Hypoxic-ischemic Encephalopathy Grade Research Articles

Measuring the impact of cardiotocograph decision support software on neonatal outcomes: A propensity score-matched observational study.

This study follows the 2017 UK INFANT Collaborative Group RCT, which compared neonatal outcomes with and without the use of the INFANT cardiotocograph decision support system for over 46000 patients in labour. The original trial failed to demonstrate a significant improvement to neonatal outcomes; however, the study design was subject to methodological critique. This Australian retrospective cohort study aimed to report perinatal outcomes before and after the introduction of INFANT decision support software for cardiotocograph use in labour. The study cohort was divided into two equivalent 18-month epochs, before and after the introduction of INFANT-Guardian® CTG decision support system. Propensity score matching analysis was undertaken to balance pre- and post-implementation groups by baseline covariates. The matched cohort included 11154 public-funded women between November 2016 and 2019, with a singleton live fetus ≥34+0weeks, being induced or in spontaneous labour. The main outcome measures were: a composite measure of serious adverse neonatal outcome comprising of one or more of: admission to intensive care nursery >48h, Apgar <4 at 5min, cord arterial pH <7.0, hypoxic ischaemic encephalopathy grade 2 or 3, therapeutic hypothermia, neonatal death. The incidence of the composite primary outcome was significantly lower following implementation of INFANT (0.57% vs. 1.00%; OR 0.57, 95%CI 0.37-0.88; P=0.01). A significant reduction in nursery admission >48h was also observed (0.05% vs. 0.30%; OR 0.18, 95%CI 0.05-0.60; P=0.002). INFANT software is associated with a reduction in serious adverse neonatal outcomes, without increasing the rate of operative delivery.

Evaluation of perinatal hypoxic encephalopathy with advanced MR sequences

Perinatal hypoxic ischemic encephalopathy (HIE) among important causes of neurological morbidity and mortality in full-term neonates. Identifying ischemic injury clinically usually is difficult in the immediate postnatal period, nonspecific clinical features are present and consid-erations regarding initiation of active life preserving therapies are needed. MR imaging is the most sensitive and specific imaging tech-nique available for the assessment of perinatal birth asphyxia related brain injury in term-born neonates. This study investigates the utility of MR spectroscopy peak ratios, ADC values along with conventional MRI. To compare the association of encephalopathy following hypoxia in term neonates with proton MRS ratios and ADC values. Conventional MRI (T1 and T2) along with DWI followed by MR Spectroscopy was done in 25 term neonates with clinical and neurological features of en-cephalopathy following perinatal asphyxia. MRS peak ratios, DWI with ADC values and conventional MRI findings were compared with each grade of HIE. Among 25 patients suspected cases of hypoxic enceph-alopathy, 15 patients had early positive conventional MR findings, 16 patients had late positive conventional MR findings, 19 patients had positive DWI, and 22 patients had positive MRS with high lac-tate/choline and lactate/NAA ratio. Higher association was found be-tween spectroscopy findings and hypoxic ischemic injury compared to MR imaging and ADC. The combination of MRS, DWI with ADC values and conventional MRI may assist in localizing and predicting the severi-ty of ischemic injury in HIE patients.

Early clinical outcome and complications associated in neonates with hypoxic ischemic encephalopathy grade II/III who underwent treatment with servo controlled whole-body therapeutic hypothermia: A prospective observational study

Background: There are limited data regarding servo-controlled whole-body therapeutic hypothermia (TH) for neonates with hypoxic-ischemic encephalopathy (HIE) Stage II/III in the Indian setting. The objectives of this study were to determine the early clinical outcome of neonates with HIE Stage II/III treated with TH and to determine the mortality rate and associated complications. Methods: This study was a prospective observational study done at a Level 3A National Neonatology Forum accredited tertiary care neonatal intensive care unit (NICU). Term neonates with HIE Grade II/III admitted to NICU within 6 h of birth were enrolled in the study. Subjects underwent servo-controlled whole-body therapeutic cooling as per the research protocol. Results: Out of 54 subjects, 22 (40.7%) had stage II HIE and 32 (59.3%) had Stage III. The mortality rate was 24% (n = 13), with all having Stage 3. Direct breastfeeds was achieved in 65.9% of successfully cooled babies within 48 h after TH treatment. About 85.4% of babies who were successfully cooled had good early clinical outcomes as evidenced by good activity, normal tone, successful direct breastfeeding, and early discharge within 72 h post treatment with TH. Coagulopathy was observed in 70.4%, raised liver enzymes in 96.3% and thrombocytopenia in 9.3%. Conclusion: There is a significant correlation of grade of encephalopathy and blood gas abnormality at admission with the outcome in babies with HIE treated with TH. Majority of babies with HIE stage 2/3 who successfully completed TH had good early clinical outcomes at the time of discharge.

Interleukin-6 as A Prognostic Biomarker in Perinatal Asphyxia.

Objective Early diagnosis is has a crucial role in both prevention and treatment of asphyxia-related complications. The current study aimed to evaluate the prognostic value of interleukin-6 (IL-6) and hypoxic-ischemic encephalopathy grade in the prediction of mortality and the developmental status of neonates affected by prenatal asphyxia. Materials & Methods This cohort study was conducted on 38 term asphyxiated infants at Ghaem hospital, Mashhad, Iran, from 2013 to 2017. The HIE grade and serum IL-6 levels were determined at the time of birth. The developmental status was evaluated using the Denver II test at the end of the two-year follow-up. Results HIE grade 3 resulted in 83% mortality rate and developmental delay among all survivors. The mean 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 of 1, 2, and 3, respectively. According to the ROC curve analysis, the cut-off level of 24 pg/ml could predict the developmental delay with sensitivity and specificity of 96 and 92%, respectively. Conclusion The IL-6 level and HIE grade are potential prognostic biomarkers for the determination of mortality and morbidity in asphyxiated neonates.

Clinico-Biochemical Correlation in Birth Asphyxia and Its Effects on Outcome.

BackgroundBirth asphyxia is a major cause of early neonatal death and leads to severe consequences such as epilepsy, cerebral palsy, and developmental delay. This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxic-ischemic encephalopathy (HIE) and to find out major risk factors contributing to the severity of HIE and neonatal death.MethodsIn this prospective cohort study (n=150), term babies weighing ≥ 2.5 kg at birth, with the diagnosis of birth asphyxia, admitted in a medical college in Odisha state from September 2014 to August 2016 were included. Clinical findings, biochemical parameters, treatment, and outcome of HIE babies were recorded.ResultThe majority of the asphyxiated babies were having moderate HIE (HIE II) (57.33%), whereas mild and severe stages were seen in 15.33%, and 27.34% of babies, respectively. Factors like prolonged labor (87.8%) and meconium-stained liquor (63.4%) were mostly attributed to the severe degree of birth asphyxia (p < 0.001). Apnea, lethargy, and hypothermia were the most remarkable feature of HIE III. The degree of hyponatremia, hypocalcemia, and hyperkalemia (124.4±4.4 mmol/l, 0.83±0.08 mmol/l, and 6.17± 0.89 mmol/l, respectively) were more severely affected in HIE III as compared to HIE l (137.5±3.8 mmol/l, 1.06±0.17 mmol/l, and 5.0±0.79 mmol/l, respectively). Serum urea and creatinine increased proportionately with an increase in the severity of HIE grade. The mildly asphyxiated neonates recovered completely, whereas all the cases who died (n=29,19.3%) belonged to the moderate or severe degree of birth asphyxia.ConclusionThe asphyxiated neonates had hyponatremia, hypocalcemia, hyperkalemia, raised serum urea, and creatinine and correlated with the severity of birth asphyxia. Prolonged labor and meconium-stained liquor were the most attributable factor for the severe degree of birth asphyxia. Effective neonatal resuscitation and quick correction of electrolyte imbalances will help in the reduction of neonatal mortality and long-term neurological sequelae.

Up-Regulation of Nfat5 mRNA and Fzd4 mRNA as a Marker of Poor Outcome in Neonatal Hypoxic-Ischemic Encephalopathy

To evaluate umbilical cord messenger RNA (mRNA) expression as biomarkers for the grade of hypoxic-ischemic encephalopathy (HIE) and long-term neurodevelopment outcome. Infants were recruited from the BiHiVE1 study, Ireland (2009-2011), and the BiHiVE2 study, Ireland, and Sweden (2013-2015). Infants with HIE were assigned modified Sarnat scores at 24hours and followed at 18-36months. mRNA expression from cord blood was measured using quantitative real-time polymerase chain reaction. We studied 124 infants (controls, n=37; perinatal asphyxia, n=43; and HIE, n=44). Fzd4 mRNA increased in severe HIE (median relative quantification, 2.98; IQR, 2.23-3.68) vs mild HIE (0.88; IQR, 0.46-1.37; P=.004), and in severe HIE vs moderate HIE (1.06; IQR, 0.81-1.20; P=.003). Fzd4 mRNA also increased in infants eligible for therapeutic hypothermia (1.20; IQR, 0.92-2.37) vs those who were ineligible for therapeutic hypothermia group (0.81; IQR, 0.46-1.53; P=.017). Neurodevelopmental outcome was analyzed for 56 infants. Nfat5 mRNA increased in infants with severely abnormal (1.26; IQR, 1.17-1.39) vs normal outcomes (0.97; IQR, 0.83-1.24; P=.036), and also in infants with severely abnormal vs mildly abnormal outcomes (0.96; IQR, 0.80-1.06; P=.013). Fzd4 mRNA increased in infants with severely abnormal (2.51; IQR, 1.60-3.56) vs normal outcomes (0.74; IQR, 0.48-1.49; P=.004) and in infants with severely abnormal vs mildly abnormal outcomes (0.97; IQR, 0.75-1.34; P=.026). Increased Fzd4 mRNA expression was observed in cord blood of infants with severe HIE; Nfat5 mRNA and Fzd4 mRNA expression were increased in infants with severely abnormal long-term outcomes. These mRNA may augment current measures as early objective markers of HIE severity at delivery.

Neonatal neuroimaging and neurophysiology predict infantile onset epilepsy after perinatal hypoxic ischemic encephalopathy

PurposeTo evaluate the accuracy of hypoxic ischemic encephalopathy (HIE) grade, and neonatal neurophysiological and neuroimaging measures for predicting development of infantile spasms syndrome (IS) or other postneonatal, infantile onset epilepsy after perinatal HIE. MethodsWe examined a population-based cohort of 92 consequent infants with moderate-to-severe HIE. The HIE grade and neonatal neuroimaging (MRI) and neurophysiology (EEG and somatosensory evoked potentials, SEPs) findings were compared to the development of IS or other epilepsy within the first year of life. ResultsOut of 74 surviving infants with follow-up information, five developed IS and one developed a focal onset epilepsy. They all had recovered from severe HIE. All survivors with inactive neonatal EEG (recorded within the first few postnatal days, n = 4) or the most severe type of brain injury in MRI (n = 3) developed epilepsy (positive predictive value, PPV 100 %). Bilaterally absent SEPs had 100 % sensitivity and 75 % PPV for epilepsy. A combination of absent SEPs and a poor MRI finding (combined deep and cortical gray matter injury) resulted in higher PPV (86 %) without lowering sensitivity (100 %). Follow-up EEGs showed recurrent epileptiform activity already between 1- and 2-months age in those that developed epilepsy, distinguishing them from those surviving without epilepsy. ConclusionsPoor neonatal neuroimaging and neurophysiological findings provide accurate prediction for development of infantile onset epilepsy after HIE. Of the neonates with severe HIE, the ones with severe neonatal MRI and neurophysiological abnormalities need frequent follow-up, including repeated EEGs, for early detection of IS.

Grading the severity of hypoxic-ischemic encephalopathy in newborn EEG using a convolutional neural network.

Electroencephalography (EEG) is a valuable clinical tool for grading injury caused by lack of blood and oxygen to the brain during birth. This study presents a novel end-to-end architecture, using a deep convolutional neural network, that learns hierarchical representations within raw EEG data. The system classifies 4 grades of hypoxic-ischemic encephalopathy and is evaluated on a multi-channel EEG dataset of 63 hours from 54 newborns. The proposed method achieves a testing accuracy of 79.6% with one-step voting and 81.5% with two-step voting. These results show how a feature-free approach can be used to classify different grades of injury in newborn EEG with comparable accuracy to existing feature-based systems. Automated grading of newborn background EEG could help with the early identification of those infants in need of interventional therapies such as hypothermia.

Cerebrospinal fluid levels of neuron-specific enolase predict the severity of brain damage in newborns with neonatal hypoxic-ischemic encephalopathy treated with hypothermia.

To investigate whether cerebrospinal fluid levels of neuron-specific enolase (CSF-NSE) during the first 72 hours correlate with other tools used to assess ongoing brain damage, including clinical grading of hypoxic-ischemic encephalopathy (HIE), abnormal patterns in amplitude integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI), as well as with the neurodevelopmental outcomes at two years of age. Prospective observational study performed in two hospitals between 2009 and 2011. Forty-three infants diagnosed with HIE within 6 hours of life were included. HIE was severe in 20 infants, moderate in 12, and mild in 11. Infants with moderate-to-severe HIE received whole-body cooling. Both the HIE cohort and a control group of 59 infants with suspected infection underwent measurement of CSF-NSE concentrations at between 12 and 72 hours after birth. aEEG monitoring was started at admission and brain MRI was performed within the first 2 weeks. Neurodevelopment was assessed at 24 months. The HIE group showed higher levels of CSF-NSE than the control group: median 70 ng/ml (29; 205) vs 10.6 ng/ml (7.7; 12.9); p <0.001. Median levels of CSF-NSE in infants with severe, moderate, and mild HIE were 220.5 ng/ml (120.5; 368.8), 45.5 ng/ml (26, 75.3), and 26 ng/ml (18, 33), respectively. CSF-NSE levels correlated were significantly higher in infants with seizures, abnormal aEEG, or abnormal MRI, compared to those without abnormalities. Infants with an adverse outcome showed higher CSF-NSE levels than those with normal findings (p<0.001), and the most accurate CSF-NSE cutoff level for predicting adverse outcome in the whole cohort was 108 ng/ml and 50ng/ml in surviving infants. In the era of hypothermia, CSF-NSE concentrations provides valuable information as a clinical surrogate of the severity of hypoxic-ischemic brain damage, and this information may be predictive of abnormal outcome at two years of age.

The effect of ladder approach on development of preterm low birth weight infants with HIE-2

Background: Premature infants with Peri-natal asphyxia leading to a hypoxic-ischemic encephalopathy (HIE) are at greater risk for cerebral palsy. HIE grade II infants have long term neurological complications due to maladaptive brain wiring during NICU stay. Ladder approach, with graded stimulation program is administered by Occupational therapist, plays a vital role to minimize the maladaptive responses to environment. Objective of this study was to effect of Ladder Approach on preterm low birth weight Infants with HIE-2 as compared to conventional treatment. Design of this study was to Prospective Block Randomized Convenient Sampling Control Trial, Experimental design study. The study was carried out in the NICU and PU ward of Tertiary care hospital in metropolitan city from April 2015 to October 2016. The study subjects included a convenient sample of 30 preterm Low birth weight HIE-2 infants randomly selected into study or control groups. Neonatal behavioural Assessment scale (NBAS), Infant Neurological International Battery (INFANIB).Methods: The preterm infants from study group who received Ladder Approach and control group who received routine conventional care only. Outcome measures NBAS was at baseline and first follow up. INFANIB was administered at second follow up to assess neurodevelopment.Results: Showed that the premature infants of the study had significant difference in neuro behavioral status with mean for all subcomponents from to post intervention mean 39.6 in experimental group and from baseline mean of 24.3 to post intervention mean score of 33.2 in control group on neurobehavioral scale. Further neurodevelopmental status showed similar results on INFANIB in experimental group.Conclusions: The premature Infants with HIE grade 2, receiving ladder approach have shown more mature responses resulting into well-organized Neurobehavioral status, and resulted in improved brain wiring as evident in INFANIB.

Role of diffusion-weighted magnetic resonance imaging in detection of neonatal hypoxic-ischemic encephalopathy

Background Hypoxic-ischemic encephalopathy (HIE) is a critical pediatric disease with challenges in diagnosis. Many diagnostic tools have been used to diagnose this condition. Among all these tools, MRI with the advanced sequence; diffusion-weighted imaging (DWI) plays a more vital role in early detection of this condition. In this research we emphasized the role of DW-MRI in the diagnosis of HIE. Aim of work The aim of this work is to evaluate the role of DW-MRI in detection and grading of HIE. Patients and methods This is a prospective study performed for 1 year (from January 2017 to January 2018). The studied group included 20 full-term neonates admitted to NICU of Assiut University Hospital with provisional diagnosis of HIE. All patients underwent brain imaging by conventional and DW-MRI. Results There was a moderate significant agreement between conventional MRI and DWI (P = 0.023) regarding both diagnosis and grading of HIE. Conclusion MR-DWI is the preferred modality of imaging in diagnosis and grading of hypoxic-ischemic injury due to its high sensitivity and easy interpretation with no need for contrast administration.

Grading Method for Hypoxic-Ischemic Encephalopathy Based on Neonatal EEG

The grading of hypoxic-ischemic encephalopathy (HIE) contributes to the clinical decision making for neonates with HIE. In this paper, an automated grading method based on electroencephalogram (EEG) data is proposed to describe the severity of HIE infants, namely mild asphyxia, moderate asphyxia and severe asphyxia. The automated grading method is based on a multi-class support vector machine (SVM) classifier, and the input features of SVM classifier include long-term features which are extracted by decomposing the EEG data into different 64 s epoch data and short-term features which are extracted by segmenting the 64 s epoch data into 8 s epoch data with 4 s overlap. Of note, the correlation coefficient and asymmetry extracted in this paper have obvious discriminating capability in HIE infants classification. The experimental results show that the proposed method can achieve the classification accuracy of 78.3%, 75.8% and 87.0% of the mild asphyxia group, moderate asphyxia group and severe asphyxia group, respectively. Moreover, the overall accuracy and kappa used to evaluate the performance of the proposed method can reach 79.5% and 0.69, respectively.

Predictive accuracy of duplex sonography vs. MRI in grading of neonatal hypoxic encephalopathy

Background: To evaluate the diagnostic accuracy of Doppler in neonates with hypoxic-ischemic encephalopathy (HIE) in correlation with MRI. Materials & Methods: During the period September 2017 to October 2019, term neonates with clinical evidence of HIE who underwent MRI were enrolled for the study. Two-dimensional duplex and color Doppler ultrasound were performed, resistive index of the middle cerebral artery was documented, and findings were correlated with MRI. Results: Of 40 consecutive neonates (29 boys and 11girls), 29 neonates with mild-moderate HIE, 7 neonates had severe HIE and 4 were normal. Accuracy of Duplex ultrasound in mild HIE is limited, however in neonates with moderate hypoxia the predictive accuracy of duplex scan as 77%, with 100% accuracy in all neonates with severe HIE. All neonates with severe HIE had increased resistance index of cerebral arteries. Conclusion: Duplex ultrasound can be used as a point of care tool not only in diagnosis of HIE, but also as a tool distinguish the grades of HIE thus aid in prognostication.

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.

Impact of therapeutic hypothermia on infantile spasms: an observational cohort study.

AimTo establish the incidence of infantile spasms in children in the southern region of the Republic of Ireland and to compare the incidence of infantile spasms before and after the introduction of therapeutic hypothermia in infants with hypoxic‐ischemic encephalopathy (HIE).MethodChildren born between 2003 and 2015 and diagnosed with infantile spasms (epileptic spasms with or without hypsarrhythmia) in the first 2 years of life were identified through audits of electroencephalography reports and paediatric neurology patient lists. Data on live births were obtained from the regional hospital statistics databases. Medical charts of infantile spasm cases were reviewed for demographic information, diagnostic workup results, treatment response, disease course, and developmental outcome.ResultsForty‐two infants with infantile spasms were identified. The cumulative incidence of infantile spasms up to the age of 2 years was 4.01 per 10 000 live births. Difference due to sex was minimal (22 males, 20 females) and most infants were delivered at or near term with gestational ages ranging between 30.0 and 41.8 weeks (median [interquartile range] 39.6wks [38.1–40.0wks]). The aetiology for infantile spasms was identified in almost two‐thirds of cases, with HIE being the single most common cause (n=7). Other causes included chromosomal and monogenetic abnormalities (n=8). Infantile spasms occurred in moderate and severe grades of HIE, with a significantly higher incidence in those with severe HIE (p=0.029). Infants with severe HIE who did not receive therapeutic hypothermia were six times more likely to develop infantile spasms compared to those who did, but the difference was not statistically significant (4 out of 16 vs 1 out of 24, p=0.138).InterpretationThis study provides detailed information about infantile spasms before and after the introduction of therapeutic hypothermia. HIE severity is a risk factor for the development of infantile spasms. The introduction of therapeutic hypothermia may have had an impact, but the effect was hard to ascertain in this cohort due to the small number of infants.What this paper adds The incidence of infantile spasms and patient characteristics in the southern region of the Republic of Ireland is similar to internationally published data.None of the infants with a history of mild hypoxic‐ischemic encephalopathy (HIE) developed infantile spasms.The risk of infantile spasms was higher in infants with severe HIE.Infantile spasms were more frequent in infants with severe HIE not treated with therapeutic hypothermia.

IMPACT OF 6% HYDROXYETHYLSTARCH 130/0.42 ON BRAIN PERFUSION IN TERM NEONATES WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Intiduction. Perinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths. Dysregulated cerebral blood flow may be a key component for secondary neurologic injury in HIE. The load of fluids to increase intravascular volume is the point of care in infants because the cerebral blood flow in neonatal period depends mainly on the cardiac output but the choice of fluids is still debatable.Objective. To determine the impact of 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution on brain perfusion in term neonates with severe hypoxic-ischemic encephalopathy.Materials and methods. Single-center, prospective, simple, randomized controlled study was performed in 205 full-term infants with hypoxic-ischemic encephalopathy grade II and grade III by Sarnat score in the period of 2012-2016. Depending on fluids for volume resuscitation, all infants were randomly divided into HES and control groups. In HES group 45 term infants with moderate to severe hypoxic-ischemic encephalopathy were treated at the 1st DOL with 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution at a dose of 10 ml/kg. The control group included 160 term neonates with hypoxic-ischemic encephalopathy undergoing routine intensive care with normal saline at a dose of 20 ml/kg as the loading volume if needed. To assess the impact of 6% HES on systemic and cerebral hemodynamics, such criteria as mean blood pressure (MBP) and transfontanel Doppler indices RI, PI and CPP were obtained at the 1st, 2nd and 3rd DOL.Results. Using of 6% HES 130/0.42 at the dose of 10 ml/kg of body weight for volume replacement in neonates with moderate to severe HIE at the 1st DOL led to increasing of Resistive Index (RI) in front cerebral artery 2nd DOL (p = 0.025) and 3rd DOL (p = 0.023).Conclusion. Administration of 6% HES 130/0.42 in a balanced crystalloid solution in term newborns with severe hypoxic-ischemic encephalopathy for volume resuscitation results in significant improvement of cerebral blood flow, specifically increasing of Doppler Resistive Index in front cerebral arteries.

A STUDY OF NEONATES WITH BIRTH ASPHYXIA FOR SEQUELAE OVER 2 YEARS

Introduction: Birth asphyxia is associated with reduction in the arterial oxygen tension, accumulation of carbon dioxide and fall in blood pH. Acidosis occurs due to anerobic utilization of glucose, production of lactic acid and accumulation of carbon dioxide.&#x0D; Aim: To study outcome of neonates who suffered birth asphyxia and Hypoxic–ischemic encephalopathy (HIE) in a teaching hospital over a period of 2 years.&#x0D; Materials &amp; Methods: 325 neonates with birth asphyxia and hypoxic ischemic encephalopathy were studied, with well defined inclusion and exclusion criteria. They were treated according to standard protocols. Observations : 106 neonates of HIE-I, 58 neonates of HIE-II, and 59 neonates of HIE-III were followed up: for various outcomes like death due to complications, cerebral palsy, developmental delay with epilepsy, hearing handicap etc.&#x0D; Results: In HIE-I no case progressed to cerebral palsy, in HIE-II 24.13% progressed into CP and in HIE-III 54.2% developed spastic cerebral palsy.&#x0D; Conclusion: Infants with severe grades of HIE have increased risk of long term neurological sequlae.&#x0D; Keywords: Neonate, Birth asphyxia, Acidosis, Neonatal encephalopathy

The Swedish Neonatal Quality Register - contents, completeness and validity.

To describe the Swedish Neonatal Quality Register (SNQ) and to determine its completeness and agreement with other registers. SNQ collects data for infants admitted to neonatal units during the first four postnatal weeks. Completeness and registers' agreement were determined cross-linking SNQ data with Swedish population registers (the Inpatient, Medical Birth and Cause of Death Registers) for a study period of five years. In total, 84712 infants were hospitalised. A total of 52806 infants occurred in both SNQ and the population registers; 28692 were only found in the population registers, and 3214 infants were only found in SNQ. Between gestational weeks 24-34, completeness of SNQ was 98-99%. Below and above these gestational ages, completeness was lower. Infants missing in SNQ were term or near-term in 99% of the cases, and their diagnoses indicated conditions managed in maternity units, or re-admissions for acute infections, managed in paediatric units. For most diagnoses, the agreement between SNQ and population registers was high, but some (bronchopulmonary dysplasia and grade of hypoxic-ischaemic encephalopathy) were often missing in the population registers. SNQ completeness and agreement against other registers, especially for preterm infants, is excellent. SNQ is a valid tool for benchmarking, quality improvement and research.

Ophthalmic outcomes following neonatal hypoxic ischaemic encephalopathy; oculomotor, biometric and refractive data in early childhood.

To investigate the functional and structural impact of neonatal hypoxic ischaemic encephalopathy (HIE) on childhood visual development. In a prospective study, the neurocognitive outcomes of 42 children with a history of neonatal HIE were assessed serially up to 5 years. For the ophthalmic component of the study, visual, refractive, orthoptic and ocular biometry measurements were obtained in 32 children, with axial length measurements estimated using the IOLMaster. For the 32 children who completed the ophthalmic component of the study, severity of HIE grade was determined to be mild, moderate, or severe in 18 (56.3%), 13 (40.6%), and 1 (3.1%) cases, respectively. One (3.1%) child was classed as visually impaired. Twelve (37.5%) were found to have ametropia. Mean (±SD) axial length was 22.09 (±0.81) mm, within the normal range for the age of this cohort. Seven of the 42 (16.7%) children who were involved in the larger neurodevelopmental arm of the study had clinical evidence of a squint. There was no correlation between the severity of HIE grade at birth and axial length or occurrence of squint. Neonatal HIE is associated with a higher incidence of squint compared with the general paediatric population. This occurred irrespective of severity of HIE grade. The ocular biometry measurements were consistent with published normative data, and no significant difference in ocular biometry was demonstrated between HIE severity groups.

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