the two independent variables of the study, only the variable “year” showed a signifcant difference between the years 2013 and 2015 (P < 0.01). The delivery mode did not have any statistically signifcant influence on the newborns’ affliction with birth asphyxia (P = 0.993). According to the results, there is a signifcant difference between the rate of birth asphyxia in Iran and its global rate in 2015, and regarding its multiple growth from 2013 to 2015, conducting a more comprehensive and extensive research on birth asphyxia risk factors at a delivery time seems justifed and inevitable.

Therapeutic hypothermia has become an established protocol for all neonates with moderate to severe Hypoxic Ischaemic Encephalopathy (HIE). There are very few studies comparing the neurodevelopmental outcomes in asphyxiated neonates who received therapeutic hypothermia or did not. This study aimed to assess the neurodevelopmental outcomes of asphyxiated neonates with features of HIE at 10-14 months of age using Bayley Scale of Infant and Toddler Development III (BSID III) and to compare this outcome between neonates who received therapeutic hypothermia and those who did not. Term infants with HIE admitted in neonatal intensive care unit (NICU) at a tertiary referral hospital were followed up at 10-14 months of age from December 2013 to August 2015. Neurodevelopmental outcomes were assessed using BSID III. A total of 76 neonates with birth asphyxia were admitted to NICU between December 2012 and August 2014. These neonates were followed up from December 2013 to August 2015, and 34 of them were included in the study. At10-14 months of age, 8 neonates (23.5%) had cognitive delay, 14 cases (41.17%) had motor delay, and 9 newborns (26.4%) had language delay using BSID III score of < 85 as cut off.
Twenty (58.82%) infants had normal development in all 3 domains. Higher percentage of infants (73.68%) who received therapeutic hypothermia had normal BSID Score as compared to 40% of the neonates with normal BSID score (>85) who did not receive therapeutic hypothermia. Statistical analysis using Chi-square test showed P-value of 0.048 as statistically significant. Neurodevelopment assessment at 10-14 months of age using BSID III of asphyxiated neonates with HIE showed significantly better outcome in infants who received therapeutic hypothermia than those who did not.

To study the nursing method of mild hypothermia therapy for moderate or severe hypoxic-ischemic encephalopathy (HIE) in neonates.
According to the inclusion and exclusion criteria, 48 patients were selected from Nanfang Hospital from December 2015 to October 2016 and randomly divided into the control group (n=24) and observation group (n=24). The control group received routine treatment and nursing, while the observation group received the same treatment as the control group combined with mild hypothermia treatment and nursing. The clinical effects were compared.
The total effective rate in the observation group was increased and mortality was decreased, and the differences were statistically significant (P=0.029 and 0.033, respectively). The 28 d neonatal behavioral neurological assessment and nursing satisfaction scores in the observation group were higher than those in the control group, and the differences were statistically significant (P=0.017 and 0.008, respectively).
Mild hypothermia therapy for moderate or severe HIE in neonates is safe and effective, and the correct nursing method is important for guaranteeing proper clinical treatment.

Asphyxia is a perinatal incident of high mortality rate. Therapeutic hypothermia in both the head and the whole body has been proposed as an effective method in this regard. In this study, we compared these methods in neonates with asphyxia. In this study, 16 neonates with asphyxia in two hospitals including Alzahra Hospital (head hypothermia) and Taleghani Hospital (whole body hypothermia) underwent therapeutic hypothermia for 72 hours. Temperature was maintained precisely controlled by several sensors. Moreover, body cooling was performed on the trunk and limbs of the neonates. The temperature and vital signs were controlled every hour while biochemistry and coagulation tests were performed regularly. Furthermore, the early and late complications of the patients, including developmental disorders, were closely evaluated. The two groups were compared using Chi-square and Mann Whitney U Test via SPSS software V.16 and the P value of less than 0.05 was considered significant. In total, 16 cases with the gestational age of 38±2 weeks were enrolled in this study. Of the 9 cases of head cooling, one expired and 2 others experienced mild developmental disorders. Of the 7 neonates of whole body cooling trail, 3 expired, one experienced minor developmental disorders and one case showed major signs of developmental disorders. No significant differences were found in terms of the feeding time (head group 5±2, body group 8±5 days) and the discharge time (head group 15±8, body group 14±5 days) of the studied neonates. The head hypothermia method seems to be associated with a lower mortality compared to the whole body method. However, the difference was not statistically significant in the sample size above. Therefore, performing such procedures on larger samples could confirm the findings of this study.