Mild Asphyxia Group Research Articles

Myocardial Work for Dynamic Monitoring of Myocardial Injury in Neonatal Asphyxia.

To assess the value of parameters of myocardial work for dynamic monitoring of myocardial injury after neonatal asphyxia. Fifty-three neonates with asphyxia admitted within 24h after delivery were divided into a mild asphyxia group (n = 40) and severe asphyxia group (n = 13). Echocardiography was performed within 24h post-birth, within 72h post-birth (48h after first echo), and during recovery. The left ventricular ejection fraction on M-mode echocardiography and by Simpson's biplane method (LVEF and Bi-EF, respectively), stroke volume (SV), cardiac output (CO), cardiac index (CI), global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), and other parameters were measured. Echocardiographic indicators were compared between groups and over time. GWI was significantly increased at 72h in the mild asphyxia group (P < 0.05) but showed no significant change over time in the severe asphyxia group (P > 0.05). While GCW increased significantly over time in both groups (P < 0.05), it increased earlier in the mild asphyxia group. Time and grouping factors had independent effects on GWI and GCW (P > 0.05). The characteristics of differences in GWI and GCW between the two groups were different from those for LVEF, Bi-EF, SV, CO, CI, and GLS and their change characteristics with improvement from treatment. GWI and GCW changed significantly during recovery from neonatal asphyxia, and their change characteristics differed between mild and severe asphyxia cases. Myocardial work parameters can be used as valuable supplements to traditional indicators of left ventricular function to dynamically monitor the recovery from myocardial injury after neonatal asphyxia.

The Diagnostic Value of Cystatin C and Mild Hypothermia Therapy Based on Immunoturbidimetry Enhanced by Nanospheres in Asphyxia Neonate

In order to evaluate the early diagnosis value of CysC and the influence of mild hypothermia on the renal damage of asphyxia neonates, the serum cystatin C (CysC) levels of asphyxia neonates and normal neonates were measured by the nanomicrosphere-enhanced immunoturbidimetric method. The treatment was carried out, and the influence of mild hypothermia treatment on the renal damage of asphyxia neonates was analyzed. The results showed that the indicators of the asphyxia group were significantly higher than those of the control group, and the severe asphyxia group was significantly higher than that of the mild asphyxia group, which was statistically significant p &lt; 0.05 ; the heart rate of patients in the mild hypothermia treatment group decreased gradually with the decrease in body temperature. And compared with the control group, there was a significant difference ( p &lt; 0.05 ); after symptomatic treatment, the two groups of ALT, AST, BUN, and SCR were improved to varying degrees, and the difference was statistically significant compared with before treatment ( p &lt; 0.05 ). Studies have shown that serum CysC level can be used as an indicator to detect glomerular filtration function and early asphyxia newborns, and it is sensitive and specific for early diagnosis of kidney damage. At the same time, it can be used to monitor clinical renal function and determine the status of asphyxia newborns.

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.

Acoustic Radiation Force Impulse Imaging With Virtual Touch Tissue Quantification Enables Characterization of Mild Hypoxic-Ischemic Brain Damage in Neonatal Rats.

The aim of this study was to investigate whether the measurement of brain tissue stiffness using acoustic radiation force impulse (ARFI) elastography with virtual touch tissue quantification can improve the early detection of neonatal hypoxic-ischemic brain damage in rats. Seven-day-old Sprague-Dawley rats were randomly assigned to 3 groups: the mild asphyxia (n = 30), moderate asphyxia (n = 30), and sham control (n = 10) groups. Rats in the mild and moderate asphyxia groups were exposed to 8% oxygen (hypoxia) for 30 and 60 minutes, respectively, at 1 hour after ligation of the right common carotid artery. An ultrasound diagnostic instrument was used to obtain 2-dimensional ultrasound images, and ARFI with virtual touch tissue quantification was used to measure shear wave velocity preoperatively and at 12, 24, 48, and 72 hours postoperatively. Hematoxylin-eosin staining was used to evaluate brain damage. Two-dimensional ultrasound imaging detected swelling and increased echogenicity at 48 to 72 hours in the mild asphyxia group and at 24 to 72 hours in the moderate asphyxia group. The shear wave velocity substantially increased from 0.65 ± 0.04 m/s preoperatively to 0.78 ± 0.07 m/s at 72 hours in the moderate asphyxia group and from 0.64 ± 0.04 m/s preoperatively to 0.70 ± 0.03 m/s at 72 hours in the mild asphyxia group. The changes in the shear wave velocity coincided with the histopathologic changes in the brain, which included neuronal demyelination, hyperplasia, and necrosis; edema around vascular structures; and hemorrhage in the ependymal and periventricular areas. Shear wave velocity data obtained with the virtual touch tissue quantification technique may be used for early diagnosis of neonatal hypoxic-ischemic brain damage.

Correlation of QT dispersion with serum potassium or blood sodium levels post-neonatal asphyxia.

To investigate the correlation between the corrected QT dispersion (QTcd) and serum potassium/sodium levels in order to evaluate their significance for early diagnosis of neonatal asphyxia. This study included 124 neonatal asphyxia patients. These patients were divided into mild and severe asphyxia groups based on their clinical features and diagnostic indexing. Sixty healthy infants were selected as controls. QTcd, and serum cardiac troponin T (cTNT), potassium and sodium levels in the three groups were compared, and the correlation between QTcd and serum potassium/sodium was analyzed by Spearman correlation tests. Both mild and severe groups developed significantly higher cTnT and QTcd (p < 0.05), but lower serum potassium and sodium compared with control group (p < 0.05). The severe group had significantly higher cTnT and QTcd (p < 0.05), but lower serum potassium and sodium when compared with mild group (p < 0.05). The serum potassium and sodium were both negatively correlated with QTcd (p < 0.05). Serum potassium and sodium can be used as indicators for neonatal asphyxia, which may markedly improve early diagnosis, prognosis and treatment efficacy.to the progression of atherosclerosis, which could be a potential target for treating atherosclerosis.

Diagnostic values of prealbumin and retinol-binding protein for liver damage caused by different degrees of neonatal asphyxia

To investigate the diagnostic values of prealbumin (PAB) and retinol-binding protein (RBP) for liver damage caused by mild or severe asphyxia. A retrospective analysis was performed on 185 neonates (including 84 premature infants and 101 full-term infants) with asphyxia. Based on the Apgar score, they were divided into two groups: mild asphyxia group (n=150) and severe asphyxia group (n=35). The levels of PAB, RBP, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were measured and compared. Their diagnostic values for liver damage were evaluated by ROC curve analysis. The premature infants in the severe asphyxia group had significantly higher AST level and significantly lower levels of PAB and RBP than those in the mild asphyxia group (P<0.05). The full-term infants in the severe asphyxia group had a significantly lower PAB level than those in the mild asphyxia group (P<0.05). After treatment, the PAB level was significantly improved in the premature infants in the severe asphyxia group and in the full-term infants in both mild and severe asphyxia group (P<0.05). The full-term infants in the mild asphyxia groups also showed a significant improvement in AST level (P<0.05). The ROC curve analysis showed that PAB had a good sensitivity and specificity for identifying liver damage caused by mild or severe asphyxia in full-term and preterm infants. PAB can be used as an indicator of liver damage caused by asphyxia in neonates, and can be used to assess the degree of asphyxia.

Relationship between neonatal asphyxia and blood glucose disorder

Objective To study the association between neonatal asphyxia and blood glucose disorder. Methods A total of 134 cases of neonatal asphyxia born in the Maternal and Child Hospital of Hubei Province between January 2013 and January 2015 were included in this study. Blood glucose levels were determined within 30 min after birth and before glucose infusion. The infants were divided into the mild asphyxia group (Apgar score 4 to 7) and severe asphyxia group (Apgar score 0 to 3) according to the Apgar score at 5 min after birth. Statistical analyses were performed using the two-sample t-test and Chi-square test. Results The incidence of asphyxia was 3.2‰ (134/41 875). Hypoglycemia was the main blood glucose disorder in the mild asphyxia group [12% (13/112)], and hyperglycemia was the main blood glucose disorder in the severe asphyxia group [32% (7/22)]. The average blood glucose level was higher in the severe asphyxia group than in the mild asphyxia group [(5.8±3.4) vs (5.0±2.3) mmol/L, t=21.979, P=0.001]. In the severe asphyxia group, the incidence of hypoglycemia was higher [18% (4/22) vs 12% (13/112), χ2=7.464, P=0.006] and the average blood glucose level was lower [(1.8±0.7) vs (2.1±0.4) mmol/L, t=5.247, P=0.042],and the incidence of hyperglycemia was also higher [32% (7/22) vs 9% (10/112), χ2=11.679, P=0.001] and the blood glucose level was higher [(11.6±3.8) vs (9.3±2.0) mmol/L, t=1.106, P=0.048]. Conclusion Neonatal asphyxia can lead to blood glucose disorders. The incidence and the severity of these disorders were higher in neonates with severe asphyxia. Key words: Asphyxia neonatorum; Glucose metabolism disorders; Blood glucose

The value of amplitude integrated electroencephalographic monitoring in early neonatal brain injury and prediction prognosis of asphyxia neonatal

Objective To discuss the value of amplitude integrated electroencephalographic (aEEG) monitoring in early neonatal brain injury and prognosis of asphyxia neonatal. Methods Seventy-two subjects of asphyxia children were divided into mild asphyxia group and severe asphyxia group. We selected 45 cases of full-term healthy children born in our hospital as control group in the same term. All the objects were observed by aEEG monitoring within 6 hours. According to the aEEG results, all the samples were redivided into normal aEEG group, mildly abnormal aEEG group and severely abnormal aEEG group. All subjects were followed-up to observe their physical growth and the nervous system development at one-year-old. Results Incidence of abnormal aEEG in mild asphyxia group and severe asphyxia group was significantly higher than that of control group (χ2=26.996, 47.07, P 0.05), all of their mental index and developmental quotient were lower in severely abnormal aEEG group (χ2=13.450, 15.285, P<0.01, respectively). Conclusion aEEG can be used to assess the early neonatal brain injury of asphyxia neonatal, and it can be used to predict the prognosis of neonatal asphyxia based on the abnormal degree of aEEG. Key words: Amplitude integrated electroencephalography; Neonatal asphyxia; Neonate; Prognosis

Effect of different time to milk on very low birth weight premature infants

Objective To discuss the effect of milking in different times on very low birth weight premature infants .Methods Totals of 78 very low birth weight premature infants were chosen and divided into the no asphyxia group A（Apgar score 7-10）, mild asphyxia group B（Apgar score 4-6.9）, sever asphyxiation group C（Apgar score 0-3.9） according to the Apgar score.Then every group was randomly divided into the subgroups：13 neonates for group A1, group A2, group B1, group B2, group C1 and group C2.Group A1, group B1 and group C1 added early trace formula into enteral feeding in 24 hours until converted to full-intestinal absorption, while group A2 , group B2 and group C2 were given the same nutrition after 24 hours.Changes of indicators of infants were observed in all groups .Results The weight gain , excrement , time to regain body bass, PPN time, FEN time and hospitalization day was respectively （17.5 ±6.6） g/d,（3.2 ±1.2） times/d, （4.7 ±2.6）d, （9.2 ±4.1）d, （20.4 ±7.1）d ,（25.6 ±4.8）d in group A1, and（11.4 ±5.3）g/d, （1.9 ± 1.7）times/d, （6.2 ±3.1） d,（13.1 ±3.7） d,（25.1 ±7.9） d and（29.7 ±5.3） d in group A2, and the differences were statistically significant （ t =7.045,5.379,6.001,5.891,5.913,7.704, respectively;P 〈0.05）.The weight gain, excrement, time to regain body bass, PPN time, FEN time and hospitalization day was respectively （10.0 ±3.5） g/d,（1.4 ±0.8） times/d,（7.9 ±3.7） d, （15.6 ±5.2） d, （27.7 ±6.8） d, （32.8 ±8.2）d in group B1, and（10.6 ±2.8）g/d,（1.3 ±1.1）times/d,（8.1 ±3.1）d,（14.8 ±6.1）d, （28.1 ±5.4）d,（36.4 ±8.7）d in group B2, and the differences were not statistically significant （t=1.964, 1.157,2.131,1.467,2.003,1.980, respectively;P〉0.05）.The weight gain, excrement, time to regain body bass, PPN time, FEN time and hospitalization day was respectively （4.4 ±1.8） g/d,（0.0 ±0.3） times /d, （13.4 ±4.8）d, （19.2 ±7.7）d, （36.1 ±9.5）d,（43.5 ±10.2）d in group C1, and （7.4 ±3.4）g/d,（1.1 ± 0.9）times/d,（10.6 ±3.1） d,（17.0 ±6.9） d,（30.2 ±7.5） d and（39.9 ±9.1） d in group C2, and the differences were statistically significant （ t =5.549,6.000,5.836,5.907,8.114,7.908, respectively;P 〈0.05）.There was statistically significant difference of gastrointestinal functional damage between group A 1 and A2（χ2 =8.496,P〈0.05）.There was no statistically significant difference of gastrointestinal functional damage between group B1 and B2 （χ2 =2.001,P〉0.05）.There was statistically significant difference of gastrointestinal functional damage between group C1 and C2 （χ2 =13.457,P 〈0.01）.Conclusions Presence of asphyxia hazard is one of the most important standards of starting breastfeeding in 24 hours for very low birth weight premature infants , and Apgar score can be used as one of the references for start milking for premature infants . Key words: Infant,low birth weight; Feeding intolerance; Music therapy; Touch therapy; Non-nutritional sucking method

THE CLINICAL SIGNIFICANCE OF SERUM LEVELS OF CK-MB AND CTN-I COMBINED WITH CORRECTED QT DISPERSION TO EVALUATE THE SEVERITY OF MYOCARDIAL INJURY AFTER ASPHYXIA IN NEONATES

ObjectivesHypoxic ischaemic myocardial injury is one of the serious complications of asphyxia in neonates, which may cause systolic dysfunction, arrhythmias, heart failure and even death. Early and accurate diagnosis may...

Evaluation of cardiac function after neonatal asphyxia by Doppler tissue imaging

To investigate the value of Doppler tissue imaging (DTI) in evaluation the changes of cardiac function after neonatal asphyxia. Sixty-two full-term neonates suffering from asphyxia at birth were divided into 2 groups according to Apgar scores: severe asphyxia group with the Apgar scores < or = 3 (n = 31) and mild asphyxia group with the Apgar scores > 3 and < or = 7 (n = 31). Thirty normal neonates were used as control group. DTI was conducted 24, 48, and 72 hours after birth to measure the values of systolic peak myocardial motion velocity (DTIs), early diastolic peak myocardial motion velocity (TDIe), late diastolic peak myocardial motion velocity (DTIa) and DTI e/a of anterior leaflet of mitral valve, and the values were compared with the left ventricular ejection fraction (LVEF) measured by M-mode ultrasound and the values of E, A, and E/A of mitral valve shown in pulsed Doppler echocardiography. The LVEF of the severe asphyxia group measured 24 h after birth was (62 +/- 4)cm/s, significantly lower than that of the control group (P < 0.05), while the values of DTIs 24, 48, and 72 hours of the severe asphyxia group were all significantly lower than those of the control group (all P < 0.05). In the severe asphyxia group the DTIs value 24 hours [(3.9 +/- 0.4) cm/s] after the birth was significantly lower than those 48 and 72 hours after birth [(5.3 +/- 0. 8)cm/s, (5.0 +/- 0.9)cm/s,both P < 0.01]. The values of E and E/A of the severe asphyxia group (55 +/- 12, 0.94 +/- 0.25) 72 h after birth of the mild asphyxia group (51 +/- 10, 0.89 +/-0.20) were both significantly lower than those of the control group (both P < 0.01), the value of A 72 h after birth of the mild asphyxia group (60 +/- 7) was significantly higher than that of the control group (P < 0.01). The values of DTIe and DTIe/a 24, 48, and 72 h after birth of the mild asphyxia group were all significantly lower than those of the control group, and the values of DTIa 24, 48, and 72 h after birth of the mild asphyxia group were all significantly higher than those of the control group (all P < 0.01). After neonatal asphyxia, both the systolic function and the diastolic function of the left ventricle decrease; and the DTI indexes can reflect the cardiac function changes more sensitively than M-mode ultrasound indexes.

130 Urinary Beta2-Microglobulin as an Indicator of Renal Lesion in Asphyxiated Neonates

BACKGROUND: Perinatal asphyxia can cause transient renal impairment or acute renal failure in neonates. Proximal tubular cells are extremely vulnerable to hipoxia.The ischemic injury results in elevated concentration of beta2microglobulin (beta2M) in urine.Urinary beta2M concentration increases with degree of tubular dysfunction.The aim of the study was to determine a concentration of beta2M in urine of asphyxiated and healthy neonates of varying gestational and postnatal age. STUDY AND THE CONTROL GROUPS: The study and the control groups were 141 neonates.The study group were 66 asphyxiated neonates,16 term and 50 preterm. Mean [SD] gestational age (GA) of term newborns was 38 (37 to 42) with mean [SD] birth weight 3290 g [703] and mean GA [SD] of preterm was 32 (30 to 36) mean [SD] birth weight 2070 g [548]. Criteria for inclusion were umbilical cord arterial pH less than 7.1 and BE less than minus 12 mmol/l. The control group were 75 neonates clinically stable 14 term (GA 37–42 mean [SD] 39 [1] mean birth weight [SD] 3440 g [500] and 57 preterm (GA 30- 36 mean [SD] 33 [2] mean [SD] birth weight 2061 g [552]. Both study and control group were divided into three subgroups of different maturation (A > 35, B-33–35, C 30–32 GA). METHODS: Urine samples were frozen at minus 20 C until assay. Beta2M was estimated in five samples on day 1, 3, 7, 14, 28 using competitive radioimmunoasay. RESULTS: We found statistically significant elevation of mean values of beta2M in urine of asphyxiated neonates compared to controls in all samples.The level of beta2M in preterm infants was significantly higher than that in term ones, both in study and control group during the entire first month of life.The highest values were observed in most immature neonates (GA 30–32). In group of asphyxiated and most immature neonates very high level of beta2M was still detected on day 28 while in fullterm it was almost normal.The beta2M excretion in asphyxiated neonates showed an increase on 1 and 3 day with a peak level at 7 day of age and than a slow decrease.Transient elevation of urinary beta2M were noted also in control group on day 3 with no significant differences between values of beta2M in the other samples in control group. We observed also correlation of beta2M with severity of perinatal asphyxia. The levels of beta2M were significantly increased in severe asphyxia group (pH less or equal 6.9) compared to mild asphyxia group. CONCLUSIONS: Measuring of beta2M can be non invasive method for determining a severity of perinatal asphyxia and renal maturation as well.

Changes and significance of plasma neuropeptide Y in newborns with asphyxia

目的 探讨神经肽Y(neuropeptide Y,NPY)与新生儿窒息的关系. 方法采用放射免疫法测定37例有新生儿窒息孕妇(窒息组)及33例正常妊娠妇女(对照组)静脉血及脐血中NPY含量. 结果(1)窒息组脐血中NPY含量为(187.47±46.63)ng/L,对照组为(115.33±29.42)ng/L.两组比较差异有显著性(t=3.113,P＜0.01),重度窒息组与轻度窒息组间差异也有显著性(t=2.001,P＜0.05).(2)窒息组母血浆NPY含量为(78.94±19.52)ng/L,对照组为(85.73±22.95)ng/L,两组间差异无显著性(t=1.721,P＞0.05),且轻、重度窒息组间差异也无显著性(t=1.512,P＞0.05).(3)窒息组脐动脉血血气分析:pH为(7.0±0.1),PO2为(1.2±0.3)kPa,PCO2为(8.9±0.8)kPa;NPY水平与脐血pH及PO2显著负相关(r=-0.451及-0.492,P＜0.01),与PCO2显著正相关(r=0.438,P＜0.01).两组母血NPY水平无差异.结论NPY参与了新生儿窒息的病理变化过程,与新生儿窒息的发生发展密切相关。