جستجوی مقالات مرتبط با کلیدواژه "perinatal asphyxia" در نشریات گروه "پزشکی"

Clinicians require more data regarding mortality and brain damage risk factors in perinatal asphyxia.

To assess early term outcomes and identify mortality risk factors in perinatal asphyxia.

This study was conducted in a referral-center tertiary intensive care unit in Istanbul, Turkey, between 2016 and 2023. We included all patients who underwent therapeutic hypothermia treatment due to perinatal asphyxia. We recorded laboratory follow-up data, magnetic resonance imaging (MRI) findings, amplitude-integrated electroencephalograms (aEEG) results, mortality, and clinical outcomes. Both conventional frequentist statistical methods and Bayesian methods were used for analysis.

A total of 164 patients were included in the study, with an overall mortality rate of 9.8%. Risk factors for mortality included LDH, troponin I, INR, lactate, 2nd day creatinine, voltage anomalies, seizures, and male gender, as well as APGAR scores. A basic chart for mortality prediction was developed. The Sarnat score showed strong evidence, and APGAR 1 showed anecdotal evidence for association with brain damage, although brain damage was independent of laboratory results and other clinical findings, based on moderate and anecdotal evidence from Bayesian calculations. Cranial MRI findings revealed profound damage in 14.8% of Sarnat 1, 21.8% of Sarnat 2, and 50% of Sarnat 3 patients.

This study presents prognostic factors for survival and brain damage in perinatal asphyxia. We recommend obtaining cranial MRI for all patients diagnosed with asphyxia, as most laboratory tests were independent of brain damage. Given that profound brain damage can occur even in Sarnat stage I patients, we emphasize the importance of therapeutic hypothermia for these patients.

Neonatal asphyxia is one of the most common neonatal problems. And kidney injuries are one of the most important complications of asphyxia in infants. Therefore, this study was designed to evaluate the effect of administering aminophylline on improving the renal function of asphyxiated preterm infants. In this single-blind randomized clinical trial, forty term neonates with perinatal asphyxia were randomized to intervention (n=21) and control (n=19) groups, respectively, receiving a intravenously single dose of aminophylline (5 mg/kg) or an equal volume of placebo (5% dextrose in water) during the first 3 hours of life. Daily urine output, 24-hour fluid intake, weight and serum creatinine were recorded during the first 5 days of life. The incidence of severe kidney dysfunction was not significantly different between the two groups. (2 infants in the group of intervention with aminophylline and 3 in the control placebo group; p=0.23). Plasma creatinine (Pcr) levels were increased in both groups on the second day and reached the maximum in the third day. Then it gradually decreased during the fourth and fifth days of life. There was no significant difference in Pcr & GFR between the groups in these five days (p>0.05). However, urinary output/input ratio was higher in the aminophylline group in the first three days of life. Prophylactic administration of aminophylline in asphyxiated neonates could not change the process of renal failure in the patients but could increase urinary output in the first days of life.

Prediction of the outcome of perinatal asphyxia (PA) is important but formidable. Apgar score has a limited role in predicting the outcome. Urinary uric acid and creatinine ratio (UA/Cr) is an early, noninvasive, and cheap biomarker of PA which may predict its morbidity. This study aimed to determine the urinary UA/Cr in neonates with PA, compare it with UA/Cr in non-asphyxiated neonates, and derive the optimum cut-off value of this ratio to label PA.
This observational cross-sectional study was carried out on 100 term neonates appropriate for gestational age (AGA) with PA (cases) and 100 non-asphyxiated term AGA babies (controls). Urine samples were collected within 24 h of life; moreover, uric acid and creatinine levels were determined by an auto-analyzer.
The mean urinary UA/Cr ratio was significantly higher in the cases, compared to the controls (3.41±0.68 vs. 1.99±0.23) (P<0.0001). The cut-off value of this ratio to label PA was>2.5 with sensitivity, specificity, positive predictive value, and negative predictive value of 98%. Urinary UA/Cr ratio and cord blood pH were significantly correlated with each other (correlation coefficient r=-0.8951, P<0.001). Moreover, the urinary UA/Cr ratio and 5-min Apgar score were also significantly correlated with each other (r=-0.8806, P<0.001).
Urinary UA/Cr ratio is a non-invasive, cheap, and reliable marker for PA with good predictive value in this study.

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

The myocardium is vulnerable to ischemic injury in acute perinatal asphyxia. Asphyxial cardiomyopathy increases mortality. Clinical assessment alone is not sufficient to evaluate myocardial injury.

This study was conducted over 2 years on neonates at the gestational age of 34 weeks or more with perinatal asphyxia. Electrocardiographic (ECG) and echocardiographic changes were studied with clinical details.

The study population comprised 57 neonates. Among them, 33 (57.9%) were male, 23 (40.4%) were born by cesarean section, and 3 (5.3%) were delivered via assisted vaginal delivery. Twenty-six neonates (45.6%) were intubated in the delivery room, and 15 (26.3%) required bag-and-mask ventilation at birth. The mean birth weight was 2679 g (461 g), and the mean gestation period was 38.4 weeks (1.6 wk).Central nervous system, hepatic, and renal involvement was observed in 53 (93%), 35 (61.4%), and 26 (45.6%) cases, respectively. Cardiac dysfunction was observed in 30 neonates (52.6%). Twenty cases (35.1%) required mechanical ventilation.ECG changes were observed in 44 neonates (77.1%). Grade I changes were observed in 10 cases (17.5%), Grade II in 14 (24.6%), and Grade III in 20 (35.1%). In 13 cases, ECG was normal. Twenty-six neonates (45.6%) had echocardiographic changes. Tricuspid regurgitation was observed in 8 cases (14%) and pulmonary artery hypertension with tricuspid regurgitation in 16 (28.1%). Mitral regurgitation with global hypokinesia was observed in 2 neonates, who eventually succumbed.

Our results demonstrated thatECG changes occurred in about three-fourths of asphyxiated neonates, and nearly half of the asphyxiated neonates had echocardiographic changes. Mitral regurgitation with global hypokinesia was associated with the worst outcome. (Iranian Heart Journal 2021; 22(2): 51-57)

Perinatal asphyxia is the third-leading (23%) cause of neonatal death worldwide. Even in cases where it is not fatal, it can lead to hypoxic injury to the brain, heart, lungs, liver, gut and kidneys. Perinatal asphyxia is especially likely to cause neurodevelopmental deficits.

In the present study, we aimed to evaluate miR-210 expression in the peripheral blood of asphyxiated neonates and to explore the connection between miR-210 expression and neurological diseases in perinatal asphyxia.

Peripheral blood samples were obtained, and clinical characteristics (sex; mode of delivery; 5 and 10 minutes Apgar scores and neonatal behaviour neurological assessment (NBNA), white blood cell (WBC), procalcitonin (PCT) and blood gas analysis scores) were recorded for 42 asphyxiated neonates and 41 healthy controls. The miR-210 expression in the peripheral blood was determined using quantitative real-time PCR (qPCR). Statistical analysis was used for predicting the relationship between miR-210 expression and other indicators associated with the diagnosis of asphyxia. Bioinformatics analysis was performed for exploring the biological function of miR-210.

The miR-210 expression was noted to be 1.8-fold higher in the peripheral blood of asphyxiated neonates than in healthy controls (P < 0.01). The area under curve (AUC) of miR-210 expression in the receiver operating characteristic (ROC) curve was > 0.7 (AUC = 0.746, P = 0.0002). For examining the association between miR-210 and autism or epilepsy, 670 putative miR-210 targets involved in neurological processes were explored; of these targets, 102 and 26 targets were significantly associated with autism and epilepsy, respectively. These results suggest the involvement of miR-210 in neurological and cardiovascular injury associated with asphyxia, but is primarily related to neurological processes.

The expression of miR-210 could be used as an indicator to diagnose neonates with asphyxia, which may help in identifying some neurological and cardiac diseases that cannot be diagnosed during traditional neonatal health screening. In addition, it could provide early prevention and treatment for asphyxiated neonates.