Asphyxiated Term Newborns Research Articles

Seizures in Asphyxiated Term Newborns Based on Admission Thompson Score at the Women and Newborn Hospital, University Teaching Hospitals in Lusaka, Zambia.

Purpose: The main purpose of the study was to investigate seizures in asphyxiated term neonates based on the admission Thompson score at the University of Zambia, Women and New-born Neonatal Intensive Care Unit. Methodology: A cross-sectional descriptive study design was used to conduct the study between (May 2022 to April 2023) in the Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital for Women and Newborns in Lusaka Zambia. Stratified sampling was used to collect 217 files of neonates born at the tertiary facility as well as those referred from other centres with Apgar scores of ≤ 7 at one and five minutes of life. A structured questionnaire was used to collect data from medical records, the Thompson score (TS) was assessed on admission and details of neonatal seizures were analyzed using chi-square, fisher’s exact test and multivariable logistic regression. Findings: On admission, TS assessment was conducted on all 217 neonates of which 169 (77.9 %) neonates were classified with mild HIE,45 (20.9 %) moderate and 3(1.4 %) with severe HIE. Most neonates (77.4%) presented with seizures on admission. Results of the chi-square and fisher's exact tests showed that Thompson's score on admission was significantly associated with seizure occurrence (p=0.001). On multivariable binary logistic regression neonates with moderate HIE had over 10 times more odds of seizure occurrence compared to neonates with a mild HIE score (aOR=10.6, CI=2.32, 48.1, p=0.002). A unique contribution to theory, practice, and policy: The study concluded that seizures were present in all categories of HIE, the majority of who were classified with moderate HIE based on the Thompson score. Therefore, improving the quality of intrapartum care at the Women and Newborn Hospital can significantly reduce the occurrence of asphyxia and its complication.

Predictive ability of 2-h serum neutrophil gelatinase-associated lipocalin for perinatal asphyxia-induced acute kidney injury.

Acute kidney injury (AKI) is a common cause of mortality and morbidity in asphyxiated newborns. Recent research suggests serum neutrophil gelatinase-associated lipocalin (sNGAL) as an early biomarker of AKI in newborns with perinatal asphyxia. The prospect of sNGAL is yet to be studied in Nigeria, with a huge burden of asphyxia-related neonatal deaths. A cross-sectional analytic study was conducted on 53 asphyxiated term newborns and 53 healthy babies at the newborn unit of the Wesley Guild Hospital Ilesa, Nigeria. sNGAL was assessed in all neonates with perinatal asphyxia at baseline (within 30min of delivery), 2h, and 48h of life. Mean sNGAL was significantly higher in asphyxiated newborns than in the control group, 81.4 (45.9) vs. 53.7 (29.2), p < 0.001. However, the mean 2-h sNGAL levels were similar in asphyxiated babies with and without AKI 100.5 (36.7) ng/ml vs. 85.3 (31.4) ng/ml, p = 0.115. The 2-h sNGAL with an AUC of 0.61 at an 83.0ng/ml cut-off had an acceptable discriminating capability of predicting AKI. The sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 51.5%, 50%, and 81%, respectively. This study shows that sNGAL levels were significantly elevated in newborns with perinatal asphyxia compared to healthy neonates, but the 2-h sNGAL is less predictive of AKI in newborns with perinatal asphyxia. The negative predictive value is high, and this may find some relevance in the attempts at early exclusion of asphyxiated babies prone to AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.

Levetiracetam or Phenobarbitone as a First-Line Anticonvulsant in Asphyxiated Term Newborns? An Open-Label, Single-Center, Randomized, Controlled, Pragmatic Trial.

Neonatal seizures are one of the most challenging problems for experts across the globe. Although there is no consensus on the "ideal" treatment of neonatal seizures, phenobarbitone has been the drug of choice for decades. Unfortunately, although extensively studied in adults and children, levetiracetam lacks rigorous evaluation in the neonatal population, despite its frequent use as an off-label drug. The objective of this open-label, randomized, active-control, single-center, pragmatic trial was to compare the effectiveness of levetiracetam with phenobarbitone for term asphyxiated infants as a first-line drug. The participants included in this study were inborn term asphyxiated infants with seizures in the first 48 hours of life. Infants satisfying the inclusion criteria were randomized to receive levetiracetam (20 mg/kg) or phenobarbitone (20 mg/kg). Clinical seizure control was noted. Infants who failed to respond to the primary drug were given the other group drug. Of 103 eligible infants, 82 were randomly assigned (44 levetiracetam group, 38 phenobarbitone group). Clinical seizure control with the primary drug and maintenance of the same for 24 hours was observed in 29 infants (65.9%) in the levetiracetam group and 13 infants (34.2%) in the phenobarbitone group (P < .05, relative risk 0.52, 95% confidence interval 0.32-0.84). Of the infants in the phenobarbitone group who did not respond to the primary drug, 57.8% were controlled after adding levetiracetam. Levetiracetam can be used with effectiveness as a first- and second-line drug in asphyxiated term infants. A more extensive study on pharmacokinetics and optimal regimen is required.

Hemodynamics of superior mesenteric artery by doppler flow velocimetry in enterally fed moderately asphyxiated newborns

Introduction: Asphyxia is an important cause of neonatal mortality and morbidity. The disturbed hemodynamics caused by asphyxia can damage a number of organ systems including gastrointestinal system. Enteral feedings can therefore be risky in the asphyxiated newborns with jeopardized blood supply. Objective: The objective of this study was to estimate the abnormal Doppler flow indices of splanchnic circulation in moderately asphyxiated term newborns on the 1st day of life. Design: This was a prospective case–control study. Study setting: This study was conducted in the Neonatology Division, Department of Pediatrics and Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. Materials and Methods: This study included thirty hemodynamically stable asphyxiated babies as cases. The controls were gestation- as well as weight-matched normal newborns. Blood flow in the superior mesenteric artery (SMA) was estimated by Doppler ultrasonography within the first 24 h of birth of the baby. The peak systolic velocity, end-diastolic velocity, time-averaged mean velocity, and the resistive index were recorded. The measurement was done before and 1 h after giving feed to the baby. The pre- and postfeed Doppler indices of the SMA were measured and compared with the controls. The tolerance of oral feeds by the babies was regularly monitored. Results: The baseline velocity in the study group prior to feeding was comparable to the control group. None of the cases developed feed intolerance and showed a similar postfeed hemodynamic response in the SMA as that of controls. Conclusion: Enteral feeds could be safely started and continued in all the moderately asphyxiated term neonates within the 1st day of life after demonstrating establishment of splanchnic flow in the Doppler study.

Fluid Supply and Feeding Practices in Cooled Asphyxiated Newborns.

Therapeutic hypothermia (TH) for 72 h is the standard treatment to reduce neurological deficits in term newborns with hypoxic-ischemic encephalopathy. There is a large variability regarding nutritional supply during TH treatment in asphyxiated newborns. We performed a retrospective multicentre study in four level I (highest level of care in Germany) NICUs, including 135 asphyxiated term newborns undergoing TH. We analyzed enteral and parenteral nutritional supply during and after TH. We correlated nutritional supply with risk factors for encephalopathy, pH, Sarnat score, mechanical ventilation, seizures, and sedation. A total of 120 of 135 neonates received enteral nutritional supply within the first 24 h, and the majority of children were fully enterally fed within the first 10 days. The grade of encephalopathy and mechanical ventilation had a significant influence on the amount of enteral fluids (p = 0.01), whereas the pH and appearance of seizures did not affect the amount of nutritional supply significantly. Furthermore, we did not observe any correlation between enteral intake and abdominal complications such as necrotizing enterocolitis. We observed a large variability of feeding regimes in the four participating NICUs. Early enteral feeding among newborns undergoing TH was performed in each NICU and was well tolerated without increased rates of complications.

Severity and immediate neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy admitted in NICU at a tertiary hospital in Bangladesh

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity and long-term neurological deficits.&#x0D; Objective: The aim of the study was to determine the severity of encephalopathy and immediate neurodevelopmental outcomes in term neonates with HIE admitted in NICU at a tertiary care hospital.&#x0D; Materials and Methods: This was a Prospective Cohort study conducted between July 2016 and June 2017 at Dhaka Medical college Hospital, Dhaka. Asphyxiated term newborns who came within 12 hours of birth were enrolled in this study. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE. Neurodevelopmental assessment was performed using age specific rapid neurodevelopmental assessment tool (RNDA) at and 3 months after discharge to identify impairment in specific developmental domains. We determined the relation between severity of HIE and clinical outcome.&#x0D; Results: 60 patients were included in this study and their mean duration of hospital stay was 7.19 ± 5.26 days. The majority, 40% had moderate HIE, followed by 33.33%, 26.67% that had mild and severe HIE respectively. A total of 20% died, and most of them had severe HIE (83.33%). Normal development was found in only 11.67% cases. Moderate and severe neurodevelopmental impairment (NDI) was found in 33.33% and 25% cases respectively. At discharge, the most severely impaired domains were speech, seizure, primitive reflex and behaviour whereas at 3 months of age it was gross motor and seizure. When neurodevelopmental outcome was compared with different stages of encephalopathy, significant association was found between moderate to severe impairment/death with stage III of HIE.&#x0D; Conclusion: Apart from mortality, a significant proportion of term neonates with HIE developed NDIs and adverse neurodevelopmental outcomes was significantly associated with severity of encephalopathy.&#x0D; Bangladesh Crit Care J March 2021; 9(1): 22-27

Brain MRI after therapeutic hypothermia in asphyxiated newborns: Predictive value at one year of imaging features

PurposeTo compare early brain MRI using a composite imaging score and outcome at one year in asphyxiated newborns treated by hypothermia. MethodsThis retrospective study included for two years consecutive asphyxiated term newborns treated by hypothermia for hypoxic-ischemic encephalopathy, and who had brain MRI before day 8. Therapeutic hypothermia was initiated within the first 6 h of life and continued for 72 h. Imaging protocol included T1 and T2 sequences, diffusion-weighted imaging (DWI), evaluated with a specific composite score, and spectroscopy. Clinical evaluation was performed at one year of age, outcome was classified as favorable/unfavorable. The primary endpoint was the correlation between our MRI score and outcome with the definition of a threshold. The secondary endpoints were to find the most relevant criteria within the score and to evaluate objective signal measurements to support subjective criteria. ResultsAmong the 33 included patients, 9 died during the first days of life, 20 had a favorable outcome, 4 an unfavorable one. MRI score was correlated to a poor clinical outcome (p < 0.001). Most of the criteria within the score and spectroscopy results were relevant (p < 0.05). Cerebral edema was objectively assessed by the signal intensity ratio of white matter compared to cerebrospinal fluid (CSF) on T2-weighted images (p < 0.001). ConclusionMRI score was predictive of neurodevelopmental outcome at one year. The most relevant criteria within the score were DWI abnormalities in basal ganglia and thalami and loss of white-cortical grey matter differentiation. Signal intensity ratio between white matter and CSF higher than 0.75 supports the presence of edema.

A comparative study on serum thyroid hormone level in asphyxiated preterm and term newborn in cord blood at birth and 72 hrs of life, in a tertiary care center

Introduction: Thyroid hormone is essential for somatic growth and neurodevelopment. Its level is influenced by various factors. Perinatal asphyxia which altered several homones in neonate still less is known about the effect on neonatal thyroid hormone levels. Our study is to evaluate the effect of perinatal asphyxia, that alters the thyroid function in both term and preterm asphyxiated newborn by comparing cord blood and 72 hours venous blood. Materials and Methods: A prospective case-control study was carried out at Tertiary care Gayatri Hospital. we evaluated thyroid function in 40 asphyxiated term newborns and 40 preterm newborns (34-36 wks) with with history of low apgar score at birth (< 6 at 1 and 5 min) with acidosis (pH < 7.20), and 40 normal healthy preterm, born by spontaneous vaginal delivery were taken. In all the cases proper maternal and perinatal history was taken and categorized accordingly. Cord blood and 72 hours after birth venous blood were collected in both babies and compared the level of thyroid hormones (T3, T4, TSH) via radioimmunoassay. Results: There was no significant difference in thyroid hormone, observed in cord blood and in venous sample 72 hours after birth in asphyxiated preterm as compared to term baby. Conclusion: Perinatal asphyxia affects thyroid function but there were less studies done so far over asphyxiated premature baby, to know the association between thyroid hormone level and asphyxia as term babies. So a larger study is needed to support and confirm our observations. Keywords: Hypoxic Ischemic Encephalopathy (HIE), Thyroid stimulating Hormone (TSH), Non-thyroidal illness syndrome.

Utility of creatine kinase MB in the diagnosis of myocardial dysfunction in asphyxiated term newborns – Prospective study

Introduction: Perinatal Asphyxia is a multi-system disorder and its effects are not limited to central Nervous System. Cardiac impairment occurs in about 24-60% of neonates with asphyxia. Myocardial dysfunction secondary to severe birth asphyxia will lead to loss of cerebral auto-regulation with subsequent severe encephalopathy. This study was done to evaluate the usefulness of Creatine Kinase MB (CKMB) in diagnosing myocardial injury in perinatal asphyxia well as prognostic indicator of perinatal asphyxia. Materials and Methods: A Hospital based Prospective Analytical Study performed in 100 asphyxiated term neonates. CKMB was evaluated for sensitivity and specificity in comparison with clinical diagnosis of myocardial injury and were correlated with results from ECG, ECHO, duration of inotrope, severity of shock and outcome. Results: In our study among 100 term asphyxiated neonates, 79% neonates had clinical evidence of myocardial injury. We had large number of neonates (41%) with HIE grade 3 while 35% were stage 1 HIE and 24% were stage 2 HIE. The ROC curve for cardiac dysfunction showed that the value of CKMB for prediction of cardiac dysfunction was 42 IU/L (sensitivity of 79.5% and specificity of 93.3%). The cut off CKMB value for prediction of mortality in our study is 91.1 IU/L with sensitivity of 90.0% and specificity of 83.8% Also the value of CKMB had strong statistical significance with severity of HIE (p Conclusion: CKMB is valuable tool in resource limited settings for early detection of myocardial injury due to perinatal asphyxia. The early detection and prompt treatment of condition will help in improving prognosis of these asphyxiated newborns. Keywords: Perinatal asphyxia, Creatine kinase – MB, Myocardial Injury.

Serum Magnesium and Calcium Status among Term Asphyxiated Newborns with Moderate to Severe Hypoxic-ischemic Encephalopathy (HIE)

Background &amp; objective: Perinatal asphyxia affects all organs of the body and brain is the most affected organ. The study was undertaken to find out the status of serum magnesium and calcium level and their significant association among asphyxiated term newborns with moderate to severe HIE.Material &amp; methods: The Cross sectional study was done in the Department of Neonatology, Dhaka Medical College Hospital during January 2012 to July 2012. A total of 102 asphyxiated term neonates were enrolled , who has H/O perinatal asphyxia and had Apgar score of 6 or &lt;6 at 5 minutes. Clinical grading of HIE into moderate and severe was done according to modified Sarnat and Sarnat scoring system .Under aseptic precautions with standard protocol , estimation of serum magnesium and calcium level in venous blood was done at 48 hours and 7th day of birth . Among the study population , 17 patients had died during follow up and 4 patients were absconded. Finally 81 patients were evaluated by both blood samples though initial 102 cases were evaluated by their first sample. 50 normal healthy infants were also evaluated for serum magnesium and calcium at their 48 hours of birth. Chi-square test was used to assess statistical significance, Pearson correlation coefficient test was done to find out correlation between serum magnesium and calcium status and APGAR score &amp; t test was done to assess the comparison between the values of serum magnesium and calcium found on two occasions.Results: Of 102 cases majority (58%) were male. Most of the cases (65.68%) were moderate HIE. Mean serum magnesium was 1.36(0.9-2.8) mg/dl and 1.16(.88-2.6) mg/dl among HIE II and HIE III respectively (p&lt;0.05). Mean serum calcium of HIE II and HIE III were 7.14(5.1-9.6) mg/dl and 6.58(5.3-9.0) mg/dl respectively (p&lt;0.05). There is positive correlation with individual APGAR score with serum magnesium (r=0.229, p=0.02) and serum calcium (r=0.231, p=0.019) level. Hypocalcaemia was found 35.82% and 57.14% among HIE II And HIE III cases respectively(p&lt;0.01). Hypomagnesaemia was found 28.36% and 45.71% among HIE II and HIE III (p&lt;0.05).Conclusion: Hypomagnesaemia and hypocalcaemia are significantly associated with the degree of severity of HIE.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 148-152

Predictive Value of Thompson-Score for Long-Term Neurological and Cognitive Outcome in Term Newborns with Perinatal Asphyxia and Hypoxic-Ischemic Encephalopathy Undergoing Controlled Hypothermia Treatment

Background: The so-called Thompson-score (TS) for newborns with hypoxic-ischemic encephalopathy (HIE) was developed before the introduction of controlled hypothermia as clinical routine. Information on the predictive value of TS in newborns undergoing therapeutic hypothermia to estimate long-term outcome is limited. Objectives: To determine the predictive value of TS to estimate long-term cognitive and neurological outcome in newborns with perinatal asphyxia treated with controlled hypothermia. Methods: Thirty-six term newborns with HIE undergoing controlled hypothermia were followed using Wechsler Preschool and Primary Scale of intelligence III test and standardized neurological examination. The primary outcome was survival without cognitive impairment, defined as an IQ ≥85. Secondary outcomes were motor outcomes, survival without relevant neurological impairment, death and epilepsy. Results: Follow-up was done in 33 out of 36 (91.6%) infants at 53 ± 12 months (mean ± SD). For all investigated parameters, a statistically significant relationship with peak TS was demonstrated. A one-point increase in peak TS indicated an OR (95% CI) of 1.5 (1.1–2.0, p = 0.006) for death or cognitive impairment, an OR (95% CI) of 2.2 (1.3–3.8, p = 0.004) for death or relevant neurologic impairment, an OR (95% CI) of 2.1 (1.3–3.5, p = 0.005) for death or epilepsy and an OR (95% CI) of 1.5 (1.1–2.1, p = 0.02) for death. Although the TS for newborns with adverse outcome (death or cognitive impairment) compared to normal outcome tended to be higher (13 [4–16] vs. 9 [0–13], d1; 15 [5–19] vs. 9 [1–14], d2; 14 [5–21] vs. 8 [2–15], d3; median [range]), there was a considerable overlap during the first 3 days of life between both groups. Conclusions: The TS seems to be a prognostic tool for predicting the long-term outcome in asphyxiated term newborns undergoing controlled hypothermia after the third day of life. A higher score appears to be significantly associated with an adverse outcome.

A study of renal functions in asphyxiated term newborns

A study of renal functions in asphyxiated term newborns

Amino acid and acylcarnitine profiles in perinatal asphyxia: a case-control study

Objective: To estimate cord blood amino acid and acylcarnitine levels in term newborns exposed to perinatal asphyxia.Materials and methods: We studied 45 asphyxiated term newborns (cases) and 20 gestational age-matched healthy newborns (control). 16 cases developed HIE according to clinical scoring and amplitude-integrated electroencephalography. Asphyxiated cases were accordingly subdivided into: HIE group (n = 16) and Asphyxia group (n = 29). Amino acid and acylcarnitine levels were measured in cord blood dried spot samples from all newborns using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Data were analyzed using one-way ANOVA with post hoc test and MetaboAnalyst-2.Results: Distinct metabolite alterations were detected in cases versus control, in HIE versus Asphyxia, and in Survivors within HIE group (n = 6) versus nonsurvivors (n = 10). Principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed increased levels of methionine and certain acylcarnitines, but reduced levels of ornithine, histidine, and arginine. Metabolite set enrichment analysis (MSEA); compared to KEGG library metabolite sets, identified some disorders with similar metabolomic derangements.Conclusions: We report UPLC-MS detectable alterations of amino acids and acylcarnitines in asphyxiated newborns at birth, that can serve as early diagnostic bedside biomarkers for HIE and predictors for its short-term outcome, and in the near future, as therapeutic targets.

Treating perinatal asphyxia with theophylline at birth helps to reduce the severity of renal dysfunction in term neonates.

Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. This study was designed to determine whether theophylline could prevent or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomised 159 severely asphyxiated term newborns to receive a single dose of 5 mg/kg intravenous theophylline (n = 78) or a placebo (n = 81) during the first hour of life. The infant's 24-hour fluid intake, urine volume, serum creatinine, creatinine clearance and sodium excretion were recorded during days one, three and five of life, starting 12 hours after the theophylline or placebo infusion. Neonates in the theophylline group had lower serum creatinine levels (0.83 ± 0.35 versus 1.47 ± 0.61; p = 0.00) and higher endogenous creatinine clearance (32.16 ± 16.34 versus 17.73 ± 7.92; p = 0.00) than the placebo group. Severe renal dysfunction, namely acute kidney injury, was present in 36 (15%) of the neonates in the theophylline group versus 117 (48%) in the placebo group (p < 0.01). A single dose of intravenous theophylline administered to term neonates with perinatal asphyxia within the first hour of life significantly decreased serum creatinine levels and significantly increased creatinine clearance.

Effect of persistent pulmonary hypertension on brain oxygenation in asphyxiated term newborns treated with hypothermia

Objective: To better understand the impact of persistent pulmonary hypertension (PPHN) on brain oxygenation in term asphyxiated newborns treated with hypothermia.Methods: The regional cerebral oxygenation saturation (rSO2) measured by near-infrared spectroscopy was compared to pre/post-ductal oxygen saturation and mean arterial blood pressure in three term asphyxiated newborns with documented PPHN during their first 4 days of life while they were being treated with hypothermia.Results: The cerebral oxygen saturation remained relatively stable when oxygen saturation was more than 92% and when there was no difference between pre- and post-ductal oxygen saturations. Episodes of desaturations with a difference between pre- and post-ductal saturations, as well as episodes of hypotension, caused a significant decrease in rSO2 in these newborns.Conclusion: This case series demonstrates that PPHN has a profound impact on brain oxygenation in term asphyxiated newborns treated with hypothermia during the first days of life after birth. PPHN may represent an additional risk factor for brain injury in these newborns during the first days of life.

Dying neurons in thalamus of asphyxiated term newborns and rats are autophagic.

Neonatal hypoxic-ischemic encephalopathy (HIE) still carries a high burden by its mortality and long-term neurological morbidity in survivors. Apart from hypothermia, there is no acknowledged therapy for HIE, reflecting the lack of mechanistic understanding of its pathophysiology. (Macro)autophagy, a physiological intracellular process of lysosomal degradation, has been proposed to be excessively activated in excitotoxic conditions such as HIE. The present study examines whether neuronal autophagy in the thalamus of asphyxiated human newborns or P7 rats is enhanced and related to neuronal death processes. Neuronal autophagy and cell death were evaluated in the thalamus (frequently injured in severe HIE) of both human newborns who died after severe HIE (n = 5) and P7 hypoxic-ischemic rats (Rice-Vannuci model). Autophagic (LC3, p62), lysosomal (LAMP1, cathepsins), and cell death (TUNEL, caspase-3) markers were studied by immunohistochemistry in human and rat brain sections, and by additional methods in rats (immunoblotting, histochemistry, and electron microscopy). Following severe perinatal asphyxia in both humans and rats, thalamic neurons displayed up to 10-fold (p < 0.001) higher numbers of autophagosomes and lysosomes, implying an enhanced autophagic flux. The highly autophagic neurons presented strong features of apoptosis. These findings were confirmed and elucidated in more detail in rats. These results show for the first time that autophagy is enhanced in severe HIE in dying thalamic neurons of human newborns, as in rats. Experimental neuroprotective strategies targeting autophagy could thus be a promising lead to follow for the development of future therapeutic approaches.

Clinical study of passive cooling in treatment of severe asphyxiated newborn infants

Objective Therapeutic hypothermia has become a standard neuroprotective treatment in term newborn infants following perinatal asphyxia, but active cooling with whole body surface or head cooling is both complex and expensive.The clinical feasibility of passive cooling in treatment of full term infants with severe asphyxia was investigated. Methods Thirty-two severe asphyxiated term newborns treated with hypothermia were analyzed, who were randomly divided into 2 groups: passive cooling group(n=17) and active cooling group(n=15). Active cooling group adopted MTRE ALLON™-thermo regulatory systems, passive cooling group using natural cooling method.Hypothermia treatment time was 72 hours.At the end of treatment, the clinical manifestations, biochemical parameters and clinical efficacy of infants between the 2 groups were compared. Results During treatment all infants had no cardiac arrhythmia, hypoglycemia, sustained metabolic acidosis, blood-borne infections, local cold injury or bleeding.Infants in passive cooling group had a relatively wide range of rectal temperature fluctuations[average (33.47±0.71) ℃] and infants in active cooling group had a relatively narrow range of rectal temperature fluctuations[average (33.66±0.29) ℃], but there was no statistically significant difference in their mean rectal temperature(t=1.941, P=0.055). One patient died in active cooling group, but there were no significant differences in suckling age, length of hospital stay, neonatal behavioral neurological assessment score, abnormal cranial ultrasound and MRI between the survivors of the two groups(all P>0.05). Conclusions In NICU, environmental temperature is relatively stable, passive cooling for asphyxiated newborns appears to be feasible for maintenance of hypothermia with a lower risk of adverse reactions. Key words: Asphyxia; Hypothermia; Infant, newborn; Passive cooling; Active cooling

Early Hyperglycemia Is Associated With Poor Gross Motor Outcome in Asphyxiated Term Newborns

BackgroundHyperglycemia after ischemic stroke in adults and after near-drowning in children is associated with a poor neurological outcome. Anaerobic metabolism of glucose leads to buildup of lactic acid, free radical production, mitochondrial failure, and ultimately an increase in neurological injury. In asphyxiated infants, high lactate peaks are seen in the basal ganglia with magnetic resonance spectroscopy. Because motor disability in asphyxiated full-term newborns often relates to injury in the basal ganglia, we hypothesized that hyperglycemia and associated buildup of lactic acid may lead to worse gross motor outcome. MethodsGlucose, blood gas values, and demographic data were abstracted from the medical records of 41 term infants with asphyxia and without confounding diagnoses. Their Gross Motor Function Classification System scores were determined from the medical record or by structured telephone interviews. ResultsThe outcomes of 14 infants were considered poor on the basis of death within the first 6 months or moderate-to-severe cerebral palsy (Gross Motor Function Classification System score 1-5). The other 27 infants had no gross motor disability (Gross Motor Function Classification System score 0). The highest recorded blood glucose correlated with poor outcome (P = 0.046 by logistic regression). Infants with hyperglycemia (blood glucose > 150 mg/dL) were more likely to have poor outcome (P = 0.017; odds ratio: 5.9; 95% confidence interval: 1.4-24.7). ConclusionsHigh blood glucose in the first 12 hours is associated with poor gross motor outcome in this cohort of asphyxiated term infants. Clinicians should avoid hyperglycemia in managing term infants with asphyxia.

Transcriptome profiling of the newborn mouse lung after hypoxia and reoxygenation: hyperoxic reoxygenation affects mTOR signaling pathway, DNA repair, and JNK-pathway regulation

The use of oxygen in acute treatment of asphyxiated term newborns is associated with increased mortality. It is unclear how hyperoxic reoxygenation after hypoxia affects transcriptional changes in the newborn lung. On postnatal day 7, C57BL/6 mice (n = 62) were randomized to 120-min hypoxia (fraction of inspired oxygen (FiO2) 0.08) or normoxia. The hypoxia group was further randomized to reoxygenation for 30 min with FiO2 0.21, 0.40, 0.60, or 1.00, and the normoxia group to FiO2 0.21 or 1.00. Transcriptome profiling was performed on homogenized lung tissue using the Affymetrix 750k expression array, and validation was carried out by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. The hypoxia-reoxygenation model induced hypoxia-inducible factor 1 (HIF-1) targets like Vegfc, Adm, and Aqp1. In total, ~70% of the significantly differentially expressed genes were detected in the two high hyperoxic groups (FiO2 0.60 and 1.00). Reoxygenation with 100% oxygen after hypoxia uniquely upregulated Gadd45g, Dusp1, Peg3, and Tgm2. Pathway analysis identified mammalian target of rapamycin (mTOR) signaling pathway, DNA repair, c-jun N-terminal kinase (JNK)-pathway regulation, and cell cycle after hyperoxic reoxygenation was applied. Acute hypoxia induces HIF-1 targets independent of the reoxygenation regime applied. Hyperoxic reoxygenation affects pathways regulating cell growth and survival. DNA-damage-responsive genes are restricted to reoxygenation with 100% oxygen.

O79 – 1599 Prognostic value of conventional EEG in asphyxiated term newborns treated with hypothermia: experience in 20 cases

O79 – 1599 Prognostic value of conventional EEG in asphyxiated term newborns treated with hypothermia: experience in 20 cases