Hypoxic Ischemic Encephalopathy Stage Research Articles

Hypoxic Ischemic Encephalopathy Indicators of Sarnat and Sarnat Scoring in Neonatal Subjects with Perinatal Asphyxia.

Hypoxic-ischemic encephalopathy (HIE) is still a relevant cause of neonatal mortality and morbidity. HIE severity can predict long-term outcomes. Sarnat staging is one of the most common methods used to evaluate HIE severity. However, an ongoing urge exists to find other accurate and affordable ways to accompany this clinical staging for HIE. This study aimed to evaluate the relationship between cerebral arteries' resistive indices and other hypoxic-ischemic encephalopathy indicators using Sarnat scoring of newborns subjected to perinatal asphyxia. In this retrospective study, 76 neonates with gestational age ≥34 weeks affected with HIE were investigated. The patients were categorized into three groups according to Sarnat staging: I, II, and III. Initially, perinatal data were analyzed to assess the correlation between HIE severity and various factors such as gestational age, type of delivery, Apgar scores, necessity for resuscitation, and requirement for respiratory assistance. Notably, these relationships were significant. Examining various symptoms in different HIE stages showed that the incidence of coagulopathy was significantly higher in severe HIE neonates than in mild neonates. Eventually, proposedly, cranial arterial Doppler indices, i.e., the anterior cerebral artery's resistive index (RI), significantly differed between HIE stage groups. This study represented a combination of available and affordable data to achieve early HIE staging, including perinatal data, clinical symptoms, and a bedside Doppler ultrasonography of cerebral perfusion. Higher cranial artery RI was associated with severe HIE and could be considered for therapeutic hypothermia, which may reduce HIE mortality and morbidity.

Troponin I, CK-MB, and inotropic score in hypoxic-ischemic encephalopathy and associated infant mortality

PurposeCardiovascular dysfunction is common in hypoxic-ischemic encephalopathy (HIE), which is one of the leading causes of multi-organ failure in neonates. We aimed to assess troponin I and creatine kinase myocardial band (CK-MB) levels, inotropic score (IS) in HIE patients, and their associations with HIE staging and mortality.MethodThe medical records of all HIE infants admitted to our unit between 2016 and 2018 were retrospectively analyzed. Demographic characteristics of the infants, seizures, anticonvulsive therapies, maximum inotrope doses, and the derived IS (dopamine dose [µg/kg/min] + dobutamine dose [µg/kg/min] + 100 × epinephrine dose [µg/kg/min]) and CK-MB and troponin-I levels obtained in the first six hours of life were compared according to HIE staging. Comparisons between survivors and non-survivors were made.ResultsThe study included data from 195 patients. Twenty-five patients were classified as stage 3, 116 as stage 2, and 54 as stage 1 HIE. Median Troponin-I, CK-MB level, and IS significantly differed by HIE staging (p < 0.01). The deceased infants had significantly higher median troponin I level [0.36 (0.02-3) vs. 0.16 (0.01–1.1) ng/ml; p = 0.006], median IS [20 (5-120) vs. 5 (5–10); p < 0.001], however, CK-MB values were comparable with survivors [129 (51–300) vs. 60.7 (31–300) ng/ml; p = 0.57]. The area under the curve was 0.93 for IS and 0.81 for Troponin I to predict mortality.ConclusionTroponin I, CK-MB, and IS could be successfully used as disease severity markers in HIE furthermore, troponin I and IS, are good predictors of mortality. These results need to be confirmed with larger prospective multi-center studies.

A comparative proteomic analysis for non-invasive early prediction of hypoxic-ischemic injury in asphyxiated neonates.

Hypoxic Ischemic Encephalopathy (HIE) is one of the principal causes of neonatal mortality and long-term morbidity worldwide. The neonatal signs of mild cerebral injury are subtle, making an early precise diagnosis difficult. Delayed detection, poor prognosis, and lack of specific biomarkers for the disease are increasing mortality rates. In this study, we intended to identify specific biomarkers using comparative proteomic analysis to predict the severity of perinatal asphyxia so that its outcome can also be prevented. A case-control study was conducted on 38 neonates, and urine samples were collected within 24 and 72h of life. A tandem mass spectrometry-based quantitative proteomics approach, followed by validation via sandwich ELISA, was performed. The LC-MS/MS-based proteomics analysis resulted in the identification of 1201 proteins in urine, with 229, 244, and 426 being differentially expressed in HIE-1, HIE-2, and HIE-3, respectively. Axon guidance, Diseases of programmed cell death, and Detoxification of reactive oxygen species pathways were significantly enriched in mild HIE versus severe HIE. Among the differentially expressed proteins in various stages of HIE, we chose to validate four proteins - APP, AGT, FABP1, and FN1 - via sandwich ELISA. Individual and cumulative ROC curves were plotted. AGT and FABP1 together showed high sensitivity, specificity, and accuracy as potential biomarkers for early diagnosis of HIE. Establishing putative urinary biomarkers will facilitate clinicians to more accurately screen neonates for brain injury and monitor the disease progression. Prompt treatment of neonates may reduce mortality and neurodevelopmental impairment.

Frequency of Acute Kidney Injury with Hypoxic Ischemic Encephalopathy Staging in Neonates with Perinatal Asphyxia: An Observational Study (Descriptive Case Series)

Perinatal asphyxia affects almost all the organs in neonates, kidneys being one of commonly affected organs. Early recognition of disturbances in renal function is important for early intervention to prevent irreversible damage to kidneys. Objective: In this study we observed the frequency of acute kidney injury (AKI) in neonates with clinical staging of hypoxemic ischemic encephalopathy (HIE) in neonates with perinatal asphyxia. Methodology: An overall number of 145 term neonates with perinatal asphyxia admitted at nursery of Liaquat University Hospital, Hyderabad from February-2019 to july-2019 were included in this study. Urine output was monitored from day one and serum creatinine was sent on third day of life. Serum creatinine was sent early of those neonates having low urine output. Results: The average birth weight was 2.72±2.67 kg. There were 106 (73.1%) males and 39 (26.9%) females. Most neonates were born via simple vaginal delivery 100 (68.97%) and few via caesarian section 45 (31.03%). Out of 145 neonates 38 (26.21%) were in stage I, 95 (65.52%) in stage II and 12 (8.28%) in stage III HIE. Frequency of AKI in neonates with perinatal asphyxia was 55 (37.93%). Incidence of AKI was significantly high in stage II 45(81.8%) as compare to stage I 0(0%) and stage III 10(18.2%) (p=0.0005). Conclusion: AKI is a common complication of perinatal asphyxia. Further multicenter based and studies on large scale need to be done to identify the inter-relationship between maternal factors and perinatal asphyxia associated AKI to prevent neonatal morbidity and mortality. Keywords: Acute kidney injury, perinatal asphyxia, hypoxic ischemic encephalopathy.

Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic-Ischemic Encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).

Cranial ultrasound findings in asphyxiated term neonates and their correlation clinically with hypoxic ischemic encephalopathy staging

Background: The survival of asphyxiated neonates has significantly increased in recent years because of numerous advancements in contemporary neonatal intensive care. The most popular and easily repeatable imaging method for the neonatal brain, the neurosonogram can demonstrate the most common types of cerebral injury in preterms and term infants. This study aims to analyse the value of cranial ultrasonography as an investigative tool for birth asphyxia babies (&gt;34 weeks) will be evaluated to learn the morphology of various cerebral lesions and to compare clinical findings with neurosonogram results. Methods: An observational study was conducted in 75 neonates (&gt;34 weeks) admitted in Government Cuddalore medical college with birth asphyxia. A detailed history and clinical examination was carried out according to the designed proforma. All the babies in the study group were subjected to cranial ultrasound and the morphology of findings studied. CUS findings were correlated clinically. Results: Among babies with HIE stage I, 89.7% had normal Cranial Ultrasound Findings, and 10.3% had abnormal findings. 43.3% babies had abnormal Cranial ultrasound findings in HIE stage II, and 70% had abnormal findings in HIE stage 3. Conclusions: Cerebral oedema was the commonest neurosonogram finding in Asphyxiated babies and HIE 3 had the maximum abnormal findings in our study. Since there is a positive correlation between the severity of hypoxic ischemic encephalopathy and cranial ultrasound findings, USG cranium can be performed as a screening tool in all neonates with birth asphyxia in whom additional investigations could not be performed.

Clinical Characteristics and Risk Factors of Neonatal Hypoxic-Ischaemic Encephalopathy and Its Associated Neurodevelopmental Outcomes During the First Two Years of Life: A Retrospective Study in Saudi Arabia.

This study aimed to determine the clinical characteristics and factors associated with neonatal hypoxic-ischaemic encephalopathy (HIE) and its neurodevelopmental outcomes. We conductedretrospective case-control researchto investigate the clinical and labour-related risk factors for HIE. In addition, a single-centre cohort study was conducted on infants with HIE to describe their neurodevelopment from birth to 24 months. For this investigation, cases with a diagnosis of HIE who were born at King Abdullah Children's Specialist Hospital (KASCH), Riyadh, Saudi Arabia, between 2015 and 2019 were identified and matched with controls from the same facility (1:4). Each case's clinical information was extracted using electronic medical records. In addition,24-monthfollow-up HIE cases were included in a cohort study to describe their neurodevelopmental outcomes. The sample includes 60 infants diagnosed with HIE and 234 infants serving as controls, with a mean gestational age of 38.8 weeks (SD 1.6)and a predominance of males (56.4%). Around one-thirdof the HIE cases (36.6%) had moderate HIE (stage 2), whereas 35.1% of infants had severe HIE (stage 3), according to Sarnat staging. Compared to the control group, children with HIE were twice as likely to be born to mothers with maternal comorbidities and more likely to have prepartum and intrapartum complications. A 24-month follow-up of neurodevelopmental outcomes for HIE babies revealed that approximately 24% exhibited delays in gross motor skill development, 22% in fine motor skill development, 33% in language skill development, and 22% in social skill development. In the HIE group, maternal comorbidities and prepartumor intrapartum complications were more common. The severity grade of HIE can be used to predict neurodevelopmental consequences. Enhancing patient care and rehabilitation requires a minimum of 24 months of neurodevelopmental follow-up.

Effect of Hypoxic Ischaemic Encephalopathy on Coagulation Profile in Neonates in a Tertiary Care Center, Agra- A Prospective Clinical Study

Introduction: Perinatal asphyxia is very common in developing countries. Coagulopathy occurs as a part of spectrum of multiorgan dysfunction following hypoxic insult. In asphyxiated neonate, bleeding due to coagulation abnormality is common and potentially life threatening. There are very few studies done on coagulation profile with perinatal asphyxia in last few decades. Aim: To evaluate the coagulation profile in neonates with hypoxic ischaemic encephalopathy in a tertiary care center, Agra. Materials and Methods: This was a prospective clinical study undertaken in Neonatal Intensive Care Unit (NICU) FH Medical College Agra, a tertiary care center catering rural and urban population. Total 60 neonates admitted with history of birth asphyxia between January 2022 to June 2022 were enrolled. Neonates were classified into Hypoxic Ischaemic Encephalopathy (HIE) stage 1, 2 and 3 (according to Sarnat and Sarnat staging). Parameters such as Prothrombin Time (PT)/ International Normalised Ratio (INR) and platelet count was analysed. For describing continuous variables means and standard deviations and for comparison Analysis of Variance (ANOVA) test and Chi-square test were used. Results: In this study, total 60 neonates were enrolled. Out of these 43 (71.61%) were male and 17 (28.33%) female. Highest number of cases 34 (56.7%) were from HIE stage 3 followed by 22 (36.7%) HIE stage 2 and 4 (6.7%) from HIE stage 1. Among them 14 newborns with HIE stage 3 were died. PT and INR was significantly deranged in HIE stage 3 and 2 (p-value &lt;0.05). HIE stage 3 has highest mortality and morbidity. Platelet count were normal in HIE stage 1 followed by decreased in HIE stage 2 and 3 and also statistically significant. Conclusion: Coagulation derangement is very common in babies with HIE and evident before clinical bleeding and this derangement is associated with poor outcome. Hence, timely intervention and appropriate management can improve the clinical outcome.

A comparative study of liver function test between normal neonates and neonates with different stages of hypoxic ischemic encephalopathy in a district medical college of Eastern India

Background: Hepatic dysfunction is a known complication in neonates with hypoxic ischemic encephalopathy (HIE). Aims and Objectives: We conducted this study to compare hepatic function between normal and asphyxiated newborn and whether the changes in liver function vary with the grade of HIE. Materials and Methods: This observational analytical cross-sectional study was done in a rural medical college of eastern India for 1 year with 51 HIE (17 each in HIE I, II, and III group) and 51 healthy neonates as control. Biochemical parameters of liver function such as alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), total serum bilirubin (TSB), serum albumin, and prothrombin time (PT) were measured in both groups between 48 and 72 h of birth. Results: We found that TSB, liver enzymes, and PT ware significantly elevated and serum albumin reduced in HIE group in comparison to control group. However, TSB, PT, and serum albumin does not differ much among three stages of HIE. By contrast, liver enzymes increases significantly among three stages of HIE, and also, there is significant difference in ALT, AST, and ALP between survivor and non-survivor of HIE babies. Conclusion: Hence, liver function test may serve as an useful early marker of perinatal asphyxia when the history of birth asphyxia is lacking and it can also be used as a prognostic indicator as there is more rise of liver enzymes from low to high grade of HIE and from survived to expired HIE babies.

Acute Renal Failure in Newborns with Birth Asphyxia

Introduction: Perinatal asphyxia is one of the common causes of neonatal morbidity and mortality. It can affect almost all the body organs and most frequently affected organs are kidneys. Acute Renal Failure is the commonest renal complication, manifested by changes in urine output and blood chemistries.&#x0D; Aims: To evaluate the renal function in asphyxiated newborns.&#x0D; Methods: This cross-sectional study was conducted, from August 2021 to February 2022, on 95 term neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur for birth asphyxia as per World Health Organization definition. All neonates with Hypoxic Ischemic Encephalopathy were staged by Sarnat and Sarnat staging. After 48 hours of life, blood sample was sent for investigations. Urine output was monitored and neonates were managed according to the hospital protocol.&#x0D; Results: Male to female ratio was M:F 1.90:1. Percentage of acute renal failure was higher in babies with higher Hypoxic Ischemic Encephalopathy grades. It was seen in 12% in Grade I, 82% in Grade II and 100% in Grade III. Renal failure had significant association with Hypoxic Ischemic Encephalopathy staging(p&lt;0.05).The means of serum creatinine significantly increased with the increase in Hypoxic Ischemic Encephalopathy grades (p&lt;0.05). Mean serum creatinine among Grade I, Grade II and Grade III newborns were 0.9±0.44, 2.2±.93and 2.9±0.38 mg/dl respectively. Mean urinary output significantly decreased as the grades of Hypoxic Ischemic Encephalopathy increased (p&lt;0.05) with mean urine output 1.5±0.38, 1.3±0.53and 1.1±0.39 ml/kg/hour respectively in Grade I, Grade II and Grade III.&#x0D; Conclusion: Neonates with higher grades of Hypoxic Ischemic Encephalopathy had higher values of serum creatinine. Urine output decreased as the grading of asphyxia increased

Prediction score for prolonged hospital stay in meconium aspiration syndrome: A multicentric collaborative cohort of south India.

With improved survival in neonates with meconium aspiration syndrome (MAS), the focus is currently on mitigating the morbidities. The objective of this study was to predict factors determining prolonged hospital stay in neonates with MAS. It was a retrospective cohort from five centers of south India between 2018 and 2020. Neonates ≥35 weeks of gestation admitted to neonatal intensive care unitwith the diagnosis of MAS and requiring oxygen beyond 24 h of life were included in the study. The morbidities in the neonates with stay ≤7 days (short stay) were compared with >7 days (prolonged stay). Logistic regression by the backward stepwise method was used for predictive score creation. Out of 347 neonates with MAS discharged home, 103 (29%) had a short stay and 244 (71%) had prolonged stay. The primary support beyond O2 (continuous positive airway pressure/mechanical ventilation) (42% vs. 83%, p < 0.001), fractional inspired oxygen (FiO2 ) at 1 h >30% (45% vs. 87%, p < 0.001), hypoxic ischemic encephalopathy(HIE) stage2 or 3 (1% vs. 27%, p < 0.001), moderate-severe persistent pulmonary artery hypertension(PPHN) (3% vs. 31%, p < 0.001) were independent factors associated with prolonged stay on logistic regression. A prediction model was devised using weighted scores of these four associated morbidities. The clinical score thus developed had 83% sensitivity, 68% specificity for the prediction of prolonged stay (area under curve:82%, 95% confidence interval [78-87], p < 0.001). More than two-thirds of neonates with MAS had prolonged stay. The primary support beyond oxygen, FiO2 requirement >30%, Moderate to severe PPHN, HIE stage2 or 3 were predictive of prolonged stay in neonates with MAS.

Incidence and outcomes of acute kidney injury in term neonates with hypoxic ischemic encephalopathy: an observational study

Background: Hypoxic ischemic encephalopathy (HIE) is one of the devastating birth related complication. It predisposes the babies to serious outcomes, an important one being acute kidney injury (AKI).Methods: A prospective crossectional observational study was conducted in Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh between November 2019 and October 2020. 153 term neonates with perinatal asphyxia were enrolled. HIE staging and AKI staging done according to Sarnat and Sarnat classification and KDIGO classification respectively. Outcome in terms of recovery, persistent deranged renal function at discharge or mortality noted.Results: In our study, incidence of Acute Kidney Injury in Hypoxic Ischemic Encephalopathy neonates was 37.7%. There was around 39-fold increase risk of developing AKI in HIE stage III versus HIE stage I. Mortality rate was found to be 51.6%. Mortality was significantly high in HIE stage III. There was around 5-fold increase risk of mortality in HIE neonates with AKI as compared to HIE neonates without AKI. 50% of the subjects who had AKI and discharged recovered of renal function before discharge and 50% recovered at 1 month follow up. In addition, there was no association found between different stages of HIE with different stages of AKI.Conclusions: It is better to screen all the birth asphyxia cases for AKI so that they can be detected early and managed accordingly.

Cystic Neuronal Necrosis of Posterior Thalami in Neonatal Hypoxic Ischemic Encephalopathy: A Case Report of an Unusual Radiological Finding

Background: Neonatal hypoxic ischemic encephalopathy (HIE) occurs as a result of any event that causes hypoxia and hypoperfusion to the developing neonatal brain. In addition to being a major cause of neonatal mortality, it is also associated with significant long-term neurological deficits. Multicystic encephalomalacia is a sequelae to global hypoxic ischemic injury which is characterized by cortical atrophy, basal ganglia/thalamic atrophy, and cystic necrosis of cerebral white matter. In this report, we present an unusual finding of cystic necrosis of thalami in HIE. Case Presentation: We present the case of a term neonate with a history of prolonged labor and meconium aspiration who developed HIE stage III. The neonate initially required ventilator support and was gradually weaned off but was reintubated in view of neonatal sepsis. Magnetic resonance imaging done on day 23 revealed diffuse cortical and white matter atrophy, signal intensity alteration in basal ganglia and thalami, and multiple well-defined areas of cerebrospinal fluid signal intensity in the white matter, consistent with multicystic encephalomalacia. An additional unusual finding was cystic necrosis, symmetrically involving bilateral posterior thalami. Conclusion: According to our observation, severe prolonged hypoxic ischemic insult does not only result in central gray matter atrophy but can also cause cystic neuronal necrosis of the same.

Survival and predictors of asphyxia among neonates admitted in neonatal intensive care units of public hospitals of Addis Ababa, Ethiopia, 2021: a retrospective follow-up study

BackgroundGlobally, perinatal asphyxia (PNA) is a significant cause of most neonatal deaths. Similarly, the burden of birth asphyxia in Ethiopia remains high (22.52%) and has been noted the second leading cause of neonatal mortality. Thus, researches on survival status and predictors of perinatal asphyxia are critical to tackle it. Therefore, the current study intended to determine the survival status and predictors of asphyxia among neonates admitted in Neonatal Intensive Care Units of public hospitals, Addis Ababa, Ethiopia.MethodsHospital-based retrospective follow-up study was conducted in four selected public hospitals of Addis Ababa from January 2016 to December 2020. Data were collected using a pretested structured questionnaire. Epi-data 4.6 and STATA Version 16 was used for data entry and analysis, respectively. Kaplan–Meier survival curve, log-rank test and Median time were computed. To find the predictors of time to recovery, a multivariable Cox proportional hazards regression model was fitted, and variables with a P-value less than 0.05 were considered statistically significant. Finally, the Schoenfeld residual test was used to check overall model fitness.ResultFour hundred eleven admitted asphyxiated babies were followed a total of 3062 neonate-days with a minimum of 1 h to a maximum of 28 days. The Overall incidence density rate of survival was 10 (95% CI: 0.08–0.11) per 100 neonate-days of observation with a median recovery time of 8 days (95% CI: 7.527–8.473). Low birth weight (Adjusted hazard ratio [AHR]: 0.67, 95% CI: 0.47–0.96), stage II hypoxic ischemic encephalopathy (HIE) (AHR: 0.70, 95% CI: 0.51–0.97), stage III HIE (AHR: 0.44, 95% CI: 0.27–0.71), seizure (AHR: 0.61, 95% CI: 0.38—0.97), thrombocytopenia (AHR: 0.44, 95% CI: 0.24–0.80) and calcium gluconate (AHR: 0.75, 95% CI: 0.58–0.99) were found to be independent predictors of time to recovery of asphyxiated neonates.ConclusionIn the current findings, the recovery time was prolonged compared to others finding. This implies early prevention, strict monitoring and taking appropriate measures timely is mandatory before babies transferred into highest stage of HIE and managing complications are recommended to hasten recovery time and increase survival of neonates.

Two Useful Umbilical Biomarkers for Therapeutic Hypothermia Decision in Patients with Hypoxic İschemic Encephalopathy with Perinatal Asphyxia: Netrin-1 and Neuron Specific Enolase

Objective: Hypoxic-ischemic encephalopathy (HIE) has a high risk of mortality in addition to serious neurological damage. In this study, we investigated the values of umbilical cord netrin-1 (NT-1) and neuron specific enolase (NSE) levels in the early diagnosis of HIE stage II/III induced by neonatal asphyxia. Study Design: In the study group, infants with gestational age ≥ 36 weeks who were diagnosed with HIE II/III were included. NT-1 and NSE levels were measured from the umbilical cord immediately after birth. Results were compared between HIE II/III and the healthy control group. Cutoff values for serum NT-1 and NSE were determined with receiver-operating characteristics curves and the area under the curve (AUC) was used to determine the diagnostic value of NT-1 and NSE levels in infants diagnosed with HIE II/III. Results: NT-1 (358.3 ± 108.3 pg/mL) and NSE (52.97 ± 17.8 ng/mL) levels in the cord blood in the HIE group were significantly higher (p = .030, p = .001, respectively) than cord blood values in the control group (NT-1 (275.1 ± 84.6 pg/mL) and NSE (28.7 ± 16.3 ng/mL)). NT-1 cutoff value for HIE was 292.3 pg/mL and 34.7 ng/mL for NSE (AUC: 990, sensitivity: 94%, specificity 100% and AUC: 1.0, sensitivity: 100% vs. specificity 100%, respectively). Conclusion: NT-1 and NSE represent candidate biomarkers with high reliability in the prediction in newborns with moderate-to-severe HIE.

Correlation of cardiac troponin T levels with inotrope requirement, hypoxic-ischemic encephalopathy, and survival in asphyxiated neonates.

BACKGROUNDCardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality. AIMTo assess cardiac troponin T (cTnT) levels in asphyxiated neonates and their correlation with echocardiography findings, inotrope requirement, hypoxic-ischemic encephalopathy (HIE) stages, and mortality.METHODScTnT levels, echocardiographic findings, the requirement of inotropes, HIE stages, and outcome were studied in neonates of gestational age ≥ 34 wk with perinatal asphyxia.RESULTSAmong 57 neonates with perinatal asphyxia, male gender, cesarean section, forceps/vacuum-assisted vaginal delivery and late preterm included 33 (57.9%), 23 (40.4%), 3 (5.3%), and 12 (21.1%) respectively. The mean gestational age was 38.4 wk (1.6 wk). HIE stages I, II, and III were observed in 7 (12.3%), 37 (64.9%), and 9 (15.8%) neonates respectively. 26 (45.6%) neonates had echocardiographic changes and 19 (33.3%) required inotropes. cTnT levels were elevated in 41 (71.9%) neonates [median (IQR); 0.285 (0.211-0.422) ng/mL]. The Median cTnT level showed an increasing trend with increasing changes in echocardiography (P = 0.002). Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels (1.99 and 0.651 ng/mL). Of 31 neonates with normal echocardiography, 18 (58.06%) showed elevated cTnT. cTnT levels were significantly higher in those who required inotropic support than those who did not (P = 0.007). Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II (P = 0.013). Survivors had lower median cTnT levels [0.210 (0.122-0.316) ng/mL] than who succumbed [0.597 (0.356-1.146) ng/mL].CONCLUSIONcTnT levels suggestive of cardiac involvement were observed in 71.9% of asphyxiated neonates. cTnT levels correlated with echocardiography findings, inotrope requirement, HIE stages, and mortality.

The value of ultrasonography in predicting outcomes at an early school age among individuals with perinatal hypoxic-ischemic encephalopathy

Neurosonography (NSG) is a readily available non-invasive radiological examination technique that assesses brain damage in neonates who experienced perinatal hypoxia. The aim of the study was to determine the relationship between hypoxic-ischemic (HI) brain injuries in full-term neonates detected during ultrasonography and mental and neuromotor development outcomes at an early school age. We evaluated 8–9-year-old children (n = 32) who had experienced hypoxia at birth with mild to moderate hypoxic-ischemic encephalopathy (HIE) and hadn’t undergone therapeutic hypothermia. The control group consisted of 8–9-year-old children (n = 16) who were born healthy. During the first five days of life, the newborns underwent cerebral ultrasonography. The HIE stage was evaluated according to the Sarnat and Sarnat scale. Neuromotor and neurological outcomes were assessed using the Gross Motor Function Classification System, the Health Utilities Index (HUI) questionnaire, the Wechsler Intelligence Scale for Children WISC-III, and structured neurological examination. In the case of moderate brain edema and/or thalamus and/or basal ganglion injuries along with cerebellum and brainstem (E/T/BG/C/B) injuries compared to other injuries, the following abnormalities were statistically significantly more common: hearing disorders (100%, p = 0.03), cerebellar dysfunction (60%, p = 0.02), epilepsy (60%, p = 0.01), a lower Working Memory Index (median, 82.0, p = 0.015). In case of moderate brain swelling (edema) and thalamus and/or basal ganglion (E/T/BG) injuries, the sensitivity and specificity of the ultrasound examination when predicting epilepsy, hearing disorders, lower full IQ, and the Perceptual Organization Index were 100%. Neurosonography helps predict the outcomes of mental and neuromotor development at an early school age in full-term neonates who experienced perinatal asphyxia/hypoxia. Moderate hypoxic-ischemic brain changes detected during ultrasonography were statistically significantly associated with hearing disorders, cerebellar dysfunction, epilepsy, and a lower Working Memory Index in children at an early school age.

Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study.

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia. Reliable biomarkers to predict neurological outcomes of neonates after perinatal asphyxia are still not accessible in clinical practice. Methods: A prospective cohort study enrolled neonates with perinatal asphyxia. Biochemical blood tests and cerebral Doppler ultrasound were measured within 6 h of age and at the 4th day old. Neurological outcomes were assessed at 1 year old. Results: Sixty-four neonates with perinatal asphyxia were enrolled. Fifty-eight (90%) had hypoxic-ischemic encephalopathy (HIE) including 20 (34%) Stage I, 21 (36%) Stage II, and 17 (29%) Stage III. In the asphyxiated infants without therapeutic hypothermia, HIE stage, PH, and base excess levels within 6 h of age were the predictors of adverse outcomes. In the asphyxiated infants receiving therapeutic hypothermia, HIE stage failed to predict outcomes. Instead, blood lactate levels and pulsatility index (PI) of medial cerebral arteries (MCA) either in 6 h of age or at the 4th day old independently predicted adverse outcomes. Conclusions: Blood lactate, which is a common accessible test at the hospital and MCA PI on cerebral ultrasound could predict adverse outcomes in asphyxiated infants receiving therapeutic hypothermia.

Assessment of 25 (OH) Vitamin D in Neonates with Hypoxic Ischemic Encephalopathy Mohammed Elsayed Hamed 1, Dina Gamal Abd Elhamed 2,

Background: Vitamin D is a hormone that affects a wide range of functions within the body. Neonatal hypoxic ischemic encephalopathy (HIE) is a serious disease that may lead to permanent brain injury. Objective: The present study aimed to study vitamin D status in hypoxic ischemic in encephalopathy. Patients and methods: A case control study carried out in newborn intensive care unit (NICU) of Zagazig University Children Hospitals. Total number of cases that met the inclusion and exclusion criteria was 49 full term neonates with HIE divided according to Sarnat stages: stage I; 20 full term neonates, stage II; 15 full term neonates and stage III; 14 full term neonates. Cases were compared to 16 healthy controls. Results: There was a statistical significant increase in Apgar score 1, 5, 10 in control group compared to all cases groups. There were no statistical significant differences between the studied groups in relation to CBC results. There was a statistical significant difference between the different stages of HIE in CRP and pH.There was a statistical significant increase in frequency of hypoxic change in stage III compared to stage II and I. All stages of HIE showed statistical significant increase in frequency of vitamin D deficiency compared to control group. Stage III had statistical significant increase in frequency of vitamin D deficiency compared to stage I and II. Conclusion: Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates. 25 (OH) vitamin D was significantly deficient in stage III more than stage I and II.

Hepatic dysfunction in asphyxiated neonates: a prospective case: control study

Background: Birth asphyxia can lead to hypoxic damage to liver at cellular level which leads to release of liver enzymes in blood as well as altered liver function. This study aimed to study the alteration of hepatic function in birth asphyxia and correlate it with different stages of hypoxic ischemic encephalopathy (HIE).Method: A case control study was conducted at SMIMER Surat which involved 115 cases and 115 controls. Cases were full term neonates admitted in the NICU with an APGAR score of 6 or less at 1 minute of birth while controls were those neonates with an APGAR score of 7 or more. Blood samples were taken at 72 hours of life and liver function tests of the 2 groups were compared.Results: The difference in aspartate transferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) levels of the cases and controls were statistically significant (p&lt;0.05). However, difference in total protein and total bilirubin in between the 2 groups was statistically insignificant. The study also found that the difference in AST, ALT and LDH was statistically significant between HIE stage 1 and stage 2 (p&lt;0.5), between HIE stage 1 and stage 3 (p&lt;0.5) but insignificant between HIE stage 2 and stage 3 (p&gt;0.5).Conclusions: The present study showed that the serum levels of hepatic enzymes were higher in full term neonates with perinatal asphyxia than full term neonates without perinatal asphyxia at the age of 72 hours. The enzyme levels showed an increasing trend with increasing severity of HIE.