Severe Perinatal Asphyxia Research Articles

EFFECTIVENESS OF MAGNESIUM SULFATE IN TERM NEONATES HAVING PERINATAL ASPHYXIA

In Pakistan, neonatal mortality and morbidity are remarkably high. Birth asphyxia (perinatal asphyxia) is one of the main contributors to this, apart from prematurity, sepsis and other causes. Objective: To assess the effectiveness of magnesium sulfate in term neonates having perinatal asphyxia Methods: This Randomized Controlled Trial was carried out at the Department of Pediatrics, Sheikh Zayed Hospital Rahim Yar Khan from July 2023 to December 2023. The overall sample size was 130 patients (65 patients in each group). Neonates in group A received MgSO through I/V, 3 doses 250mg/kg/dose, 24 hours apart along with standard treatment. Group B was a control group that received 20 ml of normal saline infusion at the same interval with similar supportive and symptomatic treatment with regular monitoring. The outcome in terms of mortality, seizure, early initiation of feed, time to the establishment of full oral feeding, duration of seizures and duration of hospital stay were assessed. All the data was analyzed by using SPSS version 25.Results: In the current study, a total of 130 neonates were enrolled. Among them, moderate asphyxia was observed in 90 (69.23%) patients whereas severe perinatal asphyxia was observed in 40(30.77%) patients. In group A, the mean level of serum magnesium in neonates with moderate asphyxia was 2.81 (±0.20) mEq/L while in neonates with severe asphyxia, it was 2.89 (±0.61) mEq/L. The moderate asphyxia patients in group-A showed significant statistical improvement in terms of seizure control (hours) (14.11±1.22 vs 18.11±1.56; P=0.01), normal cry appearance (Days) (11.1±0.12 vs 13.11±1.29; p=0.03), normal activity appearance (Days) (11.9±0.02 vs12.00±1.51; p=0.01), full oral feed acceptance by sucking (Days) (13.31±0.99 vs 14.61±1.51; p=0.01) and mean hospital stay duration (Days) (14.99±1.66 vs 16.21±1.11; p 0.02). Conclusion: Our study concludes that in asphyxiated newborns, postnatal magnesium sulphate infusion is safe and likely to enhance the short-term neurological prognosis in cases with moderate-grade encephalopathy.

Role of aminophylline in prevention of acute kidney injury in term neonates with severe perinatal asphyxia: a randomized open-label controlled trial.

Acute kidney injury (AKI) is one of the frequently observed complications in neonates with severe perinatal asphyxia. The efficacy of aminophylline in preventing or alleviating renal dysfunction in these neonates remains controversial. The current study aimed to explore whether treatment with aminophylline as adjunctive therapy is superior to standard care alone in preventing AKI in severely asphyxiated term neonates and to delineate the changes in other renal parameters. In this open-label randomized clinical trial, term neonates with severe asphyxia (n = 41) received a 5 mg/kg intravenous dose of aminophylline within the first hour after birth, in addition to standard care for birth asphyxia. The control group (n = 40) received standard care alone. Their daily urine output, weight, serum creatinine, renal functional status, and complications during the first 5 days of life were monitored and compared. The statistical package for social sciences version 25 was used for analysis. Approximately 24.39% of neonates in the aminophylline group developed AKI, compared to 35.0% in the control group (P = .088). Although urine output was generally higher in aminophylline-treated newborns than in the control group, this increase was not statistically significant (P > .05), with the most notable differences observed on the second and third postnatal days. Also, the changes in plasma creatinine levels between the two groups during this time were not statistically significant. Administering a single dose of aminophylline (5 mg/kg) within the first hour of life to severely asphyxiated term neonates might temporarily enhance urine output, but does not reduce the overall incidence of AKI.

Echocardiographic evaluation of myocardial dysfunction in term neonates with perinatal asphyxia.

One third of the neonatal deaths worldwide are attributed to perinatal asphyxia. We aimed to determine the prevalence and determinants of cardiac dysfunction, through echocardiographic evaluation, in term neonates with perinatal asphyxia. This cross-sectional study was conducted at a tertiary care setting over a period of six months from 1st January 2021 to 30th June 2021. Term neonates, weighing ≥ 2500 grams, born with Apgar score < 7 and admitted within 48-hours of life were consecutively enrolled. Using Levene classification neonates were grouped into moderate and severe perinatal asphyxia. All neonates underwent transthoracic echocardiographic evaluation after 24-hours of stabilization and within 72-hours of life. Descriptive statistics are calculated, and logistic regression analysis is done to determine the risk factors of myocardial dysfunction. Among 166 neonates, 53% (n=88) were males, mean gestational age was 38.1 ± 0.89 weeks. Moderate asphyxia was present in 121 (72.9%). Most common echocardiographic finding was pulmonary hypertension in 50% followed by patent ductus arteriosus (PDA) in 37.2% and mitral regurgitation in 6.6%. Myocardial dysfunction was detected in 28.9% of the neonates. Three independent determinants of myocardial dysfunction were severe asphyxia [adjusted odds ratio (aOR) 5.01, 95% CI 2.2-11.4; p-value <0.001], having patent ductus arteriosus (aOR 5.11, 95% CI 2.2-11.8; p-value < 0.001) and delivery through cesarean section (aOR 2.65, 95% CI 1.2-5.9; p-value 0.02). Myocardial dysfunction among neonates with perinatal asphyxia is common and severity of asphyxia, mode of delivery and presence of patent ductus arteriosus are important determinants.

Case series on monoclonal antibodies targeting calcitonin gene-related peptide in migraine patients during pregnancy: Enhancing safety data.

Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP-mAbs) are approved for adult migraine prevention but pose safety concerns in pregnancy. We assess the safety of CGRP-mAbs in the periconceptional period through a case series and literature review. Six migraine-diagnosed women received CGRP-mAbs; treatment ceased upon pregnancy. We collected data and conducted safety assessments. To provide a comprehensive context, we performed a literature review. The series includes three erenumab, two fremanezumab and one galcanezumab case. A fremanezumab recipient experienced miscarriage; severe perinatal asphyxia linked to dystocia occurred with erenumab (140 mg). Database reviews revealed 63 spontaneous abortions, eight premature births, and seven birth defects among 286 World Health Organization and 65 European Medicines Agency cases. These rates align with untreated population rates. CGRP-mAbs use in the periconceptional period does not lead to clinically significant increase in pregnancy-related pathology or adverse effects on newborns within our case series and the literature reviewed.

Renal Regional Oxygen Saturation and Acute Kidney Injury in Neonates with Perinatal Asphyxia.

Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during TH and AKI in neonates with moderate and severe perinatal asphyxia. This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO2 was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the receiver operating characteristic curve. Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO2 levels during TH. Specifically, rSrO2 levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01-1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78-0.92) were significantly associated with AKI. An increase in rSrO2 during the first 12 hours of TH and lower rSrO2 levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH. · Neonates with asphyxia often develop AKI.. · Renal saturations are affected by hypothermia and asphyxia. · Patients with AKI initially show higher rSrO2, then lower rSrO2.. · Monitoring rSrO2 identifies early AKI..

Brain Diffusion Changes in Perinatal Asphyxia Cases.

Prolonged perinatal asphyxia (PA) may cause hypoxic-ischemic damage to the brain. The aim of this study was to investigate the brain diffusion changes of patients with PA and examine the relationship with brain damage. This retrospective study included 55 patients diagnosed with PA, separated into mild and severe PA groups. For the evaluation of brain damage in all the study neonates, brain and diffusion MRI scans were performed using a 3T device. The scans were taken between 5 and 10 days postnatal, after completion of hypothermia treatment, in accordance with the standard clinical protocol of our institution. Apparent diffusion coefficient (ADC) values of the lentiform nucleus, thalamus, frontal white matter, and posterior limbs of the internal capsule were measured. Minitab package programs and SPSS version 20.0 software were used for statistical analysis and graphic drawing. Spearman's rank correlation analysis was used. The bilateral lentiform nucleus, thalamus, frontal white matter, and posterior limbs of the internal capsule ADC values were significantly higher in the severe PA group than in the mild PA group. In neonates with severe perinatal asphyxia, brain damage can be evaluated on diffusion-weighted imaging (DWI) of the cerebral deep white matter and basal ganglia. DWI, imaging with conventional brain MRI comes to the fore in clinical importance in PA patients.

Cord Blood Hepatic Enzymes as Biochemical Correlates of Hypoxic-Ischaemic Encephalopathy and Immediate Postnatal Outcome in Term Asphyxiated Babies

Background: The untoward effect of perinatal asphyxia on newborns cannot be over-emphasised.&#x0D; Objective: This study aimed to determine whether hepatic enzymes can serve as biochemical correlates of hypoxic-ischaemic encephalopathy (HIE) and immediate outcomes.&#x0D; Methods: This cross-sectional study was conducted at the neonatal intensive care unit for 15 months among 70 asphyxiated and 70 healthy neonates. The clinical staging of HIE was based on the Sarnat and Sarnat classification system. A cord blood sample was obtained for the assay of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), and Lactate dehydrogenase (LDH). The enzymatic assay was performed using the spectrophotometric method.&#x0D; Results: There was a significant positive correlation between AST (r = 0.644, p &lt;0.001), ALT (r = 0.364, p = 0.002), LDH (r = 0.377, p = 0.001), and the stages of HIE. AST correlated best with the severity of asphyxia (r = 0.644, p &lt;0.001). Of the five mortalities in this series, the cord blood enzyme levels were significantly higher than in those that survived (p &lt;0.05), and all the enzymes demonstrated a positive correlation with mortality, best with ALT (r = 0.354, p = 0.003).&#x0D; Conclusion: The worse the degree of perinatal asphyxia in the newborn, the higher the serum hepatic enzymes. Elevation of serum hepatic enzymes may also be associated with the risk of death in such babies. Efforts should be made to prevent severe perinatal asphyxia, and when it becomes inevitable, appropriate and prompt management should be instituted to limit the risk of poor outcomes.

Clinical-functional correlation with brain volumetry in severe perinatal asphyxia: a case report

BackgroundHypoxic-ischemic encephalopathy (HIE) appears in neurological conditions where some brain areas are likely to be injured, such as deep grey matter, basal ganglia area, and white matter subcortical periventricular áreas. Moreover, modeling these brain areas in a newborn is challenging due to significant variability in the intensities associated with HIE conditions. This paper aims to evaluate functional measurements and 3D machine learning models of a given HIE case by correlating the affected brain areas with the pathophysiology and clinical neurodevelopmental.Case presentationA comprehensive analysis of a term infant with perinatal asphyxia using longitudinal 3D brain information from Machine Learning Models is presented. The clinical analysis revealed the perinatal asphyxia diagnosis with APGAR <5 at 5 and 10 minutes, umbilical arterial pH of 7.0 BE of -21.2 mmol / L), neonatal seizures, and invasive ventilation mechanics. Therapeutic interventions: physical, occupational, and language neurodevelopmental therapies. Epilepsy treatment: vagus nerve stimulation, levetiracetam, and phenobarbital. Furthermore, the 3D analysis showed how the volume decreases due to age, exhibiting an increasing asymmetry between hemispheres. The results of the basal ganglia area showed that thalamus asymmetry, caudate, and putamen increase over time while globus pallidus decreases. Clinical outcomes: spastic cerebral palsy, microcephaly, treatment-refractory epilepsy.ConclusionsSlight changes in the basal ganglia and cerebellum require 3D volumetry for detection, as standard MRI examinations cannot fully reveal their complex shape variations. Quantifying these subtle neurodevelopmental changes helps in understanding their clinical implications. Besides, neurophysiological evaluations can boost neuroplasticity in children with neurological sequelae by stimulating new neuronal connections.

Risk factors of severe perinatal asphyxia at tertiary hospital

Background. Perinatal asphyxia is still one of the main causes of neonatal mortality and morbidity, especially in the first week of life in developing countries. In Indonesia, based on data reported by the Directorate of Family Health in 2020, of the 28,158 deaths of infants and toddlers, 72% (20,266 deaths) occurred during the neonatal period. One of the causes of neonatal death is perinatal asphyxia. Objective. To analyze risk factors affecting severe perinatal asphyxia in tertiary hospital. Method. Analytical observational research with case-control design. The data source is secondary data on mothers and babies born at Dr. Soetomo General Hospital from January 1 to December 31, 2021. The inclusion criteria were all neonates with perinatal asphyxia and the exclusion criteria were incomplete data. Results. The prevalence of severe perinatal asphyxia at Dr. Soetomo General Hospital in 2021 is 3.9% (115/2,885). Prematurity was significantly associated with severe perinatal asphyxia (p=0.000). Low birth weight is also significantly related to severe perinatal asphyxia (p=0.000). The most dominant risk factor for severe perinatal asphyxia is prematurity. Extremely preterm have a 232.8 (95% CI: 35.8-2920.3) times higher risk of experiencing perinatal asphyxia compared to very preterm (OR 36.2, 95% CI: 12.4-105.4), moderately preterm (OR 11.6, 95 %CI: 4.1-22.6) and late preterm (OR 3.3, 95%CI: 1.1-9.1). Conclusion. Risk factors for severe perinatal asphyxia are prematurity and low birth weight. Prematurity is the most dominant risk factor for severe perinatal asphyxia in tertiary hospital.

Relationship of passive hypothermia during transport with the incidence of early multiorgan compromise in newborns with perinatal asphyxia

BackgroundNewborns with perinatal asphyxia can be born in institutions that cannot perform therapeutic hypothermia. Therefore, hypothermia should be initiated during transport using passive hypothermia. The effects of overcooling on mortality and multiorgan compromise in newborns with perinatal asphyxia subjected to passive hypothermia are poorly understood. AimsTo evaluate the relationship between the temperature of newborns with perinatal asphyxia during transport to the neonatal intensive care unit (NICU) and incidence of multiorgan compromise. MethodsSingle-center, retrospective cohort study. Full-term or near-term newborns with moderate to severe perinatal asphyxia who required transport to the NICU between January 2021 and April 2022 were included. Exposure was defined as the temperature during transport to the unit. The main outcome assessed was the presence of multiorgan compromise during hypothermia treatment and mortality before discharge. ResultsThe study included 77 newborns, 15 of whom were admitted at a temperature <33 °C (overcooling). Multiorgan compromise was observed in 33 % and 66 % of the patients in the overcooling and passive hypothermia groups, respectively. Overcooling during transport (aOR 4.8, 95 % CI 1.3, 18.1), and the need for resuscitation (aOR 9.8, 95 % CI 1.1, 90.6) were associated with greater multiorgan compromise and mortality compared to the passive hypothermia group. ConclusionsOvercooling during transport was associated with a higher risk of mortality and multiorgan compromise upon arrival at the referral site. Strategies need to be developed to optimize the transfer and implementation of passive hypothermia in patients who are transfer to the referral center.

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

The left ventricle in well newborns versus those with perinatal asphyxia, haemodynamically significant ductus arteriosus or fetal growth restriction.

Hemodynamic changes accompanying the initial breaths at the time of birth are especially important for a smooth transition of fetal to neonatal circulation. Understanding the normal transitional physiology and the clinical impact of adverse adaptation is important for delineating pathology so as to guide physiologically relevant therapies. Disorders such as severe perinatal asphyxia, hemodynamically significant patent ductus arteriosus (and its surgical ligation) and utero-placental insufficiency underlying fetal growth restriction, can adversely affect left ventricular (LV) function. The left ventricle is the predominant chamber involved in systemic perfusion during postnatal life. Cardiac output is closely linked to afterload; the latter is determined by arterial properties such as stiffness and compliance. This article outlines normal transition in term and preterm infants. It also highlights the adverse impact of three not uncommon neonatal disorders on LV function. Perinatal asphyxia leads to a reduced LV output, superior vena cava and coronary artery blood flow and an increase in the troponin level. Multiple haemodynamic changes are observed in the premature infant with a large patent ductus arteriosus. They need careful analysis to determine when ligation should proceed. Ligation itself generally results in a dramatic increase in afterload which may lead to a reduction in LV contractility and the need for ionotropic support. Fetal growth restricted infants have a higher systolic pressure, a somewhat hypertrophied heart arising from an increased arterial wall thickness/stiffness and systemic peripheral resistance. Point of care ultrasound (POCUS) helps differentiate normal transition and that resulting from neonatal disorders. It may be increasingly utilized in guiding management.

Adverse Effects of Topiramate in Neonate with Moderate to Severe Perinatal Asphyxia: A Randomized Controlled Trial

Introduction: A harmful pregnancy condition that harms both the mother and the fetus is perinatal asphyxia. It frequently happens as a result of challenges during labour, including protracted or challenging delivery, concerns with the umbilical cord, placental abnormalities, or maternal health conditions. Topiramate, an anticonvulsant, works through a variety of different methods. Topiramate looks to be effective as a neuroprotective agent as well as an anti-seizure medication in animal models of newborn brain injury. Angiogenesis, neurogenesis, and neuronal anti-apoptotic pathways are all stimulated and regulated by topiramate. In light of this, this observational study was conducted to ascertain Topiramate's negative consequences in kids with mild to moderate neonatal hypoxia. Methods: This observational case-control study was carried out in the Neonatal ward and ICU of Dhaka Shishu Hospital from April 2015 to March 2016. A total of 64 neonates were enrolled in this study and were assigned Group A -the interventional group (n=32) received topiramate and standard treatment protocol, and Group B or the control group (n=32) received only standard treatment protocol. The data were analyzed according to standard procedure. Results: Among the study neonates, based on sex in case and control groups, respectively, seventeen (17,53%) and twenty-one (21,66%) neonates were male, and fifteen (15,47%) and eleven (11,44%) neonates were female. Statistically, the sex distribution between groups was not significant (p=0.44). USG finding of the neonates after treatment was normal in 12 (48%) and 13(41%), and abnormal in 20(32%) and 19 (59%) neonates in the control and case groups, respectively. Out of 27 neonates in the control group, 11 (41%) were neurologically normal, and 16 (59%) had abnormal neurological findings. Out of 29 neonates in the case group, 24 (73%) were neurologically normal, and 5(17%) showed abnormal neurological findings. Statistically, significant variation ..

Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria.

The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.

Paternal age, risk of congenital anomalies, and birth outcomes: a population-based cohort study.

The objective of the study was to explore the impact of paternal age on the risk of congenital anomalies and birth outcomes in infants born in the USA between 2016 and 2021. This retrospective cohort study used data from the National Vital Statistics System (NVSS) database, a data set containing information on live birth in the USA between 2016 and 2021. Newborns were divided into four groups based on their paternal age (< 25, 25-34, 35-44, and > 44years) and using the 25-34 age group as a reference. The primary outcomes were congenital anomalies involving structural anomalies and chromosome anomalies. Secondary outcomes were preterm birth, low birth weight, severe neonatal perinatal asphyxia, and admission to neonatal intensive care units (NICU). A multivariable logistic regression model was used to analyze the association between paternal age and outcomes. Overall, 17,764,695 live births were included in the final analyses. After adjusting confounding factors, advanced paternal age > 44years was associated with increased odds of congenital anomalies (adjusted odds ratio (aOR) = 1.17, 95%CI 1.12-1.21) compared with the 25-34 age group, mainly for the chromosomal anomalies (aOR = 1.59, 95%CI 1.40-1.78) but not the structure anomalies (aOR = 1.03, 95%CI 0.97-1.09). The risk of preterm delivery, low birth weight, and NICU hospitalization in their infants was increased by advanced parental age as well. Conclusion: Advanced paternal age increases the risk of congenital anomalies, especially chromosomal anomalies in their offspring, implying prenatal genetic counseling is required. What is Known: • There's a rising trend of advanced paternal age, which is associated with an increased likelihood of premature birth and low birth weight in their offspring. However, the exploration between paternal age and congenital abnormalities in offspring was limitedand contradictory. What is New: • Infants with a paternal age > 44 years were more likely to be born with congenital anomalies, especially chromosomal anomalies.

Neonatal testicular torsion after severe perinatal asphyxia treated with therapeutic hypothermia

Neonatal testicular torsion (NTT) has been postulated to occur as a result of hyperactive cremasteric reflex, which can be caused by fetal stress; however, no study has reported severe perinatal asphyxia causing NTT. We report about a male neonate with severe perinatal asphyxia treated with therapeutic hypothermia who showed left testicular torsion on the 16th day of life. We could not determine when the torsion occurred; however, we hypothesized that it occurred during the perinatal period because both perinatal asphyxia and therapeutic hypothermia could be risk factors for testicular torsion. NTT has been considered to occur as a result of a hyperactive cremasteric reflex on the loose fixation of the tunica vaginalis to the scrotal wall, and both fetal stress and low temperature have been considered to cause cremasteric reflex. NTT lacks noticeable signs and symptoms; thus, it can be overlooked in severe cases, as in our patient. Therefore, physicians treating male neonates with severe perinatal asphyxia with or without therapeutic hypothermia should examine their scrotum considering NTT. • Both perinatal asphyxia and therapeutic hypothermia could be risk factors of NTT. • The scrotum of male neonates with severe perinatal asphyxia must be examined daily. • Physicians should consider the possible occurrence of NTT.

Evaluation of renal function among term neonates with perinatal asphyxia

Background: Perinatal asphyxia is a significant cause of morbidity and mortality amongst neonates in developing countries. The incidence of perinatal asphyxia in developed countries is 2 per 1000 live births, but the rate is 10 times higher in developing countries due to inadequate access to neonatal and maternal care. Among neonates with HIE, it is difficult to predict which newborn will develop renal dysfunction so there is urgent need for publication about relations of severity of HIE and renal dysfunctionMethods: This prospective case control study was conducted on 50 term neonates as cases and 50 term neonates in control group. Neonates in case groups were diagnosed according to WHO definition of HIE and age and sex matching of babies were done. Serum creatinine was measured one baseline and another after 48 hours of life.Results: The study shows mean maternal age 25.24±4.65 in the cases and 27.44±4.17 in control group, gravida of 1.64±0.89, 1.60±0.78 in case and control group, APGAR score at 1 minute &amp; 5minutes 3.40±1.34, 5.62±1.55 in cases and 7.0±0.0, 9.0±0.0 in control group which is statistically significant (p&lt;0.001). Among cases 78% had moderate birth asphyxia and 22% had severe perinatal asphyxia. Among cases 62% (31/50) babies developed AKI and among cases with AKI 20 (62.5%) developed prerenal AKI and 37.5% (12/31) developed intrinsic AKI.Conclusions: The detection renal dysfunction at an early stage can help in early intervention and prevention of irreversible renal damage and thus, will improve overall survival of these asphyxiated neonates. Serum creatinine levels correlates with severity of HIE.

Effect of magnesium sulphate infusion on neonatal outcomes in babies with perinatal asphyxia

Introduction- With a relatively scant evidence base in Indian population, this study aimed to determine the efficacy of intravenous magnesium sulphate in neonates with moderate to severe perinatal asphyxia on the severity of seizures, number of anticonvulsants used, duration of hospitalization and feeding pattern at discharge. Methodology- This was a non-blinded randomized controlled trial that was conducted among 227 neonates admitted to the SNCU of MKCG Medical College Hospital. Randomization and allocation of eligible neonates was done using software. The intervention used was magnesium sulfate given intravenously by trained pediatricians in a loading dose of 250 mg/kg/dose, given over 1 hour in 20 ml of 5% dextrose solution. This was given at the time of admission followed by two infusions of the same dosage after 24 and 48 hours of the first dose. Outcomes on neonatal feeding, survival, need for medications and seizure management were recorded and analysed using an intention to treat protocol. Results- The distribution of most clinico-social parameters were comparable between the 2 groups. The babies who received MgSO4 within 6 hours of life achieved earlier initiation of feeds (32 hours) as compared to control groups (63 hrs). They also reached full feeding significantly earlier.

Appraising Neonatal Morbidity and Mortality in a Developing Country Categorized by Gestational Age Grouping and Implications for Targeted Interventions.

IntroductionDespite the relatively higher neonatal morbidity and mortality in developing countries, there are limited data on the detailed analysis of the burden in Nigeria. With a database of over 14,000 admissions, this study presents a compelling picture of the current trends disaggregated by their gestational age groups. It provides unique opportunities for better-targeted interventions for further reducing newborn mortality in line with SDG 3, Target 3.2.MethodsThis prospective observational study involved newborn babies admitted to the Neonatal Intensive Care Unit of the University of Ilorin Teaching Hospital, Kwara State, Nigeria, between January 2007 and December 2018. The outcome was the neonatal mortality rates. The exposure variables included birth weight, gestational age (preterm versus term), and clinical diagnosis. Frequencies were generated on tables and charts, and the trends or associations were determined.ResultsOf the 14,760 neonates admitted, 9,030 (61.2%) were term babies, 4,847 (32.8%) were preterm babies, and in 792 (5%) of the admissions, the gestational ages could not be determined. Males constituted a higher proportion with 55.9%, and the total number of deaths in the study period was 14.7%. The mortality ratio was highest among babies with a birth weight of less than 1,000 g (38.0%) and gestational age of less than 28 weeks (65.5%). The trend analysis showed that the mortality rate decreased from 17.8 to 13% over the 12 years, p-value < 0.0001. For term babies, mortality decreased by 45%, from 15.7% in 2007 to 8.7% in 2018, while the decline in mortality for preterm babies was 28.4%, from 25.7% in 2007 to 18.4% in 2018. For both categories, p-values were < 0.001. Regarding morbidity in term babies, asphyxia occurred in (1:3), jaundice (1:5), sepsis (1:6), and respiratory disorders (1:6) of admissions. For mortality, asphyxia occurred in (1:2), sepsis (1:5), jaundice (1:8), and respiratory disorders (1:10) of deaths. The leading causes of morbidity among preterm babies were asphyxia (1:4), sepsis (1:5), respiratory disorders (1:9), and jaundice (1.10). For mortality, their contributions were asphyxia (≈1:2); sepsis (1:5); respiratory disorders (1:9), and jaundice (1:10).ConclusionThere was a marked improvement in neonatal mortality trends. However, severe perinatal asphyxia, sepsis, hyperbilirubinemia, and respiratory disorders were the leading conditions contributing to 75% of the morbidities and mortalities. Measures to further accelerate the reduction in neonatal morbidity and mortality are discussed.

Comparative trial of seizure recurrence in phenobarbitone maintenance for 72 hrs versus till discharge in moderate to severe perinatal asphyxia in term infants

Background: This study was done to look for seizure recurrence in moderate to severe perinatal asphyxia when phenobarbitone was stopped at seizure free interval of 72 hours versus those in whom phenobarbitone was continued upto discharge.Methods: It was a open label randomized trial conducted in neonatal intensive care unit of department of Pediatrics, SMGS from November 2014 to October 2015. This study was conducted on term babies (&gt;37 weeks) with birth asphyxia with moderate to severe encephalopathy according to Levene classification with seizures within 24 hours admitted in NICU.Results: Recurrence of seizures was 6 (10%) in whom phenobarbitone was continued upto discharge and 8 (13.3%) in whom phenobarbitone was stopped after 72 hours of seizure free interval. These results were statistically comparable.Conclusions: There is no beneficial effect of giving phenobarbitone for more than 72 hour in neonates having moderate to severe perinatal asphyxia who are neurologically normal.