Outcome In Perinatal Asphyxia Research Articles

Quantitative EEG features during the first day correlate to clinical outcome in perinatal asphyxia.

To assess whether computational electroencephalogram (EEG) measures during the first day of life correlate to clinical outcomes in infants with perinatal asphyxia with or without hypoxic-ischemic encephalopathy (HIE). We analyzed four-channel EEG monitoring data from 91 newborn infants after perinatal asphyxia. Altogether 42 automatically computed amplitude- and synchrony-related EEG features were extracted as 2-hourly average at very early (6 h) and early (24 h) postnatal age; they were correlated to the severity of HIE in all infants, and to four clinical outcomes available in a subcohort of 40 newborns: time to full oral feeding (nasogastric tube NGT), neonatal brain MRI, Hammersmith Infant Neurological Examination (HINE) at three months, and Griffiths Scales at two years. At 6 h, altogether 14 (33%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.61, p < 0.05), and one feature correlated to NGT ([r]= 0.50). At 24 h, altogether 13 (31%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.56), six features correlated to NGT ([r]= 0.36-0.49) and HINE ([r]= 0.39-0.61), while no features correlated to MRI or Griffiths Scales. Our results show that the automatically computed measures of early cortical activity may provide outcome biomarkers for clinical and research purposes. The early EEG background and its recovery after perinatal asphyxia reflect initial severity of encephalopathy and its clinical recovery, respectively. Computational EEG features from the early hours of life show robust correlations to HIE grades and to early clinical outcomes. Computational EEG features may have potential to be used as cortical activity biomarkers in early hours after perinatal asphyxia.

The prevalence, consequences, and outcome of perinatal asphyxia in term and late preterm live-born neonatesA A case-control study from Iran

Background: Despite several investigations reporting the prevalence of asphyxia in developed and developing countries, very few studies from Iran have demonstrated the rate of neonatal asphyxia and its affecting factors. Objectives: This study aimed to determine the prevalence of asphyxia, its consequences, and neonatal outcomes among Iranian term and late preterm live-born neonates. Methods: A case-control study was conducted in three hospitals; Vali-e-Asr, Yas, and Ziaean from April 2019 to March 2020. The case group included neonates with a history of perinatal asphyxia. Twice gestational age-matched subjects without such a history also entered the study as the control group. All maternal and neonatal data were collected from participants’ medical records. Determining the prevalence of neonatal asphyxia was the primary outcome of the present study. Results: Totally 48 subjects as the case and control groups were included and 16 asphyxiated cases were observed equal to 3.3 per 1000 live-born neonates. Concerning the type of delivery, cesarean section in the control group and vaginal delivery in the case group were the most frequent types of delivery (p=0.041). Comparing neonatal variables, the results showed a significant difference regarding the groups’ genders (p=0.036). Apgar scores in the case group were also significantly lower than the control group (p=0.0001). More cases also required PPV compared to the controls (12 vs. 0; p=0.0001). Hypoxic-ischemic encephalopathy (HIE) grade 1 was also significantly more frequent in the case group than the controls (p=0.0001). The means of pH and base excess in the case group were significantly lower than the control group (p=0.0001). Conclusion: The results showed the prevalence rate of asphyxia among term and late preterm participants was 3.3 cases per 1000 live-born neonates. Apgar scores&lt;5 accompanied with metabolic acidosis, HIE, and requirement of PPV could be predictive variables for perinatal asphyxia. Observing such clinical risk factors may indicate the need of early diagnosis and timely interventions to improve neonatal outcomes.

A Study On Clinico- Neuro- radiological Correlation and Immediate Outcome of Perinatal Asphyxia in Neonates Admitted in Tertiary Care Hospital, Tirupati

A Study On Clinico- Neuro- radiological Correlation and Immediate Outcome of Perinatal Asphyxia in Neonates Admitted in Tertiary Care Hospital, Tirupati

Prevalence, Risk Factors and Outcome of Perinatal Asphyxia in Newborns at Benue State University Teaching Hospital Makurdi

Perinatal asphyxia is a global neonatal problem, which significantly contributes to both neonatal morbidity and mortality. This study was therefore undertaken to determine the prevalence, risk factors and outcomes of perinatal asphyxia in Makurdi, Nigeria. A retrospective review of clinical data of all newborns managed at the Special Care Baby Unit of the Benue State University Teaching Hospital over a 5 year period (January 2015-December 2019) was carried out using the research clinical data form. Maternal information including biodata, obstetric history, perinatal events as well as neonates' presentation and outcomes were reviewed. All inborn neonates with Apgar scores &lt;7 at 5 min or out-born neonates with no recorded Apgar scores but with history of poor cry/inability to cry at birth were classified as asphyxiated. Out of the 1142 neonates admitted during the study period, 127 neonates had perinatal asphyxia with prevalence of 11.1%. Eighty-four (66.1%) of the newborns were males, while 43(33.9%) were females with male to female ratio of 1.95:1 Majority of the newborns(89.1%) were managed and discharged without early neurologic complications; eight survived with early neurologic complications, eight were discharged against medical advice, while 7 newborns died, giving a case fatality rate of 5.5%.Risk factors significantly associated were Meconium-stained amniotic fluid(P=0.002) ,fetal presentation (P=0.030),and birth attendants (P=0.001). The burden of perinatal asphyxia still persists in our environment. Associated factors in this study were meconium-stained liquor and unskilled birth attendants. Hence pregnant women should be encouraged to attend antenatal care and should ensure skilled birth attendants attend delivery with capacity to conduct safe delivery and institute neonatal resuscitation when necessary.

Study of perinatal asphyxia and its outcome concerning nucleated RBC count in venous blood of term neonates

Introduction: Perinatal asphyxia is a serious problem globally and is one of the common causes ofneonatal mortality. Worldwide each year four million infants suffer from birth asphyxia. Of these onemillion die and an equal number develop serious sequelae. Perinatal asphyxia ranks as the secondmost important cause of neonatal death after infections accounting for about 23% of mortalityworldwide. Aim &amp; objective: To establish the level of nucleated red blood cells as an indicator ofpoor immediate outcome in perinatal asphyxia. Method: It was a case-control study done in thedepartment of pediatrics, S C B Medical College &amp; S V P PG I P, Cuttack. Observation: The NRBCcount was significantly higher in neonates with adverse outcomes than in those with favourableoutcomes (p-value &lt;0.001). NRBC count cut-off of &gt;27/100 WBC had a sensitivity of 75% andspecificity of 95.2% in predicting adverse outcome defined as death, hemiplegia, hypertonia orsignificant hypotonia, unreliable sucking and seizures resistant to Phenobarbital. Conclusion:Nucleated red blood cell count can be used as a surrogate marker for birth asphyxia. It has asignificant negative correlation with Apgar score at one minute and Apgar score at 5minutes &amp;significant positive correlation with severity of hypoxic ischemic-encephalopathy, time is taken forrecovery of neurological impairment following birth asphyxia and duration of NICU stay.

The Role of S100B Protein at 24 Hours of Postnatal Age as Early Indicator of Brain Damage and Prognostic Parameter of Perinatal Asphyxia.

Introduction. S100B protein is a cytosolic calcium-binding protein with a molecular weight of 21 kDa, which is present in various cells and concentrated mainly in the glial cells, which play a vital role in the maintenance of cellular homeostasis in the central nervous system. It is possible that increased S100B protein level might be considered as sensitive and specific indicator to predict early brain damage. Aim. To investigate the prognostic value of serum S100B protein in neonates with perinatal asphyxia (PA) at 24 hours of postnatal age. Methods. A systematic review was performed. Inclusion criteria were studies including data of neonates with PA, monitored with serum S100B, and with neurodevelopmental follow-up of at least 2 weeks. The period of bibliographic search was until January 2017. The consulted databases were MEDLINE, PsycINFO, and Embase. A combination of the following subject headings and keywords was adapted for each electronic database: “perinatal asphyxia,” “hypoxic ischemic encephalopathy,” “hypoxia-ischemia, brain,” and “S100B.” Meta-Disc1.4 software was used. Results. From the 1620 articles initially identified, 6 were finally included and reviewed. The overall diagnostic sensitivity of serum S100B was 0.80 (95% confidence interval [CI] = 0.68-0.88) and the specificity was 0.79 (95% CI = 0.70-0.87). But there was lower predictability value, that is, the positive likelihood ratio was only 3.26 (95% CI 1.74-6.12) and the negative likelihood ratio was 0.32 (95% CI = 0.20-0.5). The diagnostic odds ratio was 12.40 (95% CI = 4.66-33.0). Conclusion. Increased serum S100B level at 24 hours of postnatal life can demonstrate brain damage, but it should not be the only one used to predict PA outcome.

Clinical Features and Outcome of Birth Asphyxia in Hôpital du Cinquantenaire of Kisangani: A Cross-Sectional Study

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Aims: There paucity of studies on asphyxia, one of the three main reasons for newborn deaths in Democratic Republic of Congo (DRC). In this country, newborn mortality is among the highest in Africa. This study was conducted to identify the clinical features and outcome of perinatal asphyxia. Risk factors associated with asphyxia were also determined.&#x0D; Study Design: A cross-sectional study.&#x0D; Place and Duration of Study: It was conducted in the pediatric department of Hôpital du Cinquantenaire of Kisangani (HCK), from March 2013 to March 2017.&#x0D; Methodology: Clinical and biologic parameters (prenatal, perinatal and postnatal) of term newborns, hospitalised for perinatal asphyxia in the HCK were retrospectively collected and analysed. Data of dead newborns were compared to those who survived to determine risk factors associated with asphyxia mortality. One case matched three controls of the same sex.&#x0D; Results: During the period above, 612 newborns were received in the HCK, and 146 died. One hundred and nineteen out of 612 had perinatal asphyxia (19.4%), and 26 out of 119 died (17.8% of all newborn deaths and 21.8% of all asphyxia cases). The most frequent perinatal antecedents were premature rupture of the membranes, meconium-stained amniotic liquid, pre-eclampsia and eclampsia. In bivariate analysis, factors associated with asphyxia lethality were low birthweight (P=.02), reference from another hospital (P =.01), age more than 24 hours (P =.02), associated sepsis (P =.003), asphyxia severity (P&lt;.001) and the Stage 3 of Sarnat (P&lt;.001).&#x0D; Conclusion: The frequency of the asphyxia is high in the HCK and its mortality associated with avoidable factors. Networking newborn referral, improving skills of nurses about obstetrical and neonatal emergency cares, and making available equipment for newborn resuscitation can reduce that mortality.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

A study of urinary uric acid/creatinine ratio as an additional marker of birth asphyxia

Perinatal asphyxia refers to an impairment of the normal oxygenation during parturition and the ensuing adverse effects on the fetus/neonate. It is one of the major causes of early neonatal mortality in India. Among the institutional births, incidence is 5% and accounts for 24.3% of neonatal deaths. It is an insult to fetus or newborn due to lack of oxygen (hypoxia) or lack of perfusion (ischemia) to various organs of sufficient magnitude and duration. The aim of the study was to observe the urinary uric acid to creatnine ratio in patients with perinatal birth asphyxia in a hospital setting. It was concluded that UUA/Cr concentration increase considerably after birth asphyxia, and the increase is associated with severity of HIE with a poorer outcome. Hence, UUA/Cr might have an important role in diagnosing and predicting the outcome of perinatal asphyxia.

A study on cardiac troponin t in early diagnosis of myocardial injury due to perinatal asphyxia and its comparison with other modalities

Background: Perinatal Asphyxia is a multi-system disorder and its effects are not limited to central Nervous System. MODS determine the early outcome of asphyxiated neonate. Cardiac impairment occurs in about 25% of neonates with asphyxia. Often cardiac impairment is overlooked due to the lack of sensitive diagnostic test.Methods: A hospital based prospective analytical study performed over 50 Asphyxiated neonates admitted in our NICU from September 2016 to January 2017 myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac troponin-T card test.Results: In the present study, among the 50 neonates 32 had clinical evidence of myocardial injury. Troponin T card test has the highest sensitivity of about 84.37%, positive predictive value of 93.1% and negative predictive value of 76% in diagnosing myocardial injury in contrast to ECG and ECHO. In terms of Specificity ECHO has the highest specificity of about 94.4% when compared to ECG and Trop T. Among all the diagnostic modalities used in this study, Troponin T best predicts the severity and outcome of Perinatal asphyxia. Conclusions: Troponin T card test is a valuable tool for early detection of myocardial injury due to perinatal asphyxia. In resource limited setting where the accessibility to 12 lead ECG, ECHO, and aid of cardiologist are not available, Trop T card test will serve as an effective handy screening tool in diagnosing myocardial injury

Trans-resveratrol enriched maternal diet protects the immature hippocampus from perinatal asphyxia in rats.

Trans-resveratrol (tRESV), a polyphenol with antioxidant properties, is common in many food sources, hence easily accessible for study as a maternal dietary supplement in perinatal asphyxia (PA). Hypoxic-ischemic encephalopathy secondary to PA affects especially vulnerable brain areas such as hippocampus and is a leading cause of neonatal morbidity. The purpose of this study is to identify new epigenetic mechanisms of brain inflammation and injury related to PA and to explore the benefit of tRESV enriched maternal diet. The hippocampal interleukin 1 beta (IL-1b), tumour necrosis factor alpha (TNFα) and S-100B protein, at 24-48h after 90min of asphyxia were assessed in postnatal day 6 rats whose mothers received either standard or tRESV enriched diet. The expression of non-coding microRNAs miR124, miR132, miR134, miR146 and miR15a as epigenetic markers of hippocampus response to PA was determined 24h post-asphyxia. Our results indicate that neural response to PA could be epigenetically controlled and that tRESV reduces asphyxia-related neuroinflammation and neural injury. Moreover, tRESV could increase, through epigenetic mechanisms, the tolerance to asphyxia, with possible impact on the neuronal maturation. Our data support the neuroprotective quality of tRESV when used as a supplement in the maternal diet on the offspring's outcome in PA.

Prevalence and outcome of perinatal asphyxia: Our experience in a semi-urban setting

Introduction: Perinatal asphyxia is a significant cause of infant morbidity and mortality globally. Although considerable achievement has been made in reducing the impact of infectious diseases, much is yet to be seen in reducing the menace of perinatal asphyxia especially in semi-urban and rural areas. Materials and Methods: Data from medical records of all cases of perinatal asphyxia admitted over the study period of 30 months were retrieved and documented for the study. Results: Total admission to the special care baby unit was 1040, with 257 reported cases of perinatal asphyxia hence a prevalence of 24.7%. There were 149 (60.3%) males and 98 (39.7%) females; male:female ratio of 1.52:1. The gestation ages at delivery of the cases ranged from 35 to 44 weeks with mean of 38.02 ± 1.95; while the weight on admission ranged between 1.16 and 4.70 kg; mean weight of 2.97 ± 0.60. One hundred and eighty (72.9%) of the mothers were unbooked. About 73.3% of the deliveries occurred in the study center; vaginal deliveries accounted for 142 (57.5%) of the cases. Labor lasted between 18 and 24 h in 129 (52.2%) of the cases; however, eclampsia was the most common illness documented in these mothers. Two hundred and sixteen (87.4%) cases were discharged without documented complication, while seven deaths (2.8%) were recorded. Conclusion: Perinatal asphyxia is still prevalent in our setting; preventive measures should be adopted to reduce the disease burden by improving accessibility to health care, and also providing and increasing the acceptance of maternal antenatal care.

Early Cord Metabolite Index and Outcome in Perinatal Asphyxia and Hypoxic-Ischaemic Encephalopathy

Background: A ¹H-NMR-derived metabolomic index based on early umbilical cord blood alterations of succinate, glycerol, 3-hydroxybutyrate and O-phosphocholine has shown potential for the prediction of hypoxic-ischaemic encephalopathy (HIE) severity. Objective: To evaluate whether this metabolite score can predict 3-year neurodevelopmental outcome in infants with perinatal asphyxia and HIE, compared with current standard biochemical and clinical markers. Methods: From September 2009 to June 2011, infants at risk of perinatal asphyxia were recruited from a single maternity hospital. Cord blood was drawn and biobanked at delivery. Neonates were monitored for development of encephalopathy both clinically and electrographically. Neurodevelopmental outcome was assessed at 36-42 months using the Bayley Scales of Infant and Toddler Development, ed. III (BSID-III). Death and cerebral palsy were also considered as abnormal end points. Results: Thirty-one infants had both metabolomic analysis and neurodevelopmental outcome at 36-42 months. No child had a severely abnormal BSID-III result. The metabolite index significantly correlated with outcome (ρ² = 0.30, p < 0.01), which is robust to predict both severe outcome (area under the receiver operating characteristic curve: 0.92, p < 0.01) and intact survival (0.80, p = 0.01). There was no correlation between the index score and performance in the individual BSID-III subscales (cognitive, language, motor). Conclusions: The metabolite index outperformed other standard biochemical markers at birth for prediction of outcome at 3 years, but was not superior to EEG or the Sarnat score.

Clinical Profile and Outcome of Asphyxiated Newborn in a Medical College Teaching Hospital

Introduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as "failure to initiate and sustain breathing at birth". It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital.&#x0D; &#x0D; Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a) Apgar score equal to or less than six at five minutes, b) requirement of more than one minute of positive pressure ventilation, c) signs of fetal distress (heart rate of less than 100 beats per minute, late decelerations).&#x0D; &#x0D; Results: Out of total 425 neonatal intensive care unit (NICU) admissions, 82 (19.3%) cases were of asphyxia among which 56 were inborn and 26 were referred from outside. Of those 82 cases, 47 (57.3%) cases developed hypoxic ischemic encephalopathy (HIE); HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 25%.&#x0D; &#x0D; Conclusion: Despite advances in management of neonates, perinatal asphyxia is still the leading cause of neonatal intensive care unit admission and mortality and morbidity in neonates.

Clinico laboratory determinants of outcome among babies with perinatal asphyxia in Osogbo, Southwestern Nigeria

Background: Many clinical, pathological, biochemical and metabolic changes occur as a result of perinatal asphyxia. These changes affect many organ and systems like central nervous system, cardiovascular system, pulmonary, renal, adrenal, gastrointestinal tract, skin and haemopoetic systems. The aim of the study was to identify various clinical and biochemical determinants of outcome in perinatal asphyxia so as to institute proactive the management of such babies. Methods: All newborn infants with birth asphyxia over 5 year period (2009-2013) were retrospectively studied. The data studied included place of birth, gestational age, Apgar score, mode of resuscitation, details of complete physical examination especially as regard each of the system. Results of investigations like haematocrit, serum electrolytes and urea, blood glucose done in the first 24 hours of life and also other investigations like lumbar puncture, full blood count, cultures were noted. The outcome studied was survival and death of the babies. Results: One thousand, six hundred and seven babies were admitted into special care baby’s unit over the 5 year period, between 2009 and 2013. Nine hundred and seventy nine (60.9%) of them were males while 628 (39.1%) were females, M:F ratio was 1.6:1. Of the 1607 babies, 563 (35.0%) were asphyxiated. Of 1607 admitted during the period of study, 304 (18.9%) died while 128 (22.7%) of 563 babies with perinatal asphyxia died. Therefore, perinatal asphyxia accounted for 42.1% of the total mortality. 22 (7.8%) of the 280 babies who suffered moderate asphyxia compared with 106 (37.9%) of 283 babies who suffered severe asphyxia died. (χ2 = 72.4, p=0.000). Many of the asphyxiated babies had multisystemic adverse features. Significantly more babies who were out born, low birth weight, macrosomic and hypothermic than otherwise died. Also more babies with cyanosis, respiratory distress, apnoea, abdominal distension, feed intolerance, oliguria/anuria, bleeding disorder, abnormal muscle tone, seizures, bulging frontannel, and coma died, p ≥ 0.001. Also, mean haematocrit, plasma potassium and urea was significantly lower while plasma sodium was significantly higher among the babies who survived (p ≥0.001). Conclusions: Our findings have highlighted the major role of asphyxia in neonatal mortality and multisystemic morbidities or complications which contributed to death. It is therefore, likely that efforts at preventing perinatal asphyxia will be more rewarding. Such efforts include free and compulsory antenatal care, training of more skilled labour attendants and women empowerment.

ECG changes in birth asphyxia and its correlation with Cardiac troponin-I

Introduction: Cardiac dysfunction is well known in perinatal asphyxia caused by transit myocardial ischemia. Sometimes cardiac dysfunction may be so severe that it can cause congestive cardiac failure and shock that leads to death of newborn. ECG and serum levels of cardiac enzymes can be used to demonstrate impaired myocardial function. Material and Methods: It was a case control study conducted in the department of paediatrics, Gandhi Medical College, Bhopal over a period of 12 months from January 2013 to December 2013. Forty asphyxiated full term neonates were taken as cases and 20 healthy full term neonates as controls. Forty neonates with asphyxia admitted to NICU with gestational age &gt;37 completed weeks and with birth weight &gt;2 kg taken as cases and twenty healthy full term neonates (37 completed wks) unasphyxiated weighing &gt;2 kg at birth with clear liquor and 1 min Apgar score &gt;7. Results: Myocardial dysfunction was present in 90% of the newborns with severe birth asphyxia and 40% of newborns with moderate birth asphyxia. T wave changes were seen in 80% neonates with severe asphyxia and 33% neonates with moderate asphyxia. In present study, cTn I levels in severely asphyxiated neonates were significantly higher than moderately asphyxiated neonates and control group neonates (4.6 ng/ml, range 2.1 – 7.8, and 1.8 ng/ml, range 0.2 – 4.8 ng/ml and 0.6ng/ml, range 0.2-1ng/ml respectively). Conclusion: We found a linear relationship between levels of cardiac troponin-I and birth asphyxia. Therefore cardiac troponin-I level may be useful in predicting the mortality and outcome in perinatal asphyxia.

Inflammatory mediators as predictors of outcome in perinatal asphyxia.

To identify biomarkers for neuronal injury and outcome in perinatal asphyxia. This prospective cohort study was done in authors' level III NICU involving 80 neonates - 40 babies with perinatal asphyxia and 40 weight and gender matched normal neonates. Levels of cytokines IL-6, IL -1β, IL-2 and TNF -α in cord blood of these neonates were estimated and correlated with the severity of asphyxia and developmental outcome at 6 mo using Baroda Developmental Score. The baseline parameters revealed that there was no statistically significant difference between the two groups in terms of maternal age, parity, gestational age, gender and birth weight. The levels of cytokines IL-6 (p < 0.001) and IL-1beta (p < 0.03) were significantly higher in babies with perinatal asphyxia and correlated with the severity of asphyxia. The levels of IL-6 and IL-1β had significant negative correlation with developmental score at 6 mo. A cut off level of 14.18 pg/ml for IL-6 had 92.3 % sensitivity and 57.7 % specificity [Area under the curve = 0.80 (0.62-0.84)] for adverse neuro-developmental outcome while it was 11.17 pg/ml for IL-1β with a sensitivity of 69.2 % and specificity of 71.2 % [Area under the curve = 0.67 (0.57-0.80)]. IL-6 and IL-1 β are good predictive markers of severity of asphyxia and adverse neurological outcome.

Cardiac troponin I as an early predictor of perinatal asphyxia

Objective The objective of this study was to test the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of both severity and mortality in cases of perinatal hypoxia. Background Delivery is a stressful and risky event that poses a risk to newborns. The mother-dependent respiration has to be replaced by autonomous pulmonary breathing immediately after delivery. If delayed, it may lead to deficient oxygen supply, compromising the survival and development of the central nervous system. The outcomes of perinatal asphyxia are devastating and permanent, making it a major burden for the patient, the family, and society. Thus, there has been considerable focus on the early identification of newborns exposed to perinatal asphyxia and development of therapeutic strategies to reduce long-term morbidity and mortality. Troponin is an inhibitory protein complex located on the actin filament in all striated muscles and consists of three subunits: T, C, and I. cTnI was measured as an indicator of cardiac injury for a long time, but it has been of interest for the prediction of poor neonatal outcome in perinatal asphyxia. Aim of the study The aim of this work was to test the hypothesis that cTnI, a known marker of myocardial injury, is also an early predictor of both morbidity and mortality in cases of perinatal hypoxia. Materials and methods This study was carried out between October 2011 and June 2012. It included 40 neonates with perinatal asphyxia admitted to the neonatal ICU, El-Ahrar Zagazig General Hospital. Twenty healthy neonates matched for both age and sex were selected randomly as a control group. Blood samples were collected from the two study groups. cTnI was measured in relation to neurological sequelae, and deaths in both the groups were also evaluated. Results The mean cTnI of asphyxiated neonates was 4.6 ΁ 4.4 ng/ml, significantly higher than that of the control neonates, which was 0.55 ΁ 0.6 ng/ml. This difference was statistically significant. Conclusion cTnI was markedly increased in perinatal asphyxia. This was related to the severity of perinatal asphyxia. It can also be used as an early predictor of neonatal morbidity and mortality in perinatal asphyxia.

Oxidative stress in perinatal asphyxia in relation to outcome

To study the serum levels of oxidative stress markers - malondialdehyde (MDA) and protein carbonyl in babies with perinatal asphyxia and to correlate their levels with the outcome in terms of mortality and neurodevelopmental sequelae. A group of 40 term AGA (appropriate for gestational age) infants with perinatal asphyxia were selected as cases and same number of healthy babies as controls. Serum levels of oxidative stress markers - malondialdehyde and protein carbonyl were determined in cord blood and at 48 hours of life. Their levels were correlated with the outcome of perinatal asphyxia in terms of mortality and the long term neurological outcome. MDA and protein carbonyl, in cord blood were significantly higher among cases (5.88+/-1.40 micromol/L and 1.50+/-0.48 nmol/mg of protein respectively) than controls (3.11+/-0.82 micromol/L and 0.83+/-0.19 nmol/mg of protein respectively). Among the cases, MDA and protein carbonyl values at 48 hours of life (7.52 +/- 1.06 micrommol/L and 2.91 +/- 0.62 nmol/mg of protein respectively) were significantly higher than those at birth. MDA at birth and 48 hours was significantly higher among babies who had seizures than those who remained seizure free. These values were also significantly higher in babies who expired as compared to those who survived. Protein carbonyl values though higher in those who had seizures and in those who expired, were not statistically significant from controls. MDA and protein carbonyl at birth and 48 hours were higher in babies with developmental delay but the association was not statistically significant. In hypoxic ischemic encephalopathy (HIE), oxidative stress markers MDA and protein carbonyl are high at birth and rise further at 48 hours and the values correlate with the morbidity and mortality. Therefore, determining the serum levels of oxidative stress markers MDA and protein carbonyl will be of benefit in predicting the outcome in perinatal asphyxia.

Electrocardiographic and echocardiographic changes in perinatal asphyxia

To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia

To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.