Cases Of Perinatal Asphyxia Research Articles

Develop a web-based system using the Naïve Bayes algorithm to predict asphyxia neonatal

Introduction: Most cases of perinatal asphyxia are caused by conditions unrelated to labor. When asphyxia occurs during childbirth, it is usually caused by an obstetric emergency that was not detected during pregnancy. It is essential to prevent asphyxia by identifying the incidence of asphyxia during pregnancy. Several studies have been conducted to identify asphyxia problems developing by predictive models. However, there has been no development of a system for predicting birth asphyxia during pregnancy and carried out in primary health facilities.Purpose: Develop a web-based system using the Naïve Bayes (NB) algorithm to predict asphyxia neonatal using a dataset of antepartum risk factors in primary health facilities.Methods: This study employed research and development, which consists of 4 stages, namely literature study, development stage, expert validity, and trial.Results: A system that health workers in primary health facilities can use to predict asphyxia neonatal and recommend referrals for determining the place of childbirth has been successfully created. The system performance test predicted asphyxia neonatal with all NB evaluation values reaching more than 98%, and the prediction accuracy in the respondent test included in the High Accuracy category (MAPE value 9.06%).Conclusion: The development of a web-based system using the NB algorithm has been proven to be able to predict asphyxia neonatal and can be implemented for health workers as an effort to anticipate delays in handling cases of asphyxia neonatal because of the predicted results along with recommendations for focusing mothers with the risk of babies born asphyxia to find out possible childbirth places.

Comparative Study Between Serum Level of Total L-carnitine in Neonatal Hypoxic Ischemic Encephalopathy (HIE) and Transient Tachypnea of the Newborn (TTN)

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of cerebral palsy. Objectives: We aimed to compare the serum levels of total L-carnitine in newborns with HIE and Transient tachypnea of the newborn and to determine the correlation between associated demographic data, associated changes in laboratory findings, and outcome in cases with HIE. Methods: This comparative, prospective, and observational study was conducted at the Neonatal Intensive Care Unit (NICU) of Assiut University Children Hospital. All the cases of perinatal asphyxia and TTN admitted to the NICU during 2016 - 2018 were included. Results: It was found that the serum level of total L-carnitine decreased in both HIE (I) and TTN (II) cases, but the difference was not significant (5.51 ± 1.30 µmol/L in group I vs. 6.22 ± 2.56 µmol/l in group II). Male factor with changes in the serum sodium level (132.63 ± 9.30) and abnormal serum creatinine level (1.4 [0.7 - 15.0]) were significantly related to the outcome of HIE cases. Conclusions: The serum level of total L-carnitine declined in both HIE and TTN cases. Male factor with changes in serum sodium level and abnormal serum creatinine level were significantly related to the mortality of cases with HIE.

Is perinatal asphyxia predictable?

BackgroundThe objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management.MethodsWe did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ − 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar < 5, or need for resuscitation > 10 min.FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk.In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated.ResultsPerinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45–0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes.Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR.ConclusionsWe identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.

Prevalence of Acute Kidney Injury in Patients with Perinatal Asphyxia in Tertiary Hospital

Introduction: Perinatal asphyxia has multisystem involvement, kidneys are most frequently affected. This study was conducted to determine the relation between severity of Hypoxic Ischaemic Encephalopathy (HIE) with acute kidney injury in term neonates.&#x0D; Methods: Retrospective study was done over a period of six months (Sept 2016 to Feb 2017) at Department of Neonatology of a tertiary level maternity hospital. Total 98 cases of Perinatal asphyxia cases which were diagnosed with certain degree of HIE were evaluated for its relation with renal involvement in different stage of HIE.&#x0D; Results: Out of 98 cases of perinatal asphyxia, HIE I was 21%, HIE II was 69% and HIE III was 10%, among which 72% cases had some degree of renal problem. seventy two cases had renal problem, oliguric cases were 41 (57%) among which 33% case had persistent symptoms and associated renal function deterioration. Among 42 cases of deranged RFTs, 40% of cases has persistently deranged RFTs. In comparison to HIE II in HIE III, 22% of cases had one time derangement of RFTs and 33% cases had at least one observation of oliguria, while remaining 45% cases had persistent deterioration of RFTs and urine output, suggesting that progression in HIE stage has significant association with renal dysfunction (p &lt; 0.05). More than half of the cases of HIE III had mortality while 20.3% of HIE II cases had mortality, indicating that the mortality is highly significant with higher HIE grade (p &lt; 0.05).&#x0D; Conclusions: Renal involvement is very common in cases of perinatal asphyxia, and severity of renal involvement increases as the HIE grading increases.

Prevalence of electrolyte disturbances in perinatal asphyxia: a prospective study

BackgroundBirth asphyxia is defined as the presence of hypoxia, hypercapnia, and acidosis leading the newborn to systemic disturbances probably electrolyte disturbance also. Knowledge of these electrolyte disturbances is very valuable as it can be an important parameter affecting perinatal morbidity, mortality and ongoing management.MethodsSerum sodium, potassium and ionized calcium of asphyxiated term newborn were sent within one hour of birth as per the inclusion criteria. Statistical comparison of mean values of different electrolytes between different groups of perinatal asphyxia was performed by ANOVA test for parametric data and significant data were further analyzed using post hoc test. Bivariate analysis was done to determine the correlations between Apgar score at 5 min and serum electrolytes. Pearson test was used to calculate the correlation coefficient. Box plot was used to show the median and quartile between serum electrolytes and Apgar score at 5 min.ResultThe mean values of sodium for mild, moderate and severe asphyxia were 135.52, 130.7 and 127.15 meq/l respectively. The values of potassium for mild, moderate and severe asphyxia were 4.96, 5.93 and 6.78 meq/l respectively. Similarly, the mean values of ionized calcium for mild, moderate and severe asphyxia were 1.07, 1.12 and 0.99 mmol/l respectively. The values of sodium and potassium among different severity of asphyxia were significantly different (p-value< 0.001). Significant positive correlation was found between serum sodium and Apgar score at 5 min. Significant negative correlation was present between serum potassium and Apgar score at 5 min.ConclusionThe degree of hyponatremia and hyperkalemia was directly proportional to the severity of birth asphyxia. So these electrolyte disturbances should always be kept in mind while managing cases of perinatal asphyxia and should be managed accordingly.

Fatores de Risco Associados a Asfixia Perinatal no Hospital Universitário Méderi, 2010-2011

Introdução: a hipoxemia secundária a complicações fetais ou obstétricas é causa de asfixia perinatal e lesão cerebral no recém-nascido; 15 a 20% destas crianças morrem durante o período neonatal e 25% dos que sobrevivem, apresentam déficit neurológicos permanentes. Objetivo: determinar fatores de risco anteparto, intraparto e fetais associados ao diagnóstico de asfixia perinatal nos recém-nascidos do serviço de neonatologia do Hospital Universitário Mayor Mederi de Bogotá, nos anos 2010-2011. Materiais e métodos: estudo retrospectivo de casos e controles pareado por data de nascimento, com uma relação 1:5 (51:306). Os casos de asfixia perinatal se diagnosticaram segundo os critérios da Academia Americana de Pediatria e o Colégio Americano de Ginecologia e Obstetrícia. As associações se avaliaram com a prova de Chi-quadrado de Mantel e Haenszel ou o Teste de Fisher para dados pareados, com or e intervalo de con ança do 95%. A análise multivariada se realizou com um modelo de regressão logística condicional. Resultados: fatores de risco com associação significativa: Anteparto: antecedentes patológicos maternos e primigestação. Intraparto: desprendimento prematuro de placenta, hemorragia do terceiro trimestre, oligo-hidrâmnios, taquicardia fetal, monitoramento fetal intraparto anormal, expulsivo prolongado, febre materna, corioamnionite, convulsões maternas e bradicardia fetal. Fetais: idade gestacional por Ballard igual ou &lt;36semanas, via do nascimento instrumentado, líquido amniótico hemorrágico ou tingido de mecónio, circular de cordão, peso ao nascer igual ou &lt;2500 gramas. Os sublinhados e a síndrome hipertensiva associado à gravidez se encontraram significativos na análise multivariada. Conclusões: o reconhecimento e controle temporão dos fatores de risco deve contribuir a diminuir a probabilidade de asfixia perinatal nos recém-nascidos.

Induction of Labor With Vaginal Misoprostol Plus Oxytocin Versus Oxytocin Alone

Abstract Objective To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score. Methods This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed. Results The mean time from induction to delivery was 9.36 ± 1.97 hours in the misoprostol plus oxytocin group and 11.08 ± 3.23 in the oxytocin alone group ( P = 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia. Conclusion A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.

Induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone

Objective To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score. Methods This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed. Results The mean time from induction to delivery was 9.36 ± 1.97 hours in the misoprostol plus oxytocin group and 11.08 ± 3.23 in the oxytocin alone group ( P = 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia. Conclusion A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.

Minimizing oxidative injury to the developing brain: the therapeutic quest continues

EDITOR-IN-CHIEF Oxidative injury to the developing central nervous system continues to be an area of concern and controversy in perinatal medicine. The clinical examples of hypoxia‐ ischemia-induced oxidative stress in the perinatal period include antepartum and intrapartum asphyxial events and neonatal respiratory distress. In the last scenario, oxidative stress may also be produced during resuscitation secondary to hyperoxygenation. The spectrum of oxidative stress-induced neurological syndromes extends from behavioral and learning disabilities to cerebral palsy. However, the causal relationship between clinically recognized episodes of hypoxia and perinatal brain lesions is often uncertain. Most cases of perinatal neurological compromise do not demonstrate any defined antecedents and most cases of perinatal asphyxia do not result in any demonstrable neurodevelopmental deficit. These controversies reflect deficiencies in our knowledge in this field. Recent investigations, however, have made significant contributions to the elucidation of this complex problem, especially in the underlying molecular mechanisms 1 . Hypoxia‐ ischemia-induced neuronal injury essentially starts with neuronal energy failure, resulting in the excessive production of both oxygen-free and other secondary radicals, and non-radical reactive species which can injure cell constituents. There is direct evidence of oxygen-free radical generation in the developing brain in response to hypoxia 2,3 . Cells generate oxygen-free radicals during normal respiratory and metabolic activities. Oxygen-free radicals are redox intermedates produced during the sequential reduction of oxygen to water, as an integral part of the energy-regenerating process of oxidative phosphorylation. Biologically significant examples of oxygen-free radicals include superoxide, hydroxyl, lipid hydroperoxide, lipid peroxyl and lipid alkoxyl radicals, and also nitric oxide. The non-radical intermediates include hydrogen peroxide and singlet oxygen. These radical and non-radical products are often collectively called reactive oxygen species. The mechanisms for the formation of these agents are complex and multiple, and include mitochondrial respiration and various metabolic pathways 4‐7 . Additional mechanisms of free radical generation in the brain include inflammatory and immunological reactions, expression of adhesion molecules, and stimulation of polymorphonuclear

178: “Urinary Enzymes in Neonates after Asphyxia and during Gentamycin therapy”

Two β-Glycosidases, N-Acetyl-β-Glucosaminidase (N.A.G.), and β-Galactosidase (G.A.L.), and Acid Phosphatase (A.P.) have been estimated fluorimetrically in the urine of neonates to detect renal damage and the results expressed per m.mole urinary creatinine. Bag urines were collected, but to minimise contamination were discarded if faeces were passed simultaneously. A.P. is less affected by contamination than are G.A.L. or N.A.G.. There is no sex difference in the excretion of A.P. N.A.G. and G.A.L. can be stored ae 4°C before estimation for more than one month;A.P. should be estimated within four days. N.A.G. levels were raised in three cases of perinatal asphyxia and normal in one. Acute asphyxia in two cases did not cause any elevated enzyme levels. G.A.L. was raised in only one of the three cases while A.P. was raised once only in the same case. These results support the theory that acute asphyxia does not damage the renal tubules, while more prolonged asphyxia may. Two neonates have been studied during treatment with Gentamycin. N.A.G. levels are markedly raised during treatment - in one case eight times higher than pre-treatment levels within 24 hours. G.A.L. was intermittently raised and A.P. was not raised during treatment. The consistently raised levels of N.A.G. during Gentamycin therapy in neonates is suggestive of renal tubular cell dysfunction. We gratefully acknowledge the financial assistance of the Research Endowments Fund of St.Thomas' Hospital.