Post-asphyxial Hypoxic-ischemic Encephalopathy Research Articles

Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy

Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy

A preliminary study of multimodal evoked potentials in relation to outcome in term infants with post-asphyxial hypoxic-ischemic encephalopathy

A preliminary study of multimodal evoked potentials in relation to outcome in term infants with post-asphyxial hypoxic-ischemic encephalopathy

Can a single lactate value predict adverse outcome in critically ill newborn?

The aim of this study was to investigate the role of the lactic acidosis, as an early predictor of significant consequences and/or a fatal outcome in term neonates after a perinatal asphyxia. Severe perinatal asphyxia can generate multiple organ dysfunction and neonatal mortality. In routine clinical practice, after an admission to the Intensive Care Unit, lactate concentration was determined in capillary blood samples during the first one to six hours after birth in 55 term newborns with the post-asphyxial hypoxic-ischemic encephalopathy. The control group consisted of 36 healthy term neonates randomly selected in the maternity ward at the Gynecology and Obstetrics Clinic. Significantly higher concentrations of lactate (p 8.7 mmol/L with 80 % sensitivity and 82% specificity indicated the development of the hypoxic-ischemic encephalopathy stage II/III, while the lactate level>9.95 mmol/L was a predictor of death, with 75% sensitivity and 74.4% specificity. Determination of lactate concentrations in serum of term newborns associated with risk factors for the perinatal asphyxia is a useful tool in diagnosing metabolic disorders and ischemic damage, particularly severe clinical forms (Tab. 2, Fig. 3, Ref. 34).

Multiple organ failure in the newborn: the point of view of the pathologist

One of the most severe events occurring in critically ill patients admitted to a neonatal intensive care unit (NICU) center is represented by the multiple organ failure (MOF), a systemic inflammatory response leading to a progressive organ dysfunction and mortality in newborns. MOF may occur in newborns primarily affected by multiple single organ diseases, including respiratory distress syndrome neonatal sepsis with acute kidney injury, post-asphyxial hypoxic-ischemic encephalopathy and pandemic influenza A (H1N1) infection. In a previous article from our group, based on the histological examination of all organs at autopsy of newborns affected by MOF, all organs studied did not escape to be damaged, including thymus and pancreas normally not mentioned in the literature of MOF. The aim of this article is to review the most important pathological changes pathologists should look for in every case of MOF occurring in the perinatal period, with particular attention to systemic endothelial changes occurring in blood vessels in all organs and sytems. On the basis of our experience, matching data during the last phases of the clinicopathological diagnosis represents a useful method, much more productive as compared to the method based on giving pathological answers to the clinical questions prospected before autopsy. As for the pathological features observed in neonatal MOF, one of them deserves a particular attention: the vascular lesions, and in particular the multiple changes occurring during MOF development in endothelial cells, ending with the loss of the endothelial barrier, probably the most relevant histological lesion followed by the insurgence of interstitial edema and disseminated intravascular coagulation. Small vessels should be observed at high power, with particular attention to the size and shape of endothelial nuclei, in order to evidence endothelial swelling, probably the initial modification of the endothelial cells leading to their death. Finally, only the clinical pathological discussion may lead to a good diagnosis, correlating the morphological evidences with the clinical history and the sequence of clinical events that, at the best of our experience, are always different in a new case of MOF. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

Neonatal seizure localization using PARAFAC decomposition

The description and evaluation of two EEG-based algorithms for automatic and objective determination of the seizure location in the neonatal brain as it is reflected on the scalp. Each algorithm extracts the electrical potential distribution of the seizure over the scalp using the higher-order canonical decomposition or Parallel Factor Analysis (PARAFAC), also referred to as the CP model. This model decomposes a tensor in a sum of rank-1 components. The two algorithms differ in the way the tensor is constructed and in the type of activity they are able to extract. While the first method extracts oscillatory seizure activity, the second extracts spike train activity. We compared the seizure localization results of 21 seizures from 6 neonates with post-asphyxial hypoxic ischemic encephalopathy, with that based on the visual analysis of the EEG by a clinical neurophysiologist. There was a good agreement between the two methods in the localization of seizure onset in all. The techniques presented in this paper are robust, objective methods to determine neonatal seizure localization. They can be a useful tool for neonatal EEG analysis and for continuous brain function monitoring. The proposed algorithms significantly improve neonatal seizure localization and monitoring.

Outcome Prediction Rule for Neonatal Hypoxic-Ischemic Encephalopathy

A prognostic model for term infants with postasphyxial hypoxic-ischemic encephalopathy (HIE) based on clinical and laboratory predictors available at age 4 hours was developed at Mount Sinai Hospital and Hospital for Sick Children, Toronto, Ontario.

Multiorgan Dysfunction in Infants With Postasphyxial Hypoxic–Ischemic Encephalopathy

Multiorgan dysfunction (MOD) is a consistent feature of the postasphyxial newborn infant. MOD is related to the diving reflex which, when activated by asphyxia, shunts blood from the skin and splanchnic region to the heart, adrenal glands, and brain. The presumed goal is to protect these vital organs from hypoxic-ischemic injury. This study examined patterns of involvement of major organ/systems and combinations of these in infants with postasphyxial hypoxic-ischemic encephalopathy (HIE), and associations between dysfunction and the long-term outcome. Outcome data were available for 130 infants who met 1 or more of 4 eligibility criteria: 1) a 5-minute Apgar score below 5, metabolic acidosis, and/or a lack of respiration for 5 minutes or longer; 2) a need for mechanical ventilation at birth; 3) evidence of encephalopathy (altered consciousness and/or seizures); and/or 4) complete functional assessment of the kidneys, cardiovascular system, lungs, and liver. Severe adverse outcomes (death from postasphyxial HIE, severe cerebral palsy diagnosed in the first year of life, mild or moderate cerebral palsy with blindness or deafness in the first year; moderate cerebral palsy with developmental delay at 21-24 months of age) were noted for 80 of 130 infants, 62% of the total. All infants had at least one organ dysfunction in addition to HIE. The incidence of renal, cardiovascular, pulmonary, and hepatic dysfunction ranged from 58% to 88% of infants having a good outcome and from 64% to 86% of those with an adverse outcome. Pulmonary and hepatic dysfunctions were most frequent. The rate of adverse outcomes increased from 1 to 3 as the number of additional organs involved increased from 1 to 3, but decreased when an additional 4 organs were involved. MOD was universally present in these infants with severe postasphyxial HIE, but was not associated with long-term outcomes.

Recovery of metabolic acidosis in term infants with postasphyxial hypoxic‐ischemic encephalopathy*

To describe the base deficit (BD) values and the rate of postnatal recovery of the BD of infants with hypoxic ischemic encephalopathy due to intrapartum asphyxia; and to explore the relationships between the rate of recovery of BD, severe adverse outcome and different time patterns (acute total vs prolonged partial) of asphyxia. Clinical and laboratory data were collected from the neonatal period (n = 244) and outcome data to a minimal age of 1 y (n = 218). Rates of recovery of BD were described in four 60 min blocks of time. The values of rate of recovery were compared between the outcome groups, ignoring correlation structure within subjects and with adjustment by the generalized estimating equations method. The BD normalized within 4 h of birth in all but 9 of 244 infants. The rates of recovery of BD in infants with good and severe adverse outcome respectively were 0.11 [95% confidence interval (95% CI) 0.07, 0.14] and 0.09 (95% CI 0.07, 0.12) mmol l(-1) min(-1) over the first 4 h after birth. The rates of recovery were similar with or without buffer therapy, and after acute near-total and prolonged partial asphyxia. The BD in the great majority of infants with severe intrapartum asphyxia normalizes within 4 h of birth. The BD recovery rate of infants with adverse outcomes was similar to those with relatively good outcome. The different time patterns of asphyxial episode were not associated with differential recovery profiles.

Recovery of metabolic acidosis in term infants with postasphyxial hypoxic-ischemic encephalopathy

Recovery of metabolic acidosis in term infants with postasphyxial hypoxic-ischemic encephalopathy

Early Predictors of Adverse Outcome in Term Infants With Post-Asphyxial Hypoxic Ischemic Encephalopathy

In an attempt to identify early predictors of major disability or death apparent within the first 2 hours of life, the cases of 35 term infants given a diagnosis of postasphyxial hypoxic-ischemic encephalopathy (HIE) were reviewed. All infants were born after 37 weeks’ gestation. In addition to clinical signs of HIE and evidence of fetal distress, these infants had a low Apgar score, an initial arterial pH less than 7.20, and/or a 5-minute delay in respiration, and they required resuscitation and ventilatory assistance at birth. Signs of HIE included altered consciousness, abnormal neuromuscular tone and reflexes, seizures, and tonic eye deviation. Infants were evaluated by a neonatologist up to the age of 18 months. A severely adverse outcome (death; major motor disability, including generalized hypotonia, spastic diplegia, hemiplegia, or choreoathetosis; or developmental delay) was observed in 23 of the 35 infants (65.7%). Care had been withdrawn from only 1 of 13 infants who died. Ten babies survived with major neurologic sequelae, most often spastic quadriplegia. HIE was rated as mild in 3 cases, moderate in 18, and severe in 14. Univariate analysis identified a low 5-minute Agar score, a low initial arterial pH, a high base deficit, and the use of adrenaline as being significantly associated with a severe adverse outcome. Factors that were not significant included an abnormal fetal heart rate, abnormal findings on the cardiotocogram, cardiac arrest, seizures, and the 1-minute Apgar score. On multivariate analysis, an initial base deficit of at least 20 mEq/liter independently predicted death or severe neurologic deficit with a sensitivity of 79%, specificity of 90%, and a positive predictive value of 94%. Adding a 5-minute Apgar score of less than 4 yielded 67% sensitivity but 100% specificity, with positive and negative predictive values of 100% and 62.5%, respectively. Combining a pH of 7.1 or less with a low 5-minute Apgar score had a specificity and positive predictive value of 100% but was less sensitive. The most reliable overall predictor was a base deficit of 25 mEq/liter or more, which was 64% sensitive, 89% specific, and had positive and negative predictive values of 78% and 80%, respectively. Higher predictive values could not be achieved by combining two or more risk factors.

Early Predictors of HIE Adverse Outcome

A retrospective study of 35 term infants with post-asphyxial hypoxic-ischemic encephalopathy (HIE) was conducted at the KK Women’s and Children’s Hospital, Singapore, to determine early predictors of mortality or major motor morbidity at 18 months of age.

Predicting the Outcome of Postasphyxial Hypoxic-Ischemic Encephalopathy Within 4 Hours of Birth

Predicting the Outcome of Postasphyxial Hypoxic-Ischemic Encephalopathy Within 4 Hours of Birth

Hyperoxia and Hypocarbia in the Immediate Postnatal Period are Associated with Adverse Outcomes of Post-asphyxial HypoxicIschemic Encephalopathy(PA-HIE) † 1047

Hyperoxia and Hypocarbia in the Immediate Postnatal Period are Associated with Adverse Outcomes of Post-asphyxial HypoxicIschemic Encephalopathy(PA-HIE) † 1047

Variability of serum AST and ALT measurements in infants with moderate to severe post-asphyxial hypoxic-ischemic encephalopathy (PA-HIE) suggests variable efficiency of the Diving Reflex 1112

Variability of serum AST and ALT measurements in infants with moderate to severe post-asphyxial hypoxic-ischemic encephalopathy (PA-HIE) suggests variable efficiency of the Diving Reflex 1112

Base Deficit (BD) in Babies with Post-asphyxial Hypoxic Ischemic Encephalopathy (PA-HIE) and relationship to Outcome 1107

Base Deficit (BD) in Babies with Post-asphyxial Hypoxic Ischemic Encephalopathy (PA-HIE) and relationship to Outcome 1107

Predicting the outcome of postasphyxial hypoxicischemic encephalopathy within 4 hours of birth

Objective: To build models that predict severe adverse outcome within 4 hours of birth in patients with postasphyxial hypoxic-ischemic encephalopathy. The goal was to develop models for selecting patients for therapeutic trials of neuroprotective medications. Study design: Retrospective cohort study with follow-up to a minimum age of 12 months of 164 “outborn” term infants admitted to a tertiary neonatal intensive care unit, and 14 “inborn” term infants in the two tertiary perinatal centers in a regionalized setting. After performing univariate screening tests, multivariate models of association between risk factors and “severe adverse outcome” (death or major neurosensory impairment) were constructed. Results: Of 178 infants with postasphyxial hypoxic-ischemic encephalopathy of defined severity admitted consecutively between 1985 and 1992, 48 died, 40 survived with major neurosensory impairment, and 13 were lost to follow-up. The important predictors of severe adverse outcome in the first 4 hours were delayed onset of breathing, administration of chest compressions, and seizures. At 60 minutes of age, based on predicted probabilities of >0.50, the sensitivity of the predictive model was 85% and specificity 68%. The parameter estimates of the predictive models are reported. Conclusion: Age of onset of breathing, administration of chest compressions, and age of onset of seizures were the most important variables predictive of adverse outcome in this study. Although fairly sensitive and specific, these predictive models should be applied with caution. To build more accurate models, a template for the conduct of a large, multicenter prospective study is provided. (J Pediatr 1997;131:613-7)

Clinicopathological correlations in postasphyxial organ damage: a donor organ perspective.

1) To assess pathology in the heart, kidneys, lungs, liver, and intestine in babies dying of postasphyxial hypoxic ischemic encephalopathy (HIE), and their suitability for organ transplantation. 2) To analyze the correlation between in vivo clinical markers of collateral organ damage and autopsy findings. Retrospective cohort study of 58 infants who died of postasphyxial HIE and had autopsies during 1985 to 1994. Collateral organ damage was evaluated clinically and pathologically, and the results compared. Severe pathological changes were observed in 6% to 62% of the five organs studied; 59% of the four major organs had either minor or no pathology. The sensitivity of the clinical predictors ranged from 69% to 100%, and specificity from 50% to 97%. The organs of newborns dying of severe HIE may be suitable for use as donor organs; predictions of their suitability were most accurate for liver, kidney, and lungs, and least accurate for the heart.