Perinatal asphyxia is an important cause of death, as well as permanent neurological and developmental complications. Diagnosing in time would lead to better prognosis and applying the most proper treatment. We sought to define the predictive values of serum concentrations of interleukin-1β (IL-1β) and interleukin-6 (IL-6) in newborns with perinatal asphyxia to see if there is a relation between the short-term neurological deficit and serum IL-1β and IL-6 concentrations.
This was a prospective (case-control) study conducted between March 2006 and April 2013, at the Neonatal Intensive Care Unit, Mashhad, Iran. Serum IL-1β and IL-6 levels were measured at birth in 38 consecutive uninfected neonates with perinatal asphyxia (blood pH Serum IL-1β and IL-6 concentrations in the infants who developed perinatal asphyxia were significantly higher compared to values in the normal infants [16.88 vs 3.34 pg/mL for IL-1β, (P = 0.006), and 88.15 vs 6.74 pg/ mL for IL-6, (P Evaluating serum IL-6 and 1β simultaneously, could improve the sensitivity and specificity of early diagnosis of the perinatal asphyxia. The most appropriate indicator of perinatal asphyxia is combined measurement of interleukin 1β and interleukin 6.

Perinatal asphyxia is a major cause of neurologic morbidity and mortality. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) count per 100 white blood cells (WBC) and absolute NRBC/mm3 in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. A prospective (case-control) study was undertaken between October 2006 and December 2008, in the Neonatal Intensive Care Unit, Ghaem Hospital, Mashhad, Iran. A total of 91 infants completed the study. Levels of nucleated red blood cell per 100 white blood cells and absolute nucleated red blood cell counts in venous blood were compared for 42 asphyxiated (case group) and 49 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. The NRBC/100 WBC and absolute nucleated red blood cell levels in the blood of newborns in the control group were 3.87±5.06 and 58.21±87.57/mm3, respectively; whereas the corresponding values in the cases were 18.63±16.63 and 634.04±1002/mm3, respectively (P<0.001). A statistically significant negative correlation existed between nucleated red blood cell level and indicators of the severity of perinatal asphyxia, first minute Apgar score and blood pH (P<0.001), respectively. A positive correlation was demonstrated between these parameters and severity of asphyxia, acidosis, and poor outcome (P<0.05). The NRBC/100 WBC and/or absolute nucleated red blood cell are simple markers for assessment of severity and early outcomes of perinatal asphyxia.

Prenatal asphyxia is one of the important causes of morbidity and mortality in neonates. Several studies tried to find a marker for early diagnosis of prenatal asphyxia. This study aimed to examine the diagnostic value of urinary uric acid to creatinine (UA/Cr) ratio in perinatal asphyxia. In this study, 48 term infants with prenatal asphyxia and 48 healthy neonates were compared in terms of uric acid to creatinine ratio in urine samples from the first 24 hours of birth. Demographic data including sex, birth weight, gestational age, and mode of delivery were also recorded. The mean uric acid to creatinine ratio was significantly higher in infants with asphyxia than the control group (respectively, 2.1 ± 1.00 vs. 0.8 ± 0.20; p= 0.0001). The urine UA / Cr ratio was also positively and significantly associated with the severity of asphyxia (p= 0.0001). Urine ​​UA / Cr values were not related to neonatal sex, gestational age, and birth weight. However, the ratio was higher in emergency c-section (2± 0.90) compared with elective caesarean section (1.3 ± 0.90) and vaginal (1.26 ± 0.90). Cut-off point equal to 1.20 appears to be the most appropriate cutoff for urine UA / Cr ratio with 87% sensitivity, 91% specificity, and accuracy of the 5.89%, in the diagnosis of perinatal asphyxia in term infants. Urine UA / Cr ratio can be introduced as a marker for early, easy and cost effective detection of perinatal asphyxia.

Perinatal asphyxia is a common cause of infant morbidity and mortality and long-term neurological disabilities. Due to the high costs of admission, a large proportion of births and neonatal deaths occur in non-hospital settings. This study aimed to evaluate the incidence rate of perinatal asphyxia before and after the implementation of the health improvement program.
This descriptive-analytical study was conducted on all the infants with moderate and severe asphyxia during April 2013-2015. Subjects were divided into two groups of A and B (born after and before the health improvement program, respectively). Maternal and neonatal data were recorded in checklists and compared between these groups. Data analysis was performed in SPSS version 17.
In total, 111 asphyxiated neonates were classified into two groups of A and B, and incidence rate of asphyxia was estimated at 0.54% and 1.05%, respectively. Severe asphyxia was observed in 35.7% and 28.9% of the infants in groups A and B, respectively. Moreover, mean duration of mechanical ventilation was 25 and 79 hours in groups A and B, respectively.
According to the results of this study, implementation of the health improvement program reduced the incidence of perinatal asphyxia. In addition, number of cesarean cases due to previous C-section was observed to decrease. Therefore, it could be concluded that high-quality resuscitation efforts and restricted rules in the health improvement program lower the risk of long-term complications in asphyxiated neonates. However, no significant difference was observed in the mortality rate of the asphyxiated newborns in this study.

Perinatal asphyxia may cause multiple organ dysfunctions, including myocardial dysfunction. This study aimed to evaluate the prevalence and features of myocardial dysfunction in perinatal asphyxia.
This study was carried out on 31 neonates (≥37 weeks) with perinatal asphyxia who were admitted to the Neonatal Intensive Care Unit (NICU). The neonates underwent Electrocardiography (ECG) and Echocardiography (ECHO) in the first 72 hours of birth. Moreover, in the first 24 hours of birth, 1 cc of blood was taken from the patients for cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB) testing. Following that, venous blood gas was recorded one hour later.
The mean 1- and 5-min Apgar scores were 4±1.76 and 6.8±1.6, respectively. The mean value of serum cTnI was 4±1.76, and mean level of CK-MB was obtained at 136.51±258.51. ECGs were of grade 1. Mitral valve E-wave/Early diastolic (51%), followed by Tricuspid Regurgitation Vena Contracta (48.4%) was found to be the commonest ECHO abnormality, and Mitral annular plane systolic excursion (96.8%) was the most normal ECHO parameter. Infants with ECG grade 1 changes had a lower 5-min Apgar score (P=0.014), and higher serum cTnI level (P=0.002). ECG changes were not significantly correlated with the mean of Apgar at 1 min, umbilical vein PH, and CK-MB.
ECG and ECHO changes, serum troponin I level, and 5-min Apgar score were found to be the predictors for myocardial dysfunction caused by asphyxia in newborn infants

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.

Perinatal asphyxia may result in hypoxic damage in various body organs, especially in the central nervous system. It could induce cascade of biochemical events leading to the cell death and metabolic changes, eventually may increase plasma ammonia levels. The purpose of this study was to determine the prevalence of hyperammonemia in neonates with asphyxia and to find the relationship between ammonia levels and severity of asphyxia. In this cross-sectional study, we included 100 neonates with perinatal asphyxia in the Neonatal Intensive Care Unit of Ali-Asghar Hospital, Iran University of Medical Science, Tehran, Iran in 2010-2011. All full term patients diagnosed of asphyxia were enrolled. The relationship between plasma ammonia levels and sex, gestational age, birth weight and severity of asphyxia were determined.Data were analyzed using SPSS software. Fifty six percent of neonates were male. The mean gestational age was 38.0± 1.2 wk. Mean plasma ammonia level was 222 ± 100 μg/dl and 20% of the neonates had hyperammonemia. It was not associated with gender, gestational age, birth weight, and asphyxia severity. Six patients died and mean plasma ammonia levels was 206±122 μg/dl. In this group, there was no significant relation between plasma ammonia levels and severity of asphyxia. No significant different was seen between plasma ammonia in dead and lived neonates. According to high prevalence of hyperammonemia in neonatal asphyxia, measurement of plasma ammonia levels, is suggested to improve management of asphyxia.

Perinatal asphyxia is an important cause of mortality and permanent neurological and developmental deficit. Early and accurate diagnosis would help to establish the likely prognosis and may also help in determining the most appropriate treatment. Studies in experimental animal models suggest that a protein called Hsp70 may be a good and potentially useful marker of cellular stress that may be clinically useful in determining the presence of neonatal asphyxia. Regarding the importance of early and accurate diagnosis of asphyxia, we conducted this study, which is the first investigation of the comparison of the serum Hsp70 antigen level between asphyxiated and healthy infants. Patients and In this observational study, the serum concentrations of Hsp70 antigen were compared between neonates suffering from perinatal asphyxia (n = 50) and normal neonates (n = 51). The inclusion criteria for the cases were neonates who had reached term and had at least two clinical criteria of asphyxia. Exclusion criteria were babies with gestational age < 37 weeks, infants with congenital abnormalities or positive blood culture. Exclusion criteria in this group were the requirement to hospital stay during first week of the life or babies whose mothers had difficulties during pregnancy or delivery. Term neonates without major anomalies who had asphyxia during delivery were enrolled in the first six hours after delivery, and control group consisted of healthy term neonates without problems and normal delivery process in the first week of life. The cord blood was taken during labor to measure Hsp70 antigen level by using an in-house ELISA (The enzyme-linked immunosorbent assay). The median values of serum anti Hsp70 titers were significantly higher in asphyxiated neonates compared with non-asphyxiated neonates (0.36 [0.04 - 1.14] vs 0.24 [0.01 - 0.63]). At cutoff point = 0.3125 ng/mL, sensitivity was 58% and specificity 76% based on ROC curve. A significant difference between the serum concentrations of Hsp70 of the control and patient group was observed in this study. It is inferred serum concentrations of Hsp70 antigen may be a useful marker for the early diagnosis of that prenatal hypoxia.

N-acetyl-beta-D-glucosaminidase (NAG) is a lysosomal enzyme present in the proximal convoluted tubules of the kidneys that may be used as a marker of proximal tubular damage and nephrotoxicity. An abnormal urinary NAG excretion has been reported in different kinds of renal disorders such as acute kidney injury, urinary tract infection, vesicoureteral reflux; diabetes mellitus; nephrotic syndrome; glomerulonephritis; hypertension; perinatal asphyxia; heavy metals poisoning; drug nephrotoxicity, renal allograft rejection; and heart failure. This paper provides an overview of the diagnostic value of urinary NAG in the nephrourology field.

To evaluate the incidence, etiology, outcome, and predictors of mortality in neonates with Acute Renal Failure (ARF) in an out born Neonatal Intensive Care Unit (NICU) of India. A retrospective analysis of case records of out born neonates, who had ARF at admission or developed ARF during NICU stay, from January to December 2011 (one year) was done. Out of the total 456 neonates admitted during the study period, 44 (9.6%) neonates with ARF (32 males, 12 females) were studied. Their mean gestational age, weight, and age at admission was 34.7±3.9 weeks, 2100±630 grams, and 2.1±6.3 respectively. Causes of ARF were pre-renal in 22 (50%), intrinsic renal failure in 16 (36.3%), and post-renal in six (13.6 %). Oliguria was present in 29 neonates. Neonatal sepsis was the commonest cause of ARF, followed by perinatal asphyxia, respiratory distress syndrome, and genitourinary anomalies. ARF was present at admission in 37 neonates. The mortality rate was 15.9% (7/44). Thirty-seven (84%) were discharged with complete recovery of renal functions and followed for six months. Shock, oliguria, need for mechanical ventilation, and presence of disseminated intravascular coagulopathy (DIC) emerged as predictors of mortality in neonates with ARF. The incidence and mortality rate of neonatal ARF were 9.6% and 15.9% respectively in our out born NICU. Neonatal sepsis was the commonest cause of ARF followed by perinatal asphyxia. Shock, oliguria, need for mechanical ventilation, and presence of DIC were associated with poor outcome.