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Sample records for asphyxia

  1. Asphyxia screening kit.

    Science.gov (United States)

    Zabidi, A; Khuan, L Y; Mansor, W

    2012-01-01

    Infant asphyxia is a condition due to insufficient oxygen intake suffered by newborn babies. A 4 to 9 million occurrences of infant asphyxia are reported each year by WHO. Early diagnosis of asphyxia is important to avoid complications such as damage to the brain, organ and tissue that could lead to fatality. This is possible with the automation of screening of infant asphyxia. Here, a non-invasive Asphyxia Screening Kit is developed. It is a Graphical User Interface that automatically detects asphyxia in infants from early birth to 6 months from their cries and displays the outcome of analysis. It is built with Matlab GUI underlied with signal processing algorithms, capable of achieving a classification accuracy of 96.03%. Successful implementation of ASK will assist to screen infant asphyxia for reference to clinicians for early diagnosis. In addition, ASK also provides an interface to enter patient information and images to be integrated with existing Hospital Information Management System.

  2. Pathophysiology of Birth Asphyxia.

    Science.gov (United States)

    Rainaldi, Matthew A; Perlman, Jeffrey M

    2016-09-01

    The pathophysiology of asphyxia generally results from interruption of placental blood flow with resultant fetal hypoxia, hypercarbia, and acidosis. Circulatory and noncirculatory adaptive mechanisms exist that allow the fetus to cope with asphyxia and preserve vital organ function. With severe and/or prolonged insults, these compensatory mechanisms fail, resulting in hypoxic ischemic injury, leading to cell death via necrosis and apoptosis. Permanent brain injury is the most severe long-term consequence of perinatal asphyxia. The severity and location of injury is influenced by the mechanisms of injury, including degree and duration, as well as the developmental maturity of the brain. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Nondrowning Asphyxia in Veterinary Forensic Pathology: Suffocation, Strangulation, and Mechanical Asphyxia.

    Science.gov (United States)

    McEwen, B J

    2016-09-01

    Asphyxia in a forensic context refers to death by rapid cerebral anoxia or hypoxia due to accidental or nonaccidental injury. Death due to nondrowning asphyxia can occur with strangulation, suffocation, and mechanical asphyxia, each of which is categorized based on the mechanism of injury. Individuals dying due to various types of asphyxia may or may not have lesions, and even those lesions that are present may be due to other causes. The interpretation or opinion that death was due to asphyxia requires definitive and compelling evidence from the postmortem examination, death scene, and/or history. Beyond the postmortem examination, pathologists may be faced with questions of forensic importance that revolve around the behavioral and physiological responses in animals subjected to strangulation, suffocation, or mechanical asphyxia to determine if the animal suffered. While there is no prescriptive answer to these questions, it is apparent that, because of physiological and anatomical differences between humans and animals, for some mechanisms of asphyxia, consciousness is maintained for longer periods and the onset of death is later in animals than that described for people. Veterinary pathologists must be cognizant that direct extrapolation from the medical forensic literature to animals may be incorrect. This article reviews the terminology, classification, mechanisms, and lesions associated with asphyxial deaths in companion animals and highlights significant comparative differences of the response to various types of asphyxia in animals and people. © The Author(s) 2016.

  4. A case report of Traumatic Asphyxia

    Directory of Open Access Journals (Sweden)

    B Sah

    2015-06-01

    Full Text Available Traumatic asphyxia is a condition presenting with cervicofacial cyanosis and edema, subconjunctival hemorrhage, and petechial hemorrhages of the face, neck, and upper chest that occurs due to a compressive force to the thoracoabdominal region.In this case report a 52 years old lady who was brought to the mortuary because of death due to traumatic asphyxia as a result of being stampeded by her own cows upon her chest was discussed. Congestion on both the conjunctiva, cyanosis on chin and adjacent upper left side of neck found with a well demarcated area observed between the cyanosed area over face and the normal area of neck. Hematoma was present in the chin and the adjacent neck region.Apart from quickly eliminating organ pathologies and initiation of supportive therapy in a case of traumatic asphyxia, possibility of formation of hematoma in neck after few hours of getting injured should also be considered, as this type of hematoma may contribute to the cause of death.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12777 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 51-55

  5. Assessing birth asphyxia using strictly observational signs, the ARC ...

    African Journals Online (AJOL)

    The Apgar Scoring system is the sole assessment tool for newborn asphyxia,but the Apgar scoring system has many limitations as it does not assess conditions before and after delivery, that might trigger asphyxia. Moreover, the score combine subjective and objective signs as well as observations and measurements which ...

  6. Mothers' knowledge about birth asphyxia: The need to do more!

    African Journals Online (AJOL)

    2012-07-19

    Jul 19, 2012 ... to facilitate voluntary adaptation of behavior that promote health.[1] From the aforementioned, health ... of such complications of labor and childbirth is perinatal asphyxia. Birth asphyxia is defined as the ... to children from within and outside Ogun State of Nigeria, the hospital also offers primary care within a ...

  7. Severe Birth Asphyxia in Wesley Guild Hospital, lesa: A persistent ...

    African Journals Online (AJOL)

    To compare the incidence and the mortality associated with severe birth asphyxia over the 1994 to 1998 and 1999 to 2003 periods in a Nigerian Teaching Hospital. These periods were characterized by different social orders and health financing in the country. The babies admitted with the diagnosis of severe birth asphyxia ...

  8. Does perinatal asphyxia contribute to neurological dysfunction in preterm infants?

    NARCIS (Netherlands)

    van Iersel, Patricia A. M.; Bakker, Saskia C. M.; Jonker, Arnold J. H.; Hadders-Algra, Mijna

    Background: Children born preterm are known to be at risk for neurodevelopmental disorders. The role of perinatal asphyxia in this increased risk is still a matter of debate. Aim: To analyze the contribution of perinatal asphyxia in a population of preterm infants admitted to a secondary paediatric

  9. Imaging patterns of brain injury in term-birth asphyxia

    NARCIS (Netherlands)

    Swarte, Renate; Lequin, Maarten; Cherian, Perumpillichira; Zecic, Alexandra; van Goudoever, Johannes; Govaert, Paul

    2009-01-01

    To develop an extended asphyxia-score based on cerebral ultrasound (US) and MRI in order to gain further insight into the pathophysiology of asphyxia. First week cerebral US and MRI of 80 asphyxiated term infants were scored according to a new scoring system based on separate grading of injury to

  10. Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria ...

    African Journals Online (AJOL)

    Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria. BA West, PI Opara. Abstract. Objectives: To find the prevalence, and identify risk factors and outcome in neonates who were admitted into the Braithewaite Memorial Specialist Hospital (BMSH) for perinatal asphyxia. Method: This was a descriptive cross ...

  11. ASPHYXIA AND DEVELOPMENTAL OUTCOME IN HIGH RISK INFANTS

    Directory of Open Access Journals (Sweden)

    Valentina DUKOVSKA

    2010-04-01

    Full Text Available Asphyxia is a risk factor that is very often related to neuro-developmental issues in high risk infants and equally affects preterm and term infants, however its outcome on the developed brain differs from the outcome on the preterm brain.In preterm infants, asphyxia usually exerts a hemorrhagic or ischaemic event and periventricular leukomalacia.In term infants, asphyxia leads to cerebral edema and atrophy of the brain, which may later lead to hypoxic ischaemic encephalopathy (HIE.The number of term infants with HIE who have survived is lower than those of preterm infants, while the percentage of term infants with HIE who have neuro-developmental issues is higher. Preemies face more problems in their motor development as a result of the brain damage, while term infants suffer from encephalopathy and their cognitive abilities are more affected.We have conducted a study about the effects that asphyxia has on the developmental outcomes in high risk infants. In our study, we did a longitudinal developmental follow-up of 30 high risk infants and an evaluation of their developmental outcome using the Griffiths Mental Development Scales, from the 4th month of life until the end of the 36th month. First, we found that high risk infants had a much lower developmental outcome than the control group during the trial. Finally, we found that asphyxia makes a difference in the developmental outcome of preterm infants without asphyxia who have a very low birth weight, the preterm infants with asphyxia, and the term infants with HIE-II.

  12. From "apparent death" to "birth asphyxia": a history of blame.

    Science.gov (United States)

    Obladen, Michael

    2017-11-08

    Since the sixteenth century, competition between midwives and surgeons has created a culture of blame around the difficult delivery. In the late seventeenth century, 100 years before oxygen was discovered, researchers associated "apparent death of the newborn" with impaired respiratory function of the placenta. The diagnosis "birth asphyxia" replaced the term "apparent death of the newborn" during the mass phobia of being buried alive in the eighteenth century. This shifted the interpretation from unavoidable fate to a preventable condition. Although the semantic inaccuracy ("pulselessness") was debated, "asphyxia" was not scientifically defined until 1992. From 1792 the diagnosis was based on a lack of oxygen. "Blue" and "white" asphyxia were perceived as different disorders in the eighteenth, and as different grades of the same disorder in the nineteenth century. In 1862, William Little linked birth asphyxia with cerebral palsy, and although never confirmed, his hypothesis was accepted by scientists and the public. Fetal well-being was assessed by auscultating heart beats since 1822, and continuous electronic fetal monitoring was introduced in the 1960s without scientific assessment. It neither diminished the incidence of birth asphyxia nor of cerebral palsy, but rather raised the rate of cesarean sections and litigation against obstetricians and midwives.Pediatric Research advance online publication, 8 November 2017; doi:10.1038/pr.2017.238.

  13. Asphyxia from the eyes of the obstetrician

    Directory of Open Access Journals (Sweden)

    Alessandra Meloni

    2014-06-01

    Full Text Available Nowadays it is well recognized that there are multiple potential pathways causing hypoxic-ischemic events that may lead to cerebral palsy in term infants. The signs and symptoms of neonatal encephalopathy may range from mild to severe, depending on nature and timing of brain injury. The incidence of cerebral palsy has not changed over the last 30 years and one of the obstetricians’challenge is how to recognize babies at intrapartum risk both before and during labour. A detailed description of prepartum and intrapartum risk factors is available. A close surveillance of labour and intrapartum time should be mandatory as the valuation of all available data from obstetrical examination, cardiotocography, ultrasound and labour progression to reach the correct diagnosis with the lowest possible rate of error. The close monitoring should not exclude a humanized and compliant attitude versus labouring women and their families. We analysed the Cagliari Neonatal Intensive Care Unit (NICU activity during the last four years considering 22 asphyxiated babies (coming from 9 different hospitals who underwent hypothermia treatment. The main result was that the need to resuscitation procedures at birth correlates with adverse outcomes. Asphyxia still remains a matter of great concern also as medico legal claims. Considering that neonatal encephalopathy is a heterogeneous condition, it is unlikely that it will be eradicated. However, a comprehensive evaluation of all risk factors and of intrapartum surveillance available tools may reduce as much as possible adverse events.Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  14. Asphyxia from the eyes of the neonatologist

    Directory of Open Access Journals (Sweden)

    Paolo Gancia

    2014-06-01

    Full Text Available The perinatal asphyxia occurs at a frequency of 4-6‰ in developed countries The hypoxic-ischemic encephalopathy (HIE has an incidence of 0.5-2‰, and is a frequent cause of death and severe disability. Cerebral hypothermia is a well-established therapy of HIE, and its benefits have been described by systematic reviews and meta-analyses of numerous controlled clinical trials. Authors describe their experience in implementation of cerebral hypotermia in a Neonatal Intensive Care Unit, the creation of a network to perform neurophysiologic study of asphyxiated infants ≥ 35 weeks gestation, potential hypothermia candidates. Neurodevelopmental prognosis of HIE infants is of paramount importance for parents. To improve the quality of prognosis and communication with the parents, two studies have been undertaken. First, EEG and magnetic resonance imaging (MRI relationships analysis showed that the severity of the background EEG is associated with the severity and location of MRI lesion patterns in infants treated with hypothermia because of HIE. The second study aims to elucidate the relationships between MRI patterns and neurodevelopmental assessment by Griffiths scales. We found that neuroimaging findings correlate significantly with overall neurodevelopmental assessment at 12 and 24 months of life; in particular, this correlation is significant for the loco-motor and psycho-social sides. These instrumental data, with the EEG evaluation and clinical data, allow the neonatologist to predict quite precisely the neurological outcome of an infant. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  15. Circulatory responses to asphyxia differ if the asphyxia occurs in utero or ex utero in near-term lambs.

    Directory of Open Access Journals (Sweden)

    Kristina S Sobotka

    Full Text Available A cornerstone of neonatal resuscitation teaching suggests that a rapid vagal-mediated bradycardia is one of the first signs of perinatal compromise. As this understanding is based primarily on fetal studies, we investigated whether the heart rate and blood pressure response to total asphyxia is influenced by whether the animal is in utero or ex utero.Fetal sheep were instrumented at ∼ 139 days of gestation and then asphyxiated by umbilical cord occlusion until mean arterial blood pressure decreased to ∼ 20 mmHg. Lambs were either completely submerged in amniotic fluid (in utero; n = 8 throughout the asphyxia or were delivered and then remained ex utero (ex utero; n = 8 throughout the asphyxia. Heart rate and arterial blood pressure were continuously recorded.Heart rate was higher in ex utero lambs than in utero lambs. Heart rates in in utero lambs rapidly decreased, while heart rates in ex utero lambs initially increased following cord occlusion (for ∼ 1.5 min before they started to decrease. Mean arterial pressure initially increased then decreased in both groups.Heart rate response to asphyxia was markedly different depending upon whether the lamb was in utero or ex utero. This indicates that the cardiovascular responses to perinatal asphyxia are significantly influenced by the newborn's local environment. As such, based solely on heart rate, the stage and severity of a perinatal asphyxic event may not be as accurate as previously assumed.

  16. Asphyxia-activated corticocardiac signaling accelerates onset of cardiac arrest

    Science.gov (United States)

    Li, Duan; Mabrouk, Omar S.; Liu, Tiecheng; Tian, Fangyun; Xu, Gang; Rengifo, Santiago; Choi, Sarah J.; Mathur, Abhay; Crooks, Charles P.; Kennedy, Robert T.; Wang, Michael M.; Ghanbari, Hamid; Borjigin, Jimo

    2015-01-01

    The mechanism by which the healthy heart and brain die rapidly in the absence of oxygen is not well understood. We performed continuous electrocardiography and electroencephalography in rats undergoing experimental asphyxia and analyzed cortical release of core neurotransmitters, changes in brain and heart electrical activity, and brain–heart connectivity. Asphyxia stimulates a robust and sustained increase of functional and effective cortical connectivity, an immediate increase in cortical release of a large set of neurotransmitters, and a delayed activation of corticocardiac functional and effective connectivity that persists until the onset of ventricular fibrillation. Blocking the brain’s autonomic outflow significantly delayed terminal ventricular fibrillation and lengthened the duration of detectable cortical activities despite the continued absence of oxygen. These results demonstrate that asphyxia activates a brainstorm, which accelerates premature death of the heart and the brain. PMID:25848007

  17. Perinatal asphyxia: CNS development and deficits with delayed onset

    Directory of Open Access Journals (Sweden)

    Mario eHerrera-Marschitz

    2014-03-01

    Full Text Available Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified.In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by over expression of sentinel proteins, such as poly(ADP-ribose polymerase-1 (PARP-1, competing for NAD+ during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat foetuses into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that it constitutes a lead for exploring compounds with similar or better pharmacological profiles.

  18. Perinatal asphyxia: CNS development and deficits with delayed onset.

    Science.gov (United States)

    Herrera-Marschitz, Mario; Neira-Pena, Tanya; Rojas-Mancilla, Edgardo; Espina-Marchant, Pablo; Esmar, Daniela; Perez, Ronald; Muñoz, Valentina; Gutierrez-Hernandez, Manuel; Rivera, Benjamin; Simola, Nicola; Bustamante, Diego; Morales, Paola; Gebicke-Haerter, Peter J

    2014-01-01

    Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD(+) during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

  19. Risk factors and prognostic models for perinatal asphyxia at term

    NARCIS (Netherlands)

    Ensing, S.

    2015-01-01

    This thesis will focus on the risk factors and prognostic models for adverse perinatal outcome at term, with a special focus on perinatal asphyxia and obstetric interventions during labor to reduce adverse pregnancy outcomes. For the majority of the studies in this thesis we were allowed to use data

  20. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    Background: Cerebral Palsy is permanent sequela of severe nonprogressive insult to the immature brain of children. In Nigeria, kernicterus from neonatal jaundice and hypoxic ischaemic encephalopathy form severe birth asphyxia have been identified as among the leading causes of this scourge. Poor management of ...

  1. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    McRoy

    International Journal of Medicine and Biomedical Research. Volume 2 Issue 3 September – December 2013 ... cerebral palsy in Nigeria: are doctors' wrong beliefs and practices part of the problem? Okperi B.O ... training programs. Key words: Neonatal jaundice, birth asphyxia, cerebral palsy, health institutions, practice ...

  2. Traumatic Asphyxia with Diaphragmatic Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    Hussein Lateef

    2015-03-01

    Full Text Available Traumatic asphyxia, or Perthe’s syndrome, is a rare clinical syndrome characterized by cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, neurological symptoms, and thoracic injury. It affects both adults and children after blunt chest traumas. The diagnosis of this condition is based mainly on the specific clinical signs, which should immediately bring to mind the severity of the trauma, the various probable types of pulmonary injuries, and the need for screening and careful assessment of other organs that might also be injured. In this report, we describe the case of a 39-year-old male who developed traumatic asphyxia after severe blunt chest trauma during his work at a construction site. The patient had multiple injuries to the chest, abdomen, head and neck, which were treated conservatively. An associated diaphragmatic injury was successfully treated by video-assisted thoracic surgery. This patient is one of five patients who were admitted to Saqr Hospital in the United Arab Emirates, diagnosed with traumatic asphyxia, and treated by mechanical ventilator, supportive measures, and fiberoptic bronchoscopy, for both diagnostic and therapeutic indications, in our unit in the period between July 2006 and June 2013. As traumatic asphyxia is a systemic injury, careful assessment of the patient and looking for other injuries is mandatory. Treatment usually involves supportive measures to the affected organs, but surgical intervention may sometimes prove to be an important part of the treatment. Bronchoscopy should be performed for diagnostic and therapeutic reasons because of the associated pulmonary and possible tracheobronchial injuries.

  3. Outcomes of neonates with perinatal asphyxia at a tertiary academic ...

    African Journals Online (AJOL)

    Over 9 million children die each year during the perinatal and neonatal periods, and nearly all of these deaths occur in developing countries.[1]. Perinatal asphyxia is a serious clinical problem globally. Every year approximately 4 million babies are born asphyxiated; this results in 1 million deaths and an equal number of.

  4. Birth Asphyxia in a Nigerian Mission Hospital in Benin City ...

    African Journals Online (AJOL)

    and-five-minute Apgar scores of 2,208 live-births were recorded. Those with low Apgar scores ( 6 at one minute) were studied and their data analyzed. Results: Birth asphyxia occurred in 83.8 per 1000 live-births. The associated significant ...

  5. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    McRoy

    Background: Cerebral Palsy is permanent sequela of severe non- progressive insult to the immature brain of children. In Nigeria, kernicterus from neonatal jaundice and hypoxic ischaemic encephalopathy form severe birth asphyxia have been identified as among the leading causes of this scourge. Poor management of ...

  6. Cerebellar cytokine expression in a rat model for fetal asphyctic preconditioning and perinatal asphyxia

    DEFF Research Database (Denmark)

    Vlassaks, Evi; Brudek, Tomasz; Pakkenberg, Bente

    2014-01-01

    Asphyctic brain injury is a major cause of neuronal inflammation in the perinatal period. Fetal asphyctic preconditioning has been shown to modulate the cerebral inflammatory cytokine response, hereby protecting the brain against asphyctic injury at birth. This study was designated to examine...... the effects of perinatal asphyxia and fetal asphyctic preconditioning on the inflammatory cytokine response in the cerebellum. Fetal asphyxia was induced at embryonic day 17 by clamping the uterine vasculature for 30 min. At term birth, global perinatal asphyxia was induced by placing the uterine horns...... was decreased 96 h postfetal asphyxia. When applied as preconditioning stimulus, fetal asphyxia attenuates the cerebellar cytokine response. These results indicate that sublethal fetal asphyxia may protect the cerebellum from perinatal asphyxia-induced damage via inhibition of inflammation....

  7. Obstetric interventions and perinatal asphyxia in growth retarded term infants

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Lindmark, G

    1997-01-01

    neonatal outcome at term have been studied in relation to different types of fetal growth retardation, including sub-groups with low ponderal index or low amount of subcutaneous fat. RESULTS: The need for obstetric intervention indicated by suspected fetal asphyxia before or during labor was increased 3......BACKGROUND: The monitoring of fetal growth during pregnancy is usually justified because of the increased perinatal risk of these babies. METHODS: In 1552 infants from the Scandinavian Small for Gestational Age Study the need for obstetric interventions, risk of fetal asphyxia and immediate......-fold (6-8%) for growth retarded infants both in SGA infants in general and infants with asymmetric body proportions. The immediate perinatal outcome, however, was favorable with Apgar below 8 at 5 min in only 2% irrespective of the type of growth retardation, in spite of the fact that less than 25...

  8. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    P. Benson Ham

    2015-05-01

    Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

  9. Perinatal Asphyxia: A Review from a Metabolomics Perspective

    Directory of Open Access Journals (Sweden)

    Claudia Fattuoni

    2015-04-01

    Full Text Available Perinatal asphyxia is defined as an oxygen deprivation that occurs around the time of birth, and may be caused by several perinatal events. This medical condition affects some four million neonates worldwide per year, causing the death of one million subjects. In most cases, infants successfully recover from hypoxia episodes; however, some patients may develop HIE, leading to permanent neurological conditions or impairment of different organs and systems. Given its multifactor dependency, the timing, severity and outcome of this disease, mainly assessed through Sarnat staging, are of difficult evaluation. Moreover, although the latest newborn resuscitation guideline suggests the use of a 21% oxygen concentration or room air, such an approach is still under debate. Therefore, the pathological mechanism is still not clear and a golden standard treatment has yet to be defined. In this context, metabolomics, a new discipline that has described important perinatal issues over the last years, proved to be a useful tool for the monitoring, the assessment, and the identification of potential biomarkers associated with asphyxia events. This review covers metabolomics research on perinatal asphyxia condition, examining in detail the studies reported both on animal and human models.

  10. RISK FACTORS AND DEVELOPMENTAL OUTCOME AMONG BABIES WITH PERINATAL ASPHYXIA IN A TERTIARY CARE CENTRE

    OpenAIRE

    Sudhakar; Natarajan; Bahubali; Revathy

    2016-01-01

    BACKGROUND Birth asphyxia is commonest cause of preventable cerebral injury. It is also important cause of neonatal mortality. Incidence of birth asphyxia however is higher in developing countries and leading cause of neonatal mortality. This work is undertaken to study the incidence, risk factors and outcome of birth asphyxia. METHODOLOGY This study was conducted in the neonatal intensive care Unit of tertiary care hospital. Neonates with the APGAR score of less than...

  11. Connexin Hemichannel Blockade Is Neuroprotective after Asphyxia in Preterm Fetal Sheep

    OpenAIRE

    Davidson, Joanne O; Paul P Drury; Green, Colin R.; Nicholson, Louise F.; Laura Bennet; Alistair J. Gunn

    2014-01-01

    Asphyxia around the time of preterm birth is associated with neurodevelopmental disability. In this study, we tested the hypothesis that blockade of connexin hemichannels would improve recovery of brain activity and reduce cell loss after asphyxia in preterm fetal sheep. Asphyxia was induced by 25 min of complete umbilical cord occlusion in preterm fetal sheep (103-104 d gestational age). Connexin hemichannels were blocked by intracerebroventricular infusion of mimetic peptide starting 90 min...

  12. Correlates of birth asphyxia using two Apgar score classification methods.

    Science.gov (United States)

    Olusanya, Bolajoko O; Solanke, Olumuyiwa A

    2010-01-01

    Birth asphyxia is commonly indexed by low five-minute Apgar scores especially in resource-constrained settings but the impact of different classification thresholds on the associated risk factors has not been reported. To determine the potential impact of two classification methods of five-minute Apgar score as predictor for birth asphyxia. A cross-sectional study of preterm and term survivors in Lagos, Nigeria in which antepartum and intrapartum factors associated with "very low" (0-3) or "intermediate" (4-6) five-minute Apgar scores were compared with correlates of low five-minute Apgar scores (0-6) based on multinomial and binary logistic regression analyses. Of the 4281 mother-infant pairs enrolled, 3377 (78.9%) were full-term and 904 (21.1%) preterm. Apgar scores were very low in 99 (2.3%) and intermediate in 1115 (26.0%). Antenatal care, premature rupture of membranes (PROM), hypertensive disorders and mode of delivery were associated with very low and intermediate Apgar scores in all infants. Additionally, parity, antepartum haemorrhage and prolonged/obstructed labour (PROL) were predictive in term infants compared with maternal occupation and intrauterine growth restriction (IUGR) in preterm infants. Conversely, PROM in term infants and maternal occupation in preterm infants were not significantly associated with the composite low Apgar scores (0-6) while IUGR was associated with term infants. Predictors of birth asphyxia in preterm and term infants are likely to be affected by the Apgar score classification method adopted and the clinical implications for optimal resuscitation practices merit attention in resource-constrained settings.

  13. Neuropathology and brain weight in traumatic-crush asphyxia.

    Science.gov (United States)

    Al-Sarraj, Safa; Laxton, Ross; Swift, Ben; Kolar, Alexander J; Chapman, Rob C; Fegan-Earl, Ashley W; Cary, Nat R B

    2017-11-01

    Traumatic (crush) asphyxia is a rare condition caused by severe compression of the chest and trunk leading to often extreme so-called asphyxial signs, including cyanosis in head and neck regions, multiple petechiae, and subconjunctival haemorrhage as well as neurological manifestations. To investigate the neuropathology and brain weight in traumatic asphyxia caused by different accidents such as industrial accidents and road traffic collision. Post mortem records of 20 cases of traumatic asphyxia (TA) resulting from different causes of which four brains are available for comprehensive neuropathological examination. The expected brain weights for given body height and associated 95% confidence range were calculated according to the following formula: baseline brain weight (BBW) + body height x rate (g/cm). The 95% confidence range was calculated by adding and subtracting the standard error (SE) x 1.96 (7-8). There was a trend for higher brain weight in the TA cohort but it was not significant (1494 g vs 1404 g, p = 0.1). The upper limits of the brain weight of 95% confidence was 1680 g vs 1660 g, p = 0.9. The neuropathological examination of four available brains from the TA cohort showed severe congestion of blood vessels, perivascular haemorrhages and occasional βAPP deposits consistent with early axonal disruption. Brain examination is informative as part of investigation of TA. Developing ischaemic changes and an increase in brain weight are the most likely indicators of a prolonged period of patient's survival. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  14. Virtopsy versus autopsy in unusual case of asphyxia: case report.

    Science.gov (United States)

    Aquila, I; Falcone, C; Di Nunzio, C; Tamburrini, O; Boca, S; Ricci, P

    2013-06-10

    We report the case of a 70-year-old woman found dead in her apartment in the South of Italy in February 2011. The detailed data showed that the victim was affected by familiar-type paranoid schizophrenia. This finding was confirmed by the discovery of antipsychotic and tricyclic antidepressant drugs in the house and the deposition of her psychiatric therapist. Before the autopsy, a multislice computed tomography (MSCT) scanning of the thoracic and facial maxillo-cervical area was performed that has allowed anatomical identification and diagnosis of a mechanical obstruction as the cause of death. The autopsy has showed the presence of materials obstructing the trachea totally. Histological and toxicological investigations were carried out on the victim. The toxicological investigation has shown the presence of metabolites of tricyclic antidepressants and antipsychotics in the blood and urine. The histology showed the presence of foreign-origin materials (starch fibres) inside the pulmonary alveolus. The cause of death was asphyxia due to obstruction by food-origin material. In this case the radiological data have been compared with the autopsy and toxicological and histological data. The comparison of results has shown that MSCT scanning may aid in identification of occlusion and then in determination of the cause of death. In conclusion, MSCT scanning can be proposed in the cases of suspected asphyxia, as the screening procedure of first instance to produce preliminary information useful to rapidly develop the successive autopsy performance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Perinatal asphyxia and medical professional liability: A case series

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    Andrea Verzeletti

    2016-12-01

    Full Text Available In the context of medical professional liability, obstetrics is one of the most involved medical specialties because the unfavorable outcome of a pregnancy is difficult to accept for parents, who tend to reduce it to inappropriate care that occurred during pregnancy or birth. 32 cases of perinatal asphyxia were evaluated by the Institute of Forensic Medicine in Brescia during the period between 1999 and 2014 (13 in Civil Court and 19 in Penal Court. 9 out of the 32 pregnancies were twins, so the considerations were carried out on a total of 41 fetuses/newborns. Profiles of inadequacy were identified in 66% of cases (85% of the cases evaluated in Civil Court; 53% of the cases evaluated in Penal Court. The existence of a causal relationship between the medical conduct and the onset of asphyxia was recognized in 79% of civil cases and in 38% of penal cases. There is a “greater rigor” in the verification of causal relationship and malpractice profiles in penal cases compared to civil ones: this is in harmony with the most recent Italian Court decisions, characterized by compelling suspect’s protection in the presence of a reasonable doubt in criminal matters and by victim’s protection in civil ones.

  16. [Oxidative stress in perinatal asphyxia and hypoxic-ischaemic encephalopathy].

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    Nuñez, Antonio; Benavente, Isabel; Blanco, Dorotea; Boix, Héctor; Cabañas, Fernando; Chaffanel, Mercedes; Fernández-Colomer, Belén; Fernández-Lorenzo, José Ramón; Loureiro, Begoña; Moral, María Teresa; Pavón, Antonio; Tofé, Inés; Valverde, Eva; Vento, Máximo

    2017-06-23

    Birth asphyxia is one of the principal causes of early neonatal death. In survivors it may evolve to hypoxic-ischaemic encephalopathy and major long-term neurological morbidity. Prolonged and intense asphyxia will lead to energy exhaustion in tissues exclusively dependent on aerobic metabolism, such as the central nervous system. Energy deficit leads to ATP-dependent pumps blockage, with the subsequent loss of neuronal transmembrane potential. The most sensitive areas of the brain will die due to necrosis. In more resistant areas, neuronal hyper-excitability, massive entrance of ionic calcium, activation of NO-synthase, free radical generation, and alteration in mitochondrial metabolism will lead to a secondary energy failure and programmed neuronal death by means of the activation of the caspase pathways. A third phase has recently been described that includes persistent inflammation and epigenetic changes that would lead to a blockage of oligodendrocyte maturation, alteration of neurogenesis, axonal maturation, and synaptogenesis. In this scenario, oxidative stress plays a critical role causing direct damage to the central nervous system and activating metabolic cascades leading to apoptosis and inflammation. Moderate whole body hypothermia to preserve energy stores and to reduce the formation of oxygen reactive species attenuates the mechanisms that lead to the amplification of cerebral damage upon resuscitation. The combination of hypothermia with coadjuvant therapies may contribute to improve the prognosis. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Traumatic asphyxia following stadium crowd surge: stadium factors affecting outcome.

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    DeAngeles, D; Schurr, M; Birnbaum, M; Harms, B

    1998-10-01

    Stadium crowd surges frequently occur following major athletic events. A recent crowd surge injured more than 80 persons by trampling and/or crushing. This incident was reviewed to identify injury patterns consistent with crush-related injury. In addition, the incident was reviewed to determine which stadium policy and design factors may have potentiated this event. A recent crowd surge occurred following a college football game. This resulted in 86 people being transported to the University of Wisconsin and other area hospitals. All charts were reviewed to evaluate patient outcomes. The stadium was examined as were security system video tapes to evaluate stadium factors that contributed to this event. Current policies were obtained through the university sports administration. Of 86 patients transported for evaluation of stadium-related injuries, 10 were treated for traumatic asphyxia. Other injuries requiring hospital admission included musculo-skeletal trauma in two patients and one grade II liver injury. Six others were admitted overnight for observation. Several stadium factors were identified that contributed to the event, and appropriate changes in crowd control policies and stadium design were instated to prevent recurrence. This report details the largest single report of traumatic asphyxia second to the England Hillsborough disaster. Several stadium factors were identified that resulted in crush-related injury. Cooperative review and modification of stadium policies and design may prevent such events in the future.

  18. Early neonatal deaths associated with perinatal asphyxia in infants ≥2500g in Brazil.

    Science.gov (United States)

    Almeida, Maria Fernanda Branco de; Kawakami, Mandira Daripa; Moreira, Lícia Maria Oliveira; Santos, Rosa Maria Vaz Dos; Anchieta, Lêni Márcia; Guinsburg, Ruth

    To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing ≥2500g in Brazil from 2005 to 2010. The population study enrolled all live births of infants with birth weight ≥2500g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases, 10th Revision (P20.0, P21.0, and P24.0). An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. A total of 10,675 infants weighing ≥2500g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38%) of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (pperinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high, and meconium aspiration syndrome plays a major role. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. Environmental Enrichment Decreases Asphyxia-Induced Neurobehavioral Developmental Delay in Neonatal Rats

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    Peter Kiss

    2013-11-01

    Full Text Available Perinatal asphyxia during delivery produces long-term disability and represents a major problem in neonatal and pediatric care. Numerous neuroprotective approaches have been described to decrease the effects of perinatal asphyxia. Enriched environment is a popular strategy to counteract nervous system injuries. The aim of the present study was to investigate whether enriched environment is able to decrease the asphyxia-induced neurobehavioral developmental delay in neonatal rats. Asphyxia was induced in ready-to-deliver mothers by removing the pups by caesarian section after 15 min of asphyxia. Somatic and neurobehavioral development was tested daily and motor coordination weekly. Our results show that rats undergoing perinatal asphyxia had a marked developmental delay and worse performance in motor coordination tests. However, pups kept in enriched environment showed a decrease in the developmental delay observed in control asphyctic pups. Rats growing up in enriched environment did not show decrease in weight gain after the first week and the delay in reflex appearance was not as marked as in control rats. In addition, the development of motor coordination was not as strikingly delayed as in the control group. Short-term neurofunctional outcome are known to correlate with long-term deficits. Our results thus show that enriched environment could be a powerful strategy to decrease the deleterious developmental effects of perinatal asphyxia.

  20. TIME COURSE MODIFICATIONS INDUCED BY PERINATAL ASPHYXIA IN RAT CNS

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    Francisco Capani

    2015-04-01

    Full Text Available Perinatal asphyxia (PA induced short and long term biochemical, synaptic, cytoskeletal and astrocytes alterations that has been associated with neuronal cell death following hypoxia . The lack of knowledge about the mechanisms underlying this dysfunction prompted us to investigate the changes in the synapse and neuronal cytoskeleton and related structures. For this study we used a well established murine model of PA. Full-term pregnant rats were rapidly decapitated and the uterus horns were placed in a water bath at 37 °C for different time of asphyxia. When their physiological conditions improved, they were given to surrogate mothers. One month, four month, 6 month and 18 month after PA rats were included in this study. Modifications were analyzed using photooxidation with phalloidin-eosin, conventional electron microscopy (EM, inmunocytochemistry and ethanolic phosphotungstic acid (E-PTA staining combining with electron tomography and 3-D reconstruction techniques and molecular biology studies. After one month of the PA insult, an increase in the F-actin staining in neostriatum and hippocampus synapses was observed using correlative fluorescent electron microscopy for phalloidin-eosin. Mushroom-shaped spines showed the most consistent staining. Strong alterations in the dendrite and astroglial cytoskeleton were found at four months of PA (1. After six months of PA, postsynaptic densities (PSDs of the rat neostriatum are highly modified . We observed an increment of PSDs thickness related with the duration and severity of the hypoxic insult. In addition, PSDs showed and increase in the ubiquitination level. Using 3-d reconstruction and electron tomography we observed showed clear signs of damage in the asphyctic PSDs. These changes are correlated with intense staining for ubiquitin (2. Finally, in 18 months old rat was observed a reduction in the number of synapses in the PA animals related with a decrease in BDNF staining.(3 Using protocols

  1. [Intrapartum asphyxia: Risk factors and short-term consequences].

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    Bouiller, J-P; Dreyfus, M; Mortamet, G; Guillois, B; Benoist, G

    2016-06-01

    Intrapartum asphyxia is a rare yet serious complication during labor with immediate consequences and possible long-term neurological impairment. The international Cerebral Palsy Task Force established criteria that attribute a cerebral palsy to intrapartum asphyxia: metabolic acidemia measured at birth with pHconsequences. Our retrospective study included all births between 2002 and 2010 in a level 3 maternity of a university hospital center. Inclusion criteria were those of the Cerebral Palsy Task Force associated with a gestational age≥34weeks of gestation. We studied the conventional markers of intrapartum asphyxia: Apgar score at 5minutes, abnormal cardiotogographic recordings whether they occurred after a sentinel hypoxic event or not before and during labor. The duration of expulsive efforts, the amniotic fluid aspects, the delivery mode as well as the preexisting pregnancy pathologies were also evaluated. On the other hand, we studied the short-term consequences at the newborns: death, multiorgan failure and especially the occurring of a neonatal encephalopathy using Sarnat and Sarnat staging. One hundred and twenty-nine newborns (0.43%) out of 29,416 live births had a pHpregnancy pathology was found in 22% of the women. Hypoxic events were noted in only 9/82 of the cases. Abnormal cardiotocographic recordings were present in 97.6% of the cases. The duration of expulsive efforts as well as the amniotic fluid aspects did not interfere with the occurring of a metabolic acidemia. Caesarean rate was at 46.3% and instrumental extraction rate was at 34.1%. Thity-eight newborns (46.3%) were admitted in neonatal intensive care in which we noted 3 deaths (3.65%), 2 multiorgan failures (2.4%) and 17 neonatal encephalopathy (20.7%). The pH value seemed to influence the occurring of an encephalopathy: 50% when pH6 (Pearly neonatal encephalopathy. This study should be continued with the evaluation of hypoxia long-term consequences on the psychomotor development

  2. A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

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    Gultekin Gulbahar

    2015-01-01

    Full Text Available Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

  3. Surge of Peripheral Arginine Vasopressin in a Rat Model of Birth Asphyxia

    Science.gov (United States)

    Summanen, Milla; Bäck, Susanne; Voipio, Juha; Kaila, Kai

    2018-01-01

    Mammalian birth is accompanied by a period of obligatory asphyxia, which consists of hypoxia (drop in blood O2 levels) and hypercapnia (elevation of blood CO2 levels). Prolonged, complicated birth can extend the asphyxic period, leading to a pathophysiological situation, and in humans, to the diagnosis of clinical birth asphyxia, the main cause of hypoxic-ischemic encephalopathy (HIE). The neuroendocrine component of birth asphyxia, in particular the increase in circulating levels of arginine vasopressin (AVP), has been extensively studied in humans. Here we show for the first time that normal rat birth is also accompanied by an AVP surge, and that the fetal AVP surge is further enhanced in a model of birth asphyxia, based on exposing 6-day old rat pups to a gas mixture containing 4% O2 and 20% CO2 for 45 min. Instead of AVP, which is highly unstable with a short plasma half-life, we measured the levels of copeptin, the C-terminal part of prepro-AVP that is biochemically much more stable. In our animal model, the bulk of AVP/copeptin release occurred at the beginning of asphyxia (mean 7.8 nM after 15 min of asphyxia), but some release was still ongoing even 90 min after the end of the 45 min experimental asphyxia (mean 1.2 nM). Notably, the highest copeptin levels were measured after hypoxia alone (mean 14.1 nM at 45 min), whereas copeptin levels were low during hypercapnia alone (mean 2.7 nM at 45 min), indicating that the hypoxia component of asphyxia is responsible for the increase in AVP/copeptin release. Alternating the O2 level between 5 and 9% (CO2 at 20%) with 5 min intervals to mimic intermittent asphyxia during prolonged labor resulted in a slower but quantitatively similar rise in copeptin (peak of 8.3 nM at 30 min). Finally, we demonstrate that our rat model satisfies the standard acid-base criteria for birth asphyxia diagnosis, namely a drop in blood pH below 7.0 and the formation of a negative base excess exceeding −11.2 mmol/l. The mechanistic

  4. Surge of Peripheral Arginine Vasopressin in a Rat Model of Birth Asphyxia

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    Milla Summanen

    2018-01-01

    Full Text Available Mammalian birth is accompanied by a period of obligatory asphyxia, which consists of hypoxia (drop in blood O2 levels and hypercapnia (elevation of blood CO2 levels. Prolonged, complicated birth can extend the asphyxic period, leading to a pathophysiological situation, and in humans, to the diagnosis of clinical birth asphyxia, the main cause of hypoxic-ischemic encephalopathy (HIE. The neuroendocrine component of birth asphyxia, in particular the increase in circulating levels of arginine vasopressin (AVP, has been extensively studied in humans. Here we show for the first time that normal rat birth is also accompanied by an AVP surge, and that the fetal AVP surge is further enhanced in a model of birth asphyxia, based on exposing 6-day old rat pups to a gas mixture containing 4% O2 and 20% CO2 for 45 min. Instead of AVP, which is highly unstable with a short plasma half-life, we measured the levels of copeptin, the C-terminal part of prepro-AVP that is biochemically much more stable. In our animal model, the bulk of AVP/copeptin release occurred at the beginning of asphyxia (mean 7.8 nM after 15 min of asphyxia, but some release was still ongoing even 90 min after the end of the 45 min experimental asphyxia (mean 1.2 nM. Notably, the highest copeptin levels were measured after hypoxia alone (mean 14.1 nM at 45 min, whereas copeptin levels were low during hypercapnia alone (mean 2.7 nM at 45 min, indicating that the hypoxia component of asphyxia is responsible for the increase in AVP/copeptin release. Alternating the O2 level between 5 and 9% (CO2 at 20% with 5 min intervals to mimic intermittent asphyxia during prolonged labor resulted in a slower but quantitatively similar rise in copeptin (peak of 8.3 nM at 30 min. Finally, we demonstrate that our rat model satisfies the standard acid-base criteria for birth asphyxia diagnosis, namely a drop in blood pH below 7.0 and the formation of a negative base excess exceeding −11.2 mmol/l. The

  5. Connexin hemichannel blockade is neuroprotective after asphyxia in preterm fetal sheep.

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    Joanne O Davidson

    Full Text Available Asphyxia around the time of preterm birth is associated with neurodevelopmental disability. In this study, we tested the hypothesis that blockade of connexin hemichannels would improve recovery of brain activity and reduce cell loss after asphyxia in preterm fetal sheep. Asphyxia was induced by 25 min of complete umbilical cord occlusion in preterm fetal sheep (103-104 d gestational age. Connexin hemichannels were blocked by intracerebroventricular infusion of mimetic peptide starting 90 min after asphyxia at a concentration of 50 µM/h for one hour followed by 50 µM/24 hour for 24 hours (occlusion-peptide group, n = 6 or vehicle infusion for controls (occlusion-vehicle group, n = 7. Peptide infusion was associated with earlier recovery of electroencephalographic power after asphyxia compared to occlusion-vehicle (p<0.05, with reduced neuronal loss in the caudate and putamen (p<0.05, but not in the hippocampus. In the intragyral and periventricular white matter, peptide administration was associated with an increase in total oligodendrocyte numbers (p<0.05 and immature/mature oligodendrocytes compared to occlusion-vehicle (p<0.05, with a significant increase in proliferation (p<0.05. Connexin hemichannel blockade was neuroprotective and reduced oligodendrocyte death and improved recovery of oligodendrocyte maturation in preterm fetuses after asphyxia.

  6. Connexin Hemichannel Blockade Is Neuroprotective after Asphyxia in Preterm Fetal Sheep

    Science.gov (United States)

    Davidson, Joanne O.; Drury, Paul P.; Green, Colin R.; Nicholson, Louise F.; Bennet, Laura; Gunn, Alistair J.

    2014-01-01

    Asphyxia around the time of preterm birth is associated with neurodevelopmental disability. In this study, we tested the hypothesis that blockade of connexin hemichannels would improve recovery of brain activity and reduce cell loss after asphyxia in preterm fetal sheep. Asphyxia was induced by 25 min of complete umbilical cord occlusion in preterm fetal sheep (103–104 d gestational age). Connexin hemichannels were blocked by intracerebroventricular infusion of mimetic peptide starting 90 min after asphyxia at a concentration of 50 µM/h for one hour followed by 50 µM/24 hour for 24 hours (occlusion-peptide group, n = 6) or vehicle infusion for controls (occlusion-vehicle group, n = 7). Peptide infusion was associated with earlier recovery of electroencephalographic power after asphyxia compared to occlusion-vehicle (p<0.05), with reduced neuronal loss in the caudate and putamen (p<0.05), but not in the hippocampus. In the intragyral and periventricular white matter, peptide administration was associated with an increase in total oligodendrocyte numbers (p<0.05) and immature/mature oligodendrocytes compared to occlusion-vehicle (p<0.05), with a significant increase in proliferation (p<0.05). Connexin hemichannel blockade was neuroprotective and reduced oligodendrocyte death and improved recovery of oligodendrocyte maturation in preterm fetuses after asphyxia. PMID:24865217

  7. Effects of chronic intermittent asphyxia on haematocrit, pulmonary arterial pressure and skeletal muscle structure in rats.

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    Bradford, Aidan

    2004-01-01

    Sleep-disordered breathing in humans is a common condition associated with serious cardiovascular and other abnormalities. The prevalence and pathogenesis of increased haematocrit and pulmonary hypertension is controversial and it has been suggested that these changes only occur in patients who also have daytime continuous hypoxaemia. The hypothesis tested here is that the chronic intermittent hypoxia and asphyxia associated with sleep-disordered breathing causes erythropoiesis and pulmonary hypertension and that this occurs in the absence of periods of continuous hypoxia. In humans and animals with obstructive sleep apnoea, there are abnormalities of upper airway muscle structure that have been ascribed to increased load placed on these muscles. An alternative hypothesis is that chronic intermittent hypoxia and asphyxia cause changes in upper airway muscle structure and function. To test these hypotheses, rats were exposed to intermittent hypoxia and asphyxia for 8 h per day for 5 weeks. This caused an increase in haematocrit, right ventricular weight and pulmonary arterial pressure. There were only slight changes in diaphragm, upper airway and limb muscle structure and force production but in general, muscle fatigability was increased. In conclusion chronic intermittent hypoxia and asphyxia cause an increase in haematocrit and pulmonary arterial pressure in the absence of periods of continuous hypoxia. Chronic intermittent hypoxia and asphyxia have little effect on skeletal muscle structure and force production but increase muscle fatigue. Increased upper airway muscle fatigue could lead to a vicious cycle of further compromise in upper airway patency and further hypoxia and asphyxia.

  8. [Birth asphyxia and hypoxic ischemic encephalopathy, incidence and obstetric risk factors].

    Science.gov (United States)

    Palsdottir, Kolbrun; Dagbjartsson, Atli; Thorkelsson, Thordur; Hardardottir, Hildur

    2007-09-01

    Modern medical practice has changed dramatically during the past decades because of improved technology. Still, fetal surveillance during labor is relatively unchanged since 1960 s when fetal heart rate monitoring (FHR) became standard practice. Newborn infants are still suffering from birth asphyxia and in severe cases leading to hypoxic ischemic encephalopathy (HIE) which sometimes results in permanent neurological damage. The incidence of birth asphyxia and HIE in Iceland is unknown and so are the risk factors for severe asphyxia. The objective of this study was to assess the incidence, obstetric risk factors and the sequela of severe asphyxia at Landspitali university hospital (LSH). All term infants born at LSH from 1.1.1997- 31.12.2001 with birth asphyxia, defined as five minute Apgar score %lt;6, were included in the study (n=127). Clinical information were collected retrospectively from maternal records on maternal diseases during pregnancy, cardiotocogram (CTG), type of birth, the presence of meconium and operative delivery rates. Information was also collected regarding birth asphyxia and HIE in the neonatal period. The incidence of birth asphyxia was 9.4/1000 live term births during the study period, with increasing incidence during the three last years. The incidence of HIE was 1.4/ 1,000 live term births. Severe maternal diseases during pregnancy were not a significant risk factor for asphyxia. The amniotic fluid was meconium stained in fifty percent of cases and the umbilical cord was wrapped around the fetal neck in 41% of cases. Abnormal CTG tracing was observed in 66% of cases in the study group and in 79% of the HIE cases. Operative deliveries were significantly more common in the study cohort compared with other deliveries at LSH at the same time: ventouse delivery 22% vs 6.8% (pdiseases does not correlate with increased incidence of asphyxia, presumably due to increased surveillance of these pregnancies and a lower treshold for intervention

  9. [Neurological consequences following perinatal asphyxia in preschool age children].

    Science.gov (United States)

    Nabieva, T N

    2009-01-01

    Various groups have been addressing the question of whether perinatal asphyxia (PA) affects on newborn health and nervous system. It is widely accepted that severe PA causes motor and cognitive alterations and leads to a variety of brain disorders: cerebral palsy, epilepsy, mental retardation as well as psychiatric deficits. At the same time it was established, that large percentage of children, surviving PA didn't demonstrate apparent sequelae, but mild physical and mental delay in future. With the purpose of disclose further consequences of PA on child development, we examine 20 children (6 years old) surviving mild or moderate PA without severe neurological pathology. In most cases we revealed muscle tone disturbances, physical development and growth retardation, speech pathology in the form of dyslaliya and speech delay. Intact cognitive capacities in these children combine with limited information content. Our investigation discovered, that the presence of certain psychoneurological characteristics such as hyperexcitability, irritability, timidity, aggressiveness; reduced activity, concentration and motivation -- are the consequences of survived birth trauma. These characteristics producing undue fatiguability, inattention, restlessness and diminished working-capacity, can pose additional problems in education process. In the absence of individual approach without taking into account emotional and motivational peculiarities, this category of children could not completely realize their intact cognitive capacities and represent risk group for further mild retardation.

  10. Hippocampal Dendritic Spines Modifications Induced by Perinatal Asphyxia

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    G. E. Saraceno

    2012-01-01

    Full Text Available Perinatal asphyxia (PA affects the synaptic function and morphological organization. In previous works, we have shown neuronal and synaptic changes in rat neostriatum subjected to hypoxia leading to long-term ubi-protein accumulation. Since F-actin is highly concentrated in dendritic spines, modifications in its organization could be related with alterations induced by hypoxia in the central nervous system (CNS. In the present study, we investigate the effects of PA on the actin cytoskeleton of hippocampal postsynaptic densities (PSD in 4-month-old rats. PSD showed an increment in their thickness and in the level of ubiquitination. Correlative fluorescence-electron microscopy photooxidation showed a decrease in the number of F-actin-stained spines in hippocampal excitatory synapses subjected to PA. Although Western Blot analysis also showed a slight decrease in β-actin in PSD in PA animals, the difference was not significant. Taken together, this data suggests that long-term actin cytoskeleton might have role in PSD alterations which would be a spread phenomenon induced by PA.

  11. Management of foetal asphyxia by intrauterine foetal resuscitation

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    S Velayudhareddy

    2010-01-01

    Full Text Available Management of foetal distress is a subject of gynaecological interest, but an anaesthesiologist should know about resuscitation, because he should be able to treat the patient, whenever he is directly involved in managing the parturient patient during labour analgesia and before an emergency operative delivery. Progressive asphyxia is known as foetal distress; the foetus does not breathe directly from the atmosphere, but depends on maternal circulation for its oxygen requirement. The oxygen delivery to the foetus depends on the placental (maternal side, placental transfer and foetal circulation. Oxygen transport to the foetus is reduced physiologically during uterine contractions in labour. Significant impairment of oxygen transport to the foetus, either temporary or permanent may cause foetal distress, resulting in progressive hypoxia and acidosis. Intrauterine foetal resuscitation comprises of applying measures to a mother in active labour, with the intention of improving oxygen delivery to the distressed foetus to the base line, if the placenta is functioning normally. These measures include left lateral recumbent position, high flow oxygen administration, tocolysis to reduce uterine contractions, rapid intravenous fluid administration, vasopressors for correction of maternal hypotension and amnioinfusion for improving uterine blood flow. Intrauterine Foetal Resuscitation measures are easy to perform and do not require extensive resources, but the results are encouraging in improving the foetal well-being. The anaesthesiologist plays a major role in the application of intrauterine foetal resuscitation measures.

  12. The logistic score: a criterion for hypothermia after perinatal asphyxia?

    Science.gov (United States)

    Wayenberg, Jean-Louis

    2010-05-01

    To identify during the first hour of life the asphyxiated term neonates who further develop moderate or severe neonatal encephalopathy. In 75 asphyxiated term infants, we measured postnatal arterial base deficit (BD30), assigned an early neurological score (ENS) according to their level of consciousness, respiration pattern and neonatal reflexes at 30 min of life and calculated the logistic score (LS) = (0.33 x BD30) - ENS. The receiver operating characteristics (ROC) methodology was applied to analyze the ability of the LS to correctly classify patients into two groups: normal or mild encephalopathy (60 patients) versus moderate or severe encephalopathy (15 patients). The area under the ROC curve of the LS for moderate or severe encephalopathy (+/- standard error) was 94.4 +/- 3.6%. At the threshold value of 1.2, the LS provided 87.5% sensitivity and 73.7% positive predictive value (PPV). The PPV of LS reaches 100% for a value >3.2, but this threshold allowed only 53.3% sensitivity. The LS is predictive of the neonatal neurological evolution after birth asphyxia and may help to select the high risk patients who are potential candidates for hypothermia therapy.

  13. Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil,

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    Maria Fernanda Branco de Almeida

    Full Text Available Abstract Objective: To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing ≥2500 g in Brazil from 2005 to 2010. Methods: The population study enrolled all live births of infants with birth weight ≥2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases,10th Revision (P20.0, P21.0, and P24.0. An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. Results: A total of 10,675 infants weighing ≥2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38% of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001; the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period. Conclusions: Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high, and meconium aspiration syndrome plays a major role.

  14. Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants

    Science.gov (United States)

    Randall, Bradley B.; Paterson, David S.; Haas, Elisabeth A.; Broadbelt, Kevin G.; Duncan, Jhodie R.; Mena, Othon J.; Krous, Henry F.; Trachtenberg, Felicia L.

    2013-01-01

    OBJECTIVE: Sudden and unexplained death is a leading cause of infant mortality. Certain characteristics of the sleep environment increase the risk for sleep-related sudden and unexplained infant death. These characteristics have the potential to generate asphyxial conditions. We tested the hypothesis that infants may be exposed to differing degrees of asphyxia in sleep environments, such that vulnerable infants with a severe underlying brainstem deficiency in serotonergic, γ-aminobutyric acid-ergic, or 14-3-3 transduction proteins succumb even without asphyxial triggers (eg, supine), whereas infants with intermediate or borderline brainstem deficiencies require asphyxial stressors to precipitate death. METHODS: We classified cases of sudden infant death into categories relative to a “potential asphyxia” schema in a cohort autopsied at the San Diego County Medical Examiner’s Office. Controls were infants who died with known causes of death established at autopsy. Analysis of covariance tested for differences between groups. RESULTS: Medullary neurochemical abnormalities were present in both infants dying suddenly in circumstances consistent with asphyxia and infants dying suddenly without obvious asphyxia-generating circumstances. There were no differences in the mean neurochemical measures between these 2 groups, although mean measures were both significantly lower (P infants dying suddenly and unexpectedly. Brainstem abnormalities were associated with both asphyxia-generating and non–asphyxia generating conditions. Heeding safe sleep messages is essential for all infants, especially given our current inability to detect underlying vulnerabilities. PMID:24218471

  15. Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran

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    Fatemeh Nayeri

    2012-01-01

    Full Text Available Background: Asphyxia is a medical condition in which placental or pulmonary gas exchange is impaired or they cease all together, typically producing a combination of progressive hypoxemia and hypercapnea. Objective: In addition to regional differences in its etiology; it is important to know its risk factors. Materials and Methods: This is a case-control study, all neonates born from May 2002 to September 2005 in Vali-e-Asr Hospital were studied. 9488 newborns were born of which 6091 of the live patients were hospitalized in NICU. 546 newborns were studied as case and control group. 260 neonates (48% were female and 286 neonates (52% were male. Among the neonates who were admitted, 182 of them were diagnosed with asphyxia and twice of them (364 newborns were selected as a control group. The variables consist of; gestational age, type of delivery, birth weight, prenatal care, pregnancy and peripartum complications and neonatal disorders. Results: Our studies showed that 35 (19.2% patients had mild asphyxia, 107 (58.8% had moderate asphyxia and 40 (22% were diagnosed as severe asphyxia. Mean maternal age was 34.23±4.29yr; (range: 23-38 yr; and mean of parity was 2±1.2; (range: 1-8. Risk factors in our study included emergent Caesarian Section, preterm labor (<37w, low birth weight (<2500g, 5 minute Apgar (less than 6, need for resuscitation, nuchal cord, impaired Biophysical Profile, neonatal anemia, and maternal infertility. Conclusion: All risk factors listed above play a role in asphyxia. The majority of these factors are avoidable by means of good perinatal care

  16. [Assessment of levels of otoacoustic emission response in neonates with perinatal asphyxia].

    Science.gov (United States)

    Ribeiro, Georgea Espindola; da Silva, Daniela Polo Camargo; Montovani, Jair Cortez

    2014-09-01

    To evaluate the effects of perinatal asphyxia on the level of the response to transient otoacoustic emissions in infants. Otoacoustic emissions in 154 neonates were performed: 54 infants who suffered asphyxia at birth, measured by Apgar score and medical diagnosis, and 100 infants without risk were compared. Scores less than 4 in the first minute and/or less than 6 in the fifth minute were considered as "low Apgar". Statistical analysis of the data was performed using the Kruskal, Wilcoxon, and Mann-Whitney nonparametric tests. Lower levels of response were observed in transient otoacoustic emission in the group that suffered perinatal asphyxia, with significant values for the frequencies 2,000, 3,000, and 4,000Hz in the right ear, and 2,000 and 4,000Hz in the left ear. The analysis of the intrinsic characteristics of the otoacoustic emissions evidenced low performance of outer hair cells in neonates who had perinatal asphyxia, which may affect the development of listening skills in this population. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  17. intrapartum-related birth asphyxia in south africa- lessons from the ...

    African Journals Online (AJOL)

    The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are . typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these .deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this.

  18. Intrapartum-related birth asphyxia in South Africa lessons From the ...

    African Journals Online (AJOL)

    Background. The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report. Objectives. To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of ...

  19. Pediatric constrictive asphyxia a rare form of child abuse: A report of two cases

    NARCIS (Netherlands)

    Vester, M. E. M.; Bilo, R. A. C.; Nijs, H. G. T.; van Rijn, R. R.

    2018-01-01

    We present two cases of infants who died under suspicious circumstances. After clinical and legal investigations, non-accidental constrictive asphyxia inflicted by one of the parents was established. The first case presents a to date not yet reported, unique mechanism of trauma. In order to stop his

  20. BIRTH ASPHYXIA - PRESENTING THE CASE FOR'A STITCH IN TIME'

    African Journals Online (AJOL)

    CP) rates at a teaching hospital in a developing country, and to place these rates within the context of the current caesarean section (CS) rate. To determine the number of cases of birth asphyxia that are preventable. Design. Retrospective ...

  1. Maternal education, prematurity and the risk of birth asphyxia in selected hospitals in Jakarta

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    Cicih Opitasari

    2016-03-01

    Full Text Available AbstrakLatar belakang: Asfiksia dapat menyebabkan kerusakan organ berat dan berakibat fatal pada bayi barulahir. Berdasarkan hasil analisis lanjut Riskesdas 2007, asfiksia merupakan penyebab kematian keduapada bayi setelah infeksi. Tujuan penelitian ini adalah untuk mengidentifikasi faktor risiko yang berkaitandengan kejadian bayi asfiksia pada bayi baru lahir.Metode: Data diambil dari rekam medik wanita hamil yang melahirkan di dua rumah sakit (RS diJakarta, yang dipilih secara purposif di antara yang melahirkan pada periode 1 Januari sampai 31Desember 2011. Kelahiran asfiksia ialah bayi baru lahir dengan skor Apgar kurang dari tujuh, satu menitsetelah lahir. Analisis data dilakukan dengan menggunakan regresi logistik.Hasil: Pada analisis ini diperoleh 2777 sampel dari 4191 yang memiliki data lengkap. Proporsi asfiksiapada bayi baru lahir adalah 6,5%. Jika dibandingkan wanita berpendidikan tinggi, wanita berpendidikanrendah memiliki risiko melahirkan bayi asfiksia 4,3 kali lebih tinggi [rasio odds suaian (ORa = 4,31;P=0,000], sedangkan wanita berpendidikan menengah dibandingkan dengan yang tinggi berisiko 3,3kali lebih tinggi melahirkan bayi dengan asfiksia (ORa=3,31; P=0,000.Selanjutnya, jika dibandingkan bayi cukup bulan, bayi prematur memiliki risiko 3,1 kali lebih tinggimengalami asfiksia (ORa=3,07; P=0,000, sedangkan bayi postmatur 63% (namun tidak signifikan lebihtinggi berisiko mengalami asfiksia (P=0.118.Kesimpulan: Wanita yang memiliki tingkat pendidikan rendah dan menengah serta bayi prematur memiliki risikolebih tinggi mempunyai bayi baru lahir yang asfiksia. (Health Science Journal of Indonesia 2015;6:111-5Kata kunci: pendidikan, prematur, asfiksia bayi baru lahir AbstractBackground: Birth asphyxia can causes hypoxic ischemic organ damage in neonates. According toadvanced Indonesian Basic Health Research 2007, asphyxia was the second highest cause of infant deathafter infection (13.8%. This study aimed to identify several risk

  2. Fatores associados à asfixia perinatal Factors associated with perinatal asphyxia

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    Alfredo de Almeida Cunha

    2004-12-01

    stepwise logistic regression model. RESULTS: there were 39 (14% depressed newborns which were compared to 238 (86% not depressed babies. The final analysis (multivariate showed an association between low Apgar score and previous case of stillbirth (OR=52.6, preterm labor threat (OR=33.8, low birth weight, less than 2,500 g body weight (OR=11.2 and previous cesarean section (OR=7.4. Some factors acted as a protection, including birth weight, in grams (OR=0.9, female sex of the newborn (OR=0.1, medical complications (OR=0.4 and prematurity (gestational age < 37 weeks, OR=0.1. CONCLUSION: the study may help in the identification of fetuses at great risk of asphyxia, allowing proper reference within the health system and planning of effective assistance in neonatal intensive care units.

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

    Science.gov (United States)

    Isac, Sebastian; Panaitescu, Anca Maria; Spataru, Ana; Iesanu, Mara; Totan, Alexandra; Udriste, Amalia; Cucu, Natalia; Peltecu, Gheorghe; Zagrean, Leon; Zagrean, Ana-Maria

    2017-07-13

    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. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Neuropsychological consequences of very low birth weight and asphyxia at term: follow-up until school-age.

    Science.gov (United States)

    Korkman, M; Liikanen, A; Fellman, V

    1996-04-01

    This prospective, longitudinal study examined neuropsychological consequences of different conditions associated with risks of perinatal asphyxia. Four groups of children, 5 to 9 years of age, were studied: (1) very low birth weight (VLBW) children born small for gestational age (SGA) (n = 34); (2) VLBW children born appropriate for gestational age (AGA) (n = 43); (3) children with signs of birth asphyxia at term (birth asphyxia) (n = 36), and (4) control children (n = 45). Moderately and severely disabled children were excluded. The WISC-R and the NEPSY, a new neuropsychological assessment consisting of attention, language, motor, sensory, visuospatial, and memory subtests, were administered. The VLBW-SGA group had the poorest test results. The VLBW-AGA group was somewhat less impaired, whereas the birth asphyxia group performed at the control group level. Impairment, when present, tended to be diffuse in all groups, affecting psychometric intelligence, naming, visuo-motor performance, tactile finger discrimination, attention, and phonological analysis.

  5. Comparison of Umbilical Serum Copeptin Relative to Erythropoietin and S100B as Asphyxia Biomarkers at Birth.

    Science.gov (United States)

    Summanen, Milla; Seikku, Laura; Rahkonen, Petri; Stefanovic, Vedran; Teramo, Kari; Andersson, Sture; Kaila, Kai; Rahkonen, Leena

    2017-01-01

    Birth asphyxia, estimated to account for a million neonatal deaths annually, can cause a wide variety of neurodevelopmental impairments. There is a need to develop new, swift methods to identify those neonates who would benefit from neuroprotective treatments such as hypothermia. To examine the utility of cord serum copeptin, a stable byproduct of arginine vasopressin release, as a biomarker of birth asphyxia based on a comparison with 2 biomarkers of hypoxia and brain trauma: erythropoietin and S100B. The study population consisted of 140 singleton, term neonates: 113 controls and 27 with birth asphyxia (2/3 criteria met: umbilical artery pH Copeptin, S100B, and erythropoietin levels in umbilical artery samples were measured by immunoassays. Copeptin correlated in the entire study population more strongly with umbilical artery base excess than S100B and erythropoietin, and only copeptin correlated with arterial pH. Furthermore, only copeptin levels were significantly higher in cases of birth asphyxia, and in vaginally born neonates they were found to increase as a function of labor duration. Copeptin was elevated in neonates born via vacuum extraction, whereas erythropoietin levels showed a slight increase after emergency cesarean section. In this study population, S100B and erythropoietin were not valid biomarkers of birth asphyxia. In contrast, our work suggests that copeptin has high potential to become a routinely used biomarker for acute birth asphyxia and neonatal distress. © 2017 S. Karger AG, Basel.

  6. Asphyxia-related risk factors and their timing in spastic cerebral palsy

    DEFF Research Database (Denmark)

    Nielsen, Lene F.; Schendel, Diana; Grove, Jakob

    2008-01-01

    Objective To investigate the association of asphyxia-related conditions (reducing blood flow or blood oxygen levels in the fetus) with spastic cerebral palsy (CP) considering different gestational age groups and the timing of risk. Design Population-based case-control study. Setting Danish Cerebral...... Palsy Register in eastern Denmark and Danish Medical Birth Register. Population or Sample 271 singletons with spastic CP and 217 singleton controls, frequency matched by gestational age group, born 1982-1990 in eastern Denmark. Methods Data were abstracted from medical records, and a priori asphyxia...... an especially high risk for spastic quadriplegia. Placental and cord complications were present in 21% of cases and 12% of controls. Conclusions The risk for spastic quadriplegia from placental infarction may be linked in some cases with abnormal fetal growth (17% of all children with spastic quadriplegia and 3...

  7. Long-term sequelae of perinatal asphyxia in the aging rat

    DEFF Research Database (Denmark)

    Weitzdoerfer, R; Gerstl, N; Hoeger, H

    2002-01-01

    Information on the consequences of perinatal asphyxia (PA) on brain morphology and function in the aging rat is missing although several groups have hypothesized that PA may be responsible for neurological and psychiatric deficits in the adult. We therefore decided to study the effects of PA on t...... for understanding CNS pathology in the aging subject, animal or human.......Information on the consequences of perinatal asphyxia (PA) on brain morphology and function in the aging rat is missing although several groups have hypothesized that PA may be responsible for neurological and psychiatric deficits in the adult. We therefore decided to study the effects of PA...... on the central nervous system (CNS) in terms of morphology, immunohistochemistry, neurology and behavior in the aging animal. Hippocampus and cerebellum were evaluated morphologically by histological, immunohistochemical and magnetic resonance imaging and cerebellum also by stereological tests. Neurological...

  8. Differential involvement of the brain in neonatal asphyxia: a pathogenic explanation.

    Science.gov (United States)

    Sheth, R D; Bodensteiner, J B; Riggs, J E; Schochet, S S

    1995-11-01

    Multiple cystic lesions in brain parenchyma supplied by the anterior cerebral circulation is a recognized pattern of cerebral injury associated with hypoxic-ischemic encephalopathy in the term infant. This report presents a series of seven infants (gestational age, 39.3 +/- 2.8 weeks; range, 36 to 44 weeks) who developed multicystic encephalomalacia in the distribution of the anterior cerebral circulation after severe neonatal asphyxia. Cerebral imaging and pathologic studies demonstrate relative preservation of the cerebellum, brain stem, and cerebral structures supplied by the vertebrobasilar circulation. Compared to the vertebrobasilar vasculature, the anterior cerebral vessels in the term infant have dense sympathetic innervation. Asphyxia, a potent sympathetic stimulator, may induce vasoconstriction in the anterior circulation and differentially accentuate the effects of hypoxia/ischemia on cerebral tissue.

  9. Application of a classification system focusing on potential asphyxia for cases of sudden unexpected infant death.

    Science.gov (United States)

    Randall, Brad; Donelan, Kent; Koponen, Mark; Sens, Mary Ann; Krous, Henry F

    2012-03-01

    Current classification schemes for sudden unexpected infant death (SUID) may not be optimal for capturing scene events that potentially predispose to asphyxia. (1) To compare causes of death in a group of SUID cases assigned by multiple reviewers using our recently published classification scheme for SUID that is based on asphyxial risk at the death scene, and (2) To compare these newly assigned causes of death to that originally assigned by the medical examiners of record who performed the autopsies. Five reviewers independently assigned causes of death for 117 cases of SUID, including 83 originally diagnosed as sudden infant death syndrome (SIDS), accessioned into the San Diego SIDS/SUDC Research Project from the San Diego County Medical Examiner's Office. The diagnostic categories are: A: SIDS; B: Unexplained-Potentially Asphyxia; C: Unexplained-Other Potential Causes of Death; D: Unclassified-Other; E: Unclassified; and F: Known Cause of Death. The reviewers collectively opined that conditions at the death scene contributed to or caused death in 32-50% of all of the 117 cases as well as in 40-59% of the 83 originally diagnosed SIDS cases. Another cause of death was considered plausible in 2-12% of the SIDS cases. Application of this new classification system resulted in 55-69% decrease in SIDS diagnoses. Asphyxia as a potential contributor to, or as the specific cause of death, appears to exist in a large percentage of cases designated as SIDS using other classification schemes. When certifiers use a classification system that focuses upon potential asphyxia in determining the cause of death the incidence of SIDS dramatically declines.

  10. The "Bermuda triangle" of neonatal neurology: cerebral palsy, neonatal encephalopathy, and intrapartum asphyxia.

    Science.gov (United States)

    Shevell, Michael I

    2004-03-01

    The terms "cerebral palsy," "neonatal encephalopathy," and "intrapartum asphyxia" are frequently used in pediatric neurology. This article presents concise, verifiable definitions for each of these entities based on our current understanding and formulates the nature of the interrelationships between them. The aim is to provide a level of clarity that will enhance diagnostic and pathogenetic precision and minimize conceptual misunderstanding. This should aid future therapeutic and research efforts in this important area.

  11. Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    Aebi Christoph

    2011-05-01

    Full Text Available Abstract Background Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia. Methods Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30, chorioamnionitis (n = 33 and asphyxia (n = 25 were compared to a control group of preterm and term (n = 155 neonates. Results Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419. Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p Conclusions Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

  12. Prognostic correlative values of the late-infancy MRI pattern in term infants with perinatal asphyxia.

    Science.gov (United States)

    Tekgul, Hasan; Serdaroglu, Gul; Yalman, Osman; Tutuncuoglu, Sarenur

    2004-07-01

    The aim of this study was to define the risk ratios of the late-infancy magnetic resonance imaging pattern for long-term outcome in term infants with perinatal asphyxia. We evaluated 65 term infants with perinatal asphyxia and performed magnetic resonance imaging examinations between 4-12 months of age. Magnetic resonance imaging scans were classified as follows: (1) periventricular leukomalacia in 21 (32%) infants, (2) marked cortical atrophy in 17 (26%) infants, (3) multicystic encephalomalacia in 10 (15%) infants, (4) deep gray matter involvement in 8 (12%) infants, (5) focal cortical involvement in 6 (9%) infants, (6) myelination delay in 3 (5%) infants. The overall outcome was favorable in 19 (29%) of 65 infants. Infants with diffuse cortical involvement (multicystic encephalomalacia and marked cortical atrophy) are four times (odds ratio: 4.4 and 4.1 respectively) more likely to attain the unfavorable outcome than the infants with other patterns of magnetic resonance imaging. Infants with focal cortical involvement had relatively favorable outcome in 60% of the cases. In conclusion, it appears that the overall outcome of infants with perinatal asphyxia correlated well with the magnetic resonance imaging patterns obtained between 4 and 12 months of age.

  13. Antenatal dexamethasone after asphyxia increases neural injury in preterm fetal sheep.

    Directory of Open Access Journals (Sweden)

    Miriam E Koome

    Full Text Available BACKGROUND AND PURPOSE: Maternal glucocorticoid treatment for threatened premature delivery dramatically improves neonatal survival and short-term morbidity; however, its effects on neurodevelopmental outcome are variable. We investigated the effect of maternal glucocorticoid exposure after acute asphyxia on injury in the preterm brain. METHODS: Chronically instrumented singleton fetal sheep at 0.7 of gestation received asphyxia induced by complete umbilical cord occlusion for 25 minutes. 15 minutes after release of occlusion, ewes received a 3 ml i.m. injection of either dexamethasone (12 mg, n = 10 or saline (n = 10. Sheep were killed after 7 days recovery; survival of neurons in the hippocampus and basal ganglia, and oligodendrocytes in periventricular white matter were assessed using an unbiased stereological approach. RESULTS: Maternal dexamethasone after asphyxia was associated with more severe loss of neurons in the hippocampus (CA3 regions, 290 ± 76 vs 484 ± 98 neurons/mm(2, mean ± SEM, P<0.05 and basal ganglia (putamen, 538 ± 112 vs 814 ± 34 neurons/mm(2, P<0.05 compared to asphyxia-saline, and with greater loss of both total (913 ± 77 vs 1201 ± 75/mm(2, P<0.05 and immature/mature myelinating oligodendrocytes in periventricular white matter (66 ± 8 vs 114 ± 12/mm(2, P<0.05, vs sham controls 165 ± 10/mm(2, P<0.001. This was associated with transient hyperglycemia (peak 3.5 ± 0.2 vs. 1.4 ± 0.2 mmol/L at 6 h, P<0.05 and reduced suppression of EEG power in the first 24 h after occlusion (maximum -1.5 ± 1.2 dB vs. -5.0 ± 1.4 dB in saline controls, P<0.01, but later onset and fewer overt seizures. CONCLUSIONS: In preterm fetal sheep, exposure to maternal dexamethasone during recovery from asphyxia exacerbated brain damage.

  14. ASPHYXIA, INTRACRANIAL HEMORRHAGES AND BRAIN EDEMA OF RISK CHILDREN IN THE ADVISORY INSTITUTE IN BITOLA FROM 1989-1994

    Directory of Open Access Journals (Sweden)

    M. ILIEVSKA,

    1997-09-01

    Full Text Available 3986 files have been examined in the Advisory Institute for a five year period in relation to the present risk factors in the pre, peri and postnatal period, the occurrence of asphyxia, I.H. (intracranial hemorrhages and brain edema and their outcome for the children. There were 958 or 32% risk children, out of them 206 or 22% were with asphyxia, 25 or 3% were with brain edema and 14 or 1,5% were with intracranial hemorrhages.The analysis for the risk factors shows that 119 of them were abortive , and from them 15% were born with asphyxia; 124 were SFD and 21% of them with asphyxia; 272 children weighed over 4500 gr., 7% of them with asphyxia and 0.4% with I.H., there were 68 twins, 12% of them with asphyxia. Out of the children with no risk registered, 6 were born with I.H., or 0,2%.Mothers under the age of 18 gave birth to 13% children with asphyxia; treated for sterility and anemia during pregnancy 15%; with increased blood pressure 14%; and 5% with maintained pregnancy.The highest delivery risk is present with children born with vacuum extraction (30% or every third child is with asphyxia and 3% with I.H. and with children delivered by caesarean section (14% with asphyxia.As for the position of the fetus-Citus pedalicus gave 55% children with asphyxia, and Situs pelvicus 12%.The worst damage is suffered by infants with premature amnion disruption (62% are with asphyxia; with the umbilical cord round the neck-56% with asphyxia and 6% with I.H.; and with muddled amniotic fluid and placenta pelvia-50%.The order of risk factors related to asphyxia, I.H. and brain edema is as follows: the first is premature amnion disruption, then follows the umbilical cord round the neck, the muddled amniotic fluid, and placenta previa and Citus pedalicus-which are obstetric problems. The next are the vacuum extraction and S.C. As for the gestatory period the order is as follows: first the abortive, then the twins and hypertrofic infants. The outcome of the

  15. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes.

    Science.gov (United States)

    Dalili, Hosein; Nili, Firouzeh; Sheikh, Mahdi; Hardani, Amir Kamal; Shariat, Mamak; Nayeri, Fatemeh

    2015-01-01

    To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes. This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure. The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01). The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.

  16. Correlation between echocardiographic superior vena cava flow and short-term outcome in infants with asphyxia.

    Science.gov (United States)

    Kumagai, Takeshi; Higuchi, Ryuzo; Higa, Asumi; Tsuno, Yoshinobu; Hiramatsu, Chisako; Sugimoto, Takuya; Booka, Mina; Okutani, Takahiro; Yoshikawa, Norishige

    2013-05-01

    To assess the relationship between superior vena cava (SVC) flow and short-term outcome in infants with perinatal asphyxia. Infants in sequence born after more than 35 weeks of gestation who had been hospitalized at the NICU and normal neonatal wards of Wakayama Medical University between May 2005 and September 2010 were recruited for this observational cohort study. The study eligibility criterion was the presence of perinatal asphyxia, as evidenced by abnormal fetal heart rate monitoring and an Apgar score of 7 or less at 1 min or need for resuscitation using positive pressure ventilation. SVC flow was measured in the first three days of life by Doppler echocardiography as described by Kluckow and Evans. Short-term outcome was defined as poor if MRI demonstrated bilateral lesions of the basal ganglia and thalamus and/or multicystic encephalomalacia due to hypoxic ischemia. In the head cooling group, SVC flow in infants with a good outcome was lower than that in infants with a poor outcome at 12h (36.9±7.7 vs. 113.4±42.4 ml/kg/min (p=0.01)), 24h (75.2±25.3 vs. 155.6±45.7 ml/kg/min (p=0.03)), and 48 h (92.5±34.2 vs. 161.1±46.7 ml/kg/min (p=0.04)) after birth. SVC flow decreased promptly after introduction of head cooling in infants who had a good outcome, whereas it increased gradually after head cooling in those who had a poor outcome. We speculate that regulation of brain circulation is disrupted in infants with asphyxia who show a poor outcome. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Cerebral blood flow and oxygenation in infants after birth asphyxia. Clinically useful information?

    DEFF Research Database (Denmark)

    Greisen, Gorm

    2014-01-01

    of cellular energy charge during the hours following severe birth asphyxia was observed twenty years later by sequential cranial magnetic resonance spectroscopy. This led to the concept of delayed energy failure that is linked to mitochondrial dysfunction and apoptotic cell death. Abnormally increased...... perfusion and lack of normal cerebral blood flow regulation are also typically present, but whether the perfusion abnormalities at this secondary stage are detrimental, beneficial, or a mere epiphenomenon remains elusive. In contrast, incomplete reoxygenation of the brain during and following resuscitation...

  18. CT cold areas in both putamens in cases with history of perinatal asphyxia

    Energy Technology Data Exchange (ETDEWEB)

    Ishizaki, Asayo; Maruyama, Hiroshi (Tokyo Women' s Medical Coll. (Japan))

    1982-12-01

    CT bilaterally showed a cold area in the putamen of 5 infants with cerebral palsy who had had asphyxia at birth. The etiology was discussed, and 4 of the cases were clinically studied. All four patients had convulsive tetraplegia, or convulsive bilateral paralysis with the element of athetosis. Three of them had a history of infantile epilepsy, accompanied by abnormal ocular movement. Two patients with tetraplegia showed marked hypotonia of the trunk in ventral support (Landau). Impairment of the bilateral putamens in the abnormal muscle tone was inferred.

  19. PERINATAL ASPHYXIA AS POTENTIAL SOURCE OF CHILDREN WITH DEVELOPMENTAL PSYCHO-MOTOR DIFFICULTIES

    Directory of Open Access Journals (Sweden)

    Elizabeta ZISOVSKA

    1997-09-01

    Full Text Available Besides the great improvement of aostetrics and neanatal intensive care, certain percentage of new born children suffer from perinatal asphyxia (PA and that is one of the first reasons for hypoxic and ischemic brain damage which leads to neuro-developing handicap. In order to show how strong is the correaltion between PA and permanent sequele, an early, precise and prompt diagnosis of asphyxia and its influence on neonatal brain is neccessary.This study presents answers to the following issues.1.Which parameters define precisely the perinatal asphyxia?2.How great is the PA incidence on our material?3.What is the percentage of postasphyxic encephalopathy (PAE in the group of asphyxic new born children?4.Which of these children bear high risk for developmental psycho-motor difficulties?MaterialThe new born children delivered on time in the Clinic of Gynecology and Obstetrics.Methods1.Early diagnosis of PA according to the score consisted of high specific, sensitivity and positive and predictive value2.Consequent neurological check-ups and PAE cathegori-zation for seven days3.Ultrasound examination of CNS through big fontanelle4.Lab analysesResults5.639 successive new born children delivered on time were examined. The included scouring system covers APGAR score at the 5th minute, cardiotocographic record, base deficit in ABS, meconium around the amniotic water. According to this system, 81 child passed the PA , i.e., 14,3/ 1.000 new born children delivered on time. Out of them, 54 have signs of PAE (9,5/1000 new born children delivered on time, i.e., 66,6% of all asphyxia new born children. Classification has been made according to the PAE grade: 34 children survived the first grade (62,9%, 11 children survived the second grade (20,4% and 9 new born children survived the third grade (16,7%. According to data in literature and long year studies of this issue, the children from the group who passed the second and the third grade of PAE have the risk

  20. Comparison of the Incidence of Perinatal Asphyxia before and after the Health Improvement Program in Bentolhoda Hospital of Bojnurd, Iran

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    Mahvan Khodaparast

    2016-12-01

    Full Text Available Background: Perinatal asphyxia is a common cause of infant morbidity and mortality and long-term neurological disabilities. Due to the high costs of admission, a large proportion of births and neonatal deaths occur in non-hospital settings. This study aimed to evaluate the incidence rate of perinatal asphyxia before and after the implementation of the health improvement program. Methods: This descriptive-analytical study was conducted on all the infants with moderate and severe asphyxia during April 2013-2015. Subjects were divided into two groups of A and B (born after and before the health improvement program, respectively. Maternal and neonatal data were recorded in checklists and compared between these  groups. Data analysis was performed in SPSS version 17. Results: In total, 111 asphyxiated neonates were classified into two groups of A and B, and incidence rate of asphyxia was estimated at 0.54% and 1.05%, respectively. Severe asphyxia was observed in 35.7% and 28.9% of the infants in groups A and B, respectively. Moreover, mean duration of mechanical ventilation was 25 and 79 hours in groups A and B, respectively. Conclusion: According to the results of this study, implementation of the health improvement program reduced the incidence of perinatal asphyxia. In addition, number of cesarean cases due to previous C-section was observed to decrease. Therefore, it could be concluded that high-quality resuscitation efforts and restricted rules in the health improvement program lower the risk of long-term complications in asphyxiated neonates. However, no significant difference was observed in the mortality rate of the asphyxiated newborns in this study.

  1. Cognitive impairments at two years of age after prenatal alcohol exposure or perinatal asphyxia.

    Science.gov (United States)

    Korkman, M; Hilakivi-Clarke, L A; Autti-Rämö, I; Fellman, V; Granström, M L

    1994-04-01

    The purpose of this follow-up study was to assess and describe early cognitive impairments in two-year-old children exposed to alcohol (1) until the second trimester (n = 20), (2) until the third trimester (n = 20), (3) throughout pregnancy (n = 20), (4) children to mothers with preeclampsia (n = 37), (5) children surviving acute birth asphyxia (n = 14), and (6) a normal control group (n = 48). Alcohol exposure throughout pregnancy was found to be associated with impairments in language (mean SD score = -1.3) and visuo-motor development (mean SD score = -2.0). Preeclampsia was related to impairment in visuo-motor development (mean SD score = -1.2) and attention (mean SD score = -0.7). Alcohol exposure until the third trimester was associated with attention deficit alone (mean SD score = -0.9). Alcohol exposure until the second trimester and acute birth asphyxia were not associated with an increased risk of cognitive impairment. The study also showed that neuropsychological test profiles of language, visuo-motor functions and attention may be obtained with the aid of an adapted version of the Bayley Mental Scale and an evaluation of attention.

  2. Asphyxia, Neurologic Morbidity, and Perinatal Mortality in Early-Term and Postterm Birth.

    Science.gov (United States)

    Seikku, Laura; Gissler, Mika; Andersson, Sture; Rahkonen, Petri; Stefanovic, Vedran; Tikkanen, Minna; Paavonen, Jorma; Rahkonen, Leena

    2016-06-01

    Neonatal outcomes vary by gestational age. We evaluated the association of early-term, full-term, and postterm birth with asphyxia, neurologic morbidity, and perinatal mortality. Our register-based study used retrospective data on 214 465 early-term (37(+0)-38(+6) gestational weeks), 859 827 full-term (39(+0)-41(+6)), and 55 189 postterm (≥42(+0)) live-born singletons during 1989-2008 in Finland. Asphyxia parameters were umbilical cord pH and Apgar score at 1 and 5 minutes. Neurologic morbidity outcome measures were cerebral palsy (CP), epilepsy, intellectual disability, and sensorineural defects diagnosed by the age of 4 years. Newborns with major congenital anomalies were excluded from perinatal deaths. Multivariate analysis showed that, compared with full-term pregnancies, early-term birth increased the risk for low Apgar score (Postterm birth increased the risk for low Apgar score (postterm births, but general neurologic morbidity and perinatal mortality were not increased. Copyright © 2016 by the American Academy of Pediatrics.

  3. Pediatric constrictive asphyxia a rare form of child abuse: A report of two cases.

    Science.gov (United States)

    Vester, M E M; Bilo, R A C; Nijs, H G T; van Rijn, R R

    2018-01-10

    We present two cases of infants who died under suspicious circumstances. After clinical and legal investigations, non-accidental constrictive asphyxia inflicted by one of the parents was established. The first case presents a to date not yet reported, unique mechanism of trauma. In order to stop his daughter from crying, the father admitted that he sometimes sat on his baby while she was lying on the bed. Occasionally increasing his force by pulling with his hands on the bottom of the bed. In the second case tight swaddling and encircling chest compression was the causative mechanism. In both cases the father was sentenced to imprisonment with mandate psychiatric care. Only two previous reports of this uncommon and relatively unknown cause of child abuse, called constrictive asphyxia, are known. In all reported cases static loading of the chest resulted in rib fractures and demise of the child. This rare abusive mechanism should be known to pediatric radiologists and pathologists. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Effect of Marine Collagen Peptides on Physiological and Neurobehavioral Development of Male Rats with Perinatal Asphyxia

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    Linlin Xu

    2015-06-01

    Full Text Available Asphyxia during delivery produces long-term deficits in brain development. We investigated the neuroprotective effects of marine collagen peptides (MCPs, isolated from Chum Salmon skin by enzymatic hydrolysis, on male rats with perinatal asphyxia (PA. PA was performed by immersing rat fetuses with uterine horns removed from ready-to-deliver rats into a water bath for 15 min. Caesarean-delivered pups were used as controls. PA rats were intragastrically administered with 0.33 g/kg, 1.0 g/kg and 3.0 g/kg body weight MCPs from postnatal day 0 (PND 0 till the age of 90-days. Behavioral tests were carried out at PND21, PND 28 and PND 90. The results indicated that MCPs facilitated early body weight gain of the PA pups, however had little effects on early physiological development. Behavioral tests revealed that MCPs facilitated long-term learning and memory of the pups with PA through reducing oxidative damage and acetylcholinesterase (AChE activity in the brain, and increasing hippocampus phosphorylated cAMP-response element binding protein (p-CREB and brain derived neurotrophic factor (BDNF expression.

  5. Long-term neuroprotective effects of allopurinol after moderate perinatal asphyxia : follow-up of two randomised controlled trials

    NARCIS (Netherlands)

    Kaandorp, Joepe J.; van Bel, Frank; Veen, Sylvia; Derks, Jan B.; Groenendaal, Floris; Rijken, Monique; Roze, Elise; Venema, Monica M. A. Uniken; Rademaker, Carin M. A.; Bos, Arend F.; Benders, Manon J. N. L.

    Objective Free-radical-induced reperfusion injury has been recognised as an important cause of brain tissue damage after birth asphyxia. Allopurinol reduces the formation of free radicals, thereby potentially limiting the amount of hypoxia-reperfusion damage. In this study the long-term outcome of

  6. Environment as a risk factor in delayed development in premature, low-birthweight and mild asphyxia children.

    Science.gov (United States)

    Yanuarti, Hestu Putri; Rusmil, Kusnandi; Effendi, Sjarif Hidajat

    2014-10-01

    Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of language and visual-motor development. Environmental risk factors contributing to the delay include parents' education, family income, number of children in the family, exclusive breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature, LBW and mild asphyxia children minimizes information to parents on the importance of an optimal environment. The aim of this study was to observe the role of the environment as a risk factor for delay in language and visual-motor development. A cross-sectional study was carried out from June to December 2011 of 12-24-month-old children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City, and Muhammadiyah Hospitals. Language and visual-motor development were measured by Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic regression analysis. Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related to the delay were low parental education, low family income, non-exclusive breast-feeding (P breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756; 95% confidence interval [CI]: 10.407-2934.516, P breast-feeding are risk factors for delay in language and visual-motor development in 12-24-month-old children born premature, with LBW and mild asphyxia. © 2014 Japan Pediatric Society.

  7. Renal dysfunction in early adulthood following birth asphyxia in male spiny mice, and its amelioration by maternal creatine supplementation during pregnancy.

    Science.gov (United States)

    Ellery, Stacey J; LaRosa, Domenic A; Cullen-McEwen, Luise A; Brown, Russell D; Snow, Rod J; Walker, David W; Kett, Michelle M; Dickinson, Hayley

    2017-04-01

    Acute kidney injury affects ~70% of asphyxiated newborns, and increases their risk of developing chronic kidney disease later in life. Acute kidney injury is driven by renal oxygen deprivation during asphyxia, thus we hypothesized that creatine administered antenatally would protect the kidney from the long-term effects of birth asphyxia. Pregnant spiny mice were fed standard chow or chow supplemented with 5% creatine from 20-d gestation (midgestation). One day prior to term (37-d gestation), pups were delivered by caesarean or subjected to intrauterine asphyxia. Litters were allocated to one of two time-points. Kidneys were collected at 1 mo of age to estimate nephron number (stereology). Renal function (excretory profile and glomerular filtration rate) was measured at 3 mo of age, and kidneys then collected for assessment of glomerulosclerosis. Compared with controls, at 1 mo of age male (but not female) birth-asphyxia offspring had 20% fewer nephrons (P birth-asphyxia offspring had 31% lower glomerular filtration rate (P birth asphyxia. Maternal creatine supplementation during pregnancy may be an effective prophylactic to prevent birth asphyxia induced acute kidney injury and the emergence of chronic kidney disease.

  8. Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia.

    Science.gov (United States)

    Saha, D; Ali, M A; Haque, M A; Ahmed, M S; Sutradhar, P K; Latif, T; Sarkar, D; Husain, F

    2015-04-01

    The clinical evidence of neurological menifestations associated with asphyxia is described as hypoxic ischaemic encephalopathy (HIE). A variety of metabolic problems are present in asphyxiated newborns including hypoglycemia, hypocalcemia, hypomagnesemia and others metabolic abnormalities. Some of these biochemical disturbances may trigger seizure or potentiate further brain damage. This cross sectional case-control study was done in Mymensingh Medical College Hospital, to identify the association of hypoglycemia, hypocalcemia, hypomagnesemia in neonates with perinatal asphyxia. Study period was six months. Sample size was 60. Among total sample 30 term asphyxiated newborns of <24 hours age were case and equal number term healthy newborns <24 hours age were control. The main clinical presentations were delayed cry after birth along with respiratory distress, convulsion and absence of cry in asphyxiated newborns. Major physical findings were cyanosis, convulsion and tachypnoea in asphyxiated group. The mean value of serum calcium level was significantly lower in asphyxiated newborns (7.37 ± 0.10mg/dl) than control value (8.04±0.09mg/dl). Hypocalcemia was found among 23.33% babies in case group. On the contrary, hypocalcemia was found in single baby among control group. The mean value of serum magnesium was significantly lower in asphyxiated newborns (1.83 ± 0.04mg/dl) than control value (1.96 ± 0.05mg/dl). Hypomagnesemia was found among 3(10%) newborns but none was found among control group. Hypoglycemia was found in 7(23.33%) cases though the mean value of blood glucose was higher in case group (5.72 ± 0.62mmol/l) than control group (4.87 ± 0.15mmol/l) difference was not statistically significant. Combined hypoglycemia, hypocalcemia and hypomagnesemia were found in 1(3.33%) case; combined hypoglycemia and hypocalcemia were found in 2(6.67%) cases; and combined hypocalcemia and hypomagnesemia were found in 1(3.33%) case. During the study period, 3(10.0%) cases

  9. Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre

    DEFF Research Database (Denmark)

    Hollesen, Rikke von Benzon; Johansen, Rie Laurine Rosenthal; Rørbye, Christina

    2018-01-01

    ) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming's system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles...... and the number of deliveries between newborns with asphyxia (Apgar using statistical process control. RESULTS: Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH ...% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions...

  10. Firing probability and mean firing rates of human muscle vasoconstrictor neurones are elevated during chronic asphyxia

    DEFF Research Database (Denmark)

    Ashley, Cynthia; Burton, Danielle; Sverrisdottir, Yrsa B

    2010-01-01

    are chronically asphyxic. We tested the hypothesis that this elevated chemical drive would shift the firing pattern from that seen in healthy subjects to that seen in OSAS. The mean firing probability (52%) and mean firing rate (0.92 Hz) of 17 muscle vasoconstrictor neurones recorded in COPD were comparable...... in the obstructive sleep apnoea syndrome (OSAS) is associated with an increase in firing probability and mean firing rate, and an increase in multiple within-burst firing. Here we characterize the firing properties of muscle vasoconstrictor neurones in patients with chronic obstructive pulmonary disease (COPD), who...... in the healthy group (78%). Conversely, single neurones fired twice in 25% of cardiac intervals, similar to OSAS (27%), but significantly higher than in the healthy group (18%). We conclude that the chronic asphyxia associated with COPD results in an increase in the firing probability and mean firing frequency...

  11. Incidence of Acute Renal Failure in Birth Asphyxia and its Correlation with Hypoxic Ischemic Encephalopathy (HIE

    Directory of Open Access Journals (Sweden)

    Sugunakar Reddy B

    2017-04-01

    Full Text Available Introduction: Perinatal asphyxia is an essential reason for neonatal mortality and neurological morbidity. The general rate of this condition is assessed to be between 1 to 10 for every 1000 live births and is affected by the birth weight and gestational age of the infant furthermore by the neighbourhood accessibility of therapeutic assets. Methods: The underlying administration of every single such neonate comprised of putting the child under a servocontrolled radiant warmer and nursing them in the thermo-neutral range of temperature. About 41 cases accomplished for early identification of confusions and difficulties and their convenient administration. Following 72 h of birth and before 96 h of birth in the wake of getting educated composed assent from the guardians, under aseptic safety measures 3 ml blood was drawn and was assessed for blood urea (Berthelot strategy, serum creatinine (Jaffe’s test, serum electrolytes (Calorimetric technique and urine yield was observed by applying plastic accumulation pack (minicom and clinical state of the child was checked. Results: A sum of 1285 neonates were conceded in NICU for different issues, among them an aggregate of 90 neonates were conceded for perinatal asphyxia. A sum of 75 cases and 50 controls were chosen. The accompanying tables and figures represent the outcomes in subtle element. The outcomes got were examine blood urea and serum creatinine levels were essentially lifted in cases with renal disappointment, when contrasted with controls (P=0.001. Nevertheless, there was no distinction in electrolyte levels in both the gatherings. Conclusion: The most common perinatal danger component was MSAF (40%. In our study the commonest type of ARF in every one of the three phases of HIE was non-oliguric sort. The frequency of inherent renal disappointment in our study was 9.4%. Checking of blood urea, serum creatinine and urine yield helps in the early finding and administration of renal

  12. Maturation of the mitochondrial redox response to profound asphyxia in fetal sheep.

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    Paul P Drury

    Full Text Available Fetal susceptibility to hypoxic brain injury increases over the last third of gestation. This study examined the hypothesis that this is associated with impaired mitochondrial adaptation, as measured by more rapid oxidation of cytochrome oxidase (CytOx during profound asphyxia.Chronically instrumented fetal sheep at 0.6, 0.7, and 0.85 gestation were subjected to either 30 min (0.6 gestational age (ga, n = 6, 25 min (0.7 ga, n = 27 or 15 min (0.85 ga, n = 17 of complete umbilical cord occlusion. Fetal EEG, cerebral impedance (to measure brain swelling and near-infrared spectroscopy-derived intra-cerebral oxygenation (ΔHb = HbO(2 - Hb, total hemoglobin (THb and CytOx redox state were monitored continuously. Occlusion was associated with profound, rapid fall in ΔHb in all groups to a plateau from 6 min, greatest at 0.85 ga compared to 0.6 and 0.7 ga (p<0.05. THb initially increased at all ages, with the greatest rise at 0.85 ga (p<0.05, followed by a progressive fall from 7 min in all groups. CytOx initially increased in all groups with the greatest rise at 0.85 ga (p<0.05, followed by a further, delayed increase in preterm fetuses, but a striking fall in the 0.85 group after 6 min of occlusion. Cerebral impedance (a measure of cytotoxic edema increased earlier and more rapidly with greater gestation. In conclusion, the more rapid rise in CytOx and cortical impedance during profound asphyxia with greater maturation is consistent with increasing dependence on oxidative metabolism leading to earlier onset of neural energy failure before the onset of systemic hypotension.

  13. Prenatal nicotine exposure increases hyperventilation in α4-knock-out mice during mild asphyxia.

    Science.gov (United States)

    Avraam, Joanne; Cohen, Gary; Drago, John; Frappell, Peter B

    2015-03-01

    Prenatal nicotine exposure alters breathing and ventilatory responses to stress through stimulation of nicotine acetylcholine receptors (nAChRs). We tested the hypothesis that α4-containing nAChRs are involved in mediating the effects of prenatal nicotine exposure on ventilatory and metabolic responses to intermittent mild asphyxia (MA). Using open-flow plethysmography, we measured ventilation (V̇(E)) and rate of O2 consumption ( V̇(O2)) of wild-type (WT) and α4-knock-out (KO) mice, at postnatal (P) days 1-2 and 7-8, with and without prenatal nicotine exposure (6 mg kg(-1) day(-1) beginning on embryonic day 14). Mice were exposed to seven 2 min cycles of mild asphyxia (10% O2 and 5% CO2), each interspersed with 2 min of air. Compared to WT, α4 KO mice had increased air V̇(E) and V̇(O2) at P7-8, but not P1-2. Irrespective of age, genotype had no effect on the hyperventilatory response (increase in V̇(E)/V̇(O2)) to MA. At P1-2, nicotine suppressed air V̇(E) and V̇(O2) in both genotypes but did not affect the hyperventilatory response to MA. At P7-8 nicotine suppressed air V̇(E) and V̇(O2) of only α4 KO's but also significantly enhanced V̇(E) during MA (nearly double that of WT; p<0.001). This study has revealed complex effects of α4 nAChR deficiency and prenatal nicotine exposure on ventilatory and metabolic interactions and responses to stress. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

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    R.L. Figueira

    2016-01-01

    Full Text Available Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC. This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group: 1 preterm control (PTC, 2 preterm ventilated (PTV, 3 preterm asphyxiated (PTA, 4 preterm asphyxiated and ventilated (PTAV, 5 term control (TC, 6 term ventilated (TV, 7 term asphyxiated (TA, and 8 term asphyxiated and ventilated (TAV. We measured body, brain, and intestine weights and respective ratios [(BW, (BrW, (IW, (BrW/BW and (IW/BW]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus and intestine (jejunum/ileum tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP. IW was lower in the TA than in the other terms (P<0.05, and the IW/BW ratio was lower in the TA than in the TAV (P<0.005. PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex and TA (cortex/hippocampus (P<0.005. I-FABP was higher in PTAV (P<0.005 and TA (ileum (P<0.05. I-FABP expression was increased in PTAV subgroup (P<0.0001. Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.

  15. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar

    DEFF Research Database (Denmark)

    Maaløe, N.; Housseine, N.; Meguid, T.

    2018-01-01

    Objective: To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. Design: Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. Setting: Tanzanian low-resource...... diagnosis) fell from 120 minutes (IQR 60–240) to 74 minutes (IQR 30-130) (Mann–Whitney test for difference, P human resources and substandard care remain major challenges...

  16. Experimental modelling of the consequences of brief late gestation asphyxia on newborn lamb behaviour and brain structure.

    Directory of Open Access Journals (Sweden)

    Margie Castillo-Melendez

    Full Text Available Brief but severe asphyxia in late gestation or at the time of birth may lead to neonatal hypoxic ischemic encephalopathy and is associated with long-term neurodevelopmental impairment. We undertook this study to examine the consequences of transient in utero asphyxia in late gestation fetal sheep, on the newborn lamb after birth. Surgery was undertaken at 125 days gestation for implantation of fetal catheters and placement of a silastic cuff around the umbilical cord. At 132 days gestation (0.89 term, the cuff was inflated to induce umbilical cord occlusion (UCO, or sham (control. Fetal arterial blood samples were collected for assessment of fetal wellbeing and the pregnancy continued until birth. At birth, behavioral milestones for newborn lambs were recorded over 24 h, after which the lambs were euthanased for brain collection and histopathology assessments. After birth, UCO lambs displayed significant latencies to (i use all four legs, (ii attain a standing position, (iii find the udder, and (iv successfully suckle--compared to control lambs. Brains of UCO lambs showed widespread pathologies including cell death, white matter disruption, intra-parenchymal hemorrhage and inflammation, which were not observed in full term control brains. UCO resulted in some preterm births, but comparison with age-matched preterm non-UCO control lambs showed that prematurity per se was not responsible for the behavioral delays and brain structural abnormalities resulting from the in utero asphyxia. These results demonstrate that a single, brief fetal asphyxic episode in late gestation results in significant grey and white matter disruption in the developing brain, and causes significant behavioral delay in newborn lambs. These data are consistent with clinical observations that antenatal asphyxia is causal in the development of neonatal encephalopathy and provide an experimental model to advance our understanding of neuroprotective therapies.

  17. Treating perinatal asphyxia with theophylline at birth helps to reduce the severity of renal dysfunction in term neonates.

    Science.gov (United States)

    Raina, Alok; Pandita, Aakash; Harish, Rekha; Yachha, Monika; Jamwal, Ashu

    2016-10-01

    Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. This study was designed to determine whether theophylline could prevent or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomised 159 severely asphyxiated term newborns to receive a single dose of 5 mg/kg intravenous theophylline (n = 78) or a placebo (n = 81) during the first hour of life. The infant's 24-hour fluid intake, urine volume, serum creatinine, creatinine clearance and sodium excretion were recorded during days one, three and five of life, starting 12 hours after the theophylline or placebo infusion. Neonates in the theophylline group had lower serum creatinine levels (0.83 ± 0.35 versus 1.47 ± 0.61; p = 0.00) and higher endogenous creatinine clearance (32.16 ± 16.34 versus 17.73 ± 7.92; p = 0.00) than the placebo group. Severe renal dysfunction, namely acute kidney injury, was present in 36 (15%) of the neonates in the theophylline group versus 117 (48%) in the placebo group (p theophylline administered to term neonates with perinatal asphyxia within the first hour of life significantly decreased serum creatinine levels and significantly increased creatinine clearance. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  18. Asfixia perinatal e problemas cardíacos Perinatal asphyxia and heart problems

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    Gesmar Volga H. Herdy

    1998-08-01

    Full Text Available OBJETIVO: Avaliar a gravidade das complicações cardíacas na asfixia neonatal, sua evolução e correlacioná-las com o grau e duração do processo hipóxico. MÉTODOS: Foram estudados 90 bebês nos últimos 7 anos com grau de Apgar PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hipoxia. METHODS: Ninety babies with an Apgar score <6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG, echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41% appropriate for gestation age (AGA and 43 (59% small for gestation age (SGA. Twenty one (23% cases had arterial pH <7.2. The most common clinical conditions were: pneumonia 28 (31%, anemia 24 (26% and jaundice 12 (13%. The main cardiological findings were: systolic murmur in 46 (50%, signs of heart hypertrophy in 18 (20% and heart failure in 8 (9%. On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA in 20 (22%, tricuspid regurgitation in 6 (7%, pulmonary hypertension in 6 (7%, dyskinesia and ventricular dilatation in 4 (5%. Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%, congestion, vacuolization and loss of striae in 4 (29%. CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

  19. [Definition of perinatal asphyxia in medical literature: the need of a consensus].

    Science.gov (United States)

    González de Dios, J

    The pathophysiological definition of perinatal asphyxia (PA) is not operative in clinical practice; by this, several criteria have been proposed: abnormalities in electronic fetal monitoring, meconium stained amniotic fluid, metabolic acidemia, low Apgar score, postasphyctic neurologic and extraneurologic involvement, etc. AIMS. 1) To analyze the different definition criteria of PA in international medical literature; 2) to compare the studies in Spain about PA, and to know the epidemiological differences in relation with the definition of PA used. Bibliographic searching in PubMed data base during the period 1994 1999, using the key word perinatal asphyxia . We review the articles published in these medical journals: Pediatrics, J Pediatrics, Eur J Pediatr, Pediatr Res, Am J Obstet Gynecol, Br Med J, N Engl J Med, An Esp Pediatr and Rev Neurol. original articles with the definition of PA in term newborns; we excluded other types of articles (letters to editor, review.) and experimental models with animals. In a second part, we review 11 epidemiological studies about PA published in Spain. Twenty four articles meet the inclusion criteria: 5 in Pediatr Res, 4 in Pediatrics, 4 in J Pediatr, 3 in Eur J Pediatr, 3 in An Esp Pediatr, 3 in Rev Neurol, 1 in Am J Obstet Gynecol and 1 in N Engl J Med. Each study use a different definition: we found differences in the number and combination of criteria, and also in the cutt of points of quantitative variables (Apgar score and umbilical pH). It is not frequent to classify the severity of asphyctic event. We found important epidemiological differences in the 11 Spanish studies found in the literature about PA: the frequency of PA varies from 1.46 to 14.8% of alive newborns, the frequency of postasphyctic encephalopathy varies from 8.6 to 89%, and the frequency of neurologic sequelae varies from 11.2 to 30.5%. It is necessary to establish a common definition of PA (to differentiate between severe PA, the most important type

  20. Correlation between grades of intraventricular hemorrhage and severity of hypoxic ischemic encephalopathy in perinatal asphyxia.

    Science.gov (United States)

    Khan, R H; Islam, M S; Haque, S A; Hossain, M A; Islam, M N; Khaleque, M A; Chowdhury, B; Chowdhury, M A

    2014-01-01

    This study was done to find out the correlation between various grades of Intraventricular Hemorrhage (IVH) and stages of HIE in perinatal asphyxia and to determine the short-term outcome of the affected baby. This observational study was conducted in Neonatal ward of Dhaka Shishu Hospital (DHS) and Dhaka Medical College Hospital for period of 37 months from January 2004 to January 2007. Total 189 perinatally asphyxiated babies were enrolled for HIE staging and cranial Ultrasonogram (USG) to find out grades of IVH. Finally 178 newborns were fulfilling all the necessary criteria for statistical analysis of the collected data on prescribed questionnaire. Among 178 perinatally asphyxiated newborns HIE stages - I, II, III were 50(28%), 10(56%) and 28(16%) respectively. Out of this 178 neonates total 50(28%) developed various grades IVH. Grades of IVH, I, II, III, IV were 15(30%), 18(36%), 10(20%) and 7(14%) respectively. There was significant correlation between the severity of HIE staging and grades of IVH. Short term outcome was poor in HIE-III, IVH grade III and IV. There is a direct relationship between different grades of IVH and stages of HIE. That is more the severe stages of HIE there is more chances to develop severe grades of IVH, Immediate morbidity and mortality is dependent on the grades of IVH and severity of stages of HIE.

  1. Perinatal asphyxia in the guinea pig leads to morphologic but not neurologic, cognitive, or behavioral changes.

    Science.gov (United States)

    Hoeger, Harald; Bubna-Littitz, Herrmann; Engelmann, Mario; Schwerdtner, Ingrid; Schmid, Diethard; Lahoda, Robert; Seidl, Rainer; Lubec, Gert; Lubec, Barbara

    2003-07-01

    In a recent publication, we described neurodegeneration along with neurotransmitter deficits and impaired differentiation in the guinea pig 3 months following severe perinatal asphyxia (PA). We were therefore interested in the clinical features in terms of neurology, cognitive functions, and behavior. We tested the long-term effects of PA in an animal model, which in the rat are well documented and resemble the clinical situation. Examinations consisted of an observational battery for motor and reflex functions and the acoustic startle response setting. We tested cognitive functions in the multiple T-maze and evaluated behavior using the elevated plus maze and open field studies. No neurologic deficits were observed in the observational battery, including the acoustic startle response. Cognitive functions of memory and learning were not impaired in the multiple T-maze. In the open field and in the elevated plus maze, the system to test anxiety-related behavior, guinea pigs performed well. Our findings of patent neurology, cognitive functions, and behavior do not reflect the prominent morphologic findings of neurodegeneration. This is in agreement with corresponding studies on PA in the rat at the identical time point. We learned from this study that both test systems, although representing the standard in neuroscience, are either not sensitive enough or central nervous system lesions are clinically fully compensated.

  2. The effects of vetrabutin chlorhydrate and oxytocin on stillbirth rate and asphyxia in swine.

    Science.gov (United States)

    Mota-Rojas, D; Rosales, A M; Trujillo, M E; Orozco, H; Ramírez, R; Alonso-Spilsbury, M

    2005-12-01

    Oxytocin and vetrabutin chlorhydrate (VC) are used to reduce the duration of farrowing in swine. The objective of the present study was to evaluate the use of these products on intra-partum stillbirth (IPS) rate and asphyxia. At the onset of parturition, sows (n=180) were allocated to receive 2 mL of saline (control group), oxytocin (40 IU i.m.) or 100mg of VC per 60 kg of body weight, with all treatments given i.m. Oytocin-treated sows had a higher number of IPS than the VC and Control groups (means, 1.2, 0.8 and 0.6, respectively; Pheartbeat was 53.3, 16.9 and 12.5% (Prate of IPS, in association with a much higher incidence of ruptured umbilical cord and absence of a fetal heartbeat. Treatment with VC reduced farrowing duration by approximately 1.5h, with an IPS rate that was not significantly different from controls but significantly lower than that of oxytocin-treated sows.

  3. Perinatal asphyxia syndrome in the foal: review and a case report

    Science.gov (United States)

    2004-01-01

    This report presented a brief overview of the literature on the perinatal asphyxia syndrome (PAS) in foals as a prelude to a description of the investigation and treatment of acute onset seizures in a 24-hour-old Thoroughbred colt foal. PAS can cause a wide variety of clinical abnormalities, of which seizures due to encephalopathy are the most significant. The structural and biochemical components of CNS neurones are disrupted by the shift from oxidative to anaerobic metabolism, with a resultant deficit in cellular energy. The cells succumb to the combined effects of acidosis, neurotoxic activities of glutamate, nitric oxide and free radicals, lipid peroxidation, accumulation of intracellular calcium and destructive overactivity of intracellular enzymes. Concurrently, the hypoxia affects other organ systems and management of foals presenting with CNS signs requires the veterinarian to undertake a thorough clinical examination and to institute appropriate therapy for the various derangements induced by the hypoxic-ischaemic episode. Diazepam (0.1 to 0.2 mg/kg bwt) can be used for short-term control of seizures; phenobarbital (2 to 10 mg/kg bwt) may be required for more prolonged treatment of recurrent seizures. The needs of the affected foal for nutrients, fluids and electrolytes, antimicrobial therapy and ancillary therapies were discussed in the literature review and illustrated in the case report. PMID:21851654

  4. Perinatal asphyxia syndrome in the foal: review and a case report

    Directory of Open Access Journals (Sweden)

    Galvin Noreen

    2004-12-01

    Full Text Available This report presented a brief overview of the literature on the perinatal asphyxia syndrome (PAS in foals as a prelude to a description of the investigation and treatment of acute onset seizures in a 24-hour-old Thoroughbred colt foal. PAS can cause a wide variety of clinical abnormalities, of which seizures due to encephalopathy are the most significant. The structural and biochemical components of CNS neurones are disrupted by the shift from oxidative to anaerobic metabolism, with a resultant deficit in cellular energy. The cells succumb to the combined effects of acidosis, neurotoxic activities of glutamate, nitric oxide and free radicals, lipid peroxidation, accumulation of intracellular calcium and destructive overactivity of intracellular enzymes. Concurrently, the hypoxia affects other organ systems and management of foals presenting with CNS signs requires the veterinarian to undertake a thorough clinical examination and to institute appropriate therapy for the various derangements induced by the hypoxic-ischaemic episode. Diazepam (0.1 to 0.2 mg/kg bwt can be used for short-term control of seizures; phenobarbital (2 to 10 mg/kg bwt may be required for more prolonged treatment of recurrent seizures. The needs of the affected foal for nutrients, fluids and electrolytes, antimicrobial therapy and ancillary therapies were discussed in the literature review and illustrated in the case report.

  5. Plasma metabolite score correlates with Hypoxia time in a newly born piglet model for asphyxia

    Directory of Open Access Journals (Sweden)

    Julia Kuligowski

    2017-08-01

    Full Text Available Hypoxic-ischemic encephalopathy (HIE secondary to perinatal asphyxia is a leading cause of mortality and acquired long-term neurologic co-morbidities in the neonate. The most successful intervention for the treatment of moderate to severe HIE is moderate whole body hypothermia initiated within 6 h from birth. The objective and prompt identification of infants who are at risk of developing moderate to severe HIE in the critical first hours still remains a challenge. This work proposes a metabolite score calculated based on the relative intensities of three metabolites (choline, 6,8-dihydroxypurine and hypoxanthine that showed maximum correlation with hypoxia time in a consolidated piglet model for neonatal hypoxia-ischemia. The metabolite score's performance as a biomarker for perinatal hypoxia and its usefulness for clinical grading and decision making have been assessed and compared to the performance of lactate which is currently considered the gold standard. For plasma samples withdrawn before and directly after a hypoxic insult, the metabolite score performed similar to lactate. However, it provided an enhanced predictive capacity at 2 h after resuscitation. The present study evidences the usefulness of the metabolite score for improving the early assessment of the severity of the hypoxic insult based on serial determinations in a minimally invasive biofluid. The applicability of the metabolite score for clinical diagnosis and patient stratification for hypothermia treatment has to be confirmed in multicenter trials involving newborns suffering from HIE.

  6. Acute forces required for fatal compression asphyxia: A biomechanical model and historical comparisons.

    Science.gov (United States)

    Kroll, Mark W; Still, G Keith; Neuman, Tom S; Graham, Michael A; Griffin, Lanny V

    2017-04-01

    Background Fatalities from acute compression have been reported with soft-drink vending machine tipping, motor vehicle accidents, and trench cave-ins. A major mechanism of such deaths is flail chest but the amount of force required is unclear. Between the range of a safe static chest compression force of 1000 N (102 kg with earth gravity) and a lethal dynamic force of 10-20 kN (falling 450 kg vending machines), there are limited quantitative human data on the force required to cause flail chest, which is a major correlate of acute fatal compression asphyxia. Methods We modeled flail chest as bilateral fractures of six adjacent ribs. The static and dynamic forces required to cause such a ribcage failure were estimated using a biomechanical model of the thorax. The results were then compared with published historical records of judicial "pressing," vending machine fatalities, and automobile safety cadaver testing. Results and conclusion The modeling results suggest that an adult male requires 2550 ± 250 N of chest-applied distributed static force (260 ± 26 kg with earth gravity) or 4050 ± 320 N of dynamic force to cause flail chest from short-term chest compression.

  7. Hiding in Plain Sight: Clinically Unrecognized Fatal Tooth Asphyxia Revealed by the Forensic Autopsy.

    Science.gov (United States)

    Armstrong, Erica J

    2016-03-01

    Fatal asphyxia by choking whether by food or foreign material remains an uncommon occurrence affecting mainly those at the extremes of age and with variable and sometimes misleading clinical presentations. Prompt clinical recognition of impending airway obstruction afforded by complete physical examination and assessment is paramount for prevention of morbidity and mortality in these cases. In the elderly, a death initially presenting with sudden cardiorespiratory collapse may be erroneously certified as due to natural disease without performance of an autopsy. Fortunately, deaths subsequent to cardiorespiratory collapse, where results of the clinical work-up fail to identify an etiology and medical history is insufficient, are reportable, falling under the jurisdiction of the medical examiner/coroner. The performance of an autopsy in the evaluation of a sudden death arising after hospitalization in which the etiology remains unclear can provide valuable information to our clinical colleagues that they can apply to more timely diagnosis and treatment. Furthermore, the forensic autopsy offers clarification and answers to questions of medicolegal importance. This is particularly true for choking deaths. Presented is a choking death after tooth aspiration whereby the forensic autopsy provided specific anatomic correlation to the clinical clues not recognized before death and provided the true cause of death.

  8. Xenon augmented hypothermia reduces early lactate/N-acetylaspartate and cell death in perinatal asphyxia.

    Science.gov (United States)

    Faulkner, Stuart; Bainbridge, Alan; Kato, Takenori; Chandrasekaran, Manigandan; Kapetanakis, Andrew B; Hristova, Mariya; Liu, Mengyan; Evans, Samantha; De Vita, Enrico; Kelen, Dorottya; Sanders, Robert D; Edwards, A David; Maze, Mervyn; Cady, Ernest B; Raivich, Gennadij; Robertson, Nicola J

    2011-07-01

    Additional treatments for therapeutic hypothermia are required to maximize neuroprotection for perinatal asphyxial encephalopathy. We assessed neuroprotective effects of combining inhaled xenon with therapeutic hypothermia after transient cerebral hypoxia-ischemia in a piglet model of perinatal asphyxia using magnetic resonance spectroscopy (MRS) biomarkers supported by immunohistochemistry. Thirty-six newborn piglets were randomized (all groups n = 9), with intervention from 2 to 26 hours, to: (1) normothermia; (2) normothermia + 24 hours 50% inhaled xenon; (3) 24 hours hypothermia (33.5°C); or (4) 24 hours hypothermia (33.5°C) + 24 hours 50% inhaled xenon. Serial MRS was acquired before, during, and up to 48 hours after hypoxia-ischemia. Mean arterial blood pressure was lower in all treatment groups compared with normothermia (p 40mmHg); the combined therapy group required more fluid boluses (p xenon-augmented hypothermia reduced the temporal regression slope magnitudes for phosphorus-MRS inorganic phosphate/exchangeable phosphate pool (EPP) and phosphocreatine/EPP (both p xenon-augmented hypothermia reduced the slope (p Xenon-augmented hypothermia also reduced transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)(+) nuclei and caspase 3 immunoreactive cells in parasagittal cortex and putamen and increased microglial ramification in midtemporal cortex compared with the no treatment group (p xenon-augmented hypothermia reduced cerebral MRS abnormalities and cell death markers in some brain regions. Compared with hypothermia, xenon-augmented hypothermia did not reach statistical significance for any measure. The safety and possible improved efficacy support phase II trials. Copyright © 2011 American Neurological Association.

  9. Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets.

    Science.gov (United States)

    Linner, Rikard; Werner, Olof; Perez-de-Sa, Valeria; Cunha-Goncalves, Doris

    2012-10-01

    To investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension. One-day-old piglets were left in apnoea until heart rate and mean arterial pressure were less than 50 min(-1) and 25 mmHg, respectively. They randomly received adrenaline, 10 μgkg(-1) (n=16) or placebo (n=15) and were resuscitated with air ventilation and, when needed, closed-chest cardiac massage (CCCM). Eight not asphyxiated animals served as time controls. CCCM was required in 13 piglets given adrenaline and in 13 given placebo. Time to return of spontaneous circulation was: 72 (66-85)s vs. 77 (64-178)s [median (quartile range)] (p=0.35). Time until cerebral regional oxygen saturation (CrSO(2)) had increased to 30% was 86 (79-152)s vs. 126 (88-309)s (p=0.30). The two groups did not differ significantly in CrSO(2), heart rate, arterial pressure, right common carotid artery blood flow, or number of survivors: 13 vs. 11 animals. Plasma concentration of adrenaline, 2.5 min after resuming ventilation, was 498 (268-868)nmoll(-1) vs. 114 (80-306)nmoll(-1) (p=0.01). Corresponding noradrenaline concentrations were 1799 (1058-4182)nmoll(-1)vs. 1385 (696-3118)nmoll(-1) (ns). In the time controls, the concentrations were 0.4 (0.2-0.6)nmoll(-1) of adrenaline and 1.8 (1.3-2.4)nmoll(-1) of noradrenaline. The high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Modulation of Postnatal Neurogenesis by Perinatal Asphyxia: Effect of D1 and D2 Dopamine Receptor Agonists.

    Science.gov (United States)

    Tapia-Bustos, A; Perez-Lobos, R; Vío, V; Lespay-Rebolledo, C; Palacios, E; Chiti-Morales, A; Bustamante, D; Herrera-Marschitz, M; Morales, P

    2017-01-01

    Perinatal asphyxia (PA) is associated to delayed cell death, affecting neurocircuitries of basal ganglia and hippocampus, and long-term neuropsychiatric disabilities. Several compensatory mechanisms have been suggested to take place, including cell proliferation and neurogenesis. There is evidence that PA can increase postnatal neurogenesis in hippocampus and subventricular zone (SVZ), modulated by dopamine, by still unclear mechanisms. We have studied here the effect of selective dopamine receptor agonists on cell death, cell proliferation and neurogenesis in organotypic cultures from control and asphyxia-exposed rats. Hippocampus and SVZ sampled at 1-3 postnatal days were cultured for 20-21 days. At day in vitro (DIV) 19, cultures were treated either with SKF38393 (10 and 100 µM, a D1 agonist), quinpirole (10 µM, a D2 agonist) or sulpiride (10 μM, a D2 antagonist) + quinpirole (10 μM) and BrdU (10 μM, a mitosis marker) for 24 h. At DIV 20-21, cultures were processed for immunocytochemistry for microtubule-associated protein-2 (MAP-2, a neuronal marker), and BrdU, evaluated by confocal microscopy. Some cultures were analysed for cell viability at DIV 20-21 (LIVE/DEAD kit). PA increased cell death, cell proliferation and neurogenesis in hippocampus and SVZ cultures. The increase in cell death, but not in cell proliferation, was inhibited by both SKF38393 and quinpirole treatment. Neurogenesis was increased by quinpirole, but only in hippocampus, in cultures from both asphyxia-exposed and control-animals, effect that was antagonised by sulpiride, leading to the conclusion that dopamine modulates neurogenesis in hippocampus, mainly via D2 receptors.

  11. Proinflammatory Cytokines, Enolase and S-100 as Early Biochemical Indicators of Hypoxic-Ischemic Encephalopathy Following Perinatal Asphyxia in Newborns.

    Science.gov (United States)

    Chaparro-Huerta, Verónica; Flores-Soto, Mario Eduardo; Merin Sigala, Mario Ernesto; Barrera de León, Juan Carlos; Lemus-Varela, María de Lourdes; Torres-Mendoza, Blanca Miriam de Guadalupe; Beas-Zárate, Carlos

    2017-02-01

    Estimation of the neurological prognosis of infants suffering from perinatal asphyxia and signs of hypoxic-ischemic encephalopathy is of great clinical importance; however, it remains difficult to satisfactorily assess these signs with current standard medical practices. Prognoses are typically based on data obtained from clinical examinations and neurological tests, such as electroencephalography (EEG) and neuroimaging, but their sensitivities and specificities are far from optimal, and they do not always reliably predict future neurological sequelae. In an attempt to improve prognostic estimates, neurological research envisaged various biochemical markers detectable in the umbilical cord blood of newborns (NB). Few studies examining these biochemical factors in the whole blood of newborns exist. Thus, the aim of this study was to determine the expression and concentrations of proinflammatory cytokines (TNF-α, IL-1β and IL-6) and specific CNS enzymes (S-100 and enolase) in infants with perinatal asphyxia. These data were compared between the affected infants and controls and were related to the degree of HIE to determine their utilities as biochemical markers for early diagnosis and prognosis. The levels of the proinflammatory cytokines and enzymes were measured by enzyme-linked immunosorbent assay (ELISA) and Reverse Transcription polymerase chain reaction (RT-PCR). The expression and serum levels of the proinflammatory cytokines, enolase and S-100 were significantly increased in the children with asphyxia compared with the controls. The role of cytokines after hypoxic-ischemic insult has been determined in studies of transgenic mice that support the use of these molecules as candidate biomarkers. Similarly, S-100 and enolase are considered promising candidates because these markers have been correlated with tissue damage in different experimental models. Copyright © 2016. Published by Elsevier B.V.

  12. Pressure passive cerebral blood flow and breakdown of the blood-brain barrier in experimental fetal asphyxia

    DEFF Research Database (Denmark)

    Lou, H C; Lassen, N A; Tweed, W A

    1979-01-01

    reaching CBF values up to 6 times normal at normal MABP of about 60 to 70 mmHg, and severe ischemia reaching CBF values close to zero in large cortical areas at MABP of 30 mmHg. CVP remained essentially unchanged at 10--15 mmHg. The severe and prolonged asphyxia rendered the blood-brain barrier leaky...... to the albumin tracer Evans blue. In four other fetuses umbilical cord clamping was omitted. However, only in one of these cases was acidosis completely avoided, and CBF autoregulation maintained. The three other fetuses were acidotic at the end of the surgical procedure and had impaired autoregulation....

  13. [Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011].

    Science.gov (United States)

    Torres-Muñoz, Javier; Rojas, Christian; Mendoza-Urbano, Diana; Marín-Cuero, Darly; Orobio, Sandra; Echandía, Carlos

    2017-04-01

    Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

  14. Birth asphyxia measured by the pH value of the umbilical cord blood may predict an increased risk of attention deficit hyperactivity disorder

    DEFF Research Database (Denmark)

    Mikkelsen, Susanne Hvolgaard; Olsen, Jørn; Bech, Bodil Hammer

    2017-01-01

    AIM: Although birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder (ADHD). We examined whether birth asphyxia measured by the pH of the blood in the umbilical artery cord...... was associated with childhood ADHD. METHOD: A population-based cohort of 295 687 children born in Finland between 1991 and 2002 was followed until December 31, 2007. ADHD was identified by the International Classification of Diseases, 10th edition, as a diagnosis of hyperkinetic disorder. We examined the risk...

  15. Fatal mechanical asphyxia induces changes in energy utilization in the rat brain: An (18)F-FDG-PET study.

    Science.gov (United States)

    Ma, Suhua; You, Shengzhong; Hao, Li; Zhang, Dongchuan; Quan, Li

    2015-07-01

    This study was designed to evaluate changes in brain glucose metabolism in rats following ligature strangulation. Thirteen male Wistar rats were used in the present study, divided into control (n=7) and asphyxia groups (n=6, ligature strangulation). Positron emission tomography (PET) with 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) was used to evaluate brain glucose metabolism. Rats were scanned for PET-CT, and image data co-registered with a T2WI MRI template using SPM8 software. Image J was employed to draw regions of interest (ROIs) from the MRI template and acquire ROI activity information from the PET images. In the asphyxia group vs. controls, (18)F-FDG uptake (FU) was decreased in the substantia nigra (25.26%, pglucose metabolism distribution map in the asphyxiated rat brains were substantially changed versus controls. PET with (18)F-FDG can demonstrate excitement and inhibition of different brain areas even in cases of ligature strangulation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Propofol administration to the maternal-fetal unit improved fetal EEG and influenced cerebral apoptotic pathway in preterm lambs suffering from severe asphyxia

    NARCIS (Netherlands)

    Seehase, M.; Jennekens, W.; Zwanenburg, A.; Andriessen, P.; Collins, J.J.; Kuypers, E.; Zimmermann, L.J.; Vles, J.; Gavilanes, A.W.; Kramer, B.W.

    2015-01-01

    BACKGROUND: Term and near-term infants are at high risk of developing brain injury and life-long disability if they have suffered from severe perinatal asphyxia. We hypothesized that propofol administration to the maternal-fetal unit can diminish cerebral injury in term and near-term infant fetuses

  17. [Positional asphyxia as a cause of death in a traffic accident with the driver--in the "upside-down car position"].

    Science.gov (United States)

    Jankowski, Zbigniew; Wilmanowska, Anita; Pieśniak, Dorota; Kubiak, Anna

    2004-01-01

    We demonstrate a case of positional asphyxia of the car with the driver in the upside-down position following a traffic accident. The discussion shows the confirmity of this type of death mechanism with the facts estimated during the investigation of the place of the accident and autopsy.

  18. Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011

    Directory of Open Access Journals (Sweden)

    Javier Torres-Muñoz

    2017-04-01

    Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

  19. Children born at 32 to 35 weeks with birth asphyxia and later cerebral palsy are different from those born after 35 weeks.

    Science.gov (United States)

    Garfinkle, J; Wintermark, P; Shevell, M I; Oskoui, M

    2017-08-01

    The objectives of this study were to (1) establish the proportion of cerebral palsy (CP) that occurs with a history suggestive of birth asphyxia in children born at 32 to 35 weeks and (2) evaluate their characteristics in comparison with children with CP born at ⩾36 weeks with such a history. Using the Canadian CP Registry, children born at 32 to 35 weeks of gestation with CP with a history suggestive of birth asphyxia were compared with corresponding ⩾36 weeks of gestation children. Of the 163 children with CP born at 32 to 35 weeks and 738 born at ⩾36 weeks, 26 (16%) and 105 (14%) had a history suggestive of birth asphyxia, respectively. The children born at 32 to 35 weeks had more frequent abruptio placenta (35% vs 12%; odds ratio (OR) 4.1, 95% confidence interval (CI) 1.5 to 11.2), less frequent neonatal seizures (35% vs 72%; OR 0.20, 95% CI 0.08 to 0.52), more frequent white matter injury (47% vs 17%; OR 4.3, 95% CI 1.3 to 14.0), more frequent intraventricular hemorrhage (IVH) (40% vs 6%; OR 11.2, 95% CI 3.4 to 37.4) and more frequent spastic diplegia (24% vs 8%; OR 1.8, 95% CI 1.2 to 12.2) than the corresponding ⩾36 weeks of gestation children. Approximately 1 in 7 children with CP born at 32 to 35 weeks had a history suggestive of birth asphyxia. They had different magnetic resonance imaging patterns of injury from those born at ⩾36 weeks and a higher frequency of IVH. Importantly, when considering hypothermia in preterm neonates with suspected birth asphyxia, prospective surveillance for IVH will be essential.

  20. Formal training in general movement assessment is required to effectively evaluate infants with perinatal asphyxia in outpatient settings

    DEFF Research Database (Denmark)

    Brown, Annemette K; Greisen, Gorm; Haugsted, Ulla

    2016-01-01

    AIM: General movement assessment (GMA) can help to identify children with a high risk of developing neurological dysfunction, such as cerebral palsy, and certified training is provided in this specialism. The aim of this study was to investigate the feasibility and reliability of using video...... recordings to assess GMA, in a busy Danish outpatient clinic. METHODS: The study comprised 30-term infants born with perinatal asphyxia, who were video recorded at three months. They were assessed by two certified GMA observers and re-assessed two weeks later. Interobserver and intra-observer agreements were.......62-1.00; p video recordings were completed within our multidisciplinary outpatient clinic without delay. CONCLUSION: This study demonstrated...

  1. Atrial fibrillation in rats induced by rapid transesophageal atrial pacing during brief episodes of asphyxia: A new in vivo model

    DEFF Research Database (Denmark)

    Haugan, K.; Lam, Henrik Rye; Knudsen, C. B.

    2004-01-01

    in anesthetized male Sprague-Dawley rats. AF was reproducibly induced in 81% of the rats. The presence of AF was associated with an increased heart rate, and a decreased blood pressure. Treatment with amiodarone, D,L-sotalol, flecainide, and propranolol all reduced duration of AF, whereas verapamil treatment...... of verapamil. Relative to existing models of AF in larger animals, this model offers rapid, predictive, and inexpensive testing of antiarrhythmic/profibrillatory effects of new drugs.......Non-pharmacological in vivo models of atrial fibrillation (AF) have been developed in large animals only. We aimed to develop and characterize a new small animal non-pharmacological in vivo model of AF. AF was induced by transesophageal atrial burst pacing during 35 seconds periods of asphyxia...

  2. The Effect of Severe Birth Asphyxia on the Hemostasis System in Newborns During the First Hour of Life

    Directory of Open Access Journals (Sweden)

    I. E. Golub

    2017-01-01

    Full Text Available In newborns with severe intranatal asphyxia, the hemostasis system adaptation is impaired, thus increasing the risk of bleeding during the first day of life.The purpose of the work was to evaluate the effect of severe birth asphyxia and metabolic acidosis on the newborns' hemostasis system, based on the thromboelastography (TEG findings.Materials and methods. A retrospective analysis of medical records of 40 severely asphyxiated newborns (group 1 and 20 healthy newborns (group 2 was performed. The study was carried out during the first hour of life of the newborns.Results. Infants in group 1 demonstrated a reduced activity of platelets and enzymatic components of the coagulation. The enzymatic phase of the coagulation hemostasis (P<0.001 and the kinetics of clot strength growth significantly decreased in group 1 newborns, as compared to the second group (P<0.001 and P<0.01, respectively. The fibrin network growth rate and its structurization in group 1 newborns was lower than that in group 2 newborns (P<0.05. The platelet activity in group 1 infants was reduced as compared to group 2 (P< 0.05.Fibrinolysis in newborns did not differ at the 30th minute of the study. The correlation analysis demonstrated that decreased pH and Be values and hyperlactacidemia correlated; platelet and coagulation hemostasis parameters were altered with a shift to hypocoagulation. Conclusion. Thromboelastographic study of whole blood samples demonstrated a shift of the hemostatic system to hypocoagulation for both platelet and enzymatic components of hemostasis, without any changes in the clot lysis in severely asphyxiated newborns.

  3. Maternal creatine supplementation during pregnancy prevents acute and long-term deficits in skeletal muscle after birth asphyxia: a study of structure and function of hind limb muscle in the spiny mouse.

    Science.gov (United States)

    LaRosa, Domenic A; Ellery, Stacey J; Snow, Rod J; Walker, David W; Dickinson, Hayley

    2016-12-01

    Maternal antenatal creatine supplementation protects the brain, kidney, and diaphragm against the effects of birth asphyxia in the spiny mouse. In this study, we examined creatine's potential to prevent damage to axial skeletal muscles. Pregnant spiny mice were fed a control or creatine-supplemented diet from mid-pregnancy, and 1 d before term (39 d), fetuses were delivered by c-section with or without 7.5 min of birth asphyxia. At 24 h or 33 ± 2 d after birth, gastrocnemius muscles were obtained for ex-vivo study of twitch-tension, muscle fatigue, and structural and histochemical analysis. Birth asphyxia significantly reduced cross-sectional area of all muscle fiber types (P birth protects the muscle from asphyxia-induced damage at birth.

  4. Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015.

    Directory of Open Access Journals (Sweden)

    Olga Endrich

    Full Text Available The ICD-10 categories of the diagnosis "perinatal asphyxia" are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context.Routinely collected health data (encoding and financial data of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance.The study population included 622 cases (P20 "intrauterine hypoxia" 399, P21 "birth asphyxia" 233. By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616 = 55.84, p < 0.001, multiple R-squared = 0.312, p < 0.001 could be best explained. The classification of the severity of asphyxia could clearly be linked to the complexity of cases.The refined coding method provides clearly defined diagnoses groups and has the strongest effect on the distribution of costs. It improves the diagnosis accuracy of perinatal asphyxia concerning clinical practice, research and reimbursement.

  5. Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015.

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    Endrich, Olga; Rimle, Carole; Zwahlen, Marcel; Triep, Karen; Raio, Luigi; Nelle, Mathias

    2017-01-01

    The ICD-10 categories of the diagnosis "perinatal asphyxia" are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context. Routinely collected health data (encoding and financial data) of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance. The study population included 622 cases (P20 "intrauterine hypoxia" 399, P21 "birth asphyxia" 233). By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616) = 55.84, p clinical practice, research and reimbursement.

  6. Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control.

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    Hollesen, Rikke von Benzon; Johansen, Rie Laurine Rosenthal; Rørbye, Christina; Munk, Louise; Barker, Pierre; Kjaerbye-Thygesen, Anette

    2018-02-03

    A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%. The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a 'delivery bundle', an 'oxytocin bundle' and a 'vacuum extraction bundle'; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming's system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control. Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions. This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Life-long environmental enrichment counteracts spatial learning, reference and working memory deficits in middle-aged rats subjected to perinatal asphyxia

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    Pablo eGaleano

    2015-01-01

    Full Text Available Continuous environmental stimulation induced by exposure to enriched environment (EE has yielded cognitive benefits in different models of brain injury. Perinatal asphyxia results from a lack of oxygen supply to the fetus and is associated with long-lasting neurological deficits. However, the effects of EE in middle-aged rats suffering perinatal asphyxia are unknown. Therefore, the aim of the present study was to assess whether life-long exposure to EE could counteract the cognitive and behavioral alterations in middle-aged asphyctic rats. Experimental groups consisted of rats born vaginally (CTL, by cesarean section (C+, or by C+ following 19 min of asphyxia at birth (PA. At weaning, rats were assigned to standard (SE or enriched environment (EE for 18 months. During the last month of housing, animals were submitted to a behavioral test battery including Elevated Plus Maze, Open Field, Novel Object Recognition and Morris water maze (MWM. Results showed that middle-aged asphyctic rats, reared in SE, exhibited an impaired performance in the spatial reference and working memory versions of the MWM. EE was able to counteract these cognitive impairments. Moreover, EE improved the spatial learning performance of middle-aged CTL and C+ rats. On the other hand, all groups reared in SE did not differ in locomotor activity and anxiety levels, while EE reduced locomotion and anxiety, regardless of birth condition. Recognition memory was altered neither by birth condition nor by housing environment. These results support the importance of environmental stimulation across the lifespan to prevent cognitive deficits induced by perinatal asphyxia.

  8. Life-long environmental enrichment counteracts spatial learning, reference and working memory deficits in middle-aged rats subjected to perinatal asphyxia

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    Galeano, Pablo; Blanco, Eduardo; Logica Tornatore, Tamara M. A.; Romero, Juan I.; Holubiec, Mariana I.; Rodríguez de Fonseca, Fernando; Capani, Francisco

    2015-01-01

    Continuous environmental stimulation induced by exposure to enriched environment (EE) has yielded cognitive benefits in different models of brain injury. Perinatal asphyxia results from a lack of oxygen supply to the fetus and is associated with long-lasting neurological deficits. However, the effects of EE in middle-aged rats suffering perinatal asphyxia are unknown. Therefore, the aim of the present study was to assess whether life-long exposure to EE could counteract the cognitive and behavioral alterations in middle-aged asphyctic rats. Experimental groups consisted of rats born vaginally (CTL), by cesarean section (C+), or by C+ following 19 min of asphyxia at birth (PA). At weaning, rats were assigned to standard (SE) or enriched environment (EE) for 18 months. During the last month of housing, animals were submitted to a behavioral test battery including Elevated Plus Maze, Open Field, Novel Object Recognition and Morris water maze (MWM). Results showed that middle-aged asphyctic rats, reared in SE, exhibited an impaired performance in the spatial reference and working memory versions of the MWM. EE was able to counteract these cognitive impairments. Moreover, EE improved the spatial learning performance of middle-aged CTL and C+ rats. On the other hand, all groups reared in SE did not differ in locomotor activity and anxiety levels, while EE reduced locomotion and anxiety, regardless of birth condition. Recognition memory was altered neither by birth condition nor by housing environment. These results support the importance of environmental stimulation across the lifespan to prevent cognitive deficits induced by perinatal asphyxia. PMID:25601829

  9. Birth asphyxia measured by the pH value of the umbilical cord blood may predict an increased risk of attention deficit hyperactivity disorder.

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    Mikkelsen, Susanne Hvolgaard; Olsen, Jørn; Bech, Bodil Hammer; Wu, Chunsen; Liew, Zeyan; Gissler, Mika; Obel, Carsten; Arah, Onyebuchi

    2017-06-01

    Although birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder (ADHD). We examined whether birth asphyxia measured by the pH of the blood in the umbilical artery cord was associated with childhood ADHD. A population-based cohort of 295 687 children born in Finland between 1991 and 2002 was followed until December 31, 2007. ADHD was identified by the International Classification of Diseases, 10th edition, as a diagnosis of hyperkinetic disorder. We examined the risk of ADHD with varying pH values using Cox regression, taking time trends into consideration. When compared to the reference group, a pH value below 7.10 was significantly associated with an increased risk of ADHD. The strongest risks were observed among children with a pH value value did not contribute much to the risk among children with an Apgar score of 0-3. Birth asphyxia, defined by low pH value, may predict an increased risk of ADHD in childhood. The association between the pH value and ADHD was homogenous when stratified by gestational age and the Apgar score. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  10. Perinatal asphyxia as the leading cause of death and brain injury of newborns: prognosis and neuroprotection of long-term outcomes [

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    Herrera-Marschitz, Mario

    2007-11-01

    Full Text Available [english] Interruption of oxygen availability and re-oxygenation at birth implies a severe metabolic insult, affecting the development of the central nervous system (CNS, increasing its vulnerability to challenges occurring at adult stages. It has been reported that perinatal asphyxia produces regionally specific neuronal decrease and neurite atrophy in basal ganglia, and hippocampus. In hippocampus, a concomitant increase of neurogenesis and neurite hypertrophy has also been observed. The potential neuroprotection of nicotinamide, a non-selective inhibitor of poly (ADP-ribose polymerase (PARP-1, has been investigated, finding functional and morphological improvements when administered 24h after the insult (0.8 mmol/kg, i.p., 24, 48 and 72 h after birth.. The main effect of nicotinamide has been seen in neostriatum, preventing an asphyxia-induced decrease of the number of nNOS cells, and nNOS- and dopamine-like neurite atrophy. The present results support the idea that nicotinamide can prevent the effects elicited by a sustained energy-failure condition, as occurring during perinatal asphyxia, enlightening the enzyme PARP-1 as a novel target for neuronal protection. The support by FONDECYT, ICBM-Enlace, DAAD-CONICYT Programme-2007 grants is acknowledged.

  11. DHA-supplemented diet increases the survival of rats following asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation.

    Science.gov (United States)

    Kim, Junhwan; Yin, Tai; Shinozaki, Koichiro; Lampe, Joshua W; Becker, Lance B

    2016-11-04

    Accumulating evidence illustrates the beneficial effects of dietary docosahexaenoic acid (DHA) on cardiovascular diseases. However, its effects on cardiac arrest (CA) remain controversial in epidemiological studies and have not been reported in controlled animal studies. Here, we examined whether dietary DHA can improve survival, the most important endpoint in CA. Male Sprague-Dawley rats were randomized into two groups and received either a control diet or a DHA-supplemented diet for 7-8 weeks. Rats were then subjected to 20 min asphyxia-induced cardiac arrest followed by 30 min cardiopulmonary bypass resuscitation. Rat survival was monitored for additional 3.5 h following resuscitation. In the control group, 1 of 9 rats survived for 4 h, whereas 6 of 9 rats survived in the DHA-treated group. Surviving rats in the DHA-treated group displayed moderately improved hemodynamics compared to rats in the control group 1 h after the start of resuscitation. Rats in the control group showed no sign of brain function whereas rats in the DHA-treated group had recurrent seizures and spontaneous respiration, suggesting dietary DHA also protects the brain. Overall, our study shows that dietary DHA significantly improves rat survival following 20 min of severe CA.

  12. Accidental death due to complete autoerotic asphyxia associated with transvestic fetishism and anal self-stimulation - case report.

    Science.gov (United States)

    Atanasijević, Tatjana; Jovanović, Aleksandar A; Nikolić, Slobodan; Popović, Vesna; Jasović-Gasić, Miroslava

    2009-06-01

    A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum.

  13. [Care of the newborn with perinatal asphyxia candidate for therapeutic hypothermia during the first six hours of life in Spain].

    Science.gov (United States)

    Arnaez, Juan; Garcia-Alix, Alfredo; Calvo, Sara; Lubián-López, Simón

    2017-12-11

    The process of care and assistance from birth to the starting of therapeutic hypothermia (TH) is crucial in order to improve its effectiveness and prevent the worsening of hypoxic-ischaemic injury. A national cross-sectional study carried out in 2015 by use of a questionnaire sent to all level iii units on the care of the newborn≥35 weeks gestation within the first hours of life after a perinatal asphyxia event. According to clinical practice guidelines, the quality of care was compared between the hospitals that carried out or did not carry out TH, and according to the level of care. A total of 89/90 hospitals participated, of which 57/90 performed TH. They all used resuscitation protocols and turned off the radiant warmer after stabilisation. All of them performed glucose and blood gas analysis, monitored the central temperature, put the newborn on a diet, and performed at least two examinations for the diagnosis of hypoxic-ischaemic encephalopathy. Greater than one-third (35%) of hospitals did not have amplitude-integrated electroencephalogram, and 6/57 were TH-hospitals. The quality of care among hospitals with and without TH was similar, childbirth being better in those that performed TH, and those with a higher level of care. Level IIIc hospitals had higher scores than the others. The TH-hospitals mentioned not always having neonatologists with experience in neurological assessment and interpretation of amplitude-integrated electroencephalogram (25%), or in brain ultrasound (62%). In response to the recommendations of the asphyxiated newborn, there is a proper national health care standard with differences according to the level of care and whether TH is offered. More amplitude-integrated electroencephalogram devices are necessary, as well as more neonatologists trained in the evaluations that will be require by the newborn with hypoxic-ischaemic encephalopathy. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  14. Comparative routes of oxytocin administration in crated farrowing sows and its effects on fetal and postnatal asphyxia.

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    Mota-Rojas, Daniel; Trujillo, Ma Elena; Martínez, Julio; Rosales, Ana Ma; Orozco, Héctor; Ramírez, Ramiro; Sumano, Héctor; Alonso-Spilsbury, María

    2006-03-01

    Oxytocin is used to induce and control parturition; nevertheless, an increase in uterine contractions decreases blood flow and gaseous exchange through the uterus predisposing to intra-partum mortality in pigs. The objective of the present study was to evaluate the effect of different oxytocin administration routes on myometrial activity, fetal intrauterine hypoxia and postnatal asphyxia in crated farrowing sows. Yorkshire x Landrace hybrid sows (n = 300), that were approaching the time of parturition, were randomly assigned into six groups. Each group included 50 sows, 10 for each of the parities from one to five. A 40-IU oxytocin dosage was administered by intramuscular (IM), or intravulvar (IVU) routes, or 20 IU was administered via intravenous (IV) route. Groups 1 (G1), 3 (G3) and 5 (G5) were administered 0.9% saline solution (NaCl) IM, IVU and IV, respectively, whereas groups 2 (G2), 4 (G4) and 6 (G6) were treated with oxytocin IM, IVU and IV, respectively. There was a significantly (P fetal cardiac frequency deceleration which determines acute fetal suffering. Independent of the route of oxytocin administration, the treatments resulted in twice as many dips II compared with the respective control groups. The use of the cardiotocograph proved to be an excellent tool for establishing the oxytocin response dose in farrowing sows. A greater number of piglets born alive, which had undergone bradycardia, also showed severe acidosis and greater meconium staining in oxytocin-treated sows, indicating that the administration time (at birth of the first piglet) as well as the dosage used were not adequate treatment regimens in the present study. Further studies will be conducted to evaluate different dosages and oxytocin administration timing to determine the most desirable treatment regimen to increase myometrial contractibility without compromising fetal welfare and neonatal survival.

  15. Risks of asphyxia-related neonatal complications in offspring of mothers with type 1 or type 2 diabetes: the impact of maternal overweight and obesity.

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    Cnattingius, Sven; Lindam, Anna; Persson, Martina

    2017-07-01

    We aimed to compare the risks of severe asphyxia-related neonatal complications in the offspring of mothers with type 1 or type 2 diabetes, and to assess the impact of maternal overweight/obesity on these risks. This was a population-based study of 1,343,751 live-born singleton infants in Sweden between 1997 and 2011, including 5941 and 711 infants of mothers with type 1 and type 2 diabetes, respectively. ORs with 95% CIs were calculated for low Apgar score (0-6) at 5 min after birth, hypoxic ischaemic encephalopathy and neonatal seizures. The rates of a low Apgar score were 0.9%, 2.6% and 2.1% in the offspring of mothers without diabetes or with type 1 or type 2 diabetes, respectively. After controlling for maternal confounders (including BMI), the risk of a low Apgar score increased in the offspring of mothers with type 1 diabetes (OR 2.67, 95% CI 2.23, 3.20) but not in the offspring of mothers with type 2 diabetes (OR 1.25, 95% CI 0.66, 2.35). The ORs of hypoxic ischaemic encephalopathy or neonatal seizures were increased in the offspring of mothers with type 1 diabetes (OR 3.41, 95% CI 2.58, 4.49) and type 2 diabetes (OR 2.54, 95% CI 1.13, 5.69). Maternal overweight/obesity was a risk factor for asphyxia-related neonatal complications and low Apgar scores in the offspring of mothers with type 1 diabetes and mothers without diabetes. The risks of a low Apgar score and severe asphyxia-related neonatal complications are increased in the offspring of mothers with type 1 or type 2 diabetes. Maternal overweight/obesity is an important contributing factor.

  16. The prognostic value of multivoxel magnetic resonance spectroscopy determined metabolite levels in white and grey matter brain tissue for adverse outcome in term newborns following perinatal asphyxia

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    Doormaal, Pieter Jan van [University Medical Center Groningen and University of Groningen, Department of Pediatrics, Division of Neonatology, Groningen (Netherlands); Meander Medical Center Amersfoort, Department of Radiology, PO Box 1502, Amersfoort (Netherlands); Meiners, Linda C.; Sijens, Paul E. [University Medical Center Groningen and University of Groningen, Department of Radiology, Groningen (Netherlands); Horst, Hendrik J. ter; Veere, Christa N. van der [University Medical Center Groningen and University of Groningen, Department of Pediatrics, Division of Neonatology, Groningen (Netherlands)

    2012-04-15

    Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome. A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days. Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P = 0.003 and P = 0.017, respectively). In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy. (orig.)

  17. Effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia

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    Chun-Hua Liang1

    2017-04-01

    Full Text Available Objective: To study the effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia. Methods: 40 patients with neonatal asphyxia who were treated in our hospital between June 2013 and April 2016 were collected and divided into the control group (n=20 who received large-dose vitamin C therapy and the observation group (n=20 who received fructose diphosphate combined with large-dose vitamin C therapy according to the double-blind randomized control method, and the treatment lasted for 10 d. Immediately after admission and after 10 d of treatment, RIA method was used to detect the serum levels of oxidative stress indexes, color Doppler diasonograph was used to determine left cardiac function parameters, and the myocardial enzyme spectrum detector was used to determine myocardial enzyme spectrum index levels. Results: Immediately after admission, the differences in the systemic oxidative stress degree, the left cardiac function damage degree and the myocardial enzyme spectrum index levels were not statistically significant between two groups of patients (P>0.05. After 10 d of treatment, serum malondialdehyde (MDA, advanced oxidation protein products (AOPP, creatine kinase isoenzyme (CK-MB, N-terminal pro-brain natriuretic peptide (Nt-proBNP, heart-type fatty acid-binding protein (H-FABP and troponin I (cTnI contents of observation group were lower than those of control group (P<0.05 while superoxide dismutase (SOD content was higher than that of control group (P<0.05, and the left cardiac function parameter ejection time (ET level was higher than that of control group (P<0.05 while left ventricular isovolumetric contraction time (ICT and left ventricular isovolumetric relaxation time (IRT levels were lower than those of control group (P<0.05. Conclusion: Fructose diphosphate combined with large-dose vitamin C can reduce the systemic oxidative stress of neonatal asphyxia

  18. Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study.

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    Martina Persson

    2016-06-01

    Full Text Available Maternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI] over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term.This study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012. We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0-6 at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (<25 versus ≥25 kg/m2 in the first pregnancy. Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of -1 to <1 kg/m2, the adjusted OR for a low Apgar score in the offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12-1.58. The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00-2.02 and 1.78 (95% CI 1.19-2.68, respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI < 25 kg/m2 in the first pregnancy. A study limitation was the lack of data on the effects of obstetric interventions and neonatal resuscitation

  19. Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study.

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    Persson, Martina; Johansson, Stefan; Cnattingius, Sven

    2016-06-01

    Maternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI]) over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term. This study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk) infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012. We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0-6) at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs) were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (pregnancy. Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of -1 to offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12-1.58). The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00-2.02) and 1.78 (95% CI 1.19-2.68), respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI pregnancy. A study limitation was the lack of data on the effects of obstetric interventions and neonatal resuscitation efforts. Risks of birth-asphyxia-related outcomes increased with maternal weight gain between pregnancies. Preventing weight gain

  20. Efeitos da asfixia perinatal sobre os hormônios tireoidianos Effect of perinatal asphyxia on thyroid hormones

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    Denise N. Pereira

    2001-06-01

    Full Text Available OBJETIVO: verificar o efeito da asfixia perinatal sobre os hormônios tireóideos. MÉTODOS: Foi realizado um estudo de caso-controle, no hospital de Clínicas de Porto Alegre, envolvendo 17 recém-nascidos a termo asfixiados (A e 17 não-asfixiados (N, pareados conforme a cor, sexo, tipo de parto, idade gestacional e peso de nascimento. Foram coletados T4, T3, T4 livre, T3 reverso e TSH do sangue do cordão e do recém-nascido com 18 a 24 horas de vida, entre os que sofreram ou não asfixia perinatal. RESULTADOS: No sangue de cordão, não houve diferença na dosagem dos hormônios tireóideos, com exceção do T3 reverso, que foi mais elevado no grupo que sofreu asfixia [mediana (percentis 25-75 :A= 2(1,4-2; N= 1,41(1,13-1,92; p=0,037]. Com 18 a 24 horas de vida, foram significativamente menores no grupo de asfixiados, com exceção do T3 reverso, que foi semelhante entre os dois grupos [média ± DP: T4 A= 9,79 ± 2,59; N=14,68 ± 3,05; p OBJECTIVE: to verify the effect of perinatal asphyxia on thyroid hormone levels in term newborn infants. METHODS: We carried out a case-control study with 17 term and asphyxiated (A and 17 term and control (N newborn infants at the Hospital de Clínicas de Porto Alegre. Patients were paired according to color of skin, sex, type of delivery, gestational age, and weight at birth. We collected umbilical cord plasma T4, T3, free T4, reverse T3, and TSH after 18 to 24 hours of life and from asphyxiated and control newborn infants. RESULTS: There were no differences in thyroid hormones of cord blood, with the exception of reverse T3, which was higher in A than in controls [median (25th-75th percentile: A= 2(1.4-2; N= 1.41 (1.13-1.92; P=0.037]. Thyroid hormone levels were lower in A than in controls on samples collected within 18-24 hours after birth, except for reverse T3, which was similar in both groups [average ± SD: T4 A= 9.79 ± 2.59; N=14.68 ± 3.05; P<0.001; median T3 A= 40.83 (37.4-80.4; N= 164 (56

  1. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.

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    Martina Persson

    2014-05-01

    Full Text Available BACKGROUND: Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks. METHODS AND FINDINGS: A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk  = 0.8 per 1,000 and 894 had Apgar score 0-3 at 10 minutes (absolute risk  = 0.5 per 1,000. Compared with infants of mothers with normal BMI (18.5-24.9, the adjusted ORs (95% CI for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58; BMI 30-34.9: 1.57 (1.20-2.07; BMI 35-39.9: 1.80 (1.15-2.82; and BMI ≥40: 3.41 (1.91-6.09. The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. CONCLUSION: Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important

  2. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.

    Science.gov (United States)

    Persson, Martina; Johansson, Stefan; Villamor, Eduardo; Cnattingius, Sven

    2014-05-01

    Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks). A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk  = 0.8 per 1,000) and 894 had Apgar score 0-3 at 10 minutes (absolute risk  = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5-24.9), the adjusted ORs (95% CI) for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58); BMI 30-34.9: 1.57 (1.20-2.07); BMI 35-39.9: 1.80 (1.15-2.82); and BMI ≥40: 3.41 (1.91-6.09). The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health.

  3. Perinatal asphyxia results in altered expression of the hippocampal acylethanolamide/endocannabinoid signaling system associated to memory impairments in postweaned rats

    Directory of Open Access Journals (Sweden)

    Eduardo eBlanco Calvo

    2015-11-01

    Full Text Available Perinatal asphyxia (PA is an obstetric complication that strongly affects the CNS. The endocannabinoid system (ECS is a lipid transmitter system involved in several physiological processes including synaptic plasticity, neurogenesis, memory and mood. Endocannabinoids, and other acylethanolamides (AEs without endocannabinoid activity, have recently received growing attention as they have potential neuroprotective functions in neurological disorders, including cerebral ischemia. In the present study, we aimed to analyze the changes produced by PA in the major metabolic enzymes and receptors of the ECS/AEs in the hippocampus using a rodent model of PA. To induce PA, we removed uterine horns from ready-to-deliver rats and immersed them into a water bath during 19 min. Animals that were delivered spontaneously or by caesarean section were employed as controls. At one month of age, cognitive functions were assessed and immunohistochemical procedures were carried out to determine the expression of NeuN and GFAP, enzymes responsible for synthesis (DAGLα and NAPE-PLD and degradation (FAAH of ECS/AEs and their receptors (CB1 and PPARα in the hippocampus. Postweaned asphyctic rats showed impaired recognition and spatial reference memory that were accompanied by hippocampal astrogliosis and changes in the expression of enzymes and receptors. The most remarkable findings in asphyctic rats were a decrease in the expression of NAPE-PLD and PPARα in both hippocampal areas CA1 and CA3. In addition, postweaned cesarean delivery rats showed an increase in the immunolabeling for FAAH in the hippocampal CA3 area. Since NAPE-PLD and PPARα are proteins that participate in the biochemical process of AEs, specially the neuroprotective oleoylethanolamide, these results suggest that PA dysregulates this system. These data encourage conducting future studies using AEs as potential neuroprotective compounds in animal models of PA.

  4. Examination of physiological function and biochemical disorders in a rat model of prolonged asphyxia-induced cardiac arrest followed by cardio pulmonary bypass resuscitation.

    Science.gov (United States)

    Kim, Junhwan; Yin, Tai; Yin, Ming; Zhang, Wei; Shinozaki, Koichiro; Selak, Mary A; Pappan, Kirk L; Lampe, Joshua W; Becker, Lance B

    2014-01-01

    Cardiac arrest induces whole body ischemia, which causes damage to multiple organs particularly the heart and the brain. There is clinical and preclinical evidence that neurological injury is responsible for high mortality and morbidity of patients even after successful cardiopulmonary resuscitation. A better understanding of the metabolic alterations in the brain during ischemia will enable the development of better targeted resuscitation protocols that repair the ischemic damage and minimize the additional damage caused by reperfusion. A validated whole body model of rodent arrest followed by resuscitation was utilized; animals were randomized into three groups: control, 30 minute asphyxial arrest, or 30 minutes asphyxial arrest followed by 60 min cardiopulmonary bypass (CPB) resuscitation. Blood gases and hemodynamics were monitored during the procedures. An untargeted metabolic survey of heart and brain tissues following cardiac arrest and after CPB resuscitation was conducted to better define the alterations associated with each condition. After 30 min cardiac arrest and 60 min CPB, the rats exhibited no observable brain function and weakened heart function in a physiological assessment. Heart and brain tissues harvested following 30 min ischemia had significant changes in the concentration of metabolites in lipid and carbohydrate metabolism. In addition, the brain had increased lysophospholipid content. CPB resuscitation significantly normalized metabolite concentrations in the heart tissue, but not in the brain tissue. The observation that metabolic alterations are seen primarily during cardiac arrest suggests that the events of ischemia are the major cause of neurological damage in our rat model of asphyxia-CPB resuscitation. Impaired glycolysis and increased lysophospholipids observed only in the brain suggest that altered energy metabolism and phospholipid degradation may be a central mechanism in unresuscitatable brain damage.

  5. Phospholipid alterations in the brain and heart in a rat model of asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation.

    Science.gov (United States)

    Kim, Junhwan; Lampe, Joshua W; Yin, Tai; Shinozaki, Koichiro; Becker, Lance B

    2015-10-01

    Cardiac arrest (CA) induces whole-body ischemia, causing damage to multiple organs. Ischemic damage to the brain is mainly responsible for patient mortality. However, the molecular mechanism responsible for brain damage is not understood. Prior studies have provided evidence that degradation of membrane phospholipids plays key roles in ischemia/reperfusion injury. The aim of this study is to correlate organ damage to phospholipid alterations following 30 min asphyxia-induced CA or CA followed by cardiopulmonary bypass (CPB) resuscitation using a rat model. Following 30 min CA and CPB resuscitation, rats showed no brain function, moderately compromised heart function, and died within a few hours; typical outcomes of severe CA. However, we did not find any significant change in the content or composition of phospholipids in either tissue following 30 min CA or CA followed by CPB resuscitation. We found a substantial increase in lysophosphatidylinositol in both tissues, and a small increase in lysophosphatidylethanolamine and lysophosphatidylcholine only in brain tissue following CA. CPB resuscitation significantly decreased lysophosphatidylinositol but did not alter the other lyso species. These results indicate that a decrease in phospholipids is not a cause of brain damage in CA or a characteristic of brain ischemia. However, a significant increase in lysophosphatidylcholine and lysophosphatidylethanolamine found only in the brain with more damage suggests that impaired phospholipid metabolism may be correlated with the severity of ischemia in CA. In addition, the unique response of lysophosphatidylinositol suggests that phosphatidylinositol metabolism is highly sensitive to cellular conditions altered by ischemia and resuscitation.

  6. Perinatal asphyxia results in altered expression of the hippocampal acylethanolamide/endocannabinoid signaling system associated to memory impairments in postweaned rats

    Science.gov (United States)

    Blanco, Eduardo; Galeano, Pablo; Holubiec, Mariana I.; Romero, Juan I.; Logica, Tamara; Rivera, Patricia; Pavón, Francisco J.; Suarez, Juan; Capani, Francisco; Rodríguez de Fonseca, Fernando

    2015-01-01

    Perinatal asphyxia (PA) is an obstetric complication that strongly affects the CNS. The endocannabinoid system (ECS) is a lipid transmitter system involved in several physiological processes including synaptic plasticity, neurogenesis, memory, and mood. Endocannabinoids, and other acylethanolamides (AEs) without endocannabinoid activity, have recently received growing attention due to their potential neuroprotective functions in neurological disorders, including cerebral ischemia. In the present study, we aimed to analyze the changes produced by PA in the major metabolic enzymes and receptors of the ECS/AEs in the hippocampus using a rodent model of PA. To induce PA, we removed uterine horns from ready-to-deliver rats and immersed them into a water bath during 19 min. Animals delivered spontaneously or by cesarean section were employed as controls. At 1 month of age, cognitive functions were assessed and immunohistochemical procedures were carried out to determine the expression of NeuN and glial fibrillary acidic protein, enzymes responsible for synthesis (DAGLα and NAPE-PLD) and degradation (FAAH) of ECS/AEs and their receptors (CB1 and PPARα) in the hippocampus. Postweaned asphyctic rats showed impaired recognition and spatial reference memory that were accompanied by hippocampal astrogliosis and changes in the expression of enzymes and receptors. The most remarkable findings in asphyctic rats were a decrease in the expression of NAPE-PLD and PPARα in both hippocampal areas CA1 and CA3. In addition, postweaned cesarean delivery rats showed an increase in the immunolabeling for FAAH in the hippocampal CA3 area. Since, NAPE-PLD and PPARα are proteins that participate in the biochemical process of AEs, specially the neuroprotective oleoylethanolamide, these results suggest that PA dysregulates this system. These data encourage conducting future studies using AEs as potential neuroprotective compounds in animal models of PA. PMID:26578900

  7. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study.

    Science.gov (United States)

    Ersdal, Hege Langli; Mduma, Estomih; Svensen, Erling; Perlman, Jeffrey M

    2012-07-01

    Early initiation of basic resuscitation interventions within 60 s in apneic newborn infants is thought to be essential in preventing progression to circulatory collapse based on experimental cardio-respiratory responses to asphyxia. The objectives were to describe normal transitional respiratory adaption at birth and to assess the importance of initiating basic resuscitation within the first minutes after birth as it relates to neonatal outcome. This is an observational study of neonatal respiratory adaptation at birth in a rural hospital in Tanzania. Research assistants (n=14) monitored every newborn infant delivery and the response of birth attendants to a depressed baby. Time to initiation of spontaneous respirations or time to onset of breathing following stimulation/suctioning, or face mask ventilation (FMV) in apneic infants, and duration of FMV were recorded. 5845 infants were born; 5689 were liveborn, among these 4769(84%) initiated spontaneous respirations; 93% in ≤30 s and 99% in ≤60 s. Basic resuscitation (stimulation, suction, and/or FMV) was attempted in 920/5689(16.0%); of these 459(49.9%) received FMV. Outcomes included normal n=5613(96.0%), neonatal deaths n=56(1.0%), admitted neonatal area n=20(0.3%), and stillbirths n=156(2.7%). The risk for death or prolonged admission increases 16% for every 30 s delay in initiating FMV up to six minutes (p=0.045) and 6% for every minute of applied FMV (p=0.001). The majority of lifeless babies were in primary apnea and responded to stimulation/suctioning and/or FMV. Infants who required FMV were more likely to die particularly when ventilation was delayed or prolonged. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster.

    Science.gov (United States)

    Colville-Ebeling, Bonnie; Freeman, Michael; Banner, Jytte; Lynnerup, Niels

    2014-02-01

    Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  9. Effect of neonatal asphyxia on the impairment of the auditory pathway by recording auditory brainstem responses in newborn piglets: a new experimentation model to study the perinatal hypoxic-ischemic damage on the auditory system.

    Directory of Open Access Journals (Sweden)

    Francisco Jose Alvarez

    Full Text Available Hypoxia-ischemia (HI is a major perinatal problem that results in severe damage to the brain impairing the normal development of the auditory system. The purpose of the present study is to study the effect of perinatal asphyxia on the auditory pathway by recording auditory brain responses in a novel animal experimentation model in newborn piglets.Hypoxia-ischemia was induced to 1.3 day-old piglets by clamping 30 minutes both carotid arteries by vascular occluders and lowering the fraction of inspired oxygen. We compared the Auditory Brain Responses (ABRs of newborn piglets exposed to acute hypoxia/ischemia (n = 6 and a control group with no such exposure (n = 10. ABRs were recorded for both ears before the start of the experiment (baseline, after 30 minutes of HI injury, and every 30 minutes during 6 h after the HI injury.Auditory brain responses were altered during the hypoxic-ischemic insult but recovered 30-60 minutes later. Hypoxia/ischemia seemed to induce auditory functional damage by increasing I-V latencies and decreasing wave I, III and V amplitudes, although differences were not significant.The described experimental model of hypoxia-ischemia in newborn piglets may be useful for studying the effect of perinatal asphyxia on the impairment of the auditory pathway.

  10. Effect of neonatal asphyxia on the impairment of the auditory pathway by recording auditory brainstem responses in newborn piglets: a new experimentation model to study the perinatal hypoxic-ischemic damage on the auditory system.

    Science.gov (United States)

    Alvarez, Francisco Jose; Revuelta, Miren; Santaolalla, Francisco; Alvarez, Antonia; Lafuente, Hector; Arteaga, Olatz; Alonso-Alconada, Daniel; Sanchez-del-Rey, Ana; Hilario, Enrique; Martinez-Ibargüen, Agustin

    2015-01-01

    Hypoxia-ischemia (HI) is a major perinatal problem that results in severe damage to the brain impairing the normal development of the auditory system. The purpose of the present study is to study the effect of perinatal asphyxia on the auditory pathway by recording auditory brain responses in a novel animal experimentation model in newborn piglets. Hypoxia-ischemia was induced to 1.3 day-old piglets by clamping 30 minutes both carotid arteries by vascular occluders and lowering the fraction of inspired oxygen. We compared the Auditory Brain Responses (ABRs) of newborn piglets exposed to acute hypoxia/ischemia (n = 6) and a control group with no such exposure (n = 10). ABRs were recorded for both ears before the start of the experiment (baseline), after 30 minutes of HI injury, and every 30 minutes during 6 h after the HI injury. Auditory brain responses were altered during the hypoxic-ischemic insult but recovered 30-60 minutes later. Hypoxia/ischemia seemed to induce auditory functional damage by increasing I-V latencies and decreasing wave I, III and V amplitudes, although differences were not significant. The described experimental model of hypoxia-ischemia in newborn piglets may be useful for studying the effect of perinatal asphyxia on the impairment of the auditory pathway.

  11. neonatal asphyxia and its manager

    African Journals Online (AJOL)

    others, so as to increase blood flow to 'priority' organs such as the brain, and the heart. ... disseminated intravascular, necrotizing enterocolitis and brain damage. When the brain is deprived of oxygen a series of biochemical and mechanical events occur. .... breath sounds are audible on auscultation and the skin is pink.

  12. Therapeutic hypothermia in neonatal asphyxia

    OpenAIRE

    Cornette, L.

    2012-01-01

    Hypoxic ischemic encephalopathy is a serious condition affecting newborn infants which can result in death and disability. There is now strong clinical evidence that moderate post-asphyxial total body cooling or hypothermia in full term neonates results in long-term neuroprotection, allowing us to proclaim this innovative therapy as “standard of care.” The treatment is a time-critical emergency and should be started within 6 hours after the insult. Such requires optimal collaboration among lo...

  13. Compensatory rebound of body movements during sleep, after asphyxia in neonatal rats Resposta compensatória dos movimentos corporais do sono após a asfixia em ratos recém-nascidos

    Directory of Open Access Journals (Sweden)

    Olivia Adayr Xavier Suarez

    2008-06-01

    Full Text Available PURPOSE: The usefulness of body movements that occur during sleep when assessing perinatal asphyxia and predicting its long-term consequences is contradictory. This study investigated whether neonatal rats manifest these movements in compensatory rebound after asphyxia, and if these alterations play an important role in its pathogenesis. METHODS: Eight neonatal rats (aged 6-48h were implanted with small EMG and EKG electrodes and sleep movements were recorded over a 30-minute control period. Recordings were continued during asphyxia caused by the enclosure of the animal in a polyvinyl sheet for 60 minutes, followed by a 30-minute recovery period. RESULTS: Heart rate was lowered to bradycardic level during asphyxia causing behavioral agitation and increased waking time during the initial phase (30 minutes. Sleep-related movements were also significantly reduced from 12.5 ± 0.5 (median ± SE/2min to 9.0 ± 0.44 in the final half of the period (Anova, pOBJETIVO: A utilidade dos movimentos corporais (MC que ocorrem durante o sono para diagnosticar e predizer as conseqüências, em longo prazo, da asfixia perinatal é contraditório. Este estudo investigou se ratos recém-nascidos (RN manifestam MC em resposta compensatória à asfixia, e se estas alterações podem ter alguma importância na sua patogênese. MÉTODOS: Oito ratos RN (6-48h de vida foram submetidos à implantação de pequenos eletrodos para registros da eletromiografia e eletrocardiografia. Os MC e a freqüência cardíaca (FC foram registrados durante períodos de 30 min: fase controle (F1, fases de asfixia (F2; F3 e fase de recuperação pós-asfixia (F4. A asfixia foi promovida pelo envolvimento completo do animal com uma lâmina de polivinil. RESULTADOS: A FC diminuiu progressivamente durante F2 e F3 até a bradicardia. Em F2 houve grande agitação dos animais e aumento dos períodos de vigília. Em F3 houve redução significante dos MC de 12,5 ± 0,5 (Md ± SE/2min para 9,0

  14. Moderate hypothermia within 6 h of birth plus inhaled xenon versus moderate hypothermia alone after birth asphyxia (TOBY-Xe): a proof-of-concept, open-label, randomised controlled trial.

    Science.gov (United States)

    Azzopardi, Denis; Robertson, Nicola J; Bainbridge, Alan; Cady, Ernest; Charles-Edwards, Geoffrey; Deierl, Aniko; Fagiolo, Gianlorenzo; Franks, Nicholas P; Griffiths, James; Hajnal, Joseph; Juszczak, Edmund; Kapetanakis, Basil; Linsell, Louise; Maze, Mervyn; Omar, Omar; Strohm, Brenda; Tusor, Nora; Edwards, A David

    2016-02-01

    Moderate cooling after birth asphyxia is associated with substantial reductions in death and disability, but additional therapies might provide further benefit. We assessed whether the addition of xenon gas, a promising novel therapy, after the initiation of hypothermia for birth asphyxia would result in further improvement. Total Body hypothermia plus Xenon (TOBY-Xe) was a proof-of-concept, randomised, open-label, parallel-group trial done at four intensive-care neonatal units in the UK. Eligible infants were 36-43 weeks of gestational age, had signs of moderate to severe encephalopathy and moderately or severely abnormal background activity for at least 30 min or seizures as shown by amplitude-integrated EEG (aEEG), and had one of the following: Apgar score of 5 or less 10 min after birth, continued need for resuscitation 10 min after birth, or acidosis within 1 h of birth. Participants were allocated in a 1:1 ratio by use of a secure web-based computer-generated randomisation sequence within 12 h of birth to cooling to a rectal temperature of 33·5°C for 72 h (standard treatment) or to cooling in combination with 30% inhaled xenon for 24 h started immediately after randomisation. The primary outcomes were reduction in lactate to N-acetyl aspartate ratio in the thalamus and in preserved fractional anisotropy in the posterior limb of the internal capsule, measured with magnetic resonance spectroscopy and MRI, respectively, within 15 days of birth. The investigator assessing these outcomes was masked to allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00934700, and with ISRCTN, as ISRCTN08886155. The study was done from Jan 31, 2012, to Sept 30, 2014. We enrolled 92 infants, 46 of whom were randomly assigned to cooling only and 46 to xenon plus cooling. 37 infants in the cooling only group and 41 in the cooling plus xenon group underwent magnetic resonance assessments and were included in the analysis of

  15. Prophylactic theophylline for the prevention of severe renal dysfunction in term and post-term neonates with perinatal asphyxia: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Al-Wassia, H; Alshaikh, B; Sauve, R

    2013-04-01

    To examine the effect of prophylactic theophylline for the prevention of severe renal dysfunction in post-asphyxiated term and post-term infants. Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing prophylactic theophylline vs placebo in term infants following perinatal asphyxia. Four RCTs involving 197 infants were included in the meta-analysis. Compared with placebo, prophylactic theophylline was associated with a significant reduction in the incidence of severe renal dysfunction (pooled relative risk) using fixed-effects model was 0.38 (95% confidence interval, 0.25 to 0.57; Ptheophylline significantly reduce the incidence of severe renal dysfunction. However, because of the lack of information on the long-term renal and neurodevelopmental outcome and measured theophylline levels with relation to adverse effects observed, prudence with the clinical use of prophylactic theophylline is required. Additionally, the included trials were prior to the era of therapeutic hypothermia and thus inference of renal benefit in an infant undergoing hypothermia therapy cannot be made.

  16. Perinatal asphyxia leads to PARP-1 overactivity, p65 translocation, IL-1β and TNF-α overexpression, and apoptotic-like cell death in mesencephalon of neonatal rats: prevention by systemic neonatal nicotinamide administration.

    Science.gov (United States)

    Neira-Peña, T; Rojas-Mancilla, E; Munoz-Vio, V; Perez, R; Gutierrez-Hernandez, M; Bustamante, D; Morales, P; Hermoso, M A; Gebicke-Haerter, P; Herrera-Marschitz, M

    2015-05-01

    Perinatal asphyxia (PA) is a leading cause of neuronal damage in newborns, resulting in long-term neurological and cognitive deficits, in part due to impairment of mesostriatal and mesolimbic neurocircuitries. The insult can be as severe as to menace the integrity of the genome, triggering the overactivation of sentinel proteins, including poly (ADP-ribose) polymerase-1 (PARP-1). PARP-1 overactivation implies increased energy demands, worsening the metabolic failure and depleting further NAD(+) availability. Using a global PA rat model, we report here evidence that hypoxia increases PARP-1 activity, triggering a signalling cascade leading to nuclear translocation of the NF-κB subunit p65, modulating the expression of IL-1β and TNF-α, pro-inflammatory molecules, increasing apoptotic-like cell death in mesencephalon of neonate rats, monitored with Western blots, qPCR, TUNEL and ELISA. PARP-1 activity increased immediately after PA, reaching a maximum 1-8 h after the insult, while activation of the NF-κB signalling pathway was observed 8 h after the insult, with a >twofold increase of p65 nuclear translocation. IL-1β and TNF-α mRNA levels were increased 24 h after the insult, together with a >twofold increase in apoptotic-like cell death. A single dose of the PARP-1 inhibitor nicotinamide (0.8 mmol/kg, i.p.), 1 h post delivery, prevented the effect of PA on PARP-1 activity, p65 translocation, pro-inflammatory cytokine expression and apoptotic-like cell death. The present study demonstrates that PA leads to PARP-1 overactivation, increasing the expression of pro-inflammatory cytokines and cell death in mesencephalon, effects prevented by systemic neonatal nicotinamide administration, supporting the idea that PARP-1 inhibition represents a therapeutic target against the effects of PA.

  17. Inflammatory mediators in perinatal asphyxia and infection.

    Science.gov (United States)

    Xanthou, M; Fotopoulos, S; Mouchtouri, A; Lipsou, N; Zika, I; Sarafidou, J

    2002-01-01

    To determine serum levels of interleukin-6 (IL-6), IL-1beta, tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1) and C-reactive protein (CRP) in asphyxiated neonates and compare these inflammatory factors with those found in neonates with perinatal infection. 88 neonates were studied, of whom 36 were asphyxiated, 18 were infected and the remaining 34 were controls. Peripheral blood samples were obtained on the 1st, 3rd and 5th postnatal days. Cytokines IL-6 and IL-1beta as well as sICAM-1 serum levels did not differ between asphyxiated and infected neonates; however, at most time periods, their values were significantly higher than controls. TNF-alpha was similar in the three groups of neonates. CRP serum values were significantly higher in the infected neonates than in the asphyxiated or control subjects. Among the 54 asphyxiated and infected neonates, 15 were considered as severe cases and 39 as mild. The severe cases, at most time periods, had significantly higher IL-6, IL-1beta and sICAM-1 levels compared with the mild ones. Through receiver operating characteristic curves the cut-off points, sensitivities, and specificities for distinguishing neonates at risk or at high risk for brain damage were established. Similar increases in serum levels of IL-6, IL-1beta and sICAM-1 were found in perinatally asphyxiated and infected neonates. As these increases correlated with the severity of the perinatal insults, neonates at high risk for brain damage might be detected.

  18. Perinatal asphyxia and oxidative stress: studies in preterm IUGR pregnancies and term acute asphyxia

    NARCIS (Netherlands)

    Torrance, H.L.

    2008-01-01

    Pregnancies complicated by intrauterine growth restriction (IUGR), preeclampsia (PE) or HELLP syndrome often have to be terminated prematurely. As a consequence of the early gestational age (GA) at delivery, infants born from these pregnancies are at increased risk of developing respiratory

  19. Asfixia perinatal associada à mortalidade neonatal precoce: estudo populacional dos óbitos evitáveis Asfixia perinatal asociada a la mortalidad neonatal temprana: estudio de población de los óbitos evitables Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths

    Directory of Open Access Journals (Sweden)

    Mandira Daripa

    2013-03-01

    TODOS: Cohorte de población constituida por 2.873 óbitos evitables hasta seis días de vida asociados a la asfixia perinatal ocurridos entre enero de 2001 y diciembre de 2003. Se consideró como asfixia perinatal la presencia de hipoxia intraútero, asfixia al nacer o síndrome de aspiración de meconio en cualquier línea de la Declaración de Óbito original. Variables epidemiológicas también fueron extraídas de las Declaraciones de Nacido Vivo. RESULTADOS: En el trienio, 1,71 muertes por 1.000 nacidos vivos estaban asociadas a la asfixia perinatal, correspondiendo al 22% de los óbitos neonatales tempranos. De los 2.873 óbitos evitables, 761 (27% tuvieron lugar en São Paulo, capital; 640 (22%, en la región metropolitana de la capital; y 1.472 (51% en el interior de la provincia. En las dos primeras regiones predominaron las muertes en hospitales públicos, recién nacidos con edad gestacional inferior a 37 semanas y peso inferior a 2.500g. En el interior, los óbitos fueron más frecuentes en entidades benéficas, recién nacidos a término y con peso superior a 2.500g. La mayoría de los bebés nació durante el día en el municipio de residencia materna y evolucionó a óbito en el hospital de nacimiento hasta 24 horas después del parto. El síndrome de aspiración de meconio estuvo presente en el 18% de los óbitos. CONCLUSIONES: La asfixia perinatal es un contribuyente frecuente a la muerte neonatal temprana evitable en la provincia con el más grande producto interno bruto per capita de Brasil, lo que evidencia la necesidad de intervenciones específicas con enfoque regionalizado en la asistencia al parto y al nacimiento.OBJECTIVE: To compare the epidemiological profile of avoidable early neonatal deaths associated with perinatal asphyxia according to region of death in the State of São Paulo, Brazil. METHODS: Population-based cohort study including 2,873 avoidable deaths up to six days of life associated with perinatal asphyxia from January 2001 to December

  20. Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria

    African Journals Online (AJOL)

    owner

    2012-12-07

    Dec 7, 2012 ... 25. Aziken M, Omo-Aghoja L, Ok- onofua F. Perceptions and attitudes of pregnant women towards cae- sarean section in urban Nigeria. Acta Obstet Gynecol Scand 200;. 86:42-47. 26. Onah HE, Ikeako LC, Iloabachie. GC: Factors associated with the use of maternity services in Enugu, southeastern Nigeria.

  1. Obstetric interventions and perinatal asphyxia in growth retarded term infants

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Lindmark, G

    1997-01-01

    -fold (6-8%) for growth retarded infants both in SGA infants in general and infants with asymmetric body proportions. The immediate perinatal outcome, however, was favorable with Apgar below 8 at 5 min in only 2% irrespective of the type of growth retardation, in spite of the fact that less than 25......% of the SGA pregnancies and 10% of those with asymmetric fetal growth had been eligible for close antenatal fetal monitoring. CONCLUSION: With a moderate increase in interventions at delivery, perinatal outcome was highly favorable for term infants with a weight for gestational age, weight for length...

  2. ["Self-asphyxia"--a forensic medicine-criminal challenge].

    Science.gov (United States)

    Rabl, W; Markwalder, C; Sigrist, T

    1992-01-01

    In judicial and police circles - sometimes even in circles of medical professionals - it is still often thought that suicidal strangulation by ligature is impossible. Reviewing the forensic literature we could find more than 200 cases that have been published earlier. We report another 4 cases of suicidal strangulation. The main problems of criminalists and medical examiners in such cases are discussed. Primary investigation of the corpse in original position by a forensic scientist is of high importance.

  3. Outcomes of neonates with perinatal asphyxia at a tertiary academic ...

    African Journals Online (AJOL)

    Most of the infants were born at CMJAH (391/450, 86.9%) and by normal vaginal delivery (270/450, 60.0%). e overall survival rate was 86.7% (390/450). Forty-two infants were admitted to the intensive care unit (ICU). e ICU survival rate was 88.1% (37/42). Signicant predictors of survival were place of birth (p=0.006), mode ...

  4. Feasibility of Implementing an Early Intervention Program in an Urban Low-Income Setting to Improve Neurodevelopmental Outcome in Survivors Following Birth Asphyxia Faisabilité de mise en œuvre d'un Programme d'Intervention Précoce dans les milieux urbains à faibles revenus afin d'améliorer le résultat neurodéveloppemental chez les enfants survivant à une asphyxie à la naissance Viabilidad de la aplicación de un Programa de Intervención Precoz en un entorno urbano de bajos ingresos para mejorar el neurodesarrollo en los supervivientes luego de un cuadro de asfixia perinatal

    Directory of Open Access Journals (Sweden)

    Elwyn Chomba

    2011-08-01

    Full Text Available Birth asphyxia is a leading cause of neonatal mortality, accounting for 23% of neonatal deaths. An early intervention program (EIP could improve neuro-developmental outcomes in survivors of birth asphyxia, but its feasibility in low-income countries has not been tested.  In this pilot study in Zambia, eighty live-born infants > 1500 g of weight who had birth asphyxia and received resuscitation with bag and mask were enrolled for a study of standard care or EIP. Mothers/babies pairs were randomized into control (standard care and intervention (EIP groups and were followed up at home on a bi-weekly basis from 8 weeks to 8 months of age. Forty two mothers/babies (52.5% completed the study at 8 months. Reasons for not completing the study were: 19 (50.1% were lost to follow up, 16 (42.1% withdrew, and 3 (7.8% died. Follow-up to 8 months of age was not feasible for the majority in a large urban city with a low income population. Thus, interventions for children who have suffered birth asphyxia that require additional health care visits may not be currently feasible in the setting tested. There is a need to conduct further EIP studies to determine ways to improve follow up rates of children surviving birth asphyxia. Integrating early intervention programs with other successful health programs, such as the existing immunization programs, may improve follow up rates.L'asphyxie à la naissance est une cause majeure de la mortalité néonatale et représente 23 % des morts néonatales. Un programme d'intervention précoce (EIP, sigle en anglais pourrait améliorer les résultats neurodéveloppementaux chez les nouveau-nés survivant à une asphyxie à la naissance, mais sa faisabilité dans les pays à faibles revenus n'a pas été testée. Dans cette étude pilote conduite en Zambie, quatre-vingt nourrissons nés vivants d'un poids > 1 500 g, ayant souffert d'une asphyxie à la naissance et réanimés avec un masque et un ballon, ont été retenus pour

  5. DHA Reduces Oxidative Stress after Perinatal Asphyxia: A Study in Newborn Piglets.

    Science.gov (United States)

    Solberg, Rønnaug; Longini, Mariangela; Proietti, Fabrizio; Perrone, Serafina; Felici, Cosetta; Porta, Alessio; Saugstad, Ola Didrik; Buonocore, Giuseppe

    2017-01-01

    Perinatal hypoxic-ischemic brain damage is a major cause of acute mortality and chronic neurological morbidity in infants and children. Oxidative stress due to free radical formation and the initiation of abnormal oxidative reactions appears to play a key role. Docosahexanoic acid (DHA), a main component of brain membrane phospholipids, may act as a neuroprotectant after hypoxia-ischemia by regulating multiple molecular pathways and gene expression. The aims of this study were to test the hypothesis that DHA provides significant protection against lipoperoxidation damage in the cerebral cortex and hippocampus in a neonatal piglet model of severe hypoxia-reoxygenation. Newborn piglets, Noroc (LYLD), were subjected to severe global hypoxia. One group was resuscitated with ambient air (21% group, n = 11) and another also received 5 mg/kg of DHA 4 h after the end of hypoxia (21% DHA group, n = 10). After 9.5 h, tissues from the prefrontal cortex and hippocampus were sampled and the levels of isoprostanes, neuroprostanes, neurofurans, and F2-dihomo-isoprostanes were determined by the liquid chromatography triple quadrupole mass spectrometry technique. Lipid peroxidation biomarkers were significantly lower in both the cortex and hippocampus in the DHA-treated group compared with the untreated group. The present study demonstrates that DHA administration after severe hypoxia in newborn piglets has an antioxidative effect in the brain, suggesting a protective potential of DHA if given after injuries to the brain. © 2017 S. Karger AG, Basel.

  6. Birth asphyxia and perinatal outcome in a low resourced setting in ...

    African Journals Online (AJOL)

    Conclusion: This audit identifies resource deficiencies. Healthcare workers must have regular in-service training and education on fetal monitoring, interpretation and timeous action when an abnormal CTG occurs. The hospital management must be involved in delays in CS due to staff shortages and alternate arrangements ...

  7. Dr Alfred Velpeau (1795-1867) of Tours: the umbilical cord and birth asphyxia.

    Science.gov (United States)

    Dunn, P M

    2005-03-01

    The son of a village farrier near Tours, Velpeau rose from humble beginnings to become by dint of intelligence, hard work, and determination the leading surgeon of his day in Paris. As professor of clinical surgery in the university he was an admired and respected teacher. His writings covered most aspects of medicine, surgery, and obstetrics.

  8. [Correction of the acid-base balance in the newborn asphyxia. The use of sodium bicarbonate].

    Science.gov (United States)

    Demi, M; Meneghetti, G

    1982-01-01

    The treatment of neonatal respiratory distress associates the improvement of lung ventilation with the correction of acid-base equilibrium (metabolic acidosis). In such a context we have considered 10 newborns with respiratory distress and we monitored pH, PCO2, B.E. and standard bicarbonate in capillary blood at 1, 5, 10, 25 hours after birth. The sodium bicarbonate doses given as a result of the emogasanalisis are above those usually recommended. We then give suggestions on how to use the sodium bicarbonate required to correct the acidosis without the aid of an emogasanaliser in order to avoid the iatrogenic alcalosis danger.

  9. Neuronal Damage Induced by Perinatal Asphyxia Is Attenuated by Postinjury Glutaredoxin-2 Administration

    Science.gov (United States)

    Holubiec, Mariana Inés; Tornatore, Tamara Logica; Rivière, Stéphanie; Kölliker-Frers, Rodolfo Alberto; Tau, Julia; Blanco, Eduardo; Galeano, Pablo; Lillig, Christopher Horst

    2017-01-01

    The general disruption of redox signaling following an ischemia-reperfusion episode has been proposed as a crucial component in neuronal death and consequently brain damage. Thioredoxin (Trx) family proteins control redox reactions and ensure protein regulation via specific, oxidative posttranslational modifications as part of cellular signaling processes. Trx proteins function in the manifestation, progression, and recovery following hypoxic/ischemic damage. Here, we analyzed the neuroprotective effects of postinjury, exogenous administration of Grx2 and Trx1 in a neonatal hypoxia/ischemia model. P7 Sprague-Dawley rats were subjected to right common carotid ligation or sham surgery, followed by an exposure to nitrogen. 1 h later, animals were injected i.p. with saline solution, 10 mg/kg recombinant Grx2 or Trx1, and euthanized 72 h postinjury. Results showed that Grx2 administration, and to some extent Trx1, attenuated part of the neuronal damage associated with a perinatal hypoxic/ischemic damage, such as glutamate excitotoxicity, axonal integrity, and astrogliosis. Moreover, these treatments also prevented some of the consequences of the induced neural injury, such as the delay of neurobehavioral development. To our knowledge, this is the first study demonstrating neuroprotective effects of recombinant Trx proteins on the outcome of neonatal hypoxia/ischemia, implying clinical potential as neuroprotective agents that might counteract neonatal hypoxia/ischemia injury. PMID:28706574

  10. Neuronal Damage Induced by Perinatal Asphyxia Is Attenuated by Postinjury Glutaredoxin-2 Administration

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Romero

    2017-01-01

    Full Text Available The general disruption of redox signaling following an ischemia-reperfusion episode has been proposed as a crucial component in neuronal death and consequently brain damage. Thioredoxin (Trx family proteins control redox reactions and ensure protein regulation via specific, oxidative posttranslational modifications as part of cellular signaling processes. Trx proteins function in the manifestation, progression, and recovery following hypoxic/ischemic damage. Here, we analyzed the neuroprotective effects of postinjury, exogenous administration of Grx2 and Trx1 in a neonatal hypoxia/ischemia model. P7 Sprague-Dawley rats were subjected to right common carotid ligation or sham surgery, followed by an exposure to nitrogen. 1 h later, animals were injected i.p. with saline solution, 10 mg/kg recombinant Grx2 or Trx1, and euthanized 72 h postinjury. Results showed that Grx2 administration, and to some extent Trx1, attenuated part of the neuronal damage associated with a perinatal hypoxic/ischemic damage, such as glutamate excitotoxicity, axonal integrity, and astrogliosis. Moreover, these treatments also prevented some of the consequences of the induced neural injury, such as the delay of neurobehavioral development. To our knowledge, this is the first study demonstrating neuroprotective effects of recombinant Trx proteins on the outcome of neonatal hypoxia/ischemia, implying clinical potential as neuroprotective agents that might counteract neonatal hypoxia/ischemia injury.

  11. Conventional versus combined apgar scores in neonatal asphyxia: a prospective study

    Directory of Open Access Journals (Sweden)

    Amir Kamal Hardani

    2015-01-01

    Conclusion: In asphyxiated neonates sensitivity and specificity of combined apgar were more than conventional apgar. With respect to this study, better assessment could be achieved by combined apgar score method instead of conventional Apgar.

  12. [Positional asphyxia--death in a head-down position after falling down stairs].

    Science.gov (United States)

    Doberentz, Elke; Madea, Burkhard

    2012-01-01

    The discovery of a body in an unusual position such as a head-down position requires thorough investigation. In this article, such a death is reported. A 64-year-old man was found in a head-down position at the bottom of a narrow staircase after obviously falling down the stairs. His head was wedged between the last step and a closed sliding door. Autopsy revealed craniofacial blunt force injuries, a non-dislocated fracture of the 4th cervical vertebral body (with intact ligaments of the spine and cervical cord) and massive cerebral and pulmonary oedema. Although the heart was significantly enlarged (610 g), the coronary arteries showed only minor arteriosclerotic changes. The alcohol concentration measured was 2.06 per mil in blood and 2.67 per mil in urine. The alcohol intoxication increased the risk to fall and together with the trauma of the cervical spine made it impossible for the man to free himself so that he ultimately died in a head-down position.

  13. Carbon dioxide euthanasia in rats: Oxygen supplementation minimizes signs of agitation and asphyxia

    NARCIS (Netherlands)

    Coenen, A.M.L.; Drinkenburg, W.H.I.M.; Hoenderken, R.; Luijtelaar, E.L.J.M. van

    1995-01-01

    This paper records the effects of carbon dioxide when used for euthanasia, on behaviour, electrical brain activity and heart rate in rats. Four different methods were used. Animals were placed in a box (a) that was completely filled with carbon dioxide; (b) into which carbon dioxide was streamed at

  14. intrapartum-related birth asphyxia in south africa- lessons from the ...

    African Journals Online (AJOL)

    Longitudinal assessment of lipid ratios in the dlagnosis of type III hyperlipoproteinaemia. Clin Chirn Acta 1975; 58: 121-136. 18. Fredrickson DS, Morganroth J, Levy R. Type Ill hyperlipoprotcinemia; an analysis of two contemporary definitions. Ann Intern Med 1975; 82: 150-157. 19. Albers JJ, Warnick RG, Hazzard W. Type ...

  15. Impact of catecholamines in cardiac arrest due to acute asphyxia--a study in piglets.

    Science.gov (United States)

    Mauch, Jacqueline; Ringer, Simone; Spielmann, Nelly; Weiss, Markus

    2014-09-01

    Early intravenous epinephrine administration may help to achieve return of spontaneous circulation in cardiac arrest (CA). However, venous access can be challenging in small children. This study investigates the effect of intravenous and intramuscular epinephrine in treatment of asphyxial CA. Twenty-eight, 2-5-weeks-old, anesthetized piglets were asphyxiated by ventilation withdrawal. CA was untreated for 8 min, followed by 2 min of basic life support. Following this, epinephrine iv (10 μg·kg(-1) , group IV), epinephrine im (100 μg·kg(-1) , group IM), or normal saline (group NS) were administered. Further doses of epinephrine were given in group IV every 4 min, in group IM after 10 min if required. After twenty-two minutes of CA, iv epinephrine was given to all animals still in CA. Outcome measures were survival and epinephrine plasma concentrations. Ten animals regained spontaneous circulation after 2 min of basic life support. Therefore, no drug treatment was administered (drop out). Resuscitation was effective in 2 pigs of group IM (n = 6), in 6 of group NS (n = 8) and in all of group IV (n = 4). Nonsurvivors had higher epinephrine (P < 0.01) and norepinephrine (P < 0.01) plasma concentrations prior to start of resuscitation. Median increase in epinephrine plasma concentration from T0 to T5 was 138, 134, and 29 nm in group IV, IM, and NS, respectively. Intravenous and intramuscular administered epinephrine led to similar increase in plasma concentrations during resuscitation of asphyxial CA without hemodynamic or survival benefit. High endogenous epinephrine and norepinephrine plasma concentrations were negative predictors for survival. © 2014 John Wiley & Sons Ltd.

  16. The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia

    NARCIS (Netherlands)

    Sijens, Paul E.; Wischniowsky, Katharina; ter Horst, Hendrik J.

    2017-01-01

    Objective: The purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by H-1 magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome. Methods: At the age of 6.0 +/- 1.8 days, brain metabolites of 35 term asphyxiated newborns, treated

  17. Proinflammatory Cytokines, Enolase and S-100 as Early Biochemical Indicators of Hypoxic-Ischemic Encephalopathy Following Perinatal Asphyxia in Newborns

    Directory of Open Access Journals (Sweden)

    Verónica Chaparro-Huerta

    2017-02-01

    Conclusion: The role of cytokines after hypoxic-ischemic insult has been determined in studies of transgenic mice that support the use of these molecules as candidate biomarkers. Similarly, S-100 and enolase are considered promising candidates because these markers have been correlated with tissue damage in different experimental models.

  18. Central cortico-subcortical involvement: a distinct pattern of brain damage caused by perinatal and postnatal asphyxia in term infants

    NARCIS (Netherlands)

    Rademakers, R. P.; van der Knaap, M. S.; Verbeeten, B.; Barth, P. G.; Valk, J.

    1995-01-01

    The MR findings in a characteristic pattern of hypoxic-ischemic brain damage in term infants are described. The MR images of seven patients with cerebral palsy and a specific pattern of central cortico-subcortical cerebral damage were studied retrospectively and correlated with clinical findings.

  19. Development of cerebral gray and white matter injury and cerebral inflammation over time after inflammatory perinatal asphyxia

    NARCIS (Netherlands)

    Bonestroo, Hilde J C; Heijnen, Cobi J.; Groenendaal, Floris|info:eu-repo/dai/nl/073282596; Van Bel, Frank|info:eu-repo/dai/nl/072811455; Nijboer, Cora H.|info:eu-repo/dai/nl/311481000

    2015-01-01

    Antenatal inflammation is associated with increased severity of hypoxic-ischemic (HI) encephalopathy and adverse outcome in human neonates and experimental rodents. We investigated the effect of lipopolysaccharide (LPS) on the timing of HI-induced cerebral tissue loss and gray matter injury, white

  20. Asfixia perinatal asociada a la mortalidad neonatal temprana: estudio de población de los óbitos evitables

    OpenAIRE

    Daripa, Mandira; Caldas, Helena Maria G.; Flores, Luis Patricio O.; Waldvogel, Bernadette Cunha; Guinsburg, Ruth; Almeida, Maria Fernanda B. de

    2013-01-01

    OBJECTIVE: To compare the epidemiological profile of avoidable early neonatal deaths associated with perinatal asphyxia according to region of death in the State of São Paulo, Brazil. METHODS: Population-based cohort study including 2,873 avoidable deaths up to six days of life associated with perinatal asphyxia from January 2001 to December 2003. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia, or meconium aspiration syndrome were written in any line of the original...

  1. Asfixia perinatal associada à mortalidade neonatal precoce: estudo populacional dos óbitos evitáveis Asfixia perinatal asociada a la mortalidad neonatal temprana: estudio de población de los óbitos evitables Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths

    OpenAIRE

    Mandira Daripa; Helena Maria G. Caldas; Luis Patricio O. Flores; Bernadette Cunha Waldvogel; Ruth Guinsburg; Maria Fernanda B. de Almeida

    2013-01-01

    OBJETIVO: Comparar o perfil epidemiológico dos óbitos neonatais precoces evitáveis associados à asfixia perinatal conforme a região de ocorrência do óbito no Estado de São Paulo. MÉTODOS: Coorte populacional constituída por 2.873 óbitos evitáveis até seis dias de vida associados à asfixia perinatal ocorridos entre janeiro de 2001 e dezembro de 2003. Considerou-se como asfixia perinatal a presença de hipóxia intraútero, asfixia ao nascer ou síndrome de aspiração de mecônio em qualquer linha da...

  2. Pregnancy outcome and factors affecting vaginal delivery of twins at ...

    African Journals Online (AJOL)

    2012-12-13

    40.2%), birth asphyxia 15 (18.3%), low birth weight 12 ... peripartum complications and the babies show increased need for ..... application can be downloaded from https://market.android.com/details?id=comm.app.medknow.

  3. Learning from Health Care Workers' Opinions for Improving Quality ...

    African Journals Online (AJOL)

    hanumantp

    [WHO] emergency triage assessment and treatment (ETAT). Manual and Kilimanjaro Christian Medical Center Pediatric management manual) for the management of anticipated conditions, including birth asphyxia, extreme prematurity, meconium aspiration, general respiratory distress, congenital cardiac disease, complex ...

  4. Pilot randomized trial of therapeutic hypothermia with serial cranial ultrasound and 18-22 month follow-up for neonatal encephalopathy in a low resource hospital setting in Uganda: study protocol

    National Research Council Canada - National Science Library

    Robertson, Nicola J; Hagmann, Cornelia F; Acolet, Dominique; Allen, Elizabeth; Nyombi, Natasha; Elbourne, Diana; Costello, Anthony; Jacobs, Ian; Nakakeeto, Margaret; Cowan, Frances

    2011-01-01

    .... Under the UCL Uganda Women's Health Initiative, a pilot randomized controlled trial in infants with perinatal asphyxia was set up in the special care baby unit in Mulago Hospital, a large public hospital...

  5. Bradycardia in armadillos experimentally covered with soil.

    Science.gov (United States)

    Casanave, E B; García Samartino, L; Affanni, J M

    1995-04-01

    Chaetophractus villosus is able to maintain efficient respiratory movements when its nostrils are experimentally covered with soil. Under these conditions, a progressive bradycardia develops. It would depend on hypothermia and asphyxia.

  6. Woe patient is purple

    Directory of Open Access Journals (Sweden)

    Hatice Dogan

    2014-08-01

    Conclusion: Traumatic asphyxia is a clinical condition caused by blunt thoracoabdominal trauma, and with good trauma management patients can be discharged with less mortality and morbidity. [Cukurova Med J 2014; 39(4.000: 914-917

  7. The history and pathology of crucifixion | Retief | South African ...

    African Journals Online (AJOL)

    effects of compulsory scourging and maiming, haemorrhage and dehydration causing hypovolaemic shock and pain, but the most important factor was progressive asphyxia caused by impairment of respiratory movement. Resultant anoxaemia ...

  8. Anticonvulsant effectiveness and hemodynamic safety of midazolam in full-term infants treated with hypothermia

    NARCIS (Netherlands)

    Van Den Broek, Marcel P H; Van Straaten, Henrica L M; Huitema, Alwin D R; Egberts, Toine; Toet, Mona C.; De Vries, Linda S.; Rademaker, Karin; Groenendaal, Floris

    2015-01-01

    Background: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. Objectives: The objective was to evaluate the anticonvulsant effectiveness and

  9. Anticonvulsant Effectiveness and Hemodynamic Safety of Midazolam in Full-Term Infants Treated with Hypothermia

    NARCIS (Netherlands)

    van den Broek, MPH; Van Straaten, Henrica L M; Huitema, Alwin D R; Egberts, Toine; Toet, MC; De Vries, Linda S.; Rademaker, Karin; Groenendaal, Floris

    2015-01-01

    Background: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. Objectives: The objective was to evaluate the anticonvulsant effectiveness and

  10. Pharmacokinetics and pharmacodynamics of medication in asphyxiated newborns during controlled hypothermia. The PharmaCool multicenter study

    NARCIS (Netherlands)

    de Haan, Timo R.; Bijleveld, Yuma A.; van der Lee, Johanna H.; Groenendaal, Floris; van den Broek, Marcel P. H.; Rademaker, Carin M. A.; van Straaten, Henrica L. M.; van Weissenbruch, Mirjam M.; Vermeulen, Jeroen R.; Dijk, Peter H.; Dudink, Jeroen; Rijken, Monique; van Heijst, Arno; Dijkman, Koen P.; Gavilanes, Danilo; van Kaam, Anton H.; Offringa, Martin; Mathot, Ron A. A.

    2012-01-01

    Background: In the Netherlands, perinatal asphyxia (severe perinatal oxygen shortage) necessitating newborn resuscitation occurs in at least 200 of the 180-185.000 newly born infants per year. International randomized controlled trials have demonstrated an improved neurological outcome with

  11. Becoming a parent to a child with birth asphyxia—From a traumatic delivery to living with the experience at home

    Directory of Open Access Journals (Sweden)

    Alina Heringhaus

    2013-04-01

    Full Text Available The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU. In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP, or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent–infant separation due to the hypothermia treatment and parents’ fear of touching the infant because of the high-tech equipment seemed to hamper the parent–infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

  12. Studies on the importance of creatine during pregnancy for the mother and newborn

    OpenAIRE

    Ellery, Stacey Joan

    2017-01-01

    The primary focus of this thesis was the use of the spiny mouse to model birth asphyxia-induced neonatal Acute Kidney Injury (AKI). Understanding what effect birth asphyxia has on the neonatal kidney at a molecular, structural and functional level, determining if deficits persist into adulthood, and the potential for intervention using maternal creatine supplementation, were important goals. The work in this thesis also characterised maternal creatine homeostasis during late pregnancy, to ass...

  13. The effects of dexamethasone on post-asphyxial cerebral oxygenation in the preterm fetal sheep

    Science.gov (United States)

    Lear, Christopher A; Koome, Miriam E; Davidson, Joanne O; Drury, Paul P; Quaedackers, Josine S; Galinsky, Robert; Gunn, Alistair J; Bennet, Laura

    2014-01-01

    Exposure to clinical doses of the glucocorticoid dexamethasone increases brain activity and causes seizures in normoxic preterm fetal sheep without causing brain injury. In contrast, the same treatment after asphyxia increased brain injury. We hypothesised that increased injury was in part mediated by a mismatch between oxygen demand and oxygen supply. In preterm fetal sheep at 0.7 gestation we measured cerebral oxygenation using near-infrared spectroscopy, electroencephalographic (EEG) activity, and carotid blood flow (CaBF) from 24 h before until 72 h after asphyxia induced by 25 min of umbilical cord occlusion. Ewes received dexamethasone intramuscularly (12 mg 3 ml–1) or saline 15 min after the end of asphyxia. Fetuses were studied for 3 days after occlusion. During the first 6 h of recovery after asphyxia, dexamethasone treatment was associated with a significantly greater fall in CaBF (P dexamethasone treatment was associated with a return of CaBF to saline control levels, increased EEG power (P dexamethasone treatment after asphyxia is associated with greater hypoperfusion in the critical latent phase, leading to impaired intracerebral oxygenation that may exacerbate neural injury after asphyxia. PMID:25384775

  14. Methylene blue prevents retinal damage in an experimental model of ischemic proliferative retinopathy.

    Science.gov (United States)

    Rey-Funes, Manuel; Larrayoz, Ignacio M; Fernández, Juan C; Contartese, Daniela S; Rolón, Federico; Inserra, Pablo I F; Martínez-Murillo, Ricardo; López-Costa, Juan J; Dorfman, Verónica B; Martínez, Alfredo; Loidl, César F

    2016-06-01

    Perinatal asphyxia induces retinal lesions, generating ischemic proliferative retinopathy, which may result in blindness. Previously, we showed that the nitrergic system was involved in the physiopathology of perinatal asphyxia. Here we analyze the application of methylene blue, a well-known soluble guanylate cyclase inhibitor, as a therapeutic strategy to prevent retinopathy. Male rats (n = 28 per group) were treated in different ways: 1) control group comprised born-to-term animals; 2) methylene blue group comprised animals born from pregnant rats treated with methylene blue (2 mg/kg) 30 and 5 min before delivery; 3) perinatal asphyxia (PA) group comprised rats exposed to perinatal asphyxia (20 min at 37°C); and 4) methylene blue-PA group comprised animals born from pregnant rats treated with methylene blue (2 mg/kg) 30 and 5 min before delivery, and then the pups were subjected to PA as above. For molecular studies, mRNA was obtained at different times after asphyxia, and tissue was collected at 30 days for morphological and biochemical analysis. Perinatal asphyxia produced significant gliosis, angiogenesis, and thickening of the inner retina. Methylene blue treatment reduced these parameters. Perinatal asphyxia resulted in a significant elevation of the nitrergic system as shown by NO synthase (NOS) activity assays, Western blotting, and (immuno)histochemistry for the neuronal isoform of NOS and NADPH-diaphorase activity. All these parameters were also normalized by the treatment. In addition, methylene blue induced the upregulation of the anti-angiogenic peptide, pigment epithelium-derived factor. Application of methylene blue reduced morphological and biochemical parameters of retinopathy. This finding suggests the use of methylene blue as a new treatment to prevent or decrease retinal damage in the context of ischemic proliferative retinopathy. Copyright © 2016 the American Physiological Society.

  15. Impaired autoregulation of cerebral blood flow in the distressed newborn infant

    DEFF Research Database (Denmark)

    Lou, H C; Lassen, N A; Friis-Hansen, B

    1979-01-01

    Cerebral blood flow was measured, using the 133Xe clearance technique, a few hours after birth in 19 infants with varying degrees of respiratory distress syndrome. Ten of these infants had had asphyxia at birth. The least affected infants with normotension (systolic blood pressure 60 to 65 mm Hg......) had CBF values of about 40 ml/100 gm/minute. Hypotensive infants with asphyxia at birth or RDS or both had values for CBF of about 20 ml/100 gm/minute, or less. CBF was strongly correlated with the arterial blood pressure, showing a linear relationship that was identical in infants with asphyxia...... at birth and infants with RDS only. CBF varied considerably with spontaneous variations in blood pressure, suggesting that autoregulation was lacking. This finding may explain why distressed premature infants are prone to develop massive capillary bleeding in the germinal layer with penetration...

  16. The cranial MRI in severe cerebral palsy; A comparative study with clinical data

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Kazutaka; Itoh, Masahiro; Fueki, Noboru; Hirasawa, Kyoko; Suzuki, Noriko; Kurata, Kiyoko (Metropolitan Medical Center of the Severely Handicapped, Tokyo (Japan)); Sato, Junichi; Morimatsu, Yoshio; Yagishita, Akira

    1993-09-01

    The magnetic resonance examination was performed in 38 patients with severe cerebral palsy (CP; 15 males and 23 females) who had both motor delay (unable to move anywhere) and mental retardation (I.Q. or D.Q. below 30). Neuroimaging findings were compared with the CP type, etiology, and grade of understanding of language. Cranial magnetic resonance imagings (MRI) in CP were divided into five types. In type 1, nine predominantly showed cyst-liked ventricles and periventricular hyperintensity on T[sub 2]-weighted imaging (PVH) and only scarred basal ganglia and thalamus were visible. All suffered from neonatal asphyxia and the clinical type was rigospastic tetraplegia (RST). In type 2, eleven predominantly showed PVH and hyperintensity on T[sub 2]-weighted (HT2) in basal ganglia and thalamus. All suffered from neonatal asphyxia and the clinical type was RST or rigospastic diplegia. In type 3, five showed PVH and three had cortical atrophy. All suffered from neonatal asphyxia and the clinical type was spastic diplegia. In type 4, four predominantly showed HT2 in putamen and thalamus. Three had cortical atrophy. All suffered from neonatal asphyxia. The clinical type was athetotic CP (ATH). In type 5, nine predominantly showed HT2 in globus pallidus. Four had cortical atrophy and two had hippocampal atrophy. All suffered from neonatal jaundice and the clinical type was ATH. All patients who suffered from neonatal asphyxia and spastic CP had MRI in PVH. All patients who suffered from neonatal asphyxia and ATH showed HT2 in putamen and thalamus. Almost patients who suffered from neonatal jaundice and ATH showed HT2 in globus pallidus. With athetotic CP, cases with atrophy of the cerebral cortex and/or hippocampus were lower grade of understanding of language than no atrophy of both. The results of studies of MRI are in agreement with neuropathological findings. (author).

  17. Hypertensive peaks in the pathogenesis of intraventricular hemorrhage in the newborn. Abolition by phenobarbitone sedation

    DEFF Research Database (Denmark)

    Wimberley, P D; Lou, H C; Pedersen, H

    1982-01-01

    (33%), diagnosed by computered tomography (CT). IVH was more common in infants of lower gestational age, in infants delivered vaginally and in infants with perinatal asphyxia. Variable increases in MABP over the resting value occurred in all infants associated with increases in both active and passive...... motor activity. In 6 infant pairs matched for birth weight, gestational age, mode of delivery and severity of perinatal asphyxia, the infants who developed IVH had higher peak MABP valued compared to matched controls. Resting and minimum MABP values were not different in the two groups. We conclude...

  18. Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis

    DEFF Research Database (Denmark)

    Gjerris, A.C.; Staer-Jensen, J.; Jorgensen, J.S.

    2008-01-01

    OBJECTIVE: The aim of the present study was (1) to evaluate the relationship between umbilical cord arterial blood lactate and pH, standard base excess (SBE), and actual base excess (ABE) at delivery and (2) to suggest a cut-off level of umbilical cord arterial blood lactate in predicting fetal.......83). ROC-curves suggested a lactate cut-off level of 8mmol/l for indicating intrapartum asphyxia. CONCLUSION: Lactate in arterial umbilical cord blood might be a more direct and accordingly more correct indicator of fetal asphyxia at delivery than pH and SBE (or ABE). Its potential as a predictor...

  19. A pediatric case of life-threatening airway obstruction caused by a cervicomediastinal thymic cyst

    Energy Technology Data Exchange (ETDEWEB)

    Komura, Makoto; Kanamori, Yutaka; Sugiyama, Masahiko; Iwanaka, Tadashi [University of Tokyo Hospital, Department of Pediatric Surgery, Tokyo (Japan); Fukushima, Noriyoshi [University of Tokyo Hospital, Department of Pathology, Tokyo (Japan)

    2010-09-15

    Most patients with thymic cysts complain of a slowly enlarging, asymptomatic cervical mass. Only 6-10% suffer dysphagia, dyspnoea, stridor, cervical pain or vocal paralysis. In some rare cases sudden onset of severe dyspnoea or asphyxia is the first symptom, especially in neonates and small infants. We report a unique case of a 20-month-old child, who required emergency tracheal intubation due to asphyxia. Cervicomediastinal thymic cyst might need to be included in causes of life-threatening airway obstruction in young children. (orig.)

  20. An audit of paediatric mortality patterns in a Nigerian teaching hospital

    African Journals Online (AJOL)

    Conclusion: Perinatal and neonatal deaths constitute the vast majority of death in our environment with most of the deaths resulting from severe birth asphyxias, prematurity. Again in the post-neonatal period, infections and other preventable diseases constitute the most common cause of death in children of under age ...

  1. Factors associated with mortality among premature babies admitted ...

    African Journals Online (AJOL)

    Background: Prematurity, birth asphyxia and infections are the leading causes of neonatal mortality globally. This study was conducted to determine the mortality and associated factors among premature neonates at Bugando Medical Centre, Mwanza-Tanzania. Methods: One hundred and three premature neonates ...

  2. Pattern of neonatal admissions and outcome in a tertiary institution ...

    African Journals Online (AJOL)

    20.1%), and birth asphyxia (11.5%). Out of the 572 neonates, 111 (19.4%) died. About three quarters (76.5%) of the mortalities occurred in the first week of life with 46.4% of these occurring in the first 24 hours (X2-20.2, P < 0.001). The common ...

  3. Multifoetal Pregnancies At A Maternity Hospital In Nairobi | Musili ...

    African Journals Online (AJOL)

    pregnancy and during the antenatal period. The present study assumes that same sex twins are the same as monozygotic twins. A more detailed study on the types of placentation would be useful. As PET, anaemia, prematurity and asphyxia are ...

  4. Author Details

    African Journals Online (AJOL)

    Severe Birth Asphyxia in Wesley Guild Hospital, lesa: A persistent plague! Abstract · Vol 57, No 4 (2010) - Articles Kawasaki Disease in A Nigerian Child- a case report. Abstract · Vol 59, No 5-6 (2011) - Articles Correlation of Anthropometric Measurements with Renal Sizes in Nigerian Children: A Preliminary Report Abstract.

  5. Author Details

    African Journals Online (AJOL)

    Impact de la cesarienne subventionnee sur l'asphyxie perinatale a l'höpital de district de Be Impact of caesarean subsidy on perinatal asphyxia at the secondry hospital of Bè Abstract · Vol 17, No 2 (2015) - Articles Capacites des formations sanitaires à assurer la prise en charge et reanimation du nouveau-ne au Togo ...

  6. Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term : A Prospective Cohort Study

    NARCIS (Netherlands)

    van Iersel, Patricia A. M.; Algra, Annechien M.; Bakker, Saskia C. M.; Jonker, Arnold J. H.; Hadders-Algra, Mijna

    Background. A difficult birth at term (DBAT) may manifest as fetal acidosis and low Apgar scores and is often referred to as "perinatal asphyxia," especially when infants show signs of neonatal encephalopathy (NE). In contrast to DBAT resulting in moderate-to-severe NE, which is associated with

  7. Análise de partos acompanhados por enfermeiras obstétricas na perspectiva da humanização do parto e nascimento/Analysis of births attended by nurse midwives under the perspective of humanization of childbirth/Análisis de partos atendidos por enfermeras obstétricas bajo la perspectiva de la humanización del parto y nacimiento

    National Research Council Canada - National Science Library

    Carlos Sérgio Corrêa dos Reis; Danielle de Oliveira Miranda de Souza; Maria de Fátima Hasek Nogueira; Jane Márcia Progianti; Octavio Muniz da Costa Vargens

    2016-01-01

    ..., 36,42% remained with intact perineum. Only one case of severe perineal laceration occurred. The neonatal asphyxia (Apgar < 7) occurred in 0,55% of childbirths. Conclusion It was highlighted the importance of monitoring the labor by nurse midwifes that values and put into practice the recommendations of the Health Ministry regarding the humanization of ...

  8. An Unusual Cause of Uterine Rupture - A Case Report | Uzoigwe ...

    African Journals Online (AJOL)

    The baby was still alive at the time of delivery due to cushion-effect of the amniotic fluid but had early neonate death because of severe asphyxia and complications of prematurity. Other workers have found that fetal demise is more common when maternal injuries include trauma to the uterus 8-10. CONCLUSION: Pregnant ...

  9. Neuronal apoptosis in the neonates born to preeclamptic mothers.

    Science.gov (United States)

    Cosar, Hese; Ozer, Erdener; Topel, Hande; Kahramaner, Zelal; Turkoglu, Ebru; Erdemir, Aydin; Sutcuoglu, Sumer; Bagriyanik, Alper; Ozer, Esra Arun

    2013-07-01

    Preeclampsia may result in uteroplacental insufficiency and chronic intrauterine fetal distress. The aim of this study is to address this issue investigating neuronal apoptosis in an experimental model of preeclampsia and to evaluate the neurological outcome of the perinatal asphyxia in the neonates born to preeclamptic mother. Two out of four pregnant Sprague-Dawley rats (preeclamptic group) were given water containing 1.8% NaCl on gestation day 15 and 22 in order to establish the model of preeclampsia whereas other two (non-preeclamptic group) received normal diet. A model of perinatal asphyxia was established on the postnatal 7th day to one preeclamptic and one non-preeclamptic dam. Overall 23 pups born to overall four dams were decapitated to assess neuronal apoptosis by the TUNEL assay. The number of apoptotic neuronal cells was significantly higher in the preeclampsia groups in comparison with the control group (p = 0.006 and p = 0.006, respectively). It was also significantly higher in the asphyctic/non-preeclamptic group than the count in the control group (p = 0.01). There was also significant difference between both asphyctic groups (p = 0.003). We conclude that preeclampsia causes small babies for the gestational age and cerebral hypoplasia. Both preeclampsia and perinatal asphyxia can cause increased neuronal apoptosis in the neonatal brains. However, the prognosis for neurological outcome is much worse when the perinatal asphyxia occurs in newborns born to preeclamptic mothers.

  10. Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.

    Science.gov (United States)

    Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J; Ravelli, Anita C J

    2015-08-01

    To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. A properly conducted trial of a ventouse can prevent unexpected ...

    African Journals Online (AJOL)

    1991-05-04

    May 4, 1991 ... should be replaced by primary caesarean section. Unexpected failures of instrumental deliveries are associated with a high incidence of neonatal asphyxia and neurological sequelae. I-3. Trial of instrumentation, as introduced by Douglass and. Kaltreider4 in 1953, is well established in the management of.

  12. When Self-Pleasuring Becomes Self-Destruction: Autoerotic Asphyxiation.

    Science.gov (United States)

    Jenkins, Andrew P.

    This paper describes autoerotic asphyxia (AEA), using strangulation to enhance the pleasure of masturbation. AEA claims the lives of between 250-1,000 U.S. young men each year (though it is likely that it is underreported). Though AEA is found primarily among males, females participate, but in far smaller numbers. The most common motivation for…

  13. NJP Volume 38 Number 2 PDF.cdr

    African Journals Online (AJOL)

    Prof Ezechukwu

    birth weight are candidates for birth trauma, birth asphyxia and sometimes, death. Perinatologists are therefore gradually beaming the searchlights on the contribution of high birthweight delivery to perinatal morbidity and mortality. To determine the prevalence presentation and outcome of high birthweight deliveries in Zaria.

  14. Trends in perinatal health indices in the Amajuba District, KwaZulu ...

    African Journals Online (AJOL)

    birth, place of birth, presence of perinatal asphyxia (Apgar score <7 at 5 minutes), exposure to syphilis (mother Wassermann reaction positive), presence of meconium-stained liquor and chorioamnionitis. (foul-smelling liquor and maternal pyrexia). For the purpose of this study, these parameters were used to determine risk ...

  15. Serum calprotectin as a diagnostic marker of late onset sepsis in full ...

    African Journals Online (AJOL)

    EL-HAKIM

    delivery) or born to mothers with chorioamnionitis or PROM, unstable ventilated infants with respiratory and/or circulatory failure, and infants with neonatal asphyxia or congenital malformations were excluded from this study. Parental informed consent was obtained for every neonate before admission to the study. The.

  16. Socio-clinical issues in cerebral palsy in Sagamu, Nigeria

    African Journals Online (AJOL)

    %) than from kernicterus (22.2%) (χ2=4.989; p=0.026). However, the proportions of the children with CP from asphyxia only versus that from kernicterus only who also had speech impairment were similar (64.9% v. 50%; p=0.291). Default rate.

  17. Editorial

    African Journals Online (AJOL)

    general, they encompass infectious disease, glucose me- tabolism, newborn care, non communicable ... economy[17]; severe valvular dysfunction among rheu- matic heart diseases patients in Uganda[18] give an in- ... The rest of the articles are on acute kidney injury amongst neonates with perinatal asphyxia,[27] use of.

  18. Intrapartum fetal monitoring by ST-analysis of the fetal ECG

    NARCIS (Netherlands)

    Westerhuis, M.E.M.H.

    2010-01-01

    Objective Intrapartum fetal monitoring aims to identify fetuses at risk for neonatal and long-term injury due to asphyxia. To serve this purpose, cardiotocography (CTG) combined with ST-analysis of the fetal electrocardiogram (ECG), which is a relatively new method, may be used. The main aim of this

  19. Incidence and risk factors of neonatal thrombocytopenia: a pr

    Directory of Open Access Journals (Sweden)

    Nila Kusumasari

    2010-03-01

    Conclusions The incidence of neonatal thrombocytopenia was 12.2%. Significant risk factor of mother that caused thrombocytopenia was pre-eclampsia, while risk factors of neonates were asphyxia, sepsis and necrotizing enterocolitis.[Paediatr Indones. 2010;50:31-7].

  20. A 9 days old, female baby with Congenital Hydrocephalus | Mgelea ...

    African Journals Online (AJOL)

    A female infant, 3.5kg was born at Muhimbili National Hospital with a big head, Occipitofrontal Circumference (OFC) 49.5cm, and APGAR score 2 and 4 at first and fifth minutes respectively. She was admitted to ward 36 for the management of severe birth asphyxia. Cranial ultrasound revealed Hydrocephalus with bilateral ...

  1. Cranial ultrasound in neonates and infants in rural Africa

    African Journals Online (AJOL)

    Methods. All CU scans performed over a 32-month period at Haydom Lutheran Hospital, Tanzania, were retrospectively analysed. The patients' presenting signs and symptoms were categorised into nine groups: 1. birth asphyxia; 2. congenital syndromes; 3. neural tube defects/spina bifida; 4. macrocephalus; ...

  2. Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis

    DEFF Research Database (Denmark)

    Gjerris, Anne Cathrine Roslev; Staer-Jensen, Jette; Jørgensen, Jan Stener

    2008-01-01

    The aim of the present study was (1) to evaluate the relationship between umbilical cord arterial blood lactate and pH, standard base excess (SBE), and actual base excess (ABE) at delivery and (2) to suggest a cut-off level of umbilical cord arterial blood lactate in predicting fetal asphyxia using...

  3. Christ's crucifixion as a medico-historical event | Retief | Acta ...

    African Journals Online (AJOL)

    He probably died from the classical progressive asphyxia syndrome and hypovolaemic shock typical of the crucifixion process, finally ending in cardiac arrest as result of a vaso-vagal reflex. The latter could have been elicited by intense pain due to various causes, although hypoxaemia per se or various other less common ...

  4. original articles

    African Journals Online (AJOL)

    heart lesions and infections, chromosomal disorders, severe n:r:II perinatal asphyxia, inborn errors of metabolism, ...... neurological abnonnalities. Am' Clin Nutr 1982; 35: 617-623. 27. Horrobin OF. Nutritional and medical importance of gamma-linolenic acid. Frog Lipid Res. 1992; 31, 163-194. 28. Uauy-Dagach R, Birch EE, ...

  5. University College Hospital, Ibadan

    African Journals Online (AJOL)

    the total number of deaths. The leading causes of death were neonatal tetanus, Prematurity/low birth weight, neonatal septicaemia, severe birth asphyxia, meningitis, severe malaria, pneumonia, septicaemia, severe malnutrition, and measles. Deaths from sickle cell anaemia were found only among children above 5 years.

  6. Cerebral Palsy in Pakistani Children: A Hospital Based Survey

    Directory of Open Access Journals (Sweden)

    Atif Ahmed Khan

    2014-08-01

    Conclusion:Spastic quadriplegia or spastic diplegia are the commonest presentations in Pakistani children diagnosed with CP. The frequent etiological factors in CP development are birth asphyxia, prematurity, meningoencephalitis and kernicterus. [Cukurova Med J 2014; 39(4.000: 705-711

  7. Extraction of fetal electrocardiogram (ECG) by extended state ...

    Indian Academy of Sciences (India)

    Fetal heart rate (FHR) monitoring is a routine work for obtaining significant information about the fetal condition during pregnancy and labor. During pregnancy, the motivation for monitoring the fetal is to recognize pathological conditions, typically asphyxia with sufficient warning to enable intervention by the clinician.

  8. ORIGINAL ARTICLE

    African Journals Online (AJOL)

    User

    0.9%; OR 11.78, 95% CI 2.07-87.03, p <0.01), preterm delivery (31.5% vs. 1.9%; OR 24.35, 95% CI 7.15-91.26, ... Keywords: Preterm, Miscarriage, birth weight, asphyxia, puerperal. Journal of Medical and Biomedical Sciences (2014) ..... sion through Breastfeeding - The Kisumu. Breastfeeding Study, Kenya: A Critical Tri- al.

  9. Download this PDF file

    African Journals Online (AJOL)

    Factors favouring infant survival include nursing, up-bringing and breast-feeding by a surrogate mother (who is usually either the deceased's sister ... included prematurity, cause of maternal death was due to sepsls as a result of prolonged labour or premature rupture of fetal membranes, birth asphyxia, tetanus, respiratory ...

  10. Download this PDF file

    African Journals Online (AJOL)

    Low birth weight 136 22.0. Neonatal Septieaemia 124 20.1. Severe birth asphyxia 123 19.9. Meningitis ' t 26 4.2. Neonatal Jaundice 26 4.2. Congenital malformation 12 1.9. Congenital Heart disease 4 .6. Pneumonia 2 .3. Metabolic disorder 1 .2.

  11. Prognostisk vaerdi af PET og MRS ved evaluering af cerebral status hos børn

    DEFF Research Database (Denmark)

    Borgwardt, Lise; Danielsen, Else Rubaek; Børch, Klaus

    2002-01-01

    We report a case of a 12-week-old previously normal infant with severe brain damage after an episode of asphyxia during an RS-virus infection. Sub-acute MRI was normal, but new functional techniques, PET (positron emission tomography) and MRS (magnetic resonance spectroscopy) were severely abnormal...

  12. Author Details

    African Journals Online (AJOL)

    Mphahlele, R. Vol 7, No 1 (2013) - Articles Effect of prophylactic phenobarbital on seizures, encephalopathy and mortality in neonates with perinatal asphyxia. Abstract PDF. ISSN: 1999-7671. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's ...

  13. 2018-02-09T04:29:09Z https://www.ajol.info/index.php/all/oai oai:ojs ...

    African Journals Online (AJOL)

    article/87937 2018-02-09T04:29:09Z sajchh:ART Effect of prophylactic phenobarbital on seizures, encephalopathy and mortality in neonates with perinatal asphyxia Velaphi, S Mokhachane, M Mphahlele, R Beckh-Arnold, E Background. Seizures ...

  14. Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam : a report on three cases

    NARCIS (Netherlands)

    ter Horst, HJ; Brouwer, OF; Bos, AF

    Continuous amplitude-integrated electroencephalogram (aEEG) recording with a cerebral function monitor is a useful tool to evaluate prognoses following perinatal asphyxia in term infants. Drugs may change the pattern of the conventional EEG. This report presents three infants treated with midazolam

  15. risk factors for neonatal mortality in a regional tertiary hospital 1n ...

    African Journals Online (AJOL)

    (HIE) or hypoxic damage to other organ systems were assigned “birth asphyxia" as a cause of death. Babies who died of pneumonia. septicaemia or meningitis were assigned “sepsis” as the primary cause of death. Prematurity was assigned as the primary cause of death if a preterm baby died of organ system immaturity ...

  16. Patterns of death among avalanche fatalities: a 21-year review

    Science.gov (United States)

    Boyd, Jeff; Haegeli, Pascal; Abu-Laban, Riyad B.; Shuster, Michael; Butt, John C.

    2009-01-01

    Background Avalanches are a significant cause of winter recreational fatalities in mountain regions. The purpose of this study was to determine the relative contributions of trauma and asphyxia to avalanche deaths. Methods We reviewed all avalanche fatalities between 1984 and 2005 that had been investigated by the offices of the British Columbia Coroners Service and the Chief Medical Examiner of Alberta. In addition, we searched the database of the Canadian Avalanche Centre for fatal avalanche details. We calculated injury severity scores for all victims who underwent autopsy. Results There were 204 avalanche fatalities with mortality information over the 21-year study period. Of these, 117 victims underwent autopsy, and 87 underwent forensic external examination. Asphyxia caused 154 (75%) deaths. Trauma caused 48 (24%) deaths, with the rate of death from trauma ranging from 9% (4/44) for snowmobilers to 42% (5/12) for ice climbers. In addition, 13% (12/92) of the asphyxia victims who underwent autopsy had major trauma, defined as an injury severity score of greater than 15. Only 48% (23/48) of victims for whom trauma was the primary cause of death had been completely buried. Interpretation Asphyxia and severe trauma caused most avalanche fatalities in western Canada. The relative rates differed between snowmobilers and those engaged in other mountain activities. Our findings should guide recommendations for safety devices, safety measures and resuscitation. PMID:19213801

  17. Maternal allopurinol during fetal hypoxia lowers cord blood levels of the brain injury marker S-100B

    NARCIS (Netherlands)

    Torrance, Helen L.; Benders, Manon J.; Derks, Jan B.; Rademaker, Carin M. A.; Bos, Arie F.; Van Den Berg, Paul; Longini, Mariangela; Buonocore, Giuseppe; Venegas, MariaElena; Baquero, Hernando; Visser, Gerard H. A.; Van Bel, Frank

    BACKGROUND: Fetal hypoxia is an important determinant of neonatal encephalopathy caused by birth asphyxia, in which hypoxia-induced free radical formation plays an important role. HYPOTHESIS: Maternal treatment with allopurinol, will cross the placenta during fetal hypoxia (rimary outcome) and

  18. Traumatic Rupture of the Symphysis Pubis and Posterior Fracture ...

    African Journals Online (AJOL)

    Mrs. I. M. was a 23 years old primipara referred to UBTH with traumatic rupture of the symphysis pubis and posterior fracture dislocation of the left femoral head, after a delay in the second stage of labour that lasted 3 hours and a crude manoeuvre to deliver the fetus. The baby suffered severe birth asphyxia and convulsive ...

  19. 140

    African Journals Online (AJOL)

    2003-03-03

    Mar 3, 2003 ... (such as antepartum haemorrhage, preterm premature rapture of membranes, anaemia, hypertensive diseases in pregnancy), or environmental factors (such as trauma or malnutrition). Birth asphyxia may also arise from factors that act in labour (such as pyrexia in labour, premature rupture of membranes, ...

  20. A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary ...

    African Journals Online (AJOL)

    3.9%) perinatal deaths. All the cases of perinatal deaths and 549 (94.3%) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7%. Conclusion: ...

  1. Morbidity and mortality pattern of neonates admitted into the Special ...

    African Journals Online (AJOL)

    Background: The neonatal mortality rate in Nigeria is amongst the highest globally and is mainly due to preventable causes such as neonatal sepsis, perinatal asphyxia and prematurity. Objective: To determine the morbidity and mortality pattern of neonates admitted into the Special Care Baby Unit (SCBU) of the University ...

  2. Immediate outcome of babies with low Apgar score in Mulago ...

    African Journals Online (AJOL)

    Background: Birth asphyxia contributes significantly to perinatal morbidity and mortality especially in resource poor countries. Although the Apgar score has been in use for over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome have not been established in many sub-Saharan countries ...

  3. Congenital heart defects in spinal muscular atrophy type I : A clinical report of two siblings and a review of the literature

    NARCIS (Netherlands)

    Menke, Leonie A.; Poll-The, Bwee Tien; Clur, Sally-Ann; Bilardo, Catia M.; van der Wal, Allard C.; Lenunink, Henny H.; Cobben, Jan Maarten

    2008-01-01

    A newborn girl presented with asphyxia, joint contractures and diminished spontaneous movements. Echocardiography showed hypoplastic left heart. Spinal muscular atrophy type I (SMA I) was diagnosed by detecting a homozygous deletion in the survival motor neuron 1 gene (SMN1). In the first trimester

  4. CASE REPORT

    African Journals Online (AJOL)

    Vihar

    A female infant, 3.5kg was born at Muhimbili. National Hospital with a big head, Occipitofrontal. Circumference (OFC) 49.5cm, and APGAR score 2 and 4 at first and fifth minutes respectively. She was admitted to ward 36 for the management of severe birth asphyxia. Cranial ultrasound revealed. Hydrocephalus with bilateral ...

  5. Research

    African Journals Online (AJOL)

    Kamadjeur

    2012-03-14

    Mar 14, 2012 ... WHO ENC implementation had started slowly in some areas and it is not known how health ..... Association Centro Orientatmento Educativo Cameroun. Rapport d'activités 2008. Centre ... Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of ...

  6. Effect of prophylactic phenobarbital on seizures, encephalopathy ...

    African Journals Online (AJOL)

    the absence of inadequate monitoring or mechanical ventilation may be associated with high mortality, and it may not have an impact in infants who have had severe asphyxia. Sarkar et al. reported ndings similar to ours, i.e. that phenobarbital did not improve outcome in terms of neonatal death in infants with HIE.[28].

  7. ISSN 2073-9990 East Cent. Afr. J. s 9990 East Cent. Afr. J. s

    African Journals Online (AJOL)

    Prof Kakande

    vigorous nasogastric or orogastric placement5,6. Traumatic gastric perforation may develop as a result of severe gastric distension during bag mask resuscitation or mechanical ventilation for respiratory failure9,10. Ischemic perforations are associated with extreme prematurity, sepsis and neonatal asphyxia. Spontaneous ...

  8. Pregnancy outcome in women aged 40 years and above in Calabar ...

    African Journals Online (AJOL)

    Prematurity and birth asphyxia were the most common perinatal complications. Pregnancy at advanced maternal age, which is not rare in Calabar is high risk whose problems are compounded by illiteracy, high parity and low contraceptive usage. Effective and affordable contraceptive methods will reduce the incidence and ...

  9. The Hidden Burden of Hypoglycemia in Neonatal Mortality in Tanzania

    African Journals Online (AJOL)

    The study found out surprisingly that hypoglycaemia is among major causes of death in babies regardless of the illness.Hypoglycaemia was found to be the cause of death of neonates in 20% following Asphyxia (33%), prematurity (15%) and febrile and infectious conditions (pneumonia, malaria and sepsis) 27%, The major ...

  10. Pulse oximetry : technology to reduce child mortality in developing countries

    NARCIS (Netherlands)

    Duke, T.; Subhi, R.; Peel, D.; Frey, B.

    The causes of hypoxaemia in children include the commonest causes of childhood illness: pneumonia and other acute respiratory infections, and neonatal illness, particularly sepsis, low birthweight, birth asphyxia and aspiration syndromes. The systematic use of pulse oximetry to monitor and treat

  11. Hyperammonemia due to Adult-Onset N-Acetylglutamate Synthase Deficiency

    NARCIS (Netherlands)

    Logt, A.E. van de; Kluijtmans, L.A.J.; Huigen, M.C.; Janssen, M.C.H.

    2017-01-01

    A 59-year-old woman, with a medical history of intellectual disability after perinatal asphyxia, was admitted because of coma due to hyperammonemia after she was treated for a fracture of the pelvis. The ammonia level was 280 muM. Acquired disorders as explanation for the hyperammonemia were

  12. Risk factors and mortality rate of severely asphyxiated neonates in a ...

    African Journals Online (AJOL)

    Risk factors and mortality rate of severely asphyxiated neonates in a tertiary centre in north-central Nigeria. ... Journal Home > Vol 7, No 1 (2013) > ... Aim: The study was carried out to determine the maternal and foetal risk factors for the occurrence of severe birth asphyxia and the mortality rate of babies affected with this ...

  13. Survival of infants and children born to women who died from ...

    African Journals Online (AJOL)

    Survival of infants and children born to women who died from pregnancy and laboour related complications. ... maternal death was due to sepsls as a result of prolonged labour or premature rupture of fetal membranes, birth asphyxia, tetanus, respiratory problems, fever, convulsions, diaorrhea and vomiting and malnutrition.

  14. Premature closure of the upper esophageal sphincter as a cause of severe deglutition disorder in infancy

    DEFF Research Database (Denmark)

    Nielsen, Rasmus; Husby, Steffen; Kruse-Andersen, Søren

    2005-01-01

    Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs...

  15. Infant with a foreign body bronchus: a fishy situation!

    African Journals Online (AJOL)

    However, if it causes complete airway occlusion it may lead to asphyxia and unfortunately becomes a cause of death. Most inhaled foreign bodies in ... worsening respiratory distress. He had no preceding medical illness. From the history we gathered that he was last seen playing near a low-placed small aquarium at home.

  16. Prevalence and immediate outcomes of hypoxic Ischaemic ...

    African Journals Online (AJOL)

    Data were collected using a checklist, and analysed using Epi-info computer program. ResULTs. The study showed the prevalence of birth asphyxia at neonatal ward MNH to be ... of health and allied sciences (MUHAS) directorate of research and Publications via the Office of the Head,. Department Of Paediatrics and Child ...

  17. Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital

    African Journals Online (AJOL)

    age, single marital status, and smoking, alcohol and drug use), maternal infections, such as syphilis and malaria, and prolonged labour resulting in asphyxia, trauma and infection, have been associated with stillbirths in these countries.[6] Circumstances known to be more common in rural areas and developing countries, ...

  18. The Challenge of Improving Perinatal Care in settings with Limited ...

    African Journals Online (AJOL)

    The aim of this study was to observe and analyze midwifery care routine related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre-and post intervention observation study of midwifery a performance during childbirth was ...

  19. Download this PDF file

    African Journals Online (AJOL)

    Buchi

    CAUSES OF NEONATAL MORBIDITY AND. MORTALITY. High mortality was reported in a newborn specialty unit in Benin, southern Nigeria, 20.3% with neonatal sepsis, severe birth asphyxia, prematurity and neonatal tetanus as main morbidities.5 Maternal morbidity and peri-natal mortality rates in Abakaliki, Ebonyi state,.

  20. Institution Based Prospective Cross-Sectional Study on Patterns of ...

    African Journals Online (AJOL)

    Ten variables were found to have significant statistical associations with neonatal mortality after adjusting for demographic covariates: Prematurity (p < 0.001), Meningitis (p <0.001), Hemorrhagic Diseases (P <0.001), Hyaline Membrane Disease (P<0.001), Neonatal Sepsis (p <0.05), Meningitis (<0.05), Perinatal Asphyxia ...

  1. Obstetric Performance of Nigerian Obese Parturients | Olayemi ...

    African Journals Online (AJOL)

    The incidence of fetal macrosomia was higher in the obese group (p<0.001). Conclusion: Obesity increased the risk of preeclampsia and fetal macrosomia and operative deliveries. The risk of birth asphyxia and perinatal mortality were not increased by obesity. Key Words: Obesity, Parturient, Maternal, Neonatal, Outcome.

  2. Prevalence and outcome of macrosomic babies admitted to special ...

    African Journals Online (AJOL)

    Objective: Macrosomia has been defined as birth weight of 4.0kilogram and above. It is an important risk factor for perinatal asphyxia, birth injuries and fetal death. To determine the prevalence and outcome of management of macrosomic babies admitted to the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo ...

  3. Author Details

    African Journals Online (AJOL)

    Detection of asphyxia in infants using deep learning Convolutional Neural Network (CNN) trained on Mel Frequency Cepstrum Coefficient (MFCC) features extracted from cry sounds. Abstract PDF · Vol 9, No 3S (2017): Special Issue - Articles Design an automatic temperature control system based on pic controller for smart ...

  4. Author Details

    African Journals Online (AJOL)

    Classification of visualization exudates fundus images results using support vector machine. Abstract PDF · Vol 9, No 3S (2017): Special Issue - Articles Detection of asphyxia in infants using deep learning Convolutional Neural Network (CNN) trained on Mel Frequency Cepstrum Coefficient (MFCC) features extracted from ...

  5. Research Article Special Issue

    African Journals Online (AJOL)

    pc

    2017-11-10

    Nov 10, 2017 ... storage in educational sector such as online web-based learning system and students' learning profile ... Data mining can be used in the educational field to enhance our understanding of the learning process ..... DETECTION of asphyxia in infants using deep learning convolutional neural network (CNN).

  6. S100 protein content of umbilical cord blood in healthy newborns in relation to mode of delivery

    NARCIS (Netherlands)

    Wirds, J W; Duyn, A E J; Geraerts, S D; Preijer, E; Van Diemen-Steenvoorde, J A A M; Van Leeuwen, J H Schagen; Haas, F J L M; Gerritsen, W B M; De Boer, A; Leusink, J A

    BACKGROUND: Early detection and quantification of brain damage in neonatal asphyxia is important. In adults, S100 protein in blood is associated with damage to the central nervous system. OBJECTIVE: To determine whether S100 protein can be detected in arterial and venous cord blood of healthy

  7. Preexisting hypoxia is associated with a delayed but more sustained rise in T/QRS ratio during prolonged umbilical cord occlusion in near-term fetal sheep

    NARCIS (Netherlands)

    Wibbens, Bert; Bennet, Laura; Westgate, Jenny A.; De Haan, Harmen H.; Wassink, Guido; Gunn, Alistair J.

    There is limited information about whether preexisting fetal hypoxia alters hemodynamic responses and changes in T/ QRS ratio and ST waveform shape during subsequent severe asphyxia. Chronically instrumented near- term sheep fetuses ( 124 +/- 1 days) were identified as either normoxic Pa-O2 > 17

  8. Prevalence and outcomes of acute kidney injury in term neonates ...

    African Journals Online (AJOL)

    Background: The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is correlated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI). Methods: We conducted a prospective cohort study including 60 ...

  9. Cranial ultrasound in neonates and infants in rural Africa | Krüger ...

    African Journals Online (AJOL)

    The patients' presenting signs and symptoms were categorised into nine groups: 1. birth asphyxia; 2. congenital syndromes; 3. neural tube defects/spina bifida; 4. macrocephalus; 5. post-meningitis; 6. seizures; 7. developmental/ neuromuscular abnormalities; 8. head trauma; and 9. miscellaneous. The information derived ...

  10. ORIGINAL ARTICLES

    African Journals Online (AJOL)

    meetings at all delivery units. In our experience, South African midwives are resistant to involvement in perinatal audit, and research is required to identify barriers to the establishment of perinatal audit meetings in midwifery settings. CONCLUSION. Perinatal death from asphyxia and trauma is tragic and preventable.

  11. Iatrogenic burns injury complicating neonatal resuscitation ...

    African Journals Online (AJOL)

    La blessure dans les membres inférieurs a une surface d'environ 4%. Cette communication souligne la mauvaise méthode traditionnelle de la réanimation chez des nouveau nés. Keywords: Asphyxia, Burns, Newborn, Perinatal care, Resuscitation, Traditional medical practice. West African Journal of Medicine Vol.

  12. Socioeconomic Inequality in Malnutrition in Developing Countries

    NARCIS (Netherlands)

    E. Van de Poel (Ellen); A.R. Hosseinpoor (Ahmad); N. Speybroeck (Niko); T.G.M. van Ourti (Tom); J. Vega (Jeanette)

    2008-01-01

    textabstractEpidemiological evidence points to a small set of primary causes of child mortality that are the main killers of children aged less than 5 years: pneumonia, diarrhoea, low birth weight, asphyxia and, in some parts of the world, HIV and malaria. Malnutrition is the underlying cause of one

  13. early perinatal outcome in cases delivered through caesarian

    African Journals Online (AJOL)

    2006-05-05

    May 5, 2006 ... attributable to intrapartum hypoxia. Severe acidemia of pH 7.00 or ... hypoxia. In a study of obstetric management of foetal distress and its association with cerebral palsy,. Richmond concluded that intrapartum asphyxia is probably more .... data were analysed using appropriate standard statistical methods.

  14. Case report: Subcutaneous fat necrosis: report of a case and a ...

    African Journals Online (AJOL)

    Subcutaneous fat necrosis (SCFN) occurs in term newborn with history of difficult delivery. Apart from the soft tissue lesions, the infants may suffer from life threatening hypercalcemia as a complication of disease requiring various medications. A case of subcutaneous fat necrosis with history of birth asphyxia is presented ...

  15. JOS JOURNAL 2

    African Journals Online (AJOL)

    Phone number: 07034376627. E- mail address: kemidr1@gmail.com. ABSTRACT. Introduction: Asphyxia is a serious clinical condition in which placental or pulmonary gas exchange is impaired or ceases altogether. Reports from Nigeria have shown that a large proportion of neonates are still being diagnosed with and ...

  16. Neonatal mortality in a referral hospital in Cameroon over a seven ...

    African Journals Online (AJOL)

    Neonates with birth weight less than 2500g and a gesta- tional age less 37 weeks had a significantly higher mor- tality compared to those delivered at term and with normal birth weights. (Table 2). Causes of deaths: The main causes of deaths were: neonatal infections (37.85%), prematurity. (31.56%), neonatal asphyxia ...

  17. Challenges and opportunities for neonatal respiratory support in ...

    African Journals Online (AJOL)

    2015-12-07

    Dec 7, 2015 ... addition, delivery room resuscitation of the newborn was not routinely done. Therefore, birth asphyxia ... Specialized teams were available for care in the delivery room8-10.Early use of assisted ventilation was .... Infection control measures may also be difficult to implement. There may also be lack of piped ...

  18. SAJCH 671.indd

    African Journals Online (AJOL)

    birth, severe infections and asphyxia being the main causes.[4] Improving neonatal mortality, with ... This was a matched case-controlled retrospective record review of newborns presenting to the neonatal unit at CMJAH between 1. January 2011 and 31 ... room and maternity admission ward were considered as inborn and ...

  19. Spectrum of neonatal diseases requiring respiratory support in ...

    African Journals Online (AJOL)

    2016-08-08

    Aug 8, 2016 ... intra partum care and provision of delivery room resus- citation have all been shown to reduce asphyxia ... prematurity, infection and tetanus.4 Globally, three of these are also responsible for 75% of the causes of new- ..... Controlled clinical trial on effects of water mist on obstructive res- piratory signs, death ...

  20. Umbilical artery doppler abnormalities and associated factors in ...

    African Journals Online (AJOL)

    Background: Umbilical artery (UA) Doppler velocimetry detects foetuses at risk of asphyxia from IUGR before changes in the CTG and biophysical score are evident. This has made it a primary fetal surveillance tool in pre-eclampsia in developed countries with resultant reduction in perinatal mortality by 29%. Iatrogenic ...

  1. JOS JOURNAL 2

    African Journals Online (AJOL)

    Hypertension including pre- eclampsia, prolonged rupture of membranes, antepartum haemorrhage and precipitate labour were not significant ... prevention his study was carried out to determine the maternal and foetal risk factors for the occurrence of severe birth asphyxia and the mortality rate of babies affected with this ...

  2. TropJrnal Vol 32 No 1

    African Journals Online (AJOL)

    Mr Olusoji

    mental illness . It is associated with stress and at times discomfort especially in the early and later parts of the pregnancy. Psychiatry morbidity has been linked with adverse maternal and perinatal outcome such as low birth weight, post natal death,. 2-6 asphyxia . Social stigma associated with psychiatric disorders make ...

  3. Profile of Children with Cerebral Palsy Attending Out- patient ...

    African Journals Online (AJOL)

    Olusola Ayanniyi

    Cerebral palsy (CP) is a major cause of childhood disability. The objective of this study was to investigate the causes ... KEY WORDS: cerebral palsy, jaundice, asphyxia, infections, childhood disabilities. INTRODUCTION. Cerebral palsy (CP) is an ...... The effects of multiple pre- and perinatal risk factors on the occurrence of ...

  4. Neonatal Morbidity Pattern In Infants Born In Benin City To Nigerian ...

    African Journals Online (AJOL)

    We found that the incidence of some neonatal morbidities such as birth asphyxia, neonatal seizures, neonatal polycythaemia and hyperbilirubinaemia were significantly higher among babies born to hypertensive mothers compared with those born to their normotensive counterparts. The Caesarean delivery rate was also ...

  5. Ichthyosis prematurity syndrome: a well-defined congenital ichthyosis subtype

    DEFF Research Database (Denmark)

    Bygum, Anette; Westermark, Per; Brandrup, Flemming

    2008-01-01

    Ichthyosis prematurity syndrome is a rare syndrome characterized by the clinical triad of premature birth, thick caseous desquamating epidermis, and neonatal asphyxia. We describe two siblings with ichthyosis prematurity syndrome. The index patient was born at gestational week 34. Immediately aft...

  6. Pattern and determinants of newborn apnea in an under-resourced ...

    African Journals Online (AJOL)

    Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% ...

  7. Department of Defense Suicide Event Report (DoDSER) Data Quality Assessment

    Science.gov (United States)

    2014-11-14

    asphyxia) and manner (for example, suicide, homicide). A medical examiner or coroner usually conducts an autopsy and other medical- forensic examinations...military authorities, including any forensic or autopsy results.” Civilian law enforcement organizations do not typically investigate military specific... autopsy , command investigations, and law enforcement investigations. The DoDSER submitter is also encouraged to interview the decedent’s coworkers

  8. Prenatal and perinatal striatal injury: a hypothetical cause of attention-deficit-hyperactivity disorder?

    DEFF Research Database (Denmark)

    Toft, P.B.

    1999-01-01

    hemorrhage, intrauterine growth retardation, and asphyxia. An elevated level of lactate suggests tissue hypoxia, which may interfere with the formation of frontostriatal circuits and may play a role in the pathogenesis of the behavioral disturbances observed in a proportion of children with a history...

  9. Brain Research to Ameliorate Impaired Neurodevelopment - Home-based Intervention Trial (BRAIN-HIT)

    Science.gov (United States)

    2010-01-01

    Background This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia. Methods/Design This trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors. Discussion The trial is supervised by a trial steering committee, and an independent data monitoring committee monitors the trial

  10. SURVEI KEMATIAN NEONATAL (STUDI AUTOPSI VERBAL DI KABUPATEN CIREBON, 2004

    Directory of Open Access Journals (Sweden)

    Sarimawar Djaja

    2012-09-01

    Full Text Available In its attempt to realize the intervention program to saving newborn babies with asphyxia, the Ministry of Health will initiate to train midwives in the village in order to that they know how to operate resuscitation equipment to save neonatal baby with asphyxia. The intervention program his dubbed successful if the mortality proportion due if asphyxia decreased to half as targeted. The survey was conducted in the rural area of Cirebon district. The sample was 200 neonatal death babies, calculated using the hypothesis test with different proportion; p1 0.3 (30% neonatal death cause of asphyxia, according household health survey 2001, p2 0.15, α 0.05, β 0.2, (l-β 0.8. Neonatal dead cases happened within 12 months prior to the survey were identified by rural midwives out of their personal records. The death cases were followed up by interviewing the mother of the neonatal baby concerning its birth, illness or disorder histories before death. The diagnosis of the diseases were based on the International Classification of Diseases 10 and Wigglesworth classification, determined in union by NIHRD researchers and neonatologists. The neonatal mortality rate was 13 out of 1,000 live births. The major cause of early neonatal mortality was respiration disorder mainly caused by birth asphyxia (45%, of which 90 percent could be intervened by doing resuscitation (for babies weighed more than 1.000 gram. The second and third order of the mortality causes was infection (22% and congenital disorders (11% respectively. The major cause of late neonatal mortality was infection (56%, followed by low birth weight and prematurely born, as well as neonatal jaundice (14 percent each, and congenital disorder comes in the third place. The option to handle asphyxia with the early neonatal babies is the right effort to decrease the neonatal mortality rate. And to achieve the utmost result, it is necessary that the rural midwives maintain their standard performance (in

  11. Hepatic dysfunction in asphyxiated neonates: prospective case-controlled study.

    Science.gov (United States)

    Choudhary, Mukesh; Sharma, Deepak; Dabi, Dhanraj; Lamba, Mamta; Pandita, Aakash; Shastri, Sweta

    2015-01-01

    This study was performed to determine the occurrence of hypoxic hepatitis in full-term neonates after perinatal asphyxia and to correlate between the rise in enzymes and severity of asphyxia with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. This prospective case-controlled study was conducted in a tertiary-level hospital in India for a period of 12 months. The study group A comprised 70 newborns suffering from birth asphyxia, while 30 healthy neonates were included in group B (control). All biochemical parameters of liver function, ie, serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, bilirubin (total and direct), and international normalized ratio (INR), were measured on postnatal days 1, 3, and 10 in both study and control groups. In group A, 22.8% newborns had severe (Apgar score 0-3), 47.1% had moderate (Apgar score 4-5), and 30% had mild (Apgar score 6-7) birth asphyxia at five minutes. In all, 14.28% babies were in HIE stage I, 25.73% babies were in HIE stage II, and 11.42% babies were in HIE stage III. The rest of the newborns, 48.57%, were normal. The prevalence of liver function impairment was seen in 42.85% of asphyxiated neonates. On day 1, ALT, AST, ALP, LDH, PT, and INR were significantly higher, and total protein and serum albumin were significantly lower in group A than in group B. However, ALT and AST correlated well with increasing severity of HIE score. On day 3, there was a rising trend observed in the concentration of mean LDH as HIE staging of neonates progressed from stage 0 to stage III, and among various HIE stages, the difference in LDH was statistically significant. We concluded that AST, ALT at 24 hours, and LDH at 72 hours of animation can be a utilitarian diagnostic tool to differentiate asphyxiated neonates from non-asphyxiated neonates and to discover the severity of perinatal asphyxia because of easy

  12. [Neonatal complications related to shoulder dystocia].

    Science.gov (United States)

    Lopez, E; de Courtivron, B; Saliba, E

    2015-12-01

    To describe neonatal complications related to shoulder dystocia. This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Caso para diagnóstico Case for diagnosis

    Directory of Open Access Journals (Sweden)

    Mariane Corrêa

    2008-06-01

    Full Text Available A necrose gordurosa do subcutâneo do recém-nascido é paniculite rara e auto-limitada, caracterizada por placa eritematosa extensa com nódulos amolecidos no dorso de recém-nascidos a termo ou pós-termo. São fatores desencadeantes de relevância a pré-eclâmpsia materna, asfixia perinatal e hipercalcemia. Relata-se caso de necrose gordurosa do recém-nascido associado a pré-eclâmpsia materna e asfixia perinatal.Subcutaneous fat necrosis of the newborn is an uncommon self-limited panniculitis characterized by large erythematous patches and soft nodules on the back of full-term or post-term infants. Maternal pre-eclampsia, birth asphyxia and hypercalcemia are relevant triggers. We describe a case of subcutaneous fat necrosis in a newborn related to maternal pre-eclampsia and birth asphyxia.

  14. The man in the scarlet cloak. The mysterious death of Peter Anthony Motteux.

    Science.gov (United States)

    Ober, W B

    1991-09-01

    Peter Anthony Motteux (1663-1718), a Huguenot refugee in London, established a literary reputation by completing Sir Thomas Urquhart's translation of Rabelais' Gargantua and Pantagruel, then Cervantes' Don Quixote. He later became an import-export merchant. On his 55th birthday he donned his scarlet cloak and went out on the town. He picked up a prostitute and after some dalliance returned to her bordello. Shortly thereafter he was found dead, although the evidence is that he was in good health when he arrived. Literary evidence is that he died from assisted erotic asphyxia, a variant of autoerotic asphyxia, cf. the case of Frantisek Koczwara (Am J Forensic Med Pathol 5:145-149, 1984.)

  15. Household furniture tip-over deaths of young children.

    Science.gov (United States)

    Wolf, Barbara C; Harding, Brett E

    2011-07-01

    The potential for the injury or death of a child resulting from the tip-over of a piece of household furniture or a domestic appliance has not been previously well recognized. We reviewed nine accidental deaths of young children that resulted from avoidable residential hazards and/or lapses in supervision of the children by their caregivers. The offending household items included televisions, bedroom dressers, a kitchen stove, and a lounge chair. The causes of death were mechanical asphyxia, blunt trauma, and combined blunt head trauma and asphyxia. All of the deaths could have been prevented by appropriate anchoring of the piece of furniture and/or closer supervision of the child. A thorough multidisciplinary investigation is essential in establishing the cause and manner of death in such cases and in identifying risk factors that may aid in the prevention of future childhood deaths. © 2011 American Academy of Forensic Sciences.

  16. INCIDENCE OF APNEA ATTACK AS ALLERGIC REACTION AFTER ORAL FOOD CHALLENGE IN PATIENT WITH IgE-MEDIATED WHEAT ALLERGY.

    Science.gov (United States)

    Akashi, Masayuki

    2016-08-01

    Anaphylaxis is a severe allergic reaction that is rapid in onset and might cause death. Although wheezes, dyspnea or loss of consciousness are known to occur with severe allergic reactions with IgE-mediated food allergy, reports of apnea attack associated with IgE-mediated food allergy are rare. In this case, 9-year-old boy with IgE-mediated wheat allergy experienced apnea attack with strong desaturation after an immediate allergic reaction including erythema, abdominal pain, vomiting, and anaphylactic shock. The patient had asphyxia and cyanosis confirmed by medical staff when his oxygen saturation decreased to the 60% level, and he had occasional asphyxia over 10 seconds with no thoracic motion after a desaturation episode. Central apnea attack might be occurred in patient with IgE-mediated food allergy. However, the exact mechanism responsible remains unknown and further research is needed.

  17. [Multivariate autoregressive analysis of carotid artery blood flow waveform in a newborn with multicystic encephalomalacia].

    Science.gov (United States)

    Kojo, M; Ogawa, T; Fukushima, N; Yamada, K; Goto, K

    1995-05-01

    We analyzed the carotid artery blood flow waveform (CABFW) through multivariate autoregressive analysis in a case with multicystic encephalomalacia (MCE) after neonatal asphyxia and compared the result with those of 35 healthy newborns. The total power of CABFW was at the -2 SD level of the value for 35 healthy newborns, and the power, % power, bio-informing amounts and damping time of component 3 (damping frequency 11.15 Hz) were less than -2 SD of the values in 35 healthy newborns. The Pulsatility Index (PI) of anterior cerebral artery (ACA) was high (0.76). These results suggest that cerebral blood flow decreases because of cerebral vasoconstriction in MCE after neonatal asphyxia.

  18. Pathology of perinatal brain damage: background and oxidative stress markers.

    Science.gov (United States)

    Tonni, Gabriele; Leoncini, Silvia; Signorini, Cinzia; Ciccoli, Lucia; De Felice, Claudio

    2014-07-01

    To review historical scientific background and new perspective on the pathology of perinatal brain damage. The relationship between birth asphyxia and subsequent cerebral palsy has been extensively investigated. The role of new and promising clinical markers of oxidative stress (OS) is presented. Electronic search of PubMed-Medline/EMBASE database has been performed. Laboratory and clinical data involving case series from the research group are reported. The neuropathology of birth asphyxia and subsequent perinatal brain damage as well as the role of electronic fetal monitoring are reported following a review of the medical literature. This review focuses on OS mechanisms underlying the neonatal brain damage and provides different perspective on the most reliable OS markers during the perinatal period. In particular, prior research work on neurodevelopmental diseases, such as Rett syndrome, suggests the measurement of oxidized fatty acid molecules (i.e., F4-Neuroprostanes and F2-Dihomo-Isoprostanes) closely related to brain white and gray matter oxidative damage.

  19. Évaluation du pronostic des nouveau-nés traités par hypothermie thérapeutique

    OpenAIRE

    BEGOU, Audrey

    2016-01-01

    The consecutive hypoxic-ischemic encephalopathy causes asphyxia perinatal and present devastating consequences of neo natal death or Cerebral Palsy. Before 2000 the common treatment of new born with hypoxic-ischemic encephalopathy was poor and was essentially based upon homeostasy maintaining body liquid, electrolytic, respiratory functions and treating convulsion. Today hypothermia therapy is the only neuro protecting treatment efficient to treat hypoxic-ischemic encephalopathy. It is now a ...

  20. Physiological response to hypoxia in piglets of different birth weight

    OpenAIRE

    Ramiro Ramírez-Necoechea; Ana Rosales-Torres; María Alonso-Spilsbury; Patricia Mora-Medina; Patricia Roldan-Santiago; Rafael Hernández-González; Héctor Orozco-Gregorio; María E. Trujillo-Ortega; Daniel Mota-Rojas; Roberto Martínez-Rodríguez

    2011-01-01

    In the present study, we aimed to extend the characterization of the proposed naturalistic experimental model of piglets born with hypoxia by assessing the relationship between birth weight, intra partum asphyxia and gross indicators of neurophysiological alterations in newborn piglets. Three groups of 50 piglets each were classified according to their birth weight into normal (1000-1350 g), low (below 1000 g), and high (over 1350 g). In comparison to piglets within normal weight, those born ...

  1. Acute kidney injury in asphyxiated neonates

    OpenAIRE

    Roy Amardiyanto; Partini Pudjiastuti Trihono; Lily Rundjan; Pusponegoro, Hardiono D.

    2013-01-01

    Background Asphyxia neonatorum may result in multiorgan dysfunction including renal involvement. There is no consensus on the determination of acute kidney injury (AKI) in neonates making establishment of the diagnosis and its management becomes difficult. The Acute Kidney Injury Network (AKIN) recommends AKI criteria based on increased serum creatinine level and reduced urine output. Objectives To identify the prevalence of AKI in asphyxiated neonates using the AKIN criteria, to compare ...

  2. Acute kidney injury in asphyxiated neonates

    OpenAIRE

    Roy Amardiyanto; Partini Pudjiastuti Trihono; Lily Rundjan; Pusponegoro, Hardiono D.

    2013-01-01

    Background Asphyxia neonatorum may result in multiorgan dysfunction including renal involvement. There is no consensus on the determination of acute kidney injury (AKI) in neonates making establishment of the diagnosis and its management becomes difficult. The Acute Kidney Injury Network (AKIN) recommends AKI criteria based on increased serum creatinine level and reduced urine output. Objectives To identify the prevalence of AKI in asphyxiated neonates using the AKIN c...

  3. Acute kidney injury in asphyxiated neonates admitted to a tertiary neonatal unit in Sudan

    OpenAIRE

    Medani, Safaa A; Kheir, Abdelmoneim E. M.; Mohamed, Mazahir B

    2014-01-01

    Acute kidney injury (AKI) is a recognized complication of birth asphyxia. Early recognition of AKI is important in asphyxiated neonates as it helps in early intervention and appropriate management. The aim of this study was to determine the pattern of AKI in asphyxiated neonates and its relation to the grade of Hypoxic Ischemic Encephalopathy (HIE). This was a prospective hospital based study, conducted in the neonatal intensive care unit (NICU) at Gafaar Ibn Auf Children’s Specialized Hospit...

  4. tropical OCTOBER

    African Journals Online (AJOL)

    USER

    Key Words:Asphyxia, Low Birth Weight; Outcome; Twin Pregnancy [Trop J Obstet Gynaecol, 2006, 23:133-136]. Dr. Oluwafemi Kuti, Dr. ... Hyperemesis. 1. 0.70. Miscellaneous. 3. 2.11. Nil. 80. 56.34. B. Intrapartum. Failure To Progress. 14. 11.47. 0. 1 PPH. 9. 7.38. PIH. 6. 4.92. Fetal distress. 2. 1.64. Cord Prolapse. 1. 0.82 nd.

  5. Does Maturity Affect Cephalic Perfusion and T/QRS Ratio during Prolonged Umbilical Cord Occlusion in Fetal Sheep?

    Directory of Open Access Journals (Sweden)

    Guido Wassink

    2014-01-01

    Full Text Available T/QRS ratio monitoring is used to help identify fetal asphyxia. However, immature animals have greater capacity to maintain blood pressure during severe asphyxia, raising the possibility that they may show an attenuated T/QRS increase during asphyxia. Chronically instrumented fetal sheep at 0.6 of gestation (0.6 GA; n = 12, 0.7 GA (n = 12, and 0.8 GA (n = 8 underwent complete umbilical cord occlusion for 30 min, 25 min, or 15 min, respectively. Cord occlusion was associated with progressive metabolic acidosis and initial hypertension followed by severe hypotension, with a more rapid fall in mean arterial blood pressure (MAP and carotid blood flow (CaBF with advancing gestation. T/QRS ratio rose after occlusion more rapidly at 0.8 GA than in immature fetuses, to a similar final peak at all ages, followed by a progressive fall that was slower at 0.8 GA than in the immature fetuses. The increase in T/QRS ratio correlated with initial hypertension at 0.8 GA (P<0.05, R2 = 0.38, and conversely, its fall correlated closely with falling MAP in all gestational groups (P<0.01, R2 = 0.67. In conclusion, elevation of the T/QRS ratio is an index of onset of severe asphyxia in the last third of gestation, but not of fetal compromise.

  6. Does ST analysis have a place in electronic fetal monitoring?

    Science.gov (United States)

    Turnbull, Tamara L; Mol, Ben Willem J; Matthews, Geoff; Wilkinson, Chris; Chandraharan, Edwin; Kuah, Sabrina

    2017-03-01

    Intrapartum cardiotocography (CTG) has a high false-positive rate. This has contributed to the rapid increase in obstetric interventions without a strong improvement in perinatal outcomes. We explore the role of ST analysis (STAN®) as an adjunct to CTG in identifying fetal asphyxia during labor. We conclude that STAN® reduces the rate of fetal blood sampling and instrumental vaginal deliveries, and has the potential to reduce the number of Australian operative interventions without compromising neonatal outcome.

  7. Morbidity and mortality patterns of admissions into the special care ...

    African Journals Online (AJOL)

    The four leading causes of admissions were low birth weight (LBW) 32.7%, neonatal sepsis (NNS) 19.1%, severe birth asphyxia (SBA) 12.7%, and neonatal jaundice (NNJ) 8.7%. Eighty one (37.9%) of the LBW were term and small for gestational (SGA), while 133 (62.1%) were preterm. Of the 87 (13.3%) deaths recorded ...

  8. Effect of Different Modes of Delivery on Cord Blood Oxidative Stress Markers

    OpenAIRE

    Adekanle, Daniel Adebode; OPARINDE, Dolapo Pius; ATIBA, Adeniran Samuel; AKINTAYO, Akinyemi Akinsoji

    2013-01-01

    Background: Normal pregnancy has been associated with oxidative stress injury. Oxidative stress has been linked with poor perinatal outcome and birth asphyxia. The severity of this oxidative stress in newborn may be related to stress of different modes of delivery. Methods: Eighty seven newborn babies were recruited in both labour ward and operating theatre of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Fourty one of them was delivered via spontaneous vertex d...

  9. Peningkatan Kompetensi Manajemen Asfiksia Bayi Baru Lahir Melalui Metode Cooperative-Learning

    OpenAIRE

    Kusuma, Reni M.; Anwar, Anita D.; Prasetyo, Dwi

    2017-01-01

    Background: The competence of asphyxia management on newborn baby is essential for midwife. The quality of learning process should be improved by applying interactive learning method. The cooperative learning method is often applied to enhance the effectiveness of clinical learning process. The purpose of this research was to analyze the influence of cooperative learning on competence which consists of student’s knowledge, attitude, and skill in comparison to teacher-centered learning method....

  10. Recurrence risk of low Apgar score among term singletons: a population-based cohort study.

    Science.gov (United States)

    Ensing, Sabine; Schaaf, Jelle M; Abu-Hanna, Ameen; Mol, Ben W J; Ravelli, Anita C J

    2014-09-01

    To examine the risk of recurrence of low Apgar score in a subsequent term singleton pregnancy. Population-based cohort study. The Netherlands. A total of 190,725 women with two subsequent singleton term live births between 1999 and 2007. We calculated the recurrence risk of low Apgar score after adjustment for possible confounders. Women with an elective cesarean delivery, fetus in breech presentation or a fetus with congenital anomalies were excluded. Results were reported separately for women with a vaginal delivery or a cesarean delivery at first pregnancy. Prevalence of birth asphyxia, a 5-min Apgar score Apgar score of Apgar score in the subsequent pregnancy was 1.1% (odds ratio 2.1, 95% confidence interval 1.4-3.3). This recurrence risk was present in women with a previous vaginal delivery (odds ratio 2.1, 95% confidence interval 1.2-3.5) and in women with a previous cesarean delivery (odds ratio 3.8, 95% confidence interval 1.7-8.5). Among women with a small-for-gestational-age infant in the subsequent pregnancy and a previous vaginal delivery, the recurrence risk was 4.8% (adjusted odds ratio 5.8, 95% confidence interval 2.0-16.5). Women with birth asphyxia of the first born have twice the risk of renewed asphyxia at the next birth compared to women without birth asphyxia of the first born. This should be incorporated in the risk assessment of pregnant women. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. 6) 新生児集中管理の立場から(シンポジウム 各科領域におけるIntensive Care, 第418回新潟医学会)

    OpenAIRE

    吉沢, 浩志; Yoshizawa, Hiroshi

    1987-01-01

    Technical advances and improvements in ohstetrics and neonatal care have been mainly responsible for the improved survival of high-rigk neonates and for the accompanying improvement in the quality of the survivors. The incidence of high-risk neonates who require intensive care is approximately 2~3% of all newborns. The conditions requiring neonatal intensive care are as follows; low birth weight(less than 1,500g), respiratory disorder from any cause(RDS, MAS, birth asphyxia etc), infections, ...

  12. Intravascular "mulberry-like" bodies

    DEFF Research Database (Denmark)

    Sørensen, Flemming Brandt; Klebe, J G; Henriques, U V

    1988-01-01

    Intravascular "mulberry-like" bodies in a stillborn female infant with moderate maceration are reported. The histogenesis of these structures is discussed based on light-microscopic, immunohistochemical and ultrastructural findings. No demonstrable causal relation between the intravascular lesions...... and fetal death was found, the cause of death being attributed to intrauterine asphyxia. It is concluded, that intravascular "mulberry-bodies" most likely represent artifacts due to red blood cell autolysis....

  13. Autoerotic death due to electrocution

    Directory of Open Access Journals (Sweden)

    Piotr Arkuszewski

    2014-08-01

    Full Text Available Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area.

  14. Pattern and determinants of newborn apnea in an under-resourced ...

    African Journals Online (AJOL)

    2011-03-06

    Mar 6, 2011 ... 42.3%), severe anemia (29; 37.2%), asphyxia (25; 28.2%), hypoglycemia (23; 29.5%), seizures (21; 26.9%), sepsis (15;. 19.2%), kernicterus (10; 12.8%) and tetanus (2; 2.6%). Some of the babies had multiple etiologies. Table 1: Distribution of babies according to the age at the onset of apnea. Age (Hours).

  15. PAEDIATRIC OPHTHALMLOGY

    African Journals Online (AJOL)

    2016-11-04

    Nov 4, 2016 ... 3 (8.1). NLP. 5 (13.5). CSM. 24 (64.9). Total. 37 (100). Discussion/Conclusion: Similar to other studies, Spastic cerebral palsy is the common type[2] while birth asphyxia was the most common risk factor. Only 4 (10.8%) of subjects has history of prematurity despite the fact that increased prevalence has been ...

  16. USSR Report: Life Sciences, Biomedical and Behavioral Sciences, No. 40

    Science.gov (United States)

    1983-09-02

    periodicals and books, but also from news agency transmissions and broad- casts „ Materials from foreign-language sources are translated; those from English...are not subject to age-related variability. Evidently, they are a manifestation of epigenetic polymorphism and can be used for the study of...hemolytic disease, birth trauma and asphyxia has dropped. Some advances have been made in lowering child morbidity referable to acute droplet and

  17. Xenon and Sevoflurane Provide Analgesia during Labor and Fetal Brain Protection in a Perinatal Rat Model of Hypoxia-Ischemia

    Science.gov (United States)

    Yang, Ting; Zhuang, Lei; Rei Fidalgo, António M.; Petrides, Evgenia; Terrando, Niccolo; Wu, Xinmin; Sanders, Robert D.; Robertson, Nicola J.; Johnson, Mark R.; Maze, Mervyn; Ma, Daqing

    2012-01-01

    It is not possible to identify all pregnancies at risk of neonatal hypoxic-ischemic encephalopathy (HIE). Many women use some form of analgesia during childbirth and some anesthetic agents have been shown to be neuroprotective when used as analgesics at subanesthetic concentrations. In this study we sought to understand the effects of two anesthetic agents with presumptive analgesic activity and known preconditioning-neuroprotective properties (sevoflurane or xenon), in reducing hypoxia-induced brain damage in a model of intrauterine perinatal asphyxia. The analgesic and neuroprotective effects at subanesthetic levels of sevoflurane (0.35%) or xenon (35%) were tested in a rat model of intrauterine perinatal asphyxia. Analgesic effects were measured by assessing maternal behavior and spinal cord dorsal horn neuronal activation using c-Fos. In separate experiments, intrauterine fetal asphyxia was induced four hours after gas exposure; on post-insult day 3 apoptotic cell death was measured by caspase-3 immunostaining in hippocampal neurons and correlated with the number of viable neurons on postnatal day (PND) 7. A separate cohort of pups was nurtured by a surrogate mother for 50 days when cognitive testing with Morris water maze was performed. Both anesthetic agents provided analgesia as reflected by a reduction in the number of stretching movements and decreased c-Fos expression in the dorsal horn of the spinal cord. Both agents also reduced the number of caspase-3 positive (apoptotic) neurons and increased cell viability in the hippocampus at PND7. These acute histological changes were mirrored by improved cognitive function measured remotely after birth on PND 50 compared to control group. Subanesthetic doses of sevoflurane or xenon provided both analgesia and neuroprotection in this model of intrauterine perinatal asphyxia. These data suggest that anesthetic agents with neuroprotective properties may be effective in preventing HIE and should be tested in clinical

  18. MRI and US findings of subcutaneous fat necrosis of the newborn

    Energy Technology Data Exchange (ETDEWEB)

    Vasireddy, Syam; Long, Scott D. [Southern Illinois University, Department of Radiology, Springfield, IL (United States); St. John' s Hospital, Department of Radiology, Springfield, IL (United States); Sacheti, Bhavna [Medical College of Wisconsin, Department of Pediatric Critical Care, Milwaukee, WI (United States); Children' s Hospital Wisconsin, Department of Critical Care, Milwaukee, WI (United States); Mayforth, Ruth D. [Southern Illinois University, Department of Surgery, Springfield, IL (United States); St. John' s Hospital, Department of Surgery, Springfield, IL (United States)

    2009-01-15

    Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, benign disorder found in full-term or post-mature neonates. It usually presents in neonates who have experienced perinatal difficulty such as asphyxia, peripheral hypoxemia, hypothermia, meconium aspiration or trauma. We present a newborn with abnormal findings on MRI and US within the axilla, neck, and abdominal walls that were pathologically proved via biopsy to be subcutaneous fat necrosis. (orig.)

  19. Translational Approaches for Studying Neurodevelopmental Disorders Utilizing in Vivo Proton (+H) Magnetic Resonance Spectroscopic Imaging in Rats

    Science.gov (United States)

    Ronca, April E.

    2014-01-01

    Intrauterine complications have been implicated in the etiology of neuripsychiatric disorders including schizophrenia, autism and ADHD. This presentation will describe new translational studies derived from in vivo magnetic resonance imaging of developing and adult brain following perinatal asphyxia (PA). Our findings reveal significant effects of PA on neurometabolic profiles at one week of age, and significant relationships between early metabolites and later life phenotypes including behavior and brain morphometry

  20. Intramuscular Injection of “Site Enhancement Oil”

    DEFF Research Database (Denmark)

    Petersen, Maria Louise; Colville-Ebeling, Bonnie; Jensen, Thomas Hartvig Lindkær

    2015-01-01

    The use of intramuscular injection of foreign substances for aesthetic purposes is well known. Complications are usually local to the site of injection but can be potentially lethal. Here, we present a case of "site enhancement oil" use in a 42-year-old man who died from asphyxia due to hanging....... Macroscopic and microscopic changes as well as computed tomographic changes in injected musculature are described and the potentially lethal adverse effects after site enhancement oil use are warranted....

  1. Clinical Spectrum, Comorbidities, and Risk Factor Profile of Cerebral Palsy Children: A Prospective Study.

    Science.gov (United States)

    Minocha, Priyanka; Sitaraman, Sadasivan; Sachdeva, Pallavi

    2017-01-01

    Cerebral palsy (CP) is the most common motor disability in childhood. This study aimed to describe clinical spectrum, comorbidities, and risk factors associated with CP children. This hospital-based observational study was conducted in tertiary level hospital in Jaipur including 180 CP children aged 1-12 years, attending the Paediatric Neurology Outdoor and Child Development Centre. A detailed history of antenatal, natal, and postnatal events taken and thorough examination was performed to stratify children in proper topographical and physiological classification. Mothers of 47.7% CP children were primigravida and 17.7% mothers had anemia during pregnancy. Among natal factors, asphyxia contributed to maximum cases (52.2%). Seizure in postnatal life was the second most common risk factor for CP after asphyxia. Spastic CP (84.4%) was the most common physiological type, and quadriplegia (56.6%) was the most common topographical type observed in this study. Intellectual disability (47.7%) followed by epilepsy (41.6%) was the most common comorbidity. Even with the advancement of health-care system, asphyxia is the most common risk factor, and spastic quadriplegia is the most common type of CP. There is still a need of improving the health facilities to overcome this costly and common neuromotor disability. Widespread knowledge of common risk factors that can predispose to CP can prevent the CP development to some extent and knowledge of clinical spectrum, and comorbidities can improve their targeted treatment which can improve their growth and social participation.

  2. FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

    Directory of Open Access Journals (Sweden)

    Lakshmi

    2015-03-01

    Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

  3. Death of a seven-month-old child in a washing machine: a case report.

    Science.gov (United States)

    Osculati, Antonio; Visonà, Silvia Damiana; Re, Laura; Sozzi, Marta; Castelli, Francesca; Andrello, Luisa; Vignali, Claudia

    2017-05-01

    The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby's mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby's mother, after a psychiatric examination, was confirmed to be suffering from a mental illness-a severe depressive disorder-and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

  4. How an extended perinatal audit may improve perinatal policy.

    Science.gov (United States)

    Dehaene, Isabelle; Roelens, Kristien; Page, Geert

    2014-09-29

    Abstract Objective: A perinatal audit has the intention of quality of care improvement based on analysis of perinatal death, with our without analysis of maternal morbidity and/or mortality. Additional analysis of cases of intrapartum asphyxia could provide more insight into ways to improve quality of perinatal care. Methods: Analysis of cases of perinatal death and asphyxia in Jan Yperman Hospital, Ieper, Belgium, in 2012. Results: Three perinatal deaths occurred, none were preventable. Nineteen cases of proven metabolic acidosis have been identified. Three cases are considered possibly preventable, four cases are considered preventable. In three (possibly) preventable cases, foetal monitoring was absent during the active second stage of labour. In two preventable cases, intervention following a significant ST event in the second stage of labour was delayed. In one case intervention was delayed in the first stage of labour, while in another, indicated operative delivery in the second stage was not conducted. Conclusions: Integrating intrapartum asphyxia in the perinatal audit gives an opportunity to identify and eliminate weak points in the perinatal care chain, thereby optimizing quality of care. Lessons learned from our internal audit are the value of foetal monitoring and adequate action on significant ST events during second stage of labour.

  5. Childhood Mortality in Federal Medical Centre Umuahia, South Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Nwafor Chukwuemeka Charles

    2014-09-01

    Full Text Available Objective: This study aimed to evaluate the mortality pattern in children seen at Federal Medical Centre Umuahia (FMCU Abia state, South Eastern Nigeria. Methods: A retrospective cross sectional descriptive study over a 5-year period from January 1, 2004 to December 31, 2008 using data retrieved from the hospital’s medical records department. Results: A total of 3,814 children were admitted in the hospital and 434 of them died giving a mortality rate of 11%. The mean age was 1.7 (Std D of 3.19. Two hundred and thirty eight of them were males while 196 of them were females giving a sex ratio of 1.2:1. Majority of the mortality (49% occurred within 24 hours of admission. The major causes of death during neonatal period were birth asphyxia (34%, prematurity (24% and neonatal sepsis (24%. Malaria was the leading cause of death beyond the neonatal period accounting for 42% of cases. Other common mortality causes were pneumonia, septicaemia, diarrhea, HIV AIDS and meningitis each accounting for 10%, 10%, 7%, 7% and 5% respectively. The months of July, May and March accounted for most deaths (12%, 12% and 11% respectively. Conclusion: Birth asphyxia and malaria associated deaths were responsible for most deaths during neonatal and beyond neonatal periods respectively. Presence of trained personal at all deliveries will help to reduce neonatal asphyxia. Efforts should be made to reinforce the existing effective malaria control tools.

  6. Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease

    Science.gov (United States)

    Gabbrielli, Mario; Gualtieri, Giacomo; Ferretti, Fabio; Pozza, Andrea; Fagiolini, Andrea

    2016-01-01

    DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury. PMID:27747123

  7. Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal.

    Science.gov (United States)

    Domingues, Ana Patrícia Rodrigues; Belo, Adriana; Moura, Paulo; Vieira, Duarte Nuno

    2015-05-01

    It was to analyse the most critical areas in Obstetrics and to suggest measures to reduce or avoid the situations most often involved in these disputes. Obstetrics cases submitted to the Medico-legal Council since the creation of the National Institute of Legal Medicine and Forensic Sciences in 2001 until 2011 were evaluated. A comprehensive characterization, determination of absolute/relative frequencies, hypothesis of a linear trend over the years and the association between each parameter was done. The analysis has shown no significantly linear trend. The most common reasons for disputes were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). Perinatal asphyxia showed no significantly linear trend (p=0.58) and was usually related to perinatal deaths or permanent neurologic sequelae in newborn children. Traumatic injuries of the newborn, mostly related to instrumented deliveries, shoulder dystocia or vaginal delivery in breech presentation, has shown a significantly increased linear trend (p<0.001), especially related to instrumented deliveries. The delay/absence of cesarean section was the clinical procedure questioned in a significantly higher number of cases of perinatal asphyxia (68.7%) and of traumatic lesions of the newborn due to instrumented deliveries (20.5%). It is important to improve and correct theoretical/practical daily clinical performance in these highlighted areas, in order to reduce or even avoid situations that could end up in medico-legal litigations.

  8. Retrospective Evaluation of a National Guideline to Prevent Neonatal Hypoglycemia

    DEFF Research Database (Denmark)

    Rasmussen, Annett Helleskov; Wehberg, Sonja; Fenger-Groen, Jesper

    2017-01-01

    guideline. Of these, 1900 had World Health Organization International Classification of Diseases 10 discharge diagnoses of hypoglycemia. Diagnoses indicating hypoglycemia risk [small/large for gestational age (SGA/LGA), asphyxia, prematurity, maternal insulin-treated diabetes mellitus] were recorded....... Neonatal ward files were evaluated to validate hypoglycemia diagnoses. Adjusted odds ratios (aORs) were calculated, adjusting for sex, parity, SGA, LGA, preterm birth, and asphyxia, where relevant. Results: Primiparity and male sex were associated independently with hypoglycemia diagnosis [aORs, 1.29 (1......, the hypoglycemia incidence decreased from 30.5% to 18.6% [aOR 0.52 (0.36-0.75)] among SGA neonates, from 25.8% to 16.4% [aOR 0.57 (0.42-0.76)] among preterm infants, and from 27.4% to 16.6% [aOR 0.63 (0.34-0.83)] among those with asphyxia. LGA neonates showed a decreased incidence in obstetric wards only...

  9. Abnormalities of breathing control and airway maintenance in infants and children as a cause of cor pulmonale.

    Science.gov (United States)

    Hunt, C E; Brouillette, R T

    1982-01-01

    Respiratory control abnormalities may result in cor pulmonale. This report summarizes the clinical history, diagnostic evaluation, treatment, and outcome of 16 infants and children presenting with cor pulmonale subsequently found to be due to sleep-dependent hypoventilation. Eleven patients had cardiomegaly and electrocardiographic evidence of right ventricular hypertrophy (RVH) while 5 had only severe RVH or biventricular hypertrophy (BVH). Four infants with central hypoventilation syndrome (CHS)--absence of sleep-related ventilatory drive--had severe sleep-dependent asphyxia and resultant acute respiratory failure; all were ultimately treated with phrenic nerve pacing. One patient with alveolar hypoventilation syndrome (AHS)--a partial deficit in ventilatory drive during sleep--presented with severe pulmonary hypertension and ultimately died despite symptomatic relief with respiratory stimulants. Eleven patients presented with obstructive sleep apnea (OSA) and sleep-dependent asphyxia secondary to intermittent complete or to prolonged partial upper airway obstruction. Localized airway obstruction due to an anomalous innominate artery in 1 child was corrected by arteriopexy. Four children underwent adenotonsillectomy (T&A) with disappearance of symptoms in 1, clinical improvement in 2 and no clinical improvement in another. This unimproved patient and the 6 remaining OSA children improved dramatically after tracheostomy to bypass the sleep-dependent airway obstruction; none presently has evidence of cor pulmonale. In summary, early recognition and appropriate treatment of respiratory control disorders will improve sleep ventilation, eliminate asphyxia during sleep, and prevent the development of cor pulmonale.

  10. Comprehensive Histological and Immunochemical Forensic Studies in Deaths Occurring in Custody

    Directory of Open Access Journals (Sweden)

    Kenneth Nugent

    2017-01-01

    Full Text Available In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.

  11. Neonatal complications of postterm gestation.

    Science.gov (United States)

    Mannino, F

    1988-03-01

    Postterm gestation infants represent about 10% of the newborn population and, as compared to term gestation infants, have an increased incidence of perinatal and neonatal problems. Most postterm infants are normal appearing, although changes in the skin and a loss of subcutaneous fat occur in some. A smaller number experience the onset of fetal wasting late in gestation and appear dysmature (postmature) at birth. The incidence of infants with dysmaturity increases as postterm gestation continues; however, the prevalence of dysmaturity is greater in term infants. The most significant neonatal problems in the postterm gestation infant are the result of fetal distress and perinatal asphyxia. Those infants affected most severely may have hypoxic encephalopathy, seizures and meconium aspiration syndrome. Other problems are birth trauma (due to the large size of some postterm infants) and polycythemia. Anencephaly is associated with postterm gestation. The later intellectual development of postterm gestation infants appears normal except for those with perinatal asphyxia or severe neonatal problems. The long-term somatic growth is normal, even in dysmature-appearing infants. Postterm infants are at increased risk for perinatal asphyxia; however, with careful obstetric management, most neonatal problems can be prevented.

  12. A policy of routine umbilical cord blood gas analysis decreased missing samples from high-risk births.

    Science.gov (United States)

    Ahlberg, M; Elvander, C; Johansson, S; Cnattingius, S; Stephansson, O

    2017-01-01

    This study compared obstetric units practicing routine or selective umbilical cord blood gas analysis, with respect to the risk of missing samples in high-risk deliveries and in infants with birth asphyxia. This was a Swedish population-based cohort study that used register data for 155 235 deliveries of live singleton infants between 2008 and 2014. Risk ratios and 95% confidence intervals were calculated to estimate the association between routine and selective umbilical cord blood gas sampling strategies and the risk of missing samples. Selective sampling increased the risk ratios when routine sampling was used as the reference, with a value of 1.0, and these were significant in high-risk deliveries and birth asphyxia. The risk ratios for selective sampling were large-for-gestational age (9.07), preterm delivery at up to 36 weeks of gestation (8.24), small-for-gestational age (7.94), two or more foetal scalp blood samples (5.96), an Apgar score of less than seven at one minute (2.36), emergency Caesarean section (1.67) and instrumental vaginal delivery (1.24). Compared with routine sampling, selective umbilical cord blood gas sampling significantly increased the risks of missing samples in high-risk deliveries and in infants with birth asphyxia. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  13. Neurological abnormalities in full-term asphyxiated newborns and salivary S100B testing: the "Cooperative Multitask against Brain Injury of Neonates" (CoMBINe) international study.

    Science.gov (United States)

    Gazzolo, Diego; Pluchinotta, Francesca; Bashir, Moataza; Aboulgar, Hanna; Said, Hala Mufeed; Iman, Iskander; Ivani, Giorgio; Conio, Alessandra; Tina, Lucia Gabriella; Nigro, Francesco; Li Volti, Giovanni; Galvano, Fabio; Michetti, Fabrizio; Di Iorio, Romolo; Marinoni, Emanuela; Zimmermann, Luc J; Gavilanes, Antonio D W; Vles, Hans J S; Kornacka, Maria; Gruszfeld, Darek; Frulio, Rosanna; Sacchi, Renata; Ciotti, Sabina; Risso, Francesco M; Sannia, Andrea; Florio, Pasquale

    2015-01-01

    Perinatal asphyxia (PA) is a leading cause of mortality and morbidity in newborns: its prognosis depends both on the severity of the asphyxia and on the immediate resuscitation to restore oxygen supply and blood circulation. Therefore, we investigated whether measurement of S100B, a consolidated marker of brain injury, in salivary fluid of PA newborns may constitute a useful tool for the early detection of asphyxia-related brain injury. We conducted a cross-sectional study in 292 full-term newborns admitted to our NICUs, of whom 48 suffered PA and 244 healthy controls admitted at our NICUs. Saliva S100B levels measurement longitudinally after birth; routine laboratory variables, neurological patterns, cerebral ultrasound and, magnetic resonance imaging were performed. The primary end-point was the presence of neurological abnormalities at 12-months after birth. S100B salivary levels were significantly (P3.25 MoM S100B achieved a sensitivity of 100% (CI5-95%: 89.3%-100%) and a specificity of 100% (CI5-95%: 98.6%-100%) as a single marker for predicting the occurrence of abnormal neurological outcome (area under the ROC curve: 1.000; CI5-95%: 0.987-1.0). S100B protein measurement in saliva, soon after birth, is a useful tool to identify which asphyxiated infants are at risk of neurological sequelae.

  14. Neurological abnormalities in full-term asphyxiated newborns and salivary S100B testing: the "Cooperative Multitask against Brain Injury of Neonates" (CoMBINe international study.

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    Diego Gazzolo

    Full Text Available Perinatal asphyxia (PA is a leading cause of mortality and morbidity in newborns: its prognosis depends both on the severity of the asphyxia and on the immediate resuscitation to restore oxygen supply and blood circulation. Therefore, we investigated whether measurement of S100B, a consolidated marker of brain injury, in salivary fluid of PA newborns may constitute a useful tool for the early detection of asphyxia-related brain injury.We conducted a cross-sectional study in 292 full-term newborns admitted to our NICUs, of whom 48 suffered PA and 244 healthy controls admitted at our NICUs. Saliva S100B levels measurement longitudinally after birth; routine laboratory variables, neurological patterns, cerebral ultrasound and, magnetic resonance imaging were performed. The primary end-point was the presence of neurological abnormalities at 12-months after birth.S100B salivary levels were significantly (P3.25 MoM S100B achieved a sensitivity of 100% (CI5-95%: 89.3%-100% and a specificity of 100% (CI5-95%: 98.6%-100% as a single marker for predicting the occurrence of abnormal neurological outcome (area under the ROC curve: 1.000; CI5-95%: 0.987-1.0.S100B protein measurement in saliva, soon after birth, is a useful tool to identify which asphyxiated infants are at risk of neurological sequelae.

  15. Quality of Care during Neonatal Resuscitation in Kakamega County General Hospital, Kenya: A Direct Observation Study

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    Duncan N. Shikuku

    2017-01-01

    Full Text Available Background. Birth asphyxia is the leading cause of neonatal mortality in Kenya. Quality care during neonatal resuscitation (NR can contribute to a reduction in neonatal mortality related to birth asphyxia by 30 percent. This study assessed the quality of care (QoC during NR for newborns with birth asphyxia. Methods. Direct observations of 138 newborn resuscitations were done in labor ward and maternity theatre. Twenty-eight healthcare providers were observed 3–5 times using a structured checklist. Descriptive and inferential statistics were calculated and quality of care scores computed. Ordered logistic regression model identified HCPs characteristics associated with the QoC scores during NR. Results. Overall QoC scores were good for airway clearance (83%. Suctioning in meconium presence (40% was poorly performed. Years of experience working in maternity were associated with good drying/stimulation (β = 1.86, P=0.003, CI = 0.626–3.093 and airway maintenance (β = 1.887, P=0.009, CI = 0.469–3.305; nurses were poor compared to doctors during initial bag and mask ventilation (β = −2.338, P=0.05, CI = −4.732–0.056. Conclusion. Key steps in NR are poorly performed during drying and warmth, airway maintenance in meconium presence, and ventilation. Mentorship with periodic refresher training can improve the care provided during NR.

  16. Could intra-alveolar hemosiderin deposition in adults be used as a marker for previous asphyxial episodes in cases of autoerotic death?

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    Byard, Roger W; Masoumi, Homeyra; Haas, Elizabeth; Sage, Martin; Krous, Henry F

    2011-05-01

    Intra-alveolar hemorrhage and hemosiderin have been cited as possible markers of recent and remote asphyxial events. Little study has been undertaken of the potential significance of intra-alveolar hemosiderin in adults as a potential marker of previous sublethal asphyxial episodes. Ten cases of lethal sexual asphyxia (an entity known to be associated with repetitive sublethal asphyxial episodes) and 20 randomly selected, age- and sex-matched controls had sections of lung stained for hemosiderin. Subsequently, intra-alveolar, iron-containing macrophages were counted. All cases were men (ages 15-50 years; mean 31.8). No significant increase in hemosiderin was found in victims of sexual asphyxia, indicating that asphyxial episodes in sublethal sexual asphyxial activities may not be sufficiently intense or prolonged to cause intra-alveolar hemorrhage or that intra-alveolar hemorrhage in adults is a relatively nonspecific finding. These results do not support intra-alveolar hemosiderin deposition as a marker for previous sublethal asphyxial events in autoerotic asphyxia. © 2011 American Academy of Forensic Sciences.

  17. In Vitro Research of the Alteration of Neurons in Vagal Core in Medulla Oblongata at Asphyxic Deaths

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    Naim Haliti

    2010-08-01

    Full Text Available The aim of this study was to research the morphological changes of neurons in the vagus nerve nuclei in medulla oblongata in asphyxia related death cases. Morphological changes that were investigated were mainly in the dorsal motor respiratory center (DMRC, nucleus tractus solitarius (nTS and nucleus ambigus (nA in the medulla oblongata. In our research, the autopsy material from asphyxia related death cases was used from various etiologies: monoxide carbon (CO, liquid drowning, strangulation, electricity, clinical-pathological death, firing weapon, explosive weapon, sharp and blunt objects and death cases due to accident. The material selected for research was taken from medulla oblongata and lungs from all lobes. The material from the medulla oblongata and lungs was fixed in a 10% solution of buffered formalin. Special histochemical methods for central nervous system (CNS were employed like: Cresyl echt violet, toluidin blue, Sevier-Munger modification and Grimelius. For stereometrical analysis of the quantitative density of the neurons the universal testing system Weibel M42 was used. The acquired results show that in sudden asphyxia related death cases, there are alterations in the nuclei of vagal nerve in form of: central chromatolysis, axonal retraction, axonal fragmentation, intranuclear vacuolization, cytoplasmic vacuolization, edema, condensation and dispersion of substance of Nissl, proliferation of oligodendrocytes, astrocytes and microglia. The altered population of vagus nerve neurons does not show an important statistica! significarne compared to the overall quantity of the neurons in the nuclei of the vagus nerve (p<0,05.

  18. Violent Asphyxial Death: A Study in Dinajpur Medical College, Dinajpur

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    Md. Mizanur Rahman

    2013-07-01

    Full Text Available Background: The word asphyxia is now commonly used to describe a range of conditions for which the lack of oxygen whether it is partial (hypoxia or complete (anoxia is considered to be the cause. The cardinal signs of asphyxia are cyanosis, congestion and petechial haemorrhage.Objective: To investigate the causes and manner of asphyxial death.Materials and Methods: It was a retrospective study conducted in the department of Forensic Medicine, Dinajpur Medical College, Dinajpur during July 2004 to June 2006. A total of 96 cases were examined and recorded. These cases were brought to the morgue of Dinajpur Medical College from 13 different police stations and 1 railway GRP station of Dinajpur district. The data were collected from the autopsy reports (preserved third copy with permission of the concerned autopsy surgeons.Results: 88.55% of asphyxia deaths were due to hanging, 6.25% due to strangulation and 5.20% were due to suffocation.Conclusion: Most of the asphyxial deaths are due to hanging.

  19. Reasons for admission and neonatal outcome in the neonatal care unit of a tertiary care hospital in Addis Ababa: a prospective study

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    Tekleab AM

    2016-03-01

    Full Text Available Atnafu Mekonnen Tekleab,1 Gesit Metaferia Amaru,1 Yemisrach Abeje Tefera21Department of Pediatrics and Child Health, 2Department of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia Background: The neonatal mortality rate in Ethiopia remains greater than 35 per 1,000 live births. Hence, identifying the reasons for neonatal admission and mortality in a hospital setting is crucial to improve the quality of existing practices in the hospital. The objective of this study was to describe the reasons for admission and the magnitude of neonatal mortality in the neonatal care unit of St Paul's Hospital Millennium Medical College. Methods and subjects: A prospective cohort study was conducted. A total of 216 neonates who were admitted to the neonatal care unit of St Paul's Hospital Millennium Medical College from March 1, 2015, to May 31, 2015, were included in this study. Data fields, determined prospectively, were collected by monitoring the neonates until discharge or death. The independent variables were demographic, obstetric, and clinical characteristics, while the dependent variable was neonatal mortality. Data were analyzed using simple frequencies, odds ratio, and finally binary logistic regression analysis for mortality outcome. Results: The most common primary diagnoses at admission to the neonatal care unit were prematurity with respiratory problem (36.6%, neonatal sepsis (22.7%, and asphyxia (16.2%. Out of the 216 neonates studied, 50 (23.2% died. High case fatality was observed among neonates with the diagnosis of prematurity with respiratory problem (40.5% and asphyxia (40.0%. Under multivariate analysis, diagnosis of asphyxia was an independent predictor of mortality (adjusted odds ratio =5.817; 95% confidence interval: 1.611–20.977, while gestational age above the mean of the study population (36.6 weeks was protective of mortality (adjusted odds ratio =0.683; 95% confidence interval: 0.588–0

  20. Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

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    Mukesh Choudhary

    2015-01-01

    Full Text Available Objective This study was performed to determine the occurrence of hypoxic hepatitis in full-term neonates after perinatal asphyxia and to correlate between the rise in enzymes and severity of asphyxia with Apgar score and hypoxic ischemic encephalopathy (HIE grading of the neonates. Method and Material This prospective case-controlled study was conducted in a tertiary-level hospital in India for a period of 12 months. The study group A comprised 70 newborns suffering from birth asphyxia, while 30 healthy neonates were included in group B (control. All biochemical parameters of liver function, ie, serum alanine transferase (ALT, aspartate transferase (AST, alkaline phosphatase (ALP, lactate dehydrogenase (LDH, total protein, serum albumin, bilirubin (total and direct, and international normalized ratio (INR, were measured on postnatal days 1, 3, and 10 in both study and control groups. Results In group A, 22.8% newborns had severe (Apgar score 0–3, 47.1% had moderate (Apgar score 4–5, and 30% had mild (Apgar score 6–7 birth asphyxia at five minutes. In all, 14.28% babies were in HIE stage I, 25.73% babies were in HIE stage II, and 11.42% babies were in HIE stage III. The rest of the newborns, 48.57%, were normal. The prevalence of liver function impairment was seen in 42.85% of asphyxiated neonates. On day 1, ALT, AST, ALP, LDH, PT, and INR were significantly higher, and total protein and serum albumin were significantly lower in group A than in group B. However, ALT and AST correlated well with increasing severity of HIE score. On day 3, there was a rising trend observed in the concentration of mean LDH as HIE staging of neonates progressed from stage 0 to stage III, and among various HIE stages, the difference in LDH was statistically significant. Conclusion We concluded that AST, ALT at 24 hours, and LDH at 72 hours of animation can be a utilitarian diagnostic tool to differentiate asphyxiated neonates from non-asphyxiated neonates and

  1. Hubungan Preeklamsi Berat dengan Hasil Luaran Janin (Fetal Outcome di RSUD Al-Ihsan Kabupaten Bandung

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    Dave Orlando Gumay

    2015-09-01

    Full Text Available Abstrak Preeklamsi merupakan salah satu penyebab morbiditas dan mortalitas pada ibu dan neonatus. Beberapa keadaan hasil luaran janin pada ibu preeklamsi di antaranya small for gestasional age (SGA, asifiksia, prematuritas, dan stillbirth. Penelitian ini bertujuan menganalisis hubungan preeklamsi berat dengan hasil luaran janin (fetal outcome di RSUD Al-Ihsan Kabupaten Bandung periode 1 Januari 2012–31 Maret 2014. Penelitian menggunakan metode rancangan deskriptif analitik dengan pendekatan cross-sectional. Penentuan jumlah subjek penelitian didapatkan dari jumlah populasi sebanyak 137 orang. Analisis statistik dilakukan secara bivariat dengan menggunakan metode chi-kuadrat derajat kepercayaan 95%. Hasil penelitian ini didapatkan hasil luaran janin dari ibu preeklamsi berat sebesar 33 kasus (24,1% SGA, 73 kasus (53,3% asfiksia ringan-sedang dan 13 kasus (9,5% asfiksia berat pada APGAR menit pertama, 18 kasus (13,1% lahir prematur, serta 1 kasus (0,7% stillbirth. Terdapat hubungan preeklamsi berat dengan SGA (p=0,001; PR=6,928; 95% IK=2,797–17,162, asfiksia ringan-sedang APGAR 1 menit (p=0,001; PR=2,483; 95% IK=1,504–4,100, asfiksia berat APGAR 1 menit (p=0,001; PR=7,222; 95% IK=1,963–26,567, prematuritas (p=0,010; PR=3,303; 95% IK=1,269–8,597. Simpulan, terdapat hubungan preeklamsi berat dengan variabel hasil luaran janin yakni SGA, asfiksia ringan-sedang dan berat APGAR 1 menit, serta prematuritas. Kata kunci: Hasil luaran janin, preeklamsi berat   The Correlation between Severe Preeclampsia and Fetal Outcomes in RSUD Al-Ihsan Bandung Abstract Preeclampsia is one of the causes of maternal-neonates morbidity and mortality. Several conditions of fetal outcomes in women with preeclampsia including small for gestasional age (SGA, asphyxia, prematurity and stillbirth. This study aims was to analyze the relationship between severe preeclampsia with fetal outcome in Al-Ihsan Hospital Bandung District period 1 January 2012−31 March 2014

  2. Non-avalanche-related snow immersion deaths: tree well and deep snow immersion asphyxiation.

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    Van Tilburg, Christopher

    2010-09-01

    Non-avalanche-related snow immersion death (NARSID), or snow immersion asphyxiation, is a significant winter mountain hazard for skiers and snowboarders. This phenomenon occurs predominately in western North America, where large tree wells and deep snowpacks develop. Although statistics are difficult to procure, snow immersion asphyxiation has resulted in more than 70 documented deaths in the past 2 decades. The primary purpose of this review is to examine the existing literature on NARSID to help prevent such dangerous accidents through educating wilderness medicine professionals and fostering public awareness. The exact duration of burial to time of death and the cause of death are not precisely known but can be postulated from accident reports, experimental snow burial studies, and avalanche literature. In most cases, death probably occurs within 15 to 30 minutes from the time of burial. However, survival after prolonged burial in a tree well and deep snow is possible. The cause of death is asphyxiation, probably due to one of the mechanisms that produce asphyxia in avalanche burial victims: positional asphyxia, airway obstruction, or carbon dioxide displacement asphyxia. Prevention of snow immersion asphyxiation begins with skiers and snowboarders staying within the limits of their skills, using the proper tools for deep powder, staying in control at all times, and employing a buddy system. A skier or snowboarder who falls near or into a tree well should tuck, roll, and try to land upright, grab the tree trunk or a branch, and yell or blow a whistle to alert partners. If buried upside down, the person should stay calm and create an air pocket, which is probably of paramount importance. Skiers and snowboarders should use avalanche safety equipment to lessen the risk of snow submersion asphyxiation. Copyright 2010 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  3. Risk factors for cerebral palsy.

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    Suvanand, S; Kapoor, S K; Reddaiah, V P; Singh, U; Sundaram, K R

    1997-01-01

    Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.

  4. A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival.

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    Morgan, Ryan W; Kilbaugh, Todd J; Shoap, Wesley; Bratinov, George; Lin, Yuxi; Hsieh, Ting-Chang; Nadkarni, Vinay M; Berg, Robert A; Sutton, Robert M

    2017-02-01

    Most pediatric in-hospital cardiac arrests (IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR. After 7min of asphyxia followed by VF, 4-week-old piglets received either hemodynamic-directed CPR (HD-CPR; compression depth titrated to SBP of 90mmHg and vasopressor administration to maintain CoPP ≥20mmHg); or Standard Care (compression depth 1/3 of the anterior-posterior chest diameter and epinephrine every 4min). All animals received CPR for 10min prior to the first defibrillation attempt. CPR was continued for a maximum of 20min. Protocolized intensive care was provided to all surviving animals for 4h. The primary outcome was 4-h survival. Survival rate was greater with HD-CPR (12/12) than Standard Care (6/10; p=0.03). CoPP during HD-CPR was higher compared to Standard Care (point estimate +8.1mmHg, CI95: 0.5-15.8mmHg; p=0.04). Chest compression depth was lower with HD-CPR than Standard Care (point estimate -14.0mm, CI95: -9.6 to -18.4mm; pCPR vs. Standard Care (median 5 vs. 2; pCPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Paediatricians’ perspectives on global health priorities for newborn care in a developing country: a national survey from Nigeria

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    Olusanya Bolajoko O

    2012-07-01

    Full Text Available Abstract Background An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. Methods Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with Mann-Whitney U test. Results Valid responses were received from 152 (65.8% of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. Conclusions Current global priorities for neonatal survival in Nigeria largely accord with paediatricians’ views except for neonatal jaundice which is commonly subsumed under “other“ or "miscellaneous" neonatal conditions. While the

  6. Disease profile and Outcome of Newborn admitted to Neonatology unit of BPKIHS

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    Piush Kanodia

    2015-12-01

    Full Text Available Background & Objectives: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. Every year, millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU for various indications. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit.Materials & Methods: A retrospective study was conducted at neonatology unit of BPKIHS, from January 2014 to December 2014. A total of 1009 neonates (both inborn and out-born were admitted to neonatology division during the study period. Data was collected from the hospital record section. Ethical clearance was taken from the institutional ethical committee before the initiation of the study. Data was entered and descriptive analysis was done by using SPSS 20.0.Results: Total of 1009 neonates were admitted in neonatology unit. Among them, 349(34.5% cases were admitted due neonatal sepsis, 236 (23.3% due to prematurity and 233 (23.1% with birth asphyxia. Among birth asphyxia, 102(43.7% were in HIE III, 34.3% and 21.8% in HIE II and HIE I, respectively. The overall mortality was 47 (4.7% during hospital stay.Conclusion: Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortalityJCMS Nepal. 2015;11(3:20-24.

  7. Risk Factors for Intraventricular Hemorrhage in Preterm Infants Born at 34 Weeks of Gestation or Less Following Preterm Premature Rupture of Membranes.

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    Lu, Hongyan; Wang, Qiuxia; Lu, Junyin; Zhang, Qiang; Kumar, Pravesh

    2016-04-01

    The objective of this study is to identify possible perinatal risk factors related to intraventricular hemorrhage (IVH) in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes (pPROM). A total of 292 preterm infants born at 34 weeks of gestation or less following pPROM were enrolled in the study, while 155 newborns with incomplete data, especially those that lack histological examination of the placenta, maternal details, and neonatal characteristics, have been further excluded. Finally, data of 137 preterm infants were included in the analysis. All infants underwent ultrasonographic screening for IVH. Thirty-three infants with IVH were considered as cases and 104 infants without IVH were considered as controls. The association between risk factors and IVH was evaluated by univariate and multivariate logistic regression analyses. The incidence of IVH in preterm infants born at 34 weeks of gestation or less following pPROM was 24.1%, while the incidence of maternal chorioamnionitis was 43.8%. By univariate analysis, gestational age, birth weight, asphyxia resuscitation, maternal chorioamnionitis, fetal distress, amniotic fluid index, and latency of the rupture of membranes to birth were found to be significantly different between the 2 groups. By logistic regression analysis, lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis were found to be independent risk factors for IVH. Lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis are independent risk factors for IVH in preterm infants born at 34 weeks of gestation or less following pPROM. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Features of newborns with intrauterine growth restriction (according to the data of perinatal center of the Saratov region

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    Chernenkov Yu.V.

    2017-03-01

    Full Text Available Objective: to identify risk factors that adversely affect the development of fetus and child small for gestational age; to assess the incidence of the intrauterine development of fetus and newborn; to analyze the health indicators of these children. Material and Methods. Cases of 226 children (6.6% with diagnosed intrauterine growth restriction of the fetus were examined, including 134 of prematurity (59%. Results. The most common risk factors for the intrauterine development of the fetus were: violation of the utero-placental circulation — 196 cases, the uterine scar — 78 women, urinary tract infection — 94. Extragenital pathology was found in all women, the threat of termination of pregnancy in 109 cases, medical history of abortions in 106 women and 83 anaemia in women. Birth asphyxia was observed in 102 children (45%, prematurity in 71 cases (31.4%. Asphyxia of severe degree accounted 1 (0.5% premature and 1 (0.45% full-term baby. Asphyxia of moderate severity (4-6 points accounted 70 (30.9% preterm and 31 (13.7% full-term infants. The most common form of the intrauterine development of the fetus asymmetrical revealed 178 cases (79.1%. Conclusion: Perinatal factors such as medical abortion, urinary tract infection, extragenital pathology are preventable. The predominant form of the intrauterine development of the fetus is asymmetric form, symmetric and dysplastic revealed to a greater degree in premature infants. Children with low weight for gestational age should be adequately provided with the necessary nutrients, fortifiers, vitamins and in the process of rehabilitation — cerebropro-tective therapy.

  9. Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal.

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    Manandhar, S R; Manandhar, D S; Adhikari, D; Shrestha, J; Rai, C; Rana, H; Paudel, M

    2015-01-01

    Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International. Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 . There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities. Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to

  10. West syndrome, vigabatrine, adrenocorticotropic hormone

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    Ünsal Yılmaz

    2014-03-01

    Full Text Available Objective: Limited data are available on the etiology, clinical approach, treatment and outcome in West syndrome. In the present study, we aimed to document clinical characteristics, etiology and treatment response in children with West syndrome. Methods: Hospital charts of children who were diagnosed with West syndrome between July-2011 and December- 2013 and who had a follow-up at least 12-month, were reviewed retrospectively. Results: 38 patients (14 females, 24 males, mean aged 27.1±7.60 months were included. The mean age of seizure onset, interval to diagnosis, and follow-up period were 6.23±4.27 months, 1.36±1.58 months, and 19.3±5.86 months respectively. Perinatal asphyxia (13, tuberous sclerosis (2, cortical dysplasia (2, encephalitis (1, asphyxia due to aspiration (1, congenital cytomegalovirus infection (1, perinatal infarct (1, nonketotic hyperglycinemia (1 and Prader Willi syndrome (1 were the identified causes. The etiology could not be ascertained in the remaining 15 children. Psychomotor development was mildly retarded in 12, moderately retarded in 13, and severely in 13 patients at onset, and did not change significantly at month 12. The initial therapy was synthetic adrenocorticotropic hormone in 11, vigabatrin in 17, levetiracetam in 8 and valproate in 2 patients. At 12th month of therapy, 15 patients were seizure-free, 12 patients showed more than 50% decrease in seizure frequency, and remaining 11 patients showed no significant reduction in seizure frequency. Conclusion: Besides the perinatal asphyxia as most frequent cause, a wide variety of disorders can present as West syndrome. Although, a 12-month-long treatment achieves seizure control in half of the patients, not beneficial effect on psychomotor development was seen. J Clin Exp Invest 2014; 5 (1: 86-92

  11. Predictive Value of Nucleated Red Blood Cell Counts in Cord and Peripheral Blood of Asphyxiated Term Neonates in the First Week of Life

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    B Bahman Bijari

    2010-03-01

    Full Text Available Introduction: Increased numbers of nucleated red blood cells (NRBC circulating in the blood of neonates can be associated with relative hypoxia and adverse outcomes. Thus, the aim of this study was to assess the NRBC count during the first week of life in neonates diagnosed with asphyxia as compared to healthy neonates and to determine the short-term morbidity and mortality for the affected babies. Methods: The cross-sectional study compared 15 healthy neonates with 15 neonates diagnosed with asphyxia confirmed by pH of cord blood or Apgar scores. The nucleated red blood cell (NRBC counts were calculated right after birth, and on days 3 and 7, and the hematological parameters of umbilical cord blood were also evaluated. The infants were followed for mortality and associated morbidity. Statistical analysis was conducted using the Mann-Whitney U test, analysis of variance, chi-square tests, and Pearson’s correlation coefficient. A p-value < 0.05 was considered as statistically significant. Results: The initial NRBC counts were significantly higher in the asphyxiated group than in the control group and the difference remained significant through the end of first week. All of the umbilical cord blood parameters were significantly lower in the study group and were negatively correlated with the NRBC count. At birth, higher NRBC count correlated with higher mortality. conclution: Results show that NRBC count is a useful predictive factor for neonatal asphyxia through the end of the first week of life, although a larger study population and a longer follow up period seems to be necessary.

  12. Fuzzy expert system in the prediction of neonatal resuscitation

    Directory of Open Access Journals (Sweden)

    M.A.M. Reis

    2004-05-01

    Full Text Available In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.

  13. Angiogenesis dysregulation in term asphyxiated newborns treated with hypothermia.

    Directory of Open Access Journals (Sweden)

    Henna Shaikh

    Full Text Available Neonatal encephalopathy following birth asphyxia is a major predictor of long-term neurological impairment. Therapeutic hypothermia is currently the standard of care to prevent brain injury in asphyxiated newborns but is not protective in all cases. More robust and versatile treatment options are needed. Angiogenesis is a demonstrated therapeutic target in adult stroke. However, no systematic study examines the expression of angiogenesis-related markers following birth asphyxia in human newborns.This study aimed to evaluate the expression of angiogenesis-related protein markers in asphyxiated newborns developing and not developing brain injury compared to healthy control newborns.Twelve asphyxiated newborns treated with hypothermia were prospectively enrolled; six developed eventual brain injury and six did not. Four healthy control newborns were also included. We used Rules-Based Medicine multi-analyte profiling and protein array technologies to study the plasma concentration of 49 angiogenesis-related proteins. Mean protein concentrations were compared between each group of newborns.Compared to healthy newborns, asphyxiated newborns not developing brain injury showed up-regulation of pro-angiogenic proteins, including fatty acid binding protein-4, glucose-6-phosphate isomerase, neuropilin-1, and receptor tyrosine-protein kinase erbB-3; this up-regulation was not evident in asphyxiated newborns eventually developing brain injury. Also, asphyxiated newborns developing brain injury showed a decreased expression of anti-angiogenic proteins, including insulin-growth factor binding proteins -1, -4, and -6, compared to healthy newborns.These findings suggest that angiogenesis pathways are dysregulated following birth asphyxia and are putatively involved in brain injury pathology and recovery.

  14. Melatonin and the newborn brain.

    Science.gov (United States)

    Colella, Marina; Biran, Valérie; Baud, Olivier

    2016-11-01

    Brain injury related to preterm birth and neonatal asphyxia is a leading cause of childhood neuromotor and cognitive disabilities. Unfortunately, the strategies to prevent perinatal brain damages remain limited. Among the candidate molecules, melatonin appears to be one of the most promising agents for its antioxidant and neuromodulatory action. Robust preclinical evidences and few clinical studies have suggested a neuroprotective benefit conferred by neonatal exposure to melatonin. This review recapitulates current basic research, safety and pharmacokinetic data and ongoing clinical trials on the use of melatonin as a neuroprotective agent in the newborn. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Cardiovascular dysfunction in infants with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Armstrong, Katey

    2012-04-01

    Severe perinatal asphyxia with hypoxic ischaemic encephalopathy occurs in approximately 1-2\\/1000 live births and is an important cause of cerebral palsy and associated neurological disabilities in children. Multiorgan dysfunction commonly occurs as part of the asphyxial episode, with cardiovascular dysfunction occurring in up to a third of infants. This narrative paper attempts to review the literature on the importance of early recognition of cardiac dysfunction using echocardiography and biomarkers such as troponin and brain type natriuretic peptide. These tools may allow accurate assessment of cardiac dysfunction and guide therapy to improve outcome.

  16. Intranasal pyrrolidine dithiocarbamate decreases brain inflammatory mediators and provides neuroprotection after brain hypoxia-ischemia in neonatal rats

    OpenAIRE

    Wang, Zhi; Zhao, Huijuan; Peng, Shuling; Zuo, Zhiyi

    2013-01-01

    Brain injury due to birth asphyxia is the major cause of death and long-term disabilities in newborns. We determined whether intranasal pyrrolidine dithiocarbamate (PDTC) could provide neuroprotection in neonatal rats after brain hypoxia-ischemia (HI). Seven-day old male and female Sprague-Dawley rats were subjected to brain HI. They were then treated by intranasal PDTC. Neurological outcome were evaluated 7 or 30 days after the brain HI. Brain tissues were harvested 6 or 24 h after the brain...

  17. [Research development and application of virtopsy].

    Science.gov (United States)

    Chen, Yi-Jiu

    2014-10-01

    Autopsy represents traditional and classical examination in forensic medicine. It was suggested that conventional autopsy, nowadays sometimes rejected or not tolerated by people for its damage to corpse. Virtopsy offers a non-invasive investigation approach and can also reflect fracture, soft-tissue injury, wound track, organ trauma objectively and accurately. Thus, virtopsy can provide visual and powerful evidence for forensic pathological practice. This article mainly synthesizes the latest literature at home and abroad and reviews application of virtopsy in forensic trauma identification, mechanical asphyxia, drowning, hypothermia and hyperpothermia, disease diagnosis and research of finite element method applicated in trauma investigation to illustrate this new direction of forensic research.

  18. Clinical hypoxic-ischemic encephalopathy score of the Iberoamerican Society of Neonatology (Siben: A new proposal for diagnosis and management

    Directory of Open Access Journals (Sweden)

    José Maria Rodriguez Perez

    Full Text Available Summary Hypoxic ischemic encephalopathy is a major complication of perinatal asphyxia, with high morbidity, mortality and neurologic sequelae as cerebral palsy, mostly in poor or developing countries. The difficulty in the diagnosis and management of newborns in these countries is astonishing, thus resulting in unreliable data on this pathology and bad outcomes regarding mortality and incidence of neurologic sequelae. The objective of this article is to present a new clinical diagnostic score to be started in the delivery room and to guide the therapeutic approach, in order to improve these results.

  19. Severe calcinosis cutis in an infant

    Energy Technology Data Exchange (ETDEWEB)

    Puvabanditsin, Surasak; Patel, Jigneshkumar B. [University of Medicine and Dentistry of New Jersey, Department of Pediatrics, Newark, NJ (United States); University of Medicine and Dentistry of New Jersey, Department of Surgery, Newark, NJ (United States); Garrow, Eugene; Titapiwatanakun, Ruetima; Getachew, Rahel [University of Medicine and Dentistry of New Jersey, Department of Pediatrics, Newark, NJ (United States)

    2005-05-01

    We report on an infant with severe asphyxia and persistent pulmonary hypertension as a newborn. The baby received prolonged intravenous calcium gluconate therapy for hypocalcemia. At 5 weeks of age, multiple firm, indurated areas (armor-like lesions) were palpable in the subcutaneous tissues of the trunk, arms, legs, and face, particularly in skin folds. Roentgenographic study showed generalized soft-tissue calcifications throughout the body, extremities, and face. Calcinosis cutis occurs through a variety of pathogenetic mechanisms. Case reports on calcinosis cutis in infants are uncommon, and the calcifications are mostly localized. In our patient, they are generalized. (orig.)

  20. A fatal case of Perthes syndrome

    Directory of Open Access Journals (Sweden)

    Jérôme Jobé

    2013-01-01

    Full Text Available Perthes syndrome, or traumatic asphyxia, is a clinical syndrome associating cervicofacial cyanosis with cutaneous petechial haemorrhages and subconjonctival bleeding resulting from severe sudden compressive chest trauma. Deep inspiration and a Valsalva maneuver just prior to rapid and severe chest compression, are responsible for the development of this syndrome. Current treatment is symptomatic: urgent relief of chest compression and cardiopulmonary resuscitation if needed. Outcome may be satisfactory depending on the duration and severity of compression. Prolonged thoracic compression may sometimes lead to cerebral anoxia, irreversible neurologic damage and death. We report a fatal case of Perthes syndrome resulting from an industrial accident.

  1. Visual disorders in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Govind Amita

    1988-01-01

    Full Text Available Seventy children with cere-bral palsy were examined for aetiological factors responsible, type of disorder and ocular abnormalities. The overall inci-dence of ocular abnormalities was 68.69%, the highest frequency being of squint (35.7%. Other anomalies detected inclu-ded refractive errors (28.5%, optic atrophy (10% and coloboma (2.9%. Most children were spastic quadriplegics with asphyxia as the major aetiological factor. The study created an awareness amongst parents of these children. The visual status of those affected could be improved for imparting education and training in a better way.

  2. Accidental hanging by a T-shirt collar in a man with morphine intoxication: an unusual case.

    Science.gov (United States)

    Kodikara, Sarathchandra; Alagiyawanna, Ramesh

    2011-09-01

    Accidental hanging is rare across all age groups, and it is even rarer in the adult population except in autoerotic asphyxia. Few cases have been reported in the literature, which describe unusual patterns of accidental hanging. This article focuses on an unusual pattern of accidental hanging of a 25-year-old man, who was in a state of morphine-induced central nervous system depression and found dead in a sitting position with the collar of his T-shirt hanging off a jutting-out root of a tree. The hanged collar acted as a ligature compressing the neck.

  3. Committee Opinion No. 644: The Apgar Score.

    Science.gov (United States)

    2015-10-01

    The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.

  4. Does internal podalic version of the non-vertex second twin still have a place in obstetrics?

    DEFF Research Database (Denmark)

    Jonsdottir, Fjola; Stokholm, Lonny Merete; Secher, Niels Jørgen

    2015-01-01

    of delivery mode, 5-min Apgar score, asphyxia, umbilical cord pH, admission to neonatal intensive care unit, treatment by mechanical ventilation, and experience level of obstetricians performing internal podalic version. RESULTS: 457 births were available for analysis: 39 cases of internal podalic version...... version than the cesarean section group, however, fewer cases needed mechanical ventilation. Thirty internal versions and breech extractions were performed by obstetricians with >5 years clinical experience and three by trainees. CONCLUSION: Cesarean sections for a second twin seem to have been frequent...

  5. Perinatal death and neurological damage as a sequential chain of poor outcome.

    Science.gov (United States)

    Doi, Koutarou; Sameshima, Hiroshi; Kodama, Yuki; Furukawa, Seishi; Kaneko, Masatoki; Ikenoue, Tsuyomu

    2012-06-01

    We investigated the risk factors of perinatal death and neurological damage. Perinatal death and neurological damage were retrospectively investigated using a population-based study of 108 024 deliveries from 1998 to 2007. Main factors studied were asphyxia, growth restriction and preterm delivery perinatal deaths (4.3/1000) and 220 neurological damages (2.0/1000). Preterm delivery accounted for 50% of perinatal deaths and neurological damage, whereas it constituted 2.6% of total births. Multiple regression analyses showed that prematurity death, neonatal death and neurological damage. Prematurity perinatal death to neurological damage.

  6. Angiotensin Converting Enzyme-induced Angioedema - A Dangerous New Epidemic

    DEFF Research Database (Denmark)

    Rasmussen, Eva Rye; Mey, Kristianna; Bygum, Anette

    2013-01-01

    to asphyxia has increased. This is mainly due to pharmaceuticals such as angiotensin converting enzyme-inhibitors, which are extensively used worldwide. Some aspects of the pathophysiology have been elucidated and the vasoactive molecule bradykinin is shown to be one of the main causative agents....... The diagnosis is often delayed and traditional treatment usually ineffective. Complement C1 inhibitor concentrate and bradykinin receptor antagonists, normally used to treat patients with hereditary angioedema, have shown good results when used in patients with bradykinin-mediated angioedema. This review...

  7. Multicystic encephalomalacia in term infants.

    Science.gov (United States)

    Frigieri, G; Guidi, B; Costa Zaccarelli, S; Rossi, C; Muratori, G; Ferrari, F; Cavazzuti, G B

    1996-12-01

    The terms "multicystic encephalomalacia" and "subcortical leucomalacia" (SCL) are used to describe the presence of areas of necrosis that develop into cystic lesions inside the brain. These lesions are generally due to severe asphyxia and/or hypotension. The designation SCL can also be used to describe the extent and the seat of the lesion in the brain or to distinguish subcortical lesions from periventricular and/or combined ones. In this study we give an account of our experience with eight newborns admitted to our neonatal intensive care unit, who presented clinical-neurological alterations and encephalomalacic lesions whose presence was documented by ultrasonography.

  8. [Multicystic encephalomalacia in twin pregnancies].

    Science.gov (United States)

    Sans Fito, A; Campistol Plana, J; Poo Argüelles, P; Krauel Vidal, J

    1990-02-01

    Multicystic encephalomalacia (ME) is a rare entity in the pediatric age. In ME brain tissue in substituted by cavities of variable size. ME has different etiologies being asphyxia and circulatory alterations the most important factors. In monozygotic twins there is an increased incidence of structural anomalies than dizygotic twins. We present four twin patients with ME. Three of them had a prenatal dead sibling. The fourth pair of twins had a twin-twin transfusion. We want to stress the utility of brain echography in early diagnosis of ME.

  9. Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction

    Directory of Open Access Journals (Sweden)

    Hiroshi Ito

    2010-05-01

    Full Text Available Hiroshi Ito1, Hiroyoshi Kawaai1, Shinya Yamazaki1, Yosuke Suzuki21Division of Systemic Management, Department of Oral Function, 2Division of Radiology and Diagnosis, Department of Medical Sciences, Ohu University, Post Graduate School of Dentistry, Koriyama City, Fukushima Prefecture, JapanAbstract: From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm. All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway

  10. Treatable newborn and infant seizures due to inborn errors of metabolism.

    Science.gov (United States)

    Campistol, Jaume; Plecko, Barbara

    2015-09-01

    About 25% of seizures in the neonatal period have causes other than asphyxia, ischaemia or intracranial bleeding. Among these are primary genetic epileptic encephalopathies with sometimes poor prognosis and high mortality. In addition, some forms of neonatal infant seizures are due to inborn errors of metabolism that do not respond to common AEDs, but are amenable to specific treatment. In this situation, early recognition can allow seizure control and will prevent neurological deterioration and long-term sequelae. We review the group of inborn errors of metabolism that lead to newborn/infant seizures and epilepsy, of which the treatment with cofactors is very different to that used in typical epilepsy management.

  11. Glucose-6-Phosphate Dehydrogenase Deficiency and Adrenal Hemorrhage in a Filipino Neonate with Hyperbilirubinemia

    Directory of Open Access Journals (Sweden)

    Akira Ohishi

    2013-05-01

    Full Text Available We report on a Filipino neonate with early onset and prolonged hyperbilirubinemia who was delivered by a vacuum extraction due to a prolonged labor. Subsequent studies revealed adrenal hemorrhage and glucose-6-phosphate dehydrogenase (G6PD deficiency. It is likely that asphyxia and resultant hypoxia underlie the occurrence of adrenal hemorrhage and the clinical manifestation of G6PD deficiency and that the presence of the two events explains the early onset and prolonged hyperbilirubinemia of this neonate. Our results represent the importance of examining possible underlying factors for the development of severe, early onset, or prolonged hyperbilirubinemia.

  12. Ischiopagus tripus conjoined twins in a western lowland gorilla (Gorilla gorilla).

    Science.gov (United States)

    Langer, S; Jurczynski, K; Gessler, A; Kaup, F-J; Bleyer, M; Mätz-Rensing, K

    2014-05-01

    Conjoined twinning is rare in man and non-human primates. The current report describes a case of ischiopagus tripus conjoined Western Lowland gorilla (Gorilla gorilla) twins. The female twins were joined at the umbilical and pelvic region, involving the liver, xiphoid, umbilicus, body wall and skin. Computed tomography revealed two complete spines. The combined pelvic space was formed by two sacra, each connected with two iliac bones. The twins were only conjoined by a common pubis. Cause of death was attributed to cardiac and circulatory collapse resulting from a large patent foramen ovale (8 mm in diameter) of one twin and neonatal asphyxia. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. PHARMACOTHERAPY OF ACUTE STENOSING LARYNGOTRACHEITIS. WHAT DRUGS ARE DATA-BASED?

    Directory of Open Access Journals (Sweden)

    L. M. Ogorodova

    2012-01-01

    Full Text Available Acute stenosing laryngotracheitis is the most common cause of the upper respiratory tract obstruction in children at the age of 6 months to 6 years old. It is the rapidly occurring syndrome, consisting of barking cough, hoarseness, stridor. The disease can be associated with development of respiratory failure and asphyxia, so pediatricians and emergency care doctors must be well aware of rational pharmacotherapy of this condition. The review contains the descriptions of the drugs, which efficacy is confirmed by convincing evidence database. 

  14. Racking the brain: Detection of cerebral edema on postmortem computed tomography compared with forensic autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Nicole [Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich (Switzerland); Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Ampanozi, Garyfalia; Schweitzer, Wolf; Ross, Steffen G.; Gascho, Dominic [Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich (Switzerland); Ruder, Thomas D. [Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich (Switzerland); Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Freiburgstrasse, 3010 Bern (Switzerland); Thali, Michael J. [Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich (Switzerland); Flach, Patricia M., E-mail: patricia.flach@irm.uzh.ch [Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich (Switzerland); Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2015-04-15

    Graphical abstract: -- Highlights: •Postmortem swelling of the brain is a typical finding on PMCT and occurs concomitant with potential antemortem or agonal brain edema. •Cerebral edema despite normal postmortem swelling is indicated by narrowed temporal horns and symmetrical herniation of the cerebral tonsils on PMCT. •Cases with intoxication or asphyxia demonstrated higher deviations of the attenuation between white and gray matter (>20 Hounsfield Units) and a ratio >1.58 between the gray and white matter. •The Hounsfield measurements of the white and gray matter help to determine the cause of death in cases of intoxication or asphyxia. -- Abstract: Purpose: The purpose of this study was to compare postmortem computed tomography with forensic autopsy regarding their diagnostic reliability of differentiating between pre-existing cerebral edema and physiological postmortem brain swelling. Materials and methods: The study collective included a total of 109 cases (n = 109/200, 83 male, 26 female, mean age: 53.2 years) and were retrospectively evaluated for the following parameters (as related to the distinct age groups and causes of death): tonsillar herniation, the width of the outer and inner cerebrospinal fluid spaces and the radiodensity measurements (in Hounsfield Units) of the gray and white matter. The results were compared with the findings of subsequent autopsies as the gold standard for diagnosing cerebral edema. p-Values <0.05 were considered statistically significant. Results: Cerebellar edema (despite normal postmortem swelling) can be reliably assessed using postmortem computed tomography and is indicated by narrowed temporal horns and symmetrical herniation of the cerebellar tonsils (p < 0.001). There was a significant difference (p < 0.001) between intoxication (or asphyxia) and all other causes of death; the former causes demonstrated higher deviations of the attenuation between white and gray matter (>20 Hounsfield Units), and the gray to

  15. Different extent in decline of infant mortality by region and cause in Shenyang, China.

    Science.gov (United States)

    Huang, Yan-Hong; Wu, Qi-Jun; Li, Li-Li; Li, Da; Li, Jing; Zhou, Chen; Wu, Lang; Zhu, Jingjing; Gong, Ting-Ting

    2016-04-14

    To compare the pattern of cause of death of infant mortality rates by urban/rural areas as well as to generate knowledge for potential strategies to decrease this mortality, we carried out a study by analyzing the infant mortality data from the Shenyang Women and Children Health Care Centre. From 1997 to 2014, 970,583 live births and 6510 infant deaths were registered. Infant mortality rates, percent change, and annual percent change (APC) were calculated. The infant mortality significantly decreased by 5.92%, 7.41%, and 3.92% per year in overall, urban, and rural areas, respectively. Among the categories of causes of infant death, congenital anomalies (APC = -7.87%), asphyxia-related conditions (APC = -9.43), immaturity-related conditions (APC = -3.44%), diseases of the nervous system and sense organs (APC = -6.01%), and diseases of the respiratory system (APC = -6.29%) decreased significantly in the observational periods. Additionally, among selective causes of infant death, pneumonia, congenital heart disease, neural tube defects, preterm birth and low birth weight, birth asphyxia, and intracranial hemorrhage of the newborn significantly decreased by 5.45%, 5.45%, 16.47%, 2.18%, 10.95%, and 10.33% per year, respectively. In conclusion, infant mortality has been continuously decreased in Shenyang from 1997 to 2014, although further efforts are still needed to decrease the infant mortality in rural areas.

  16. Dexmedetomidine Postconditioning Reduces Brain Injury after Brain Hypoxia-Ischemia in Neonatal Rats.

    Science.gov (United States)

    Ren, Xiaoyan; Ma, Hong; Zuo, Zhiyi

    2016-06-01

    Perinatal asphyxia can lead to death and severe disability. Brain hypoxia-ischemia (HI) injury is the major pathophysiology contributing to death and severe disability after perinatal asphyxia. Here, seven-day old Sprague-Dawley rats were subjected to left brain HI. Dexmedetomidine was given intraperitoneally after the brain HI. Yohimbine or atipamezole, two α2 adrenergic receptor antagonists, were given 10 min before the dexmedetomidine injection. Neurological outcome was evaluated 7 or 28 days after the brain HI. Frontal cerebral cortex was harvested 6 h after the brain HI. Left brain HI reduced the left cerebral hemisphere weight assessed 7 days after the brain HI. This brain tissue loss was dose-dependently attenuated by dexmedetomidine. Dexmedetomidine applied within 1 h after the brain HI produced this effect. Dexmedetomidine attenuated the brain HI-induced brain tissue and cell loss as well as neurological and cognitive dysfunction assessed from 28 days after the brain HI. Dexmedetomidine postconditioning-induced neuroprotection was abolished by yohimbine or atipamezole. Brain HI increased tumor necrosis factor α and interleukin 1β in the brain tissues. This increase was attenuated by dexmedetomidine. Atipamezole inhibited this dexmedetomidine effect. Our results suggest that dexmedetomidine postconditioning reduces HI-induced brain injury in the neonatal rats. This effect may be mediated by α2 adrenergic receptor activation that inhibits inflammation in the ischemic brain tissues.

  17. Assessment of serum magnesium levels and its outcome in neonates of eclamptic mothers treated with low-dose magnesium sulfate regimen

    Science.gov (United States)

    Das, Monalisa; Chaudhuri, Patralekha Ray; Mondal, Badal C.; Mitra, Sukumar; Bandyopadhyay, Debasmita; Pramanik, Sushobhan

    2015-01-01

    Objectives: Magnesium historically has been used for treatment and/or prevention of eclampsia. Considering the low body mass index of Indian women, a low-dose magnesium sulfate regime has been introduced by some authors. Increased blood levels of magnesium in neonates is associated with increased still birth, early neonatal death, birth asphyxia, bradycardia, hypotonia, gastrointestinal hypomotility. The objective of this study was to assess safety of low-dose magnesium sulfate regimen in neonates of eclamptic mothers treated with this regimen. Materials and Methods: This was a cross-sectional observational study of 100 eclampsia patients and their neonates. Loading dose and maintenance doses of magnesium sulfate were administered to patients by combination of intravenous and intramuscular routes. Maternal serum and cord blood magnesium levels were estimated. Neonatal outcome was assessed. Results: Bradycardia was observed in 18 (19.15%) of the neonates, 16 (17.02%) of the neonates were diagnosed with hypotonia. Pearson Correlation Coefficient showed Apgar scores decreased with increase in cord blood magnesium levels. Unpaired t-test showed lower Apgar scores with increasing dose of magnesium sulfate. The Chi-square/Fisher's exact test showed significant increase in hypotonia, birth asphyxia, intubation in delivery room, Neonatal Intensive Care Unit (NICU) care requirement, with increasing dose of magnesium sulfate. (P ≤ 0.05). Conclusion: Several neonatal complications are significantly related to increasing serum magnesium levels. Overall, the low-dose magnesium sulfate regimen was safe in the management of eclamptic mothers, without toxicity to their neonates. PMID:26600638

  18. Effect of oxygen inhalation at birth on the reduction of early postnatal mortality in pigs.

    Science.gov (United States)

    Herpin, P; Hulin, J C; Le Dividich, J; Fillaut, M

    2001-01-01

    Asphyxia during delivery is considered a main cause of stillbirth in pigs, but piglets suffering from intermittent asphyxia during delivery are also less viable at birth and less prone to adapt to extrauterine life. In an effort to improve pig viability, one attractive solution would be to increase oxygen supply through oxygen inhalation by the newborn pig. The objective of this study was to test effects of oxygen inhalation immediately after birth on various physiological parameters and piglet survival. The experiment was performed on 252 Piétrain x Large White piglets, half of them reoxygenated immediately after birth. They were maintained during 20 min in a chamber where oxygen concentration was monitored at 40% and were then put back with the sow and the control pigs. Oxygen inhalation affected piglet metabolism. Through stimulation of oxidative metabolism (reduction of circulating levels of lactate) and lowering of the level of postnatal hypothermia (particularly for the lightest pigs), oxygen inhalation increased piglet viability and reduced mortality during the 1st d of life by 75% (2 vs 8%). No additional effects were observed during the following days and overall mortality between birth and weaning at 21 d was reduced from 12 to 8%.

  19. β-Amyloid precursor protein staining of the brain in sudden infant and early childhood death.

    Science.gov (United States)

    Jensen, Lisbeth Lund; Banner, Jytte; Ulhøi, Benedicte Parm; Byard, Roger W

    2014-06-01

    To develop and validate a scoring method for assessing β-amyloid precursor protein (APP) staining in cerebral white matter and to investigate the occurrence, amount and deposition pattern based on the cause of death in infants and young children. Archival cerebral tissue was examined from a total of 176 cases (0 to 3 years of age). Each of the APP-stained sections was graded according to a simple scoring system based on the number and type of changes in eight anatomical regions. Examination of the sections revealed some degree of APP staining in 95% of the cases. The highest mean APP scores were found in cases of head trauma, and the lowest scores were found in the cases of drowning. APP staining, although sometimes minimal, was found in all 48 cases of and sudden infant death syndrome (SIDS). Patterns of APP staining (the amount and distribution) were different in cases of head trauma, infection and SIDS but were similar in the SIDS and asphyxia groups. This study demonstrates the use of an integrated scoring system that was developed to assess APP staining in the brain. APP staining was seen in a high proportion of cases, including relatively sudden deaths. The amount of APP was significantly higher in cases of trauma than in nontraumatic deaths. However, APP was detected within all groups. The pattern of APP staining was similar in infants who had died of SIDS and from mechanical asphyxia. © 2013 British Neuropathological Society.

  20. Hypothermia therapy for newborns with hypoxic ischemic encephalopathy.

    Science.gov (United States)

    Silveira, Rita C; Procianoy, Renato S

    2015-01-01

    Therapeutic hypothermia reduces cerebral injury and improves the neurological outcome secondary to hypoxic ischemic encephalopathy in newborns. It has been indicated for asphyxiated full-term or near-term newborn infants with clinical signs of hypoxic-ischemic encephalopathy (HIE). A search was performed for articles on therapeutic hypothermia in newborns with perinatal asphyxia in PubMed; the authors chose those considered most significant. There are two therapeutic hypothermia methods: selective head cooling and total body cooling. The target body temperature is 34.5 °C for selective head cooling and 33.5 °C for total body cooling. Temperatures lower than 32 °C are less neuroprotective, and temperatures below 30 °C are very dangerous, with severe complications. Therapeutic hypothermia must start within the first 6h after birth, as studies have shown that this represents the therapeutic window for the hypoxic-ischemic event. Therapy must be maintained for 72 h, with very strict control of the newborn's body temperature. It has been shown that therapeutic hypothermia is effective in reducing neurologic impairment, especially in full-term or near-term newborns with moderate hypoxic-ischemic encephalopathy. Therapeutic hypothermia is a neuroprotective technique indicated for newborn infants with perinatal asphyxia and hypoxic-ischemic encephalopathy. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  1. INFLUENCE OF FETOPLACENTAL INSUFFICIENCY ON THE FORMATION OF PERINATAL PATHOLOGY IN PRETERM NEONATES

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    N. P. Molokanova

    2013-01-01

    Full Text Available Aim: to identify features of early neonatal period in preterm infants of women with fetoplacental insufficiency (FPI. Patients and methods: we conducted a retrospective study of early neonatal period in 76 preterm infants with gestational age from 28 to 36 weeks. Of these, 31 were born by women with FPI (study group and 45 neonates from mothers without complications during pregnancy (control group. We analyzed course of pregnancy and delivery in both groups. Infant’s conditions were assessed using Apgar and Silverman Score. Neurological status, severity of respiratory and cardio-vascular failure were take into account in the first 7 days of life. Results: women with FPI had significantly higher levels of total extragenital pathology, hypertension was found only in mothers of the main group. The extent of Doppler abnormalities in most cases was light, while the most severe 3d grade was detected only in 4 women (12,9%, which had caused the birth of infants in severe asphyxia. Pathology of respiratory and central nervous system was dominated in preterm infants of both groups. Conclusions: the number of infants with serious conditions born by mothers with FPI is significantly higher than that determined by the deterioration of the utero-placental blood flow. Preterm neonates in women with FPI form a risk group of perinatal asphyxia.

  2. Immunohistochemical detection of early myocardial damage in two sudden deaths due to intentional butane inhalation. Two case reports with review of literature.

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    Novosel, Irena; Kovačić, Zdravko; Gusić, Stjepan; Batelja, Lovorka; Nestić, Marina; Seiwerth, Sven; Skavić, Josip

    2011-04-01

    The abuse of household and other commercially available products containing volatile organic solvents is underrecognized. Not infrequently intentional butane inhalation results in high morbidity and mortality. A fatal outcome of butane abuse can be caused by asphyxia, cardiac arrhythmia or trauma. The reported number of cases in which death was the consequence of pure butane inhalation is limited, and in most cases a mixture of propellants was involved. This report covers two cases of sudden death due to the sniffing of a cigarette lighter refill containing butane. Autopsy was followed by toxicological, pathohistological and immunohistochemical analysis. Butane gas was confirmed in samples of blood, urine, brain and lungs by the gas chromatography method - "headspace" technique. Histology showed almost identical changes in the lungs and heart in both cases. The morphology of heart damage on standard H/E stains was of special interest because it displayed all the characteristics of chronic and acute myocardial hypoxia found in the absence of atherosclerotic heart disease. In order to confirm early cardiac death caused by asphyxia due to butane inhalation a panel of immunohistochemical agents was used: Myoglobin, Desmin, Fibronectin, Fibrinogen and CC9. Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  3. Support-vector-machines-based multidimensional signal classification for fetal activity characterization

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    Ribes, S.; Voicu, I.; Girault, J. M.; Fournier, M.; Perrotin, F.; Tranquart, F.; Kouamé, D.

    2011-03-01

    Electronic fetal monitoring may be required during the whole pregnancy to closely monitor specific fetal and maternal disorders. Currently used methods suffer from many limitations and are not sufficient to evaluate fetal asphyxia. Fetal activity parameters such as movements, heart rate and associated parameters are essential indicators of the fetus well being, and no current device gives a simultaneous and sufficient estimation of all these parameters to evaluate the fetus well-being. We built for this purpose, a multi-transducer-multi-gate Doppler system and developed dedicated signal processing techniques for fetal activity parameter extraction in order to investigate fetus's asphyxia or well-being through fetal activity parameters. To reach this goal, this paper shows preliminary feasibility of separating normal and compromised fetuses using our system. To do so, data set consisting of two groups of fetal signals (normal and compromised) has been established and provided by physicians. From estimated parameters an instantaneous Manning-like score, referred to as ultrasonic score was introduced and was used together with movements, heart rate and associated parameters in a classification process using Support Vector Machines (SVM) method. The influence of the fetal activity parameters and the performance of the SVM were evaluated using the computation of sensibility, specificity, percentage of support vectors and total classification accuracy. We showed our ability to separate the data into two sets : normal fetuses and compromised fetuses and obtained an excellent matching with the clinical classification performed by physician.

  4. Intrapartum cardiotocography (CTG) and ST-analysis of labor in diabetic patients.

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    Yli, Branka M; Källen, Karin; Khoury, Janette; Stray-Pedersen, Babill; Amer-Wåhlin, Isis

    2011-07-01

    To determine the prevalence and types of intrapartum cardiotocography (CTG) patterns and investigate their relationship to moderate acidemia in term fetuses of diabetic mothers. Also, to assess if the combination of fetal electrocardiogram (FECG) and those CTG patterns strengthens the association with moderate acidemia. The material for this study is obtained from the Swedish randomized control trial and the European Union ST-analysis trial. We developed an analytical model for CTG patterns based on the progress in CTG changes, in a longitudinal periodic manner. The model was then combined with information regarding changes in ST interval that indicate threatening asphyxia, and the findings were analyzed to determine correlation with the presence of moderate acidemia at birth. This study involved data of 413 diabetic mothers. A preterminal CTG was more common in the diabetes mellitus (DM) group (6/70, 8.6%) than in the gestational diabetes (GD) group (3/307, 1.0%; P=0.003). For diabetic mothers (i.e., DM+GD) with a normal CTG at the start of monitoring, the presence of FECG data indicating asphyxia significantly increased the likelihood of an umbilical artery pHCTG was non-reassuring at the start of monitoring, no significant association was found between pHCTG is more common in the fetuses of DM than GD mothers during labor. When CTG was normal at the start of recording, the addition of FECG information gave a significant add on information to predict moderate acidemia.

  5. Cardiotocography (CTG as the screening method of fetal condition assessment

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    V. Zulčić-Nakić

    2007-02-01

    Full Text Available A basic function of fetal monitoring is an analysis of fetal cardiac action. Cardiotocography (CTG cannot provide all necessary information for assessment of the fetal condition as it is not sufficiently reliable and gives a large number of false positive results that increase the number of cesarean sections. An objective of this work was to establish CTG reliability as a method for assessment of intrapartal fetal condition. Based on CTG parameters (baseline fetal heart rate, fetal heart rate variability, oscillations and decelerations 100 pathological CTG records, collected at Obstetrics and Gynecology Department of the Tuzla University Clinic Hospital from 01.12.2004 to 05.08.2005 were identified. Using binomial distribution they were classified as non-pathological (indicating absence of asphyxia and pathological (indicating possible presence of asphyxia. After the delivery the condition of newborns was assessed according to the Apgar score. Based on comparison between certain pathological parametres of CTG records and newborns’ conditions at birth the results indicated high positive predictive values whereas sensitivity and accuracy were low. Apgar score 1. from 7 upwards was given to 96 (96% newborns whereas Apgar score 2 from 7 upwards was given to all the newborns with previous pathological CTG records. Results have confirmed that CTG can be used only as a screening method for assessment of intrapartal fetal condition.

  6. Care of the infant of the diabetic mother.

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    Hay, William W

    2012-02-01

    Gestational diabetes mellitus (GDM) from all causes of diabetes is the most common medical complication of pregnancy and is increasing in incidence, particularly as type 2 diabetes continues to increase worldwide. Despite advances in perinatal care, infants of diabetic mothers (IDMs) remain at risk for a multitude of physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, hypertrophic cardiomyopathy, and congenital anomalies, particularly of the central nervous system. Overt type 1 diabetes around conception produces marked risk of embryopathy (neural tube defects, cardiac defects, caudal regression syndrome), whereas later in gestation, severe and unstable type 1 maternal diabetes carries a higher risk of intrauterine growth restriction, asphyxia, and fetal death. IDMs born to mothers with type 2 diabetes are more commonly obese (macrosomic) with milder conditions of the common problems found in IDMs. IDMs from all causes of GDM also are predisposed to later-life risk of obesity, diabetes, and cardiovascular disease. Care of the IDM neonate needs to focus on ensuring adequate cardiorespiratory adaptation at birth, possible birth injuries, maintenance of normal glucose metabolism, and close observation for polycythemia, hyperbilirubinemia, and feeding intolerance.

  7. Field Testing of Second Generation of Colour-Coded Rings for Detecting Slow Progress of Labour at Rural Health Centres.

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    Pratinidhi, Asha K; Doke, P P; Shrotri, A N; Patange, R P; Vhaval, Vaishali; Patil, Supriya S; Patil, Sujata V; Kakade, S V

    2016-10-01

    An innovative appropriate technological tool of colour-coded rings based on cervicographic principles was developed to monitor deliveries. To study efficacy, feasibility and acceptability of colour-coded rings for monitoring active phase of labour. All consecutive deliveries occurring at selected primary health centres from Pune, Satara and Kolhapur Districts of Maharashtra, during 15 months period were included in the study and matched control groups. Training of medical officers and nurses from both study and control area was undertaken in routine natal and post-natal care. In addition, training of use of colour-coded rings was given to health workers from the study area. There were 6705 live births from study area and 6341 from control area. Perinatal mortality rate for study area was 15.9/1000 LB while that was 23.9/1000 LB for control area (p < 0.01). The cause-specific perinatal mortality due to birth asphyxia for the study area was 4.2/1000 LB while that was 8.5/1000 LB for control area (p = 0.0019). Higher use rate of colour-coded rings associated with reduction in cause-specific mortality rate due to birth asphyxia in study area indicated that use of colour-coded rings is effective, feasible and acceptable option to cervicography under field conditions.

  8. Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy

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    Agrawal Jyoti

    2012-07-01

    Full Text Available Abstract Background Perinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE is a common problem causing multi organ dysfunction including myocardial involvement which can affect the outcome. Objective To evaluate the myocardial dysfunction in neonates having HIE by electrocardiographic(ECG and cardiac enzymes (CK Total, CK-MB and Troponin I and find out the relationship with HIE and outcome. Design/Methods This was a hospital based prospective study. Sixty term neonates who had suffered perinatal asphyxia and developed HIE were enrolled. Myocardial involvement was assessed by clinical, ECG, and CK Total, CK-MB and Troponin I measurements. Results Of 60 cases, 13(21.7% were in mild, 27(45% in moderate and 20(33.3% belonged to severe,HIE. ECG was abnormal in 46 (76.7%; of these 19 (41.3% had grade I, 13 (28.2% grades II and III each and 1 (2.1% with grade IV changes. Serum levels of CK Total, CK- MB and Troponin I were raised in 54 (90%, 52 (86.6% and 48 (80% neonates, respectively. ECG changes and enzymatic levels showed increasing abnormalities with severity of HIE, and the differences among different grades were significant (p = 0.002, 0.02, Conclusions Abnormal ECG and cardiac enzymes levels are found in HIE and can lead to poor outcome due to myocardial damage Early detection can help in better management and survival of these neonates.

  9. Neuroimaging in cerebral palsy - report from north India.

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    Aggarwal, Anju; Mittal, Hema; Kr Debnath, Sanjib; Rai, Anuradha

    2013-01-01

    Only few Indian reports exist on neuroimaging abnormalities in children with cerebral palsy (CP) from India. We studied the clinico-radiological profile of 98 children diagnosed as CP at a tertiary centre in North India. Relevant investigations were carried out to determine the etiology. Among the 98 children studied, 80.5% were males and 22.2% were premature. History of birth asphyxia was present in 41.9%. Quadriplegic CP was seen in 77.5%, hemiplegic in 11.5%, and diplegic in 10.5%. Other abnormalities were microcephaly (60.5%), epilepsy (42%), visual abnormality (37%), and hearing abnormality (20%). Neuroimaging was abnormal in 94/98 (95.91%). Abnormalities were periventricular white matter abnormalities (34%), deep grey matter abnormalities (47.8%), malformations (11.7%), and miscellaneous lesions (6.4%). Neuroimaging findings did not relate to the presence of birth asphyxia, sex, epilepsy, gestation, type of CP, or microcephaly. Neuroimaging is helpful for etiological diagnosis, especially malformations.

  10. The Global Network Neonatal Cause of Death algorithm for low-resource settings.

    Science.gov (United States)

    Garces, Ana L; McClure, Elizabeth M; Pérez, Wilton; Hambidge, K Michael; Krebs, Nancy F; Figueroa, Lester; Bose, Carl L; Carlo, Waldemar A; Tenge, Constance; Esamai, Fabian; Goudar, Shivaprasad S; Saleem, Sarah; Patel, Archana B; Chiwila, Melody; Chomba, Elwyn; Tshefu, Antoinette; Derman, Richard J; Hibberd, Patricia L; Bucher, Sherri; Liechty, Edward A; Bauserman, Melissa; Moore, Janet L; Koso-Thomas, Marion; Miodovnik, Menachem; Goldenberg, Robert L

    2017-06-01

    This study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur. We enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014 to 2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and/or a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death. One-third (33.1%) of the 3068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies. The Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  11. Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model.

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    Lee, Donald E; Lee, Lauren G; Siu, Danny; Bazrafkan, Afsheen K; Farahabadi, Maryam H; Dinh, Tin J; Orellana, Josue; Xiong, Wei; Lopour, Beth A; Akbari, Yama

    2017-04-01

    Recent electrophysiological studies have suggested surges in electrical correlates of consciousness (i.e., elevated gamma power and connectivity) after cardiac arrest (CA). This study examines electrocorticogram (ECoG) activity and coherence of the dying brain during asphyxial CA. Male Wistar rats (n = 16) were induced with isoflurane anesthesia, which was washed out before asphyxial CA. Mean phase coherence and ECoG power were compared during different stages of the asphyxial period to assess potential neural correlates of consciousness. After asphyxia, the ECoG progressed through four distinct stages (asphyxial stages 1-4 [AS1-4]), including a transient period of near-electrocerebral silence lasting several seconds (AS3). Electrocerebral silence (AS4) occurred within 1 min of the start of asphyxia, and pulseless electrical activity followed the start of AS4 by 1-2 min. AS3 was linked to a significant increase in frontal coherence between the left and right motor cortices (p conscious processing.

  12. Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic.

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    Resegue, Rosa; Puccini, Rosana Fiorini; Silva, Edina Mariko Koga da

    2008-01-02

    Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. Retrospective study at a multidisciplinary reference center, Embu, São Paulo. All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

  13. Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

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    Rosa Resegue

    Full Text Available CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mother’s age 5 days, prematurity and mother’s age 18 years and older. Low birth weight, history of perinatal asphyxia and mother’s age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

  14. Effect of Creatine Monohydrate Supplementation on Various Hematological and Serum Biochemical Parameters of Male Albino Mice following Neonatal Hypoxia-Ischemia Encephalopathy

    Science.gov (United States)

    Nazir, Nabia; Gillani, Quratulane; Akbar, Atif

    2013-01-01

    Background. Present study was designed to report the effect of 2% creatine monohydrate supplementation for 8, 12 and 15 weeks on hematology and serum biochemical profile of male albino mouse following hypoxic ischemic insult on postnatal day 10. Methods. 66 Blood samples (2% creatine monohydrate supplemented (N = 34) and unsupplemented (N = 32)) were analyzed for various hematological (blood glucose, packed cell volume, total WBC count, total RBC count) and serum biochemical parameters (cholesterol, AST, ALT, HDL, LDL, total protein, triglycerides). Results. ALT had higher concentrations in mice feeding on normal diet for 8 (P > 0.01) and 12 weeks (P > 0.01) following asphyxia and in 12 weeks treatment without asphyxia (P = 0.006) when compared with the creatine supplemented mice. LDL (P = 0.011) and cholesterol (P > 0.01) had higher concentrations in mice on normal diet for 12 weeks following hypoxia ischemia. Cholesterol (P > 0.01) in 12 and glucose (P = 0.006) in 15 week treatment group had significantly lower concentrations in creatine supplemented male albino mice when compared with untreated group following hxpoic-ischemic insult. Conclusion. We concluded that creatine supplementation following hypoxic ischemic insult helps in maintain the normal blood chemistry. PMID:24170981

  15. Lower respiratory tract foreign bodies: a retrospective review of morbidity, mortality and first aid management.

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    Rouillon, I; Charrier, J B; Devictor, D; Portier, F; Lebret, I Kerurien; Attal, P; Le Pajolec, C; Bobin, S

    2006-11-01

    The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment. Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment. The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia. We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.

  16. Patterns of Phrenic Nerve Discharge after Complete High Cervical Spinal Cord Injury in the Decerebrate Rat.

    Science.gov (United States)

    Ghali, Michael George Zaki; Marchenko, Vitaliy

    2016-06-15

    Studies conducted since the second half of the 19th century have revealed spontaneous as well as pharmacologically induced phasic/rhythmic discharge in spinal respiratory motor outputs of cats, dogs, rabbits, and neonatal rats following high cervical transection (Tx). The extent to which these various studies validate the existence of a true spinal respiratory rhythm generator remains debated. In this set of studies, we seek to characterize patterns of spontaneous phasic/rhythmic, asphyxia-induced, and pharmacologically induced activity occurring in phrenic nerve (PhN) discharge after complete high cervical (C1-C2) spinal cord transection. Experiments were performed on 20 unanesthetized decerebrate Sprague-Dawley adult male rats. Patterns of spontaneous activity after spinalization included tonic, phasic, slow oscillatory, and long-lasting tonic discharges. Topical application of antagonists of GABAA and glycine receptors to C1- and C2- spinal segments induced left-right synchronized phasic decrementing activity in PhN discharge that was abolished by an additional C2Tx. Asphyxia elicited increases in tonic activity and left-right synchronized gasp-like bursts in PhN discharge, demonstrating the presence of spinal circuits that may underlie a spinal gasping-like mechanism. We conclude that intrinsic slow oscillators and a phasic burst/rhythm generator exist in the spinal cord of the adult rat. If present in humans, this mechanism may be exploited to recover respiratory function in patients sustaining severe spinal cord injury.

  17. Current reports on autoerotic deaths--five persistent myths.

    Science.gov (United States)

    Sauvageau, Anny

    2014-01-01

    Autoerotic deaths are defined as accidental deaths that occur during individual, solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused unintentional death. In the Western countries, the incidence of these deaths is of approximately 0.5 deaths per million inhabitants per year. In this paper, five myths about autoerotic death are explored. Myth #1: the manner of death in autoerotic death is usually accidental but could also be suicidal or natural (reality: by definition, all autoerotic deaths are accidental). Myth #2: autoerotic death can happen with a sexual partner (reality: by definition, autoerotic deaths are solitary activities). Myth #3: an escape mechanism must be found at the scene (reality: there is no escape mechanism to be observed at the scene in the majority of autoerotic deaths). Myth #4: all autoerotic deaths are related to asphyxia (reality: not all autoerotic deaths are related to asphyxia). Myth #5: masturbation is an important component of all autoerotic activities and therefore all autoerotic deaths (reality: evidence of masturbation at the scene is a rare finding).

  18. Characterization of a cerebral palsy-like model in rats: Analysis of gait pattern and of brain and spinal cord motor areas.

    Science.gov (United States)

    Dos Santos, Adriana Souza; de Almeida, Wellington; Popik, Bruno; Sbardelotto, Bruno Marques; Torrejais, Márcia Miranda; de Souza, Marcelo Alves; Centenaro, Lígia Aline

    2017-08-01

    In an attempt to propose an animal model that reproduces in rats the phenotype of cerebral palsy, this study evaluated the effects of maternal exposure to bacterial endotoxin associated with perinatal asphyxia and sensorimotor restriction on gait pattern, brain and spinal cord morphology. Two experimental groups were used: Control Group (CTG) - offspring of rats injected with saline during pregnancy and Cerebral Palsy Group (CPG) - offspring of rats injected with lipopolysaccharide during pregnancy, submitted to perinatal asphyxia and sensorimotor restriction for 30days. At 29days of age, the CPG exhibited coordination between limbs, weight-supported dorsal steps or weight-supported plantar steps with paw rotation. At 45days of age, CPG exhibited plantar stepping with the paw rotated in the balance phase. An increase in the number of glial cells in the primary somatosensory cortex and dorsal striatum were observed in the CPG, but the corpus callosum thickness and cross-sectional area of lateral ventricle were similar between studied groups. No changes were found in the number of motoneurons, glial cells and soma area of the motoneurons in the ventral horn of spinal cord. The combination of insults in the pre, peri and postnatal periods produced changes in hindlimbs gait pattern of animals similar to those observed in diplegic patients, but motor impairments were attenuated over time. Besides, the greater number of glial cells observed seems to be related to the formation of a glial scar in important sensorimotor brain areas. Copyright © 2017 ISDN. Published by Elsevier Ltd. All rights reserved.

  19. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births

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    Núbia Karla O. Almeida

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVES: To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS: Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS: For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years, and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births, of low Apgar score at 5 min (for term births, of macrosomia (for non-primiparous women, and of asphyxia. CONCLUSION: As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.

  20. Suicide by asphyxiation with or without helium inhalation in the region of Amsterdam (2005-2014).

    Science.gov (United States)

    van den Hondel, Karen E; Buster, Marcel; Reijnders, Udo J L

    2016-11-01

    Annually about 28% of the 5800 death of unnatural cause in the Netherlands are a result of suicide. In 2012 and 2013 a movie and a book were published about a "dignified end of life" which also described the suicide using the exit bag to establish asphyxia using helium. The purpose of this study is to investigate if the suicide methods changed since the publicity in 2013 about suicidal asphyxiation by using helium gas. This study especially focuses on suicide using the 'exit bag' with or without helium gas. In the period 2005 to 2014 all suicides in the region of Amsterdam-Amstelland and Zaanstreek-Waterland were analyzed and from these suicides cases using the exit bag were selected. The study shows a rising trend with the use of the helium (P > 0.01) and a decreasing trend for suicide by asphyxia using an exit bag (P suicides using the helium method is rising in Amsterdam-Amstelland and Zaanstreek-Waterland, while suicides by asphyxiation without helium are decreasing. The specific publicity of books about suicides using helium may have influenced this transition. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  1. Impact of cerebral visual impairments on motor skills : implications for developmental coordination disorders.

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    Sylvie Chokron

    2016-10-01

    Full Text Available Cerebral visual impairment (CVI has become the primary cause of visual impairment and blindness in children in industrialized countries. Its prevalence has increased sharply, due to increased survival rates of children who sustain severe neurological conditions during the perinatal period. Improved diagnosis has probably contributed to this increase. As in adults, the nature and severity of CVI in children relate to the cause, location and extent of damage to the brain. In the present paper, we define CVI and how this impacts on visual function. We then define DCD and discuss the link between CVI and DCD. The neuroanatomical correlates and aetiologies of DCD are also presented in relationship with CVI as well as the consequences of perinatal asphyxia and preterm birth on the occurrence and nature of DCD and CVI. This paper underlines why there are both clinical and theoretical reasons to disentangle CVI and DCD, and to categorise the features with more precision. In order to offer the most appropriate rehabilitation, we propose a systematic and rapid evaluation of visual function in at-risk children who have survived preterm birth or perinatal asphyxia whether or not they have been diagnosed with cerebral palsy or DCD.

  2. De novo point mutations in patients diagnosed with ataxic cerebral palsy.

    Science.gov (United States)

    Parolin Schnekenberg, Ricardo; Perkins, Emma M; Miller, Jack W; Davies, Wayne I L; D'Adamo, Maria Cristina; Pessia, Mauro; Fawcett, Katherine A; Sims, David; Gillard, Elodie; Hudspith, Karl; Skehel, Paul; Williams, Jonathan; O'Regan, Mary; Jayawant, Sandeep; Jefferson, Rosalind; Hughes, Sarah; Lustenberger, Andrea; Ragoussis, Jiannis; Jackson, Mandy; Tucker, Stephen J; Németh, Andrea H

    2015-07-01

    Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain.

  3. Dual-source computed tomography may define cardiac contusion in patients with blunt chest trauma in ED.

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    Emet, Mucahit; Saritemur, Murat; Altuntas, Bayram; Karaca, Leyla; Sari, Fatih Mehmet; Bilgin, Yasin; Kantarci, Mecit; Aslan, Sahin

    2015-06-01

    We report a 20-year-old woman with blunt chest trauma because of a motor vehicle injury who has traumatic asphyxia and hypotension. The diagnosis of blunt cardiac injury was put by using dual-energy computed tomography in the emergency department because other laboratory and imaging modalities were useless. After hospitalization in intensive care unit, she was treated with supportive and antiedema therapy. The patient was extubated on the fifth day and discharged on the ninth day without any sequel. Coexistence of traumatic asphyxia with blunt cardiac injury is rare. Several imaging techniques such as transthoracic and transesophageal echocardiography, contrast-enhanced multislice thorax computed tomography or initial electrocardiogram, and troponin I levels are used to detect the myocardial damage, but diagnostic capability is low. Dual-energy computed tomography is a promising new technology with the ability of defining blunt cardiac injuries and may have an indication in the emergency setting in patients with hemodynamic instability to rule in traumatic cardiac complications especially when electrocardiogram and transthoracic echocardiography are useless in the emergency department.

  4. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

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    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  5. KEMATIAN TAHANAN DI RUANG SEL POLISI KONTROVERSI PEMBUNUHAN ATAU BUNUH DIRI DILIHAT DARI SUDUT PANDANG ILMU KEDOKTERAN FORENSIK

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    Rika Susanti

    2012-05-01

    Full Text Available AbstrakKematian tahanan cukup sering ditemukan, beberapa cara mati dapat terjadi. Kasus yang banyak adalah cara mati dengan bunuh diri. Tugas dokter dalam menangani kasus kematian yang diotopsi adalah untuk menentukan sebab mati dan mekanisme mati, sedangkan cara mati adalah kewenangan penyidik. Pada kematian akibat asfiksia mekanik, akan ditemukan ciri umum yang sama, tetapi dokter dapat memperkirakan jenis asfiksia dari gambaran luka yang ditemukan tubuh korban.Dua kakak beradik, laki-laki, umur masing-masing 18 tahun dan 15 tahun ditemukan dalam keadaan tergantung di runag tahanan polisi. Otopsi dilakukan antara 24-48 jam post mortem. Pada pemeriksaan ditemukan luka lecet tekan dengan pola sesuai kasus gantung dileher dan beberapa luka lecet dan memar dianggota gerak terutama anggota gerak bawah. Kuku berwarna keunguan, daerah leher dan wajah berwarna lebih gelap. Tubuh kedua korban sudah mulai membusuk. Pada pemeriksaan dalam ditemukan memar pada otot leher, tanda-tanda mati lemas pada beberapa organ, sedangkan pada bagian tubuh lain tidak ditemukan tanda-tanda kekerasan.Sebab kematian kekerasan tumpul dileher karena ditemukan tanda-tanda intravitalitas luka, dan tanda- tanda asfiksia pada tubuh korban, pola luka dileher sesuai pola gantung. Tidak ditemukan tanda kekerasan lain yang bisa menyebabkan kematian. Beberapa luka lecet dengan umur yang berbeda-beda ditemukan di ekstremitas hal ini bisa disebabkan oleh berbagai kekerasan tumpul. Kasus ini menjadi kontroversi karena kematian di tahanan dianggap ada kelalain petugas, dan korban adalah usia anak dan kakak beradik.Kata kunci : kematian di tahanan-asfiksis mekanik-cara matiAbstractDeath of prisoner quite often find in several methods. The most case of death are by suicide method. Physician role in autopsy is to found cause of death and death mechanism, whereas death method is authority of investigating officer. Death caused by mechanical asphyxia will find the same general characteristic

  6. Trend analysis of mortality rates and causes of death in children under 5 years old in Beijing, China from 1992 to 2015 and forecast of mortality into the future: an entire population-based epidemiological study.

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    Cao, Han; Wang, Jing; Li, Yichen; Li, Dongyang; Guo, Jin; Hu, Yifei; Meng, Kai; He, Dian; Liu, Bin; Liu, Zheng; Qi, Han; Zhang, Ling

    2017-09-18

    To analyse trends in mortality and causes of death among children aged under 5 years in Beijing, China between 1992 and 2015 and to forecast under-5 mortality rates (U5MRs) for the period 2016-2020. An entire population-based epidemiological study was conducted. Data collection was based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Trends in mortality and leading causes of death were analysed using the χ 2 test and SPSS 19.0 software. An autoregressive integrated moving average (ARIMA) model was fitted to forecast U5MRs between 2016 and 2020 using the EViews 8.0 software. Mortality in neonates, infants and children aged under 5 years decreased by 84.06%, 80.04% and 80.17% from 1992 to 2015, respectively. However, the U5MR increased by 7.20% from 2013 to 2015. Birth asphyxia, congenital heart disease, preterm/low birth weight and other congenital abnormalities comprised the top five causes of death. The greatest, most rapid reduction was that of pneumonia by 92.26%, with an annual average rate of reduction of 10.53%. The distribution of causes of death differed among children of different ages. Accidental asphyxia and sepsis were among the top five causes of death in children aged 28 days to 1 year and accident was among the top five causes in children aged 1-4 years. The U5MRs in Beijing are projected to be 2.88‰, 2.87‰, 2.90‰, 2.97‰ and 3.09‰ for the period 2016-2020, based on the predictive model. Beijing has made considerable progress in reducing U5MRs from 1992 to 2015. However, U5MRs could show a slight upward trend from 2016 to 2020. Future considerations for child healthcare include the management of birth asphyxia, congenital heart disease, preterm/low birth weight and other congenital abnormalities. Specific preventative measures should be implemented for children of various age groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All

  7. Characterisation of Classical Sudden Infant Death Syndrome SIDS and Gray Zone SIDS in Japan Using Japanese Pathology and Autopsy Report 1982-1986 From the Japanese Society of Pathology

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    Toshiko Sawaguchia

    1996-07-01

    Full Text Available There is no standardised criterion on the handling of Classical Sudden Infant Death Syndrome (SIDS and Gray Zone SIDS. Particularly international discussion is needed on the handling of Gray Zone cases. Autopsy findings for Classical SIDS and Gray Zone SIDS in Japan has been analysed in preparing the basic data for this discussion in this report. The material analysed was found in the Japanese Pathology and Autopsy Report from the Japanese Society of Pathology (January 1982 to December 1986. A x2 test was required to find the difference between Classical SIDS and Gray Zone SIDS in each autopsy finding. In addition, factor analysis (the principal factor method with Varimax rotation was carried out to identify the structure of the autopsy findings not only for Gray Zone SIDS but also for Classical SIDS. Using the x2 test a lymph tissue enlargement was found to have a high statistical value in Classical SIDS. Congestion, thymus enlargement, pulmonary oedema, adrenal gland atrophy, lymph tissue enlargement and neonate were recorded with .high factor loadings in Classical SIDS by factor analysis. Pneumonia, premature baby, and cardiomegaly was recorded with high statistical value in Gray Zone SIDS by the x2 test. Asphyxia, congestion, atelectasis, pulmonary emphysema, adrenal gland atrophy, premature baby, thymus hypoplasia, cardial malformation and ectopic hemopoesis were recorded as having high factor loadings in Gray Zone SIDS using factor analysis. Thymus enlargement and adrenal gland atrophy were recorded in the third factor of Gray Zone SIDS having rather high negative factor loading using factor analysis. It is remarkable that asphyxia was extracted in the first factor of Gray Zone SIDS with the highest loading factor using factor analysis. This fact might suggest indirectly that a percentage of Gray Zone SIDS would be underdiagnosed because of a substitutional diagnosis of asphyxia as being an external cause of death in Japan, even in general

  8. Effect of hypertensive disorders during pregnancy on neonatal outcomes and umbilical artery flow

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    Dong-mei ZHENG

    2013-09-01

    Full Text Available Objective To observe the effect of hypertensive disorders during pregnancy (HDP on neonatal outcomes and umbilical artery flow. Methods A prospective cohort study method was employed, and 60 pregnant women met the HDP diagnostic criteria (HDP group, aged 31.2±6.0 years, gestation time 251.0±9.0d, hospitalized from Sep. 2011 to May. 2012, and delivered live-born infants and 63 pregnant women with normal blood pressure and without medical or surgical ailments (control group, aged 30.2±2.8 years, gestation time 251.9±7.7d, hospitalized in the the same period, and had live birth were involved in present study. The indexes of umbilical artery blood flow were measured, the adverse neonatal outcomes (neonatal asphyxia, low birth weight babies and premature labor were recorded, and the correlation was analyzed between the adverse neonatal outcomes and the indexes of umbilical artery blood flow. Results The incidence of adverse neonatal outcomes (neonatal asphyxia, low birth weight newborns and premature labor was higher in HDP group (58.3%, 45.0% and 53.3%, respectively than in control group (6.3%, 3.2% and 3.2%, respectively, P<0.05. The results of umbilical artery blood flow indexes, including pulsatility index (PI, resistance index (RI and systolic/diastolic ratio (S/D in HDP group (0.897±0.176, 0.588±0.701 and 2.655±0.346, respectively were significantly higher than in control group (0.741±0.123, 0.525±0.650 and 2.120±0.364, respectively, P<0.05. The indexes of umbilical artery blood flow (PI, RI and S/D in newborns with adverse outcomes were significantly higher than in those newborn without adverse outcomes. Multivariate logistic regression revealed a positive correlation between RI and adverse neonatal outcomes. Conclusions The indexes of umbilical artery blood flow appear to be abnormal in pregnant women with HDP, and adverse neonatal conditions (neonatal asphyxia, low birth weight newborns and premature labor are prone to

  9. Reduced infancy and childhood epilepsy following hypothermia-treated neonatal encephalopathy.

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    Liu, Xun; Jary, Sally; Cowan, Frances; Thoresen, Marianne

    2017-11-01

    To investigate what proportion of a regional cohort of cooled infants with neonatal encephalopathy develop epilepsy (determined by the International League Against Epilepsy [ILAE] definition and the number of antiepileptic drugs [AEDs]) up to 8 years of age. From 2006-2013, 151 infants with perinatal asphyxia underwent 72 h cooling. Clinical and amplitude-integrated electroencepalography (aEEG) with single-channel EEG-verified neonatal seizures were treated with AEDs. Brain magnetic resonance imaging (MRI) was assessed using a 0-11 severity score. Postneonatal seizures, epilepsy rates, and AED treatments were documented. One hundred thirty-four survivors were assessed at 18-24 months; adverse outcome was defined as death or Bayley III composite Cognition/Language or Motor scores <85 and/or severe cerebral palsy or severely reduced vision/hearing. Epilepsy rates in 103 children age 4-8 years were also documented. aEEG confirmed seizures occurred precooling in 77 (57%) 151 of neonates; 48% had seizures during and/or after cooling and received AEDs. Only one infant was discharged on AEDs. At 18-24 months, one third of infants had an adverse outcome including 11% mortality. At 2 years, 8 (6%) infants had an epilepsy diagnosis (ILAE definition), of whom 3 (2%) received AEDs. Of the 103 4- to 8-year-olds, 14 (13%) had developed epilepsy, with 7 (7%) receiving AEDs. Infants/children on AEDs had higher MRI scores than those not on AEDs (median [interquartile range] 9 [8-11] vs. 2 [0-4]) and poorer outcomes. Nine (64%) of 14 children with epilepsy had cerebral palsy compared to 13 (11%) of 120 without epilepsy, and 10 (71%) of 14 children with epilepsy had adverse outcomes versus 23 (19%) of 120 survivors without epilepsy. The number of different AEDs given to control neonatal seizures, aEEG severity precooling, and MRI scores predicted childhood epilepsy. We report, in a regional cohort of infants cooled for perinatal asphyxia, 6% with epilepsy at 2 years (2% on AEDs

  10. Correlation of Apgar Score with Asphyxial Hepatic Injury and Mortality in Newborns: A Prospective Observational Study From India.

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    Sharma, Deepak; Choudhary, Mukesh; Lamba, Mamta; Shastri, Sweta

    2016-01-01

    The objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns. This is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured on postnatal days 1, 3, and 10 in the study and control groups. Neonatal mortality was observed in the study and control population. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for deranged hepatic function showed significant correlation (odds ratio [OR] 4.88, 95% CI 3.26-5.84, P = 0.01 and OR 2.46, 95% CI 1.94-3.32, P = 0.02, respectively). There was a significant increase in serum lactate dehydrogenase (LDH) and total bilirubin on day 1 and serum LDH at age of 10th postnatal life in severely asphyxiated neonates when compared to moderately asphyxiated neonates, whereas there was a significant decrease in total bilirubin and serum albumin on day 3 in severely asphyxiated neonates. There was a significant increase in serum alanine transaminase, serum LDH, and total bilirubin on day 1, serum aspartate transaminase, serum LDH, and total bilirubin on day 3, and International Normalized Ratio on day 10 of postnatal life when severely asphyxiated neonates were compared with normal neonates. There was a significant reduction in total protein and serum albumin on day 1 and direct bilirubin on day 3 in severely asphyxiated neonates when compared with normal neonates. There was a significant increase in neonatal mortality in severely asphyxiated neonates when compared to the other two groups. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated

  11. Paternal and maternal age at pregnancy and autism spectrum disorders in offspring

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    Luh Putu Rihayani Budi

    2016-11-01

    Full Text Available Background The prevalence of autism spectrum disorders (ASDs has increased 10 times over the past half century, while paternal and maternal age at pregnancy has also increased. Studies looking for an association between paternal or maternal age at pregnancy and ASDs in offspring have not been conclusive. Objective To assess for possible associations between paternal and maternal age at pregnancy and ASDs in offspring. Methods This case-control study had 50 case and 100 control subjects, each case was matched for age and gender to two controls. Case subjects were obtained by consecutive sampling of patients aged 18 months to 7 years who visited the Developmental Behavioral & Community Pediatrics Outpatient Clinic and private growth and development centers from January to April 2013, while control group were children of the same age range and same gender who visited pediatric outpatient clinic at Sanglah Hospital mostly due to acute respiratory tract infection, without ASDs as assessed by the DSM-IV-TR criteria. We interviewed parents to collect the following data: maternal and paternal age at pregnancy, child’s birth weight, history of asphyxia, hospital admission during the neonatal period, pathological labor, maternal smoking during pregnancy, paternal smoking, and gestational age. Data analysis was performed with Chi-square and Fisher’s exact tests. Results Multivariable analysis showed that higher paternal age at pregnancy was associated with ASDs in offspring (OR 6.3; 95%CI 2.0 to 19.3; P 0.001. However, there was no significant association between maternal age during pregnancy and the incidence of ASDs. Asphyxia and paternal smoking were also associated with higher incidence of ASDs in the offspring (OR 10.3; 95%CI 1.9 to 56.5; P 0.007 and OR 3.2; 95%CI 1.5 to 6.9; P 0.003, respectively. Conclusion Paternal age >=40 years increased the risk of ASDs in offspring by 6.3 times. In addition, paternal smoking increased the risk of ASDs in

  12. [Application of Bayes Probability Model in Differentiation of Yin and Yang Jaundice Syndromes in Neonates].

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    Mu, Chun-sun; Zhang, Ping; Kong, Chun-yan; Li, Yang-ning

    2015-09-01

    To study the application of Bayes probability model in differentiating yin and yang jaundice syndromes in neonates. Totally 107 jaundice neonates who admitted to hospital within 10 days after birth were assigned to two groups according to syndrome differentiation, 68 in the yang jaundice syndrome group and 39 in the yin jaundice syndrome group. Data collected for neonates were factors related to jaundice before, during and after birth. Blood routines, liver and renal functions, and myocardial enzymes were tested on the admission day or the next day. Logistic regression model and Bayes discriminating analysis were used to screen factors important for yin and yang jaundice syndrome differentiation. Finally, Bayes probability model for yin and yang jaundice syndromes was established and assessed. Factors important for yin and yang jaundice syndrome differentiation screened by Logistic regression model and Bayes discriminating analysis included mothers' age, mother with gestational diabetes mellitus (GDM), gestational age, asphyxia, or ABO hemolytic diseases, red blood cell distribution width (RDW-SD), platelet-large cell ratio (P-LCR), serum direct bilirubin (DBIL), alkaline phosphatase (ALP), cholinesterase (CHE). Bayes discriminating analysis was performed by SPSS to obtain Bayes discriminant function coefficient. Bayes discriminant function was established according to discriminant function coefficients. Yang jaundice syndrome: y1= -21. 701 +2. 589 x mother's age + 1. 037 x GDM-17. 175 x asphyxia + 13. 876 x gestational age + 6. 303 x ABO hemolytic disease + 2.116 x RDW-SD + 0. 831 x DBIL + 0. 012 x ALP + 1. 697 x LCR + 0. 001 x CHE; Yin jaundice syndrome: y2= -33. 511 + 2.991 x mother's age + 3.960 x GDM-12. 877 x asphyxia + 11. 848 x gestational age + 1. 820 x ABO hemolytic disease +2. 231 x RDW-SD +0. 999 x DBIL +0. 023 x ALP +1. 916 x LCR +0. 002 x CHE. Bayes discriminant function was hypothesis tested and got Wilks' λ =0. 393 (P =0. 000). So Bayes

  13. The window of opportunity for treatment withdrawal.

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    Wilkinson, Dominic

    2011-03-01

    Physicians sometimes refer to a "window of opportunity" for withdrawing life-sustaining treatment in patients with acute severe brain injury. There is a period of critical illness and physiological instability when treatment withdrawal is likely to be followed by death but prognosis is uncertain. If decisions are delayed, greater prognostic certainty can be achieved, but with the risk that the patient is no longer dependent on life support and survives with very severe disability. In this article I draw on the example of birth asphyxia and highlight the role that the window of opportunity sometimes plays in decisions about life-sustaining treatment in intensive care. I outline the potential arguments in favor of and against taking the window into account. I argue that it is, at least sometimes, ethical and appropriate for physicians and parents to be influenced by the window of opportunity in their decisions about life-sustaining treatment.

  14. Obstetric Outcomes of Twin Pregnancies in Japanese Women Aged 40 and Older.

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    Suzuki, Shunji

    2017-10-01

    The aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29. This was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536). Although the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups. Advanced maternal age did not seem to affect obstetric outcomes in twin pregnancies seriously.

  15. A case of bulbar type cerebral palsy: representative symptoms of dorsal brainstem syndrome.

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    Hiyane, Masato; Saito, Yoshiaki; Saito, Takashi; Komaki, Hirofumi; Nakagawa, Eiji; Sugai, Kenji; Sasaki, Masayuki; Sato, Noriko; Yamamoto, Toshiyuki; Imai, Yoko

    2012-10-01

    In this study, we present the case of a 2-year-old boy who exhibited facial and bulbar paralysis since birth, severe dysphagia, signs of oculomotor disturbance, jaw jerks, pyramidal signs on both toes, intellectual disability, and severe gastroesophageal reflux. His blink reflex and auditory/somatosensory evoked potentials suggested abnormalities in the lower brainstem, and magnetic resonance imaging showed a T2 hyperintense area in the pontine tegmentum. These findings combined with the patient's symptoms suggested "dorsal brainstem syndrome" and indicated a possibility of prenatal asphyxia in this patient. Nosologic issues regarding this subgroup of cerebral palsy are discussed here. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  16. Luxatio erecta humeri: Report of a swimming injury with analysis of the mechanism of the injury and associated injuries in literature.

    Science.gov (United States)

    Gökkuş, Kemal; Sagtas, Ergin; Saylik, Murat; Aydın, Ahmet Turan; Atmaca, Halil

    2015-01-01

    Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

  17. Luxatio erecta humeri: Report of a swimming injury with analysis of the mechanism of the injury and associated injuries in literature

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    Kemal Gökkus

    2015-01-01

    Full Text Available Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.. We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

  18. RESPONSES OF SHEEP TO ZYGADENUS GRAMINEUS, "DEATH CAMAS".

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    McLaughlin, A R

    1931-01-30

    An extract of Zygadenus gramineus, "death camas," from which most of the resins had been removed was given intravenously to sheep prepared for recording blood-pressure and respiratory movements. Following the intravenous injection of this extract there occurred a respiratory inhibition which in the case of the injection of larger amounts of the extract was followed by asphyxia-like rises of blood-pressure. The graphic record of this asphyxial condition was practically duplicated by closing the tracheal cannula for a short time following the recovery of the animal from the effects of the plant extract. Although, from a field standpoint, no satisfactory antidote has been found, it has been demonstrated that caffein sodio-benzoate possesses marked powers of stimulation for the respiratory center affected by the depressive substances found in Zygadenus gramineus.

  19. Hearing screenings on children under three years at risk of hearing impairment.

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    Marcelino Lizano Rabelo

    2011-09-01

    Full Text Available This article presents the results of newborn hearing screenings on infants under three years at risk of hearing impairment at Paediatric Hospital of Sancti Spíritus¸on from 2008 to 2010. All children at risk of hearing impairment were tested by an auditory brainstem response (ABR for the positive diagnosis of hearing impairment. Results: Over the period, 398 infants were screened, among whom 36 (8,98% were diagnosed as deaf or hard of hearing. twenty seven children (6,8% had a sensorineural hearing impairment, The most important risk factors for sensorineural hearing loss were: severe birth asphyxia; mechanic ventilation, and antibiotics.Conclusion: Our hearing screening on infants at risk allowed 36 children diagnosed as hearing impairment, all of then received early management.

  20. Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review.

    Science.gov (United States)

    Carlin, Rebecca F; Moon, Rachel Y

    2017-02-01

    Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States. While its exact cause is unknown, sudden infant death syndrome is believed to be multifactorial, ie, occurs in infants with underlying biological vulnerability who experience an exogenous stressor, such as prone/side sleeping or soft bedding, during a critical developmental period. Much genetic and physiologic evidence points to impaired arousal responses to hypercarbia and hypoxia, which ultimately leads to asphyxia. Known risk factors for infants include prone and side sleeping, soft bedding, bed sharing, inappropriate sleep surfaces (including sofas), exposure to tobacco smoke, and prematurity; protective factors include breastfeeding, pacifier use, room sharing, and immunizations. Despite our improved understanding of the physiologic mechanisms that cause sudden infant death, the mainstay of risk reduction continues to be a safe sleep environment, as most infants who die suddenly and unexpectedly do so in unsafe sleep environments.

  1. Setting health research priorities using the CHNRI method: I. Involving funders

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    Igor Rudan

    2016-06-01

    Full Text Available In 2007 and 2008, the World Health Organization's Department for Child and Adolescent Health and Development commissioned five large research priority setting exercises using the CHNRI (Child Health and Nutrition Research Initiative method. The aim was to define research priorities related to the five major causes of child deaths for the period up to the year 2015. The selected causes were childhood pneumonia, diarrhoea, birth asphyxia, neonatal infections and preterm birth/low birth weight. The criteria used for prioritization in all five exercises were the “standard” CHNRI criteria: answerability, effectiveness, deliverability, potential for mortality burden reduction and the effect on equity. Having completed the exercises, the WHO officers were left with another question: how “fundable” were the identified priorities, i.e. how attractive were they to research funders?

  2. in vitro activation of complement and contact system by lactic acidosis

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    J. Sonntag

    1998-01-01

    Full Text Available The activation of complement and contact systems occurs in reperfusion injuries with initial tissue hypoxia, and lactic acidosis such as mycardial infarction and birth asphyxia. The aim of our experiment was the formal proof of activation by sole lactic acidosis. Lactic acid was added to blood and plasma samples from 10 healthy volunteers. C5a and factor XIIa were measured by EIA after incubation at 37°C for 1 h. Both concentrations increased (P<0.0001 by Friedman analysis in blood and plasma samples with increasing amount of added lactic acid. Lactic acidosis can activate C5 from the complement system and factor XII from the contact system directly, even in the absence of cellular components.

  3. Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular.

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    Jasso-Gutiérrez, Luis; Durán-Arenas, Luis; Flores-Huerta, Samuel; Cortés-Gallo, Gabriel

    2012-01-01

    To evaluate the structure and processes of care of neonatal intensive care units (NICU) providing health care to neonates with respiratory insufficiency, and financed by Seguro Popular. A cross-sectional design was used; 21 NICU were included. Information was collected from four sources: Seguro Popular database, self-applicable interviews to medical staff, structure and processes format, and reviews of clinical charts. structure, processes of care, drug supplies, training, and neonates' clinical conditions. The analysis of the database included 9 679 newborns. The respiratory disorders were transitory tachypnea, non-specific respiratory insufficiency, respiratory distress syndrome, (RDS) perinatal asphyxia, and meconium aspiration syndrome. 90% of NICU'S directors considered that drug supply was good, whereas only 16% of neonatologist had this opinion. 58.5% of neonates with RDS had <37 gestation weeks. 34.2% with RDS were prescribed alveolar surfactant; 51% received dosages above recommended standards. Recommendations to improve infrastructure and care processes are issued.

  4. Amniotic Fluid Aspiration in Medicolegal Autopsies

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    Sermet Koç

    1999-04-01

    Full Text Available Amniotic fluid aspiration occurs due to intrauterine anoxia. Being one of the causes of respiratory insufficiency and death in newborns, it can be diagnosed solely by histopathological examination. In the present paper, 12 cases with the diagnosis of amniotic fluid aspiration in autopsies between 1996-1997 in the mortuary section of the Council of Forensic Medicine are reevaluated from the medicolegal point of view. In the majority of the cases, delivery took place in locations other than hospitals, and the lack of medical intervention has been an important factor for the infavorable outcome of the autopsies. Findings of amniotic fluid aspiration stained with meconium were detected in four cases. Key words: Amniotic fluid aspiration, intrauterin asphyxia, Neonatal death, Medicolegal autopsy.

  5. On the physical death of Jesus Christ.

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    Edwards, W D; Gabel, W J; Hosmer, F E

    1986-03-21

    Jesus of Nazareth underwent Jewish and Roman trials, was flogged, and was sentenced to death by crucifixion. The scourging produced deep stripelike lacerations and appreciable blood loss, and it probably set the stage for hypovolemic shock, as evidenced by the fact that Jesus was too weakened to carry the crossbar (patibulum) to Golgotha. At the site of crucifixion, his wrists were nailed to the patibulum and, after the patibulum was lifted onto the upright post (stipes), his feet were nailed to the stipes. The major pathophysiologic effect of crucifixion was an interference with normal respirations. Accordingly, death resulted primarily from hypovolemic shock and exhaustion asphyxia. Jesus' death was ensured by the thrust of a soldier's spear into his side. Modern medical interpretation of the historical evidence indicates that Jesus was dead when taken down from the cross.

  6. Laktat i navlearterie- og navleveneblod hos nyfødte

    DEFF Research Database (Denmark)

    Rubak, Sune Leisgaard Mørck; Henriksen, Tine Brink

    2010-01-01

    in arterial umbilical cord blood was higher than in venous umbilical cord blood; furthermore, that O2 and pH in arterial umbilical cord blood were lower than in venous umbilical cord blood. Regression analysis including the factors lactate and "active second stage of labour" showed that lactate significantly......INTRODUCTION: In theory, lactate may be used as a more precise measure of the degree of metabolic acidosis than other previous methods, thereby enabling differentiation between acute and chronic foetal hypoxia. The aim of the study was to describe lactate in arterial and venous cord blood...... in an unselected population of newborn children without signs of foetal hypoxia or perinatal asphyxia. MATERIAL AND METHODS: The study included 208 newborn children. The umbilical cord of the children was double clamped within 30 seconds and thereafter blood was drawn from an umbilical arterial and venous cord...

  7. Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care.

    Science.gov (United States)

    Lansky, Sônia; Lima Friche, Amélia Augusta de; Silva, Antônio Augusto Moura da; Campos, Deise; Azevedo Bittencourt, Sonia Duarte de; Carvalho, Márcia Lazaro de; Frias, Paulo Germano de; Cavalcante, Rejane Silva; Cunha, Antonio José Ledo Alves da

    2014-08-01

    This study examined neonatal deaths in the live-births cohort in the Birth in Brazil survey, which interviewed and examined medical records of 23,940 mothers from February 2011 to October 2012. Potential risk factors were analyzed using hierarchical modeling. Neonatal mortality rate was 11.1/1,000, the highest rates occurring in the North and Northeast regions and in lower social classes. Low birth weight, risks during pregnancy and conditions of the newborn were the main factors associated with neonatal death. Inadequate prenatal and childbirth care point to unsatisfactory quality of health care. Difficulty in gaining hospital admission for delivery, and children with birth weightcare unit, indicate gaps in health system organization. Deaths from intra-partum asphyxia in term babies and late prematurity express preventable neonatal mortality. Better quality health care, especially hospital care during labor and birth, poses the main public policy challenge to progress in reducing mortality and inequalities in Brazil.

  8. Has electronic fetal heart rate monitoring made a difference.

    Science.gov (United States)

    Steer, Philip J

    2008-02-01

    Electronic fetal heart rate monitoring (EFHRM) has revolutionised our understanding of the function of the cardiovascular system of the fetus during labour, and how the fetus responds to hypoxia. However, although it is a sensitive technique for the detection of hypoxia during labour, it is relatively non-specific for detecting the development of acidosis. Moreover, it is highly dependent on accurate interpretation of fetal heart rate (FHR) patterns, which has been shown to be commonly of a low standard in everyday clinical practice. Use of EFHRM has probably reduced the incidence of birth asphyxia, but it has also contributed to the rise in the caesarean section rate. Ancillary techniques, such as pulse oximetry, have not proved useful, although ST-segment analysis of the ECG waveform shows some promise. Computerised expert systems for the analysis of FHR patterns may be more successful at avoiding poor outcomes.

  9. Computed tomographic (CT) scans in cerebral palsy (CP)

    Energy Technology Data Exchange (ETDEWEB)

    Kolawole, T.M.; Patel, P.J. (King Saud Univ., Riyadh (Saudi Arabia). Dept. of Radiology); Mahdi, A.H. (King Saud Univ., Riyadh (Saudi Arabia). Dept. of Paediatrics)

    1989-11-01

    The CT findings in 120 cerebral palsied children are analysed. The 72.5% positive findings are correlated with the clinical types, as well as the aetiological basis for the cerebral palsy. The spastic type, 83.3% of the total number of children, had the highest positive findings. The yield was increased in children with seizures (91.3%) and those in the postnatal group (90%), as well as those with birth trauma and neonatal asphyxia (94%). The findings were those of atrophy in 30.8%, hydrocephalus, in 10%, infarct in 11.6%, porencephaly in 8.3% and others. The atropic changes and their patterns are explained. Treatable lesions, such as tumour, hydrocephalus, subdural haematoma, porencephaly and hygroma were identified in 22.5% of cases. It is concluded that CT scan is definitely efficacious in the management of cerebral palsied children. (orig.).

  10. A breath of fresh air for cryogenics training

    CERN Multimedia

    HSE Unit

    2014-01-01

    Whether you work full-time in a cryogenic installation or are required to handle cryogenic substances temporarily, you need to have followed the appropriate safety training.   Photo: Christoph Balle. Two new training courses are now available in English and French at CERN: “Cryogenic Safety – Fundamentals” (at the Prévessin Training Centre) and “Cryogenic Safety – Helium Transfer” (at the Cryolab). The first covers the content of levels 1 and 2 of the old “Cryogenic Safety” course. The second is a completely new course for CERN: it covers specific aspects of the transfer of liquid helium, such as the evaporation process of helium and the associated risks to human health (asphyxia due to displacement of oxygen), the colour code for gas bottles, etc. These training modules have been rewritten in response to the increase in the number of projects involving cryogenics and following various related incident...

  11. Accidental infant death and stroller-prams.

    Science.gov (United States)

    Byard, R W; Beal, S M; Simpson, A; Carter, R F; Khong, T Y

    1996-08-05

    A three-month-old boy and an eight-month-old boy died from accidental positional asphyxia and hanging, respectively, after being placed to sleep unsupervised in stroller-prams. Both infants had moved down towards the fronts of the stroller-prams. The younger infant fell out when the footplate collapsed and he was found hanging from a metal bar on the side. The older infant had partly slipped through the front and was suspended with his head and arms within the stroller-pram and with his face pushed firmly into the mattress by a horizontal metal bar. Stroller-prams are a potentially dangerous sleeping environment unless infants are closely supervised, gaps in the front of stroller-prams closed and upright footplates stabilised.

  12. The shifting sands of medico-legal intra-partum Ctg (I-P Ctg) monitoring.

    Science.gov (United States)

    Buttigieg, George G

    2016-03-01

    Intra-partum (IP) surveillance of the unborn child by cardiotacography (CTG) monitoring is the commonest obstetric procedure in the developed world.(1) It is also the most medico-legally contested obstetric procedure in labour. In 2011, 'birth asphyxia' comprised 50% of the UK National Health Service (NHS) litigation costs,(2) and in the 2000-2010 decade, the same NHS paid out £3.1 billion for maternity medico-legal claims (the highest of any speciality), mostly involving cerebral palsy and CTG misinterpretation.(3) This article looks at a number of characteristics of IP CTG monitoring which argue for its questionable solidity of base in court proceedings. © The Author(s) 2015.

  13. An autopsy case of asthmatic death: Usefulness of biochemical examination

    Directory of Open Access Journals (Sweden)

    Kinoshita Hiroshi

    2008-01-01

    Full Text Available Background. Asthma is the one of the major causes of sudden death in Japan. Postmortem diagnosis of asthma has been based on morphological findings in lungs, but it histological evidence, was also reported that the biochemical markers such as total and specific immunoglobulin E (IgE are useful. Case report. We present here a case of fatal asthmatic death. A Japanese male in his thirties, complaining of dyspnea, collapsed suddenly. He was taken by ambulance to hospital, but cardiopulmonary resuscitation was ineffective. From autopsy findings, we concluded that the cause of death was asphyxia due to asthma attack. Biochemical findings indicated that the deceased had a severe asthmatic condition. Conclusion. In the presented case, the biochemical examination of the serum obtained at autopsy gave helpful information for the diagnosis that asthmatic attack was a cause of death.

  14. [The analysis of the course of pregnancy, delivery and postpartum among women touched by flood disaster in Kotlin Kłodzki in July 1997].

    Science.gov (United States)

    Neuberg, M; Pawłosek, W; Lopuszański, M; Neuberg, J

    1998-12-01

    A natural disaster has been defined as a disruption of human ecology that exceeds the capacity of the community to function normally. Little is known about the influence of flood disaster on reproductive outcomes. This study reviews perinatal medical problems in pregnant women during the flood disaster from Kłodzko Region in July 1997. 47 pregnant women were investigated which injured from the flood disaster. We observed a psychosocial stress in this women. A control random group consists of 100 pregnant women in 1996. Reproductive outcomes include pregnancy loss in 55.3% and other severe disorders: premature delivery, missed abortion, birth asphyxia, premature rupture of membranes, intrauterine growth retardation. Psychosocial stress observed during the flood disaster cause many perinatal complications and pregnancy loss. Intensive perinatal medical care must usually be provided from outside the disaster area.

  15. Retropharyngeal hematoma secondary to cervical spine surgery: report of one fatal case.

    Science.gov (United States)

    Dedouit, Fabrice; Grill, Stéphane; Guilbeau-Frugier, Céline; Savall, Frédéric; Rougé, Daniel; Telmon, Norbert

    2014-09-01

    A 53-year-old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered. © 2014 American Academy of Forensic Sciences.

  16. Pathophysiology of foetal oxygenation and cell damage during labour.

    Science.gov (United States)

    Yli, Branka M; Kjellmer, Ingemar

    2016-01-01

    A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses. Although intrapartum events may account for no more than one-third of cases with an adverse neurological outcome, they are important because they can be influenced successfully. This review describes the mechanisms underlying foetal hypoxia during labour, acid-base balance and gas exchange, and the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Although the mechanisms involved include similar initiating events, principally ischaemia and excitotoxicity, and similar final common pathways to cell death, there are certain unique maturational factors that influence the type and pattern of cellular injury. Copyright © 2015. Published by Elsevier Ltd.

  17. Severe life threatening maxillofacial infection in pregnancy presented as Ludwig's angina.

    Science.gov (United States)

    Abramowicz, Shelly; Abramowicz, Jacques S; Dolwick, M Franklin

    2006-01-01

    Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. There is very little published information regarding this condition in the pregnant patient. A 24-year old black female was admitted at 26 weeks gestation with tooth pain, submandibular swelling, severe trismus, and dysphagea, consistent with Ludwig's angina. Her treatment included emergent tracheostomy, incision and drainage of associated spaces, teeth extraction, and antibiotic therapy. During a life threatening infectious situation such as the one described, risks of maternal and fetal morbidity include both septicemia and asphyxia. Furthermore, the healthcare provider must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.

  18. Histopathological changes in lungs of the mountain snow avalanche victims and its potential usefulness in determination of cause and mechanism of death

    Directory of Open Access Journals (Sweden)

    Mariusz Kobek

    2016-09-01

    Full Text Available On 28 January 2003 snow avalanche in the Polish Tatras happened, in which 8 people died and 5 were injured. We tried to determine cause and manner of death in 6 fatal victims instead of advanced late post mortem changes in internal organs. Taking into consideration the circumstances of death, we paid special attention to histopathological examination of lungs, extended by Gomori’s and AZAN staining. Pattern of the changes was similar to those observed in forensic medicine in cases of asphyxia due to airway obstruction and/or immobilization of chest and abdomen (Perthes’ syndrome. Histopathological study with the use of more specific staining methods has a significant diagnostic value during establishing the cause and mechanism of death of the deceased snow avalanche victims with advanced post mortem changes.

  19. Pietro Manni (1778-1839) and the care of the apparently dead in the Age of Positivism.

    Science.gov (United States)

    Cascella, Marco

    2016-08-01

    When can a man be declared 'really dead'? Being able to determine whether an individual's life has ended or not implies two important considerations, whether we can resuscitate him and avoid premature burial, the fear of which is termed 'taphophobia'. By the end of the 18th century, several scientists were involved in the study of apparent death and resuscitation. Pietro Manni was an obstetrician who, affected by his brother's death and his inability to help him, devoted himself to the study of apparent death, which became his aim in life. His Practical handbook for the care of the apparently dead is a detailed essay on resuscitation with a precise arrangement of topics - ventilation, tracheostomy, electricity and asphyxia in newborns - organised into chapters and paragraphs that resemble current texts on resuscitation. © The Author(s) 2016.

  20. Neurologic manifestations of diphtheria and pertussis.

    Science.gov (United States)

    Sanghi, Viraj

    2014-01-01

    Historically, diphtheria was a major cause of morbidity and mortality in the prevaccine era. However, in recent times there has been a resurgence of diphtheria, especially in the newly independent states of the former USSR. Diphtheritic polyneuropathy can be a serious complication in patients who have a severe infection. In patients with pertussis, seizures and encephalopathy can occur as a complication of asphyxia. Vaccination against diphtheria and pertussis in children and booster vaccination in adults is recommended. DTP (diphtheria, tetanus, pertussis) vaccination has been shown to increase the risk of febrile seizures in children. Currently, it appears that the risk of vaccine-induced encephalopathy and/or epilepsy following DTP vaccination, if any, is extremely low. © 2014 Elsevier B.V. All rights reserved.

  1. Breech delivery at a University Hospital in Tanzania

    DEFF Research Database (Denmark)

    Högberg, Ulf; Claeson, Catrin; Krebs, Lone

    2016-01-01

    death (stillbirths + in-hospital neonatal deaths) and moderate asphyxia. Maternal outcomes, such as death, hemorrhage, and length of hospital stay, were also described. Results: The CD rate for breech presentation increased from 28 % in 1999 to 78 % in 2010. Perinatal deaths were associated with vaginal...... sound at admission, and absence of pregnancy-related complication as indication for CD. Of 2,765 mothers who had a breech delivery, 1,655 met the inclusion criteria. Analyses were stratified by mode of delivery, taking into account also other birth characteristics. The outcome measures were perinatal...... delivery (VD) (adjusted odds ratio (aOR) 6.2; 95 % confidence interval (CI) 3.0-12.6) and referral (aOR 2.1; 95 % CI 1.1-3.9), but not with parity, birth weight, or delivery year. Overall perinatal mortality was 5.8 % and this did not decline, due to an increase in stillbirths among vaginal breech...

  2. Mortality due to injuries in Maputo City, Mozambique

    DEFF Research Database (Denmark)

    Nizamo, Hanifa; Meyrowitsch, Dan Wolf; Zacarias, Eugénio

    2006-01-01

    Records of all registered deaths due to injuries maintained by the Legal Medicine Department in Maputo City for the period 1 January to 31 December 2000 were reviewed. Among the 1135 registered deaths, road traffic injuries accounted for the most common underlying cause of death (43.7%), followed.......1%) and suicides (4.2%). Prevention of road traffic injuries and improved emergency care and health facility-based treatment is needed to reduce injury-related mortality....... by firearm discharge (8.7%) and burns (7.8%). For all deaths, skull fracture (21.9%), organ system injury (17.2%) and brain tissue injury (9.3%) were the most important intermediate causes of death and among the immediate causes of death acute anaemia (21.9%) was the most common followed by asphyxia (14...

  3. Assessment of the Relationship between Recurrent High-risk Pregnancy and Mothers’ Previous Experience of Having an Infant Admitted to a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Sedigheh Hantoosh Zadeh

    2015-01-01

    Full Text Available Background & aim:  High-risk pregnancies increase the risk of Intensive Care Unit (ICU and Neonatal Intensive Care Unit (NICU admission in mothers and their newborns. In this study, we aimed to identify the association between the recurrence of high-risk pregnancy and mothers’ previous experience of having an infant admitted to NICU. Methods:We performed a cohort, retrospective study to compare subsequent pregnancy outcomes among 232 control subjects and 200 female cases with a previous experience of having a newborn requiring NICU admission due to intrauterine growth retardation, preeclampsia, preterm birth, premature rupture of membranes, and asphyxia. The information about the prevalence of subsequent high-risk pregnancies was gathered via phone calls. Results: As the results indicated, heparin, progesterone, and aspirin were more frequently administered in the case group during subsequent pregnancies, compared to the control group (P

  4. Epileptic Encephalopathy in Children with Risk Factors for Brain Damage

    Science.gov (United States)

    Ricardo-Garcell, Josefina; Harmony, Thalía; Porras-Kattz, Eneida; Colmenero-Batallán, Miguel J.; Barrera-Reséndiz, Jesús E.; Fernández-Bouzas, Antonio; Cruz-Rivero, Erika

    2012-01-01

    In the study of 887 new born infants with prenatal and perinatal risk factors for brain damage, 11 children with West syndrome that progressed into Lennox-Gastaut syndrome and another 4 children with Lennox-Gastaut syndrome that had not been preceded by West syndrome were found. In this study we present the main findings of these 15 subjects. In all infants multifactor antecedents were detected. The most frequent risk factors were prematurity and severe asphyxia; however placenta disorders, sepsis, and hyperbilirubinemia were also frequent. In all infants MRI direct or secondary features of periventricular leukomalacia were observed. Followup of all infants showed moderate to severe neurodevelopmental delay as well as cerebral palsy. It is concluded that prenatal and perinatal risk factors for brain damage are very important antecedents that should be taken into account to follow up those infants from an early age in order to detect and treat as early as possible an epileptic encephalopathy. PMID:22957240

  5. Metabolomics Application in Maternal-Fetal Medicine

    Directory of Open Access Journals (Sweden)

    Vassilios Fanos

    2013-01-01

    Full Text Available Metabolomics in maternal-fetal medicine is still an “embryonic” science. However, there is already an increasing interest in metabolome of normal and complicated pregnancies, and neonatal outcomes. Tissues used for metabolomics interrogations of pregnant women, fetuses and newborns are amniotic fluid, blood, plasma, cord blood, placenta, urine, and vaginal secretions. All published papers highlight the strong correlation between biomarkers found in these tissues and fetal malformations, preterm delivery, premature rupture of membranes, gestational diabetes mellitus, preeclampsia, neonatal asphyxia, and hypoxic-ischemic encephalopathy. The aim of this review is to summarize and comment on original data available in relevant published works in order to emphasize the clinical potential of metabolomics in obstetrics in the immediate future.

  6. The Importance of Calcified Stylohyoid Ligament to the Neck Injury a Case Report

    Directory of Open Access Journals (Sweden)

    Gürcan Altun

    2005-04-01

    Full Text Available Stylohyoid ligament (LS is an anatomical structure between the styloid processes of temporal bone and cornu minus of hyoid bone. LS may calcify as elongated styloid processes and it may occur partly or completely. Elongated styloid process or calcified stylohyoid ligament gives a complex of symptoms described by Eagle such as craniofacial and cervical pain, dysphagia and foreign body sensation, and it is called Eagle's Syndrome. An 82-year-old man died due to mechanical asphyxia from hanging. Calcified stylohyoid ligaments were showed on examination of the internal structures of his neck. According to forensic medicine, the importance of calcified stylohyoid ligament reviewed to the autopsies has neck injuries. Key words: Neck injury, stylohyoid ligament, hanging

  7. Curved reformat of the paediatric brain MRI into a 'flat-earth map' - standardised method for demonstrating cortical surface atrophy resulting from hypoxic-ischaemic encephalopathy.

    Science.gov (United States)

    Simpson, Ewan; Andronikou, Savvas; Vedajallam, Schadie; Chacko, Anith; Thai, Ngoc Jade

    2016-09-01

    Hypoxic-ischaemic encephalopathy is optimally imaged with brain MRI in the neonatal period. However neuroimaging is often also performed later in childhood (e.g., when parents seek compensation in cases of alleged birth asphyxia). We describe a standardised technique for creating two curved reconstructions of the cortical surface to show the characteristic surface changes of hypoxic-ischaemic encephalopathy in children imaged after the neonatal period. The technique was applied for 10 cases of hypoxic-ischaemic encephalopathy and also for age-matched healthy children to assess the visibility of characteristic features of hypoxic-ischaemic encephalopathy. In the abnormal brains, fissural or sulcal widening was seen in all cases and ulegyria was identifiable in 7/10. These images could be used as a visual aid for communicating MRI findings to clinicians and other interested parties.

  8. The Apgar Score.

    Science.gov (United States)

    2015-10-01

    The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. Copyright © 2015 by the American Academy of Pediatrics.

  9. Heart size in new born infants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Won; Yu, Yun Jeong; Chung, Hye Kyung [Eul-ji General Hospital, Seoul (Korea, Republic of)

    1985-10-15

    Cardiac size of 291 new-bone infants was measured using the method illustrated on Fig 1. Among the 291 infants, 53 were asphyxiated, and asphyxia was only regarded from Apgar score below 6 on 1 min. and 5 min. Remaining 238 infants were normal, and classified to group with lung abnormalities and without lung abnormalities on chest A-P film. The results are as follows; 1. The average CTR. of normal group was 52.37. (C/T1; 54.89, C/T2; 49.43, C/T3; 49.15, C/T4;55.97) 2. The average CTR. of asphyxiated group was 54.91 (C/T1; 57.13, C/T2; 51.69, C/T3; 51.94, C/T4;58.25) 3. Consequently, asphyxiated infants revealed larger cardiac size than normal infant group.

  10. Brain magnetic resonance imaging of infants exposed prenatally to buprenorphine

    Energy Technology Data Exchange (ETDEWEB)

    Kahila, H.; Kivitie-Kallio, S.; Halmesmaki, E.; Valanne, L.; Autti, T. [Dept. of Obstetrics and Gynecology, Dept. of Pediatrics, and Helsinki Medical Imaging Center, Helsinki Univ. Central Hospital (Finland)

    2007-02-15

    Purpose: To evaluate the brains of newborns exposed to buprenorphine prenatally. Material and Methods: Seven neonates followed up antenatally in connection with their mothers' buprenorphine replacement therapy underwent 1.5T magnetic resonance imaging (MRI) of the brain before the age of 2 months. The infants were born to heavy drug abusers. Four mothers were hepatitis C positive, and all were HIV negative. All mothers smoked tobacco and used benzodiazepines. All pregnancies were full term, and no perinatal asphyxia occurred. All but one neonate had abstinence syndrome and needed morphine replacement therapy. Results: Neither structural abnormalities nor abnormalities in signal intensity were recorded. Conclusion: Buprenorphine replacement therapy does not seem to cause any major structural abnormalities of the brain, and it may prevent known hypoxic-ischemic brain changes resulting from uncontrolled drug abuse. Longitudinal studies are needed to assess possible abnormalities in the brain maturation process.

  11. Evaluation of reported fatality data associated with workers using respiratory protection in the United States (1990-2012).

    Science.gov (United States)

    Cowan, Dallas M; Benson, Stacey M; Cheng, Thales J; Hecht, Shelby; Boulos, Nancy M; Henshaw, John

    2017-07-04

    OSHA revised the 1971 respiratory protection standard in 1998 to add guidance for selecting and maintaining respirators. Fatality reports from 1990 to 2012 were used to characterize historical trends in fatalities associated with respirators. Industry- and time-specific trends were evaluated to determine the effect of the revision to the standard on respirator-related fatalities; 174 respirator-related deaths were reported. The majority of fatalities were associated with using an airline respirator (n = 34) or the absence of using a respirator in required spaces (n = 38). Overall, 79% of fatalities were associated with asphyxia. Fatalities were associated with improper employee use or lack of employer compliance. Reductions in fatality rates over time appeared to be associated with the revisions to the respirator standard, although other variables may influence rates (eg, controls). Recommendations for employers and employees regarding maintaining safe use of respirators are provided.

  12. Perinatal outcome of macrosomic infants born to diabetic versus non-diabetic mothers.

    Science.gov (United States)

    Lloreda-García, Jose Maria; Sevilla-Denia, Sandra; Rodríguez-Sánchez, Alba; Muñoz-Martínez, Pablo; Díaz-Ruiz, Marta

    2016-10-01

    To assess the incidence and perinatal complications of macrosomic infants born to diabetic and non-diabetic mothers. A six-year retrospective study of newborns at our hospital. A total of 996 macrosomic newborns were found. Maternal characteristics, mode of delivery, and perinatal outcomes were studied. Of 18005 newborns, 996 were macrosomic infants (5.53%). Of these, 103 (10.3%) were born to diabetic mothers. Diabetic mothers had higher parity (1.89 vs. 1.35; Pneonatal period for hypoglycemia, jaundice, respiratory distress, and asphyxia, and a greater need of intensive care. Obstetric trauma rates were similar in both groups. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Quenching tank: Accidental drowning in hot quenching oil.

    Science.gov (United States)

    Mugadlimath, Anand B; Sane, Mandar Ramchandra; Zine, Kailash U; Hiremath, Rekha M

    2017-06-01

    We describe an unusual case of drowning in fluid other than water in an industrial setting. A 26-year-old man was working in an industry which performs surface treatment of mechanical steel parts with quenching oil. He fell into the quenching oil (which was hot due to immersion of red hot metal parts), and as he was working alone in the particular section, there was a fatal outcome. A medico-legal autopsy was performed. The causes of death were found to be multiple, with the association of drowning, extensive superficial burns and asphyxia due to laryngeal oedema. To our knowledge, it is the first report of drowning in hot quenching oil, and only nine previous observations of drowning in industrial environments have been reported in the international literature. Even though rare, these kinds of accidental deaths can be prevented in dangerous industries with proper precautions and strict adherence to standard operating procedures.

  14. CT findings in neonatal hypothermia

    Energy Technology Data Exchange (ETDEWEB)

    Schulman, H.; Laufer, L.; Berginer, J.; Hertzanu, Y. [Department of Radiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P. O. Box 151, Beer-Sheva 84101 (Israel); Hershkowitz, E.; Berenstein, T.; Sofer, S. [Pediatric Intensive Care Unit, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel); Maor, E. [Department of Pathology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel)

    1998-06-01

    Background. Newborn infants are particularly prone to hypothermia, a condition with a high mortality. Objective. To study the CT brain patterns in infants with hypothermia and neurological symptoms. Materials and methods. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Results. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the `reversal sign`. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. Conclusions. The `reversal sign` has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause. (orig.) With 6 figs., 1 tab., 13 refs.

  15. [Perinatal brain injury in infants with depressed EEG activities immediately after birth].

    Science.gov (United States)

    Hayakawa, F; Okumura, A; Kuno, K; Watanabe, K

    1996-01-01

    We investigated the developmental outcome and features of brain imaging in 33 infants with moderate or severe depression of background EEG activities immediately after birth. Lesions due to perinatal injury were observed in 25 infants on neonatal ultrasonography and/or childhood MRI. These findings strongly correlated with their gestational age. Periventricular leukomalacia and posthermorrhagic porencephaly were observed in preterm infants. On the other hand, perinatal injury of mature brain type, such as multicystic encephalomalacia, parasagittal infarct, bilateral basal ganglia/thalamic lesion, and subcortical leukomalacia, were observed in full-term infants. Periventricular leukomalacia rather correlated with moderate depression of EEG activities than severe depression like observed in full-term neonates who have brain lesions due to perinatal asphyxia.

  16. CT findings in neonatal hypothermia.

    Science.gov (United States)

    Schulman, H; Laufer, L; Berginer, J; Hershkowitz, E; Berenstein, T; Sofer, S; Maor, E; Hertzanu, Y

    1998-06-01

    Newborn infants are particularly prone to hypothermia, a condition with a high mortality. To study the CT brain patterns in infants with hypothermia and neurological symptoms. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the 'reversal sign'. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. The 'reversal sign' has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause.

  17. Metabolomics in Newborns.

    Science.gov (United States)

    Noto, Antonio; Fanos, Vassilios; Dessì, Angelica

    2016-01-01

    Metabolomics is the quantitative analysis of a large number of low molecular weight metabolites that are intermediate or final products of all the metabolic pathways in a living organism. Any metabolic profiles detectable in a human biological fluid are caused by the interaction between gene expression and the environment. The metabolomics approach offers the possibility to identify variations in metabolite profile that can be used to discriminate disease. This is particularly important for neonatal and pediatric studies especially for severe ill patient diagnosis and early identification. This property is of a great clinical importance in view of the newer definitions of health and disease. This review emphasizes the workflow of a typical metabolomics study and summarizes the latest results obtained in neonatal studies with particular interest in prematurity, intrauterine growth retardation, inborn errors of metabolism, perinatal asphyxia, sepsis, necrotizing enterocolitis, kidney disease, bronchopulmonary dysplasia, and cardiac malformation and dysfunction. © 2016 Elsevier Inc. All rights reserved.

  18. Ursodeoxycholic acid in the treatment of intraheptic cholestasis of pregnancy.

    Science.gov (United States)

    Liu, Yuling; Qiao, Fuyuan; Liu, Haiyi; Liu, Dayan

    2006-01-01

    In order to observe the effect of ursodeoxycholic acid (UDCA) in the treatment of intrahepatic cholestasis of pregnancy (ICP), 68 patients with ICP were equally divided into treatment group and control group at random. The patients in treatment group were administered with UDCA 300 mg three times every day and those in control group received a combination of 10% glucose, Vitamin C and Inosine. Itching scores, serum ALT and total bile acids (TBA) were measured before, during and after treatment. The results showed that as compared with those before treatment, itching scores, serum ALT and TBA were significantly reduced after treatment (P < 0.05). The occurrences of premature labor, fetal asphyxia and meconium staining in amniotic fluid were significantly lower in treatment group than in control group (P < 0.05). It was suggested that UDCA was an effective drug in the treatment of ICP.

  19. Towards evidence-based resuscitation of the newborn infant.

    Science.gov (United States)

    Manley, Brett J; Owen, Louise S; Hooper, Stuart B; Jacobs, Susan E; Cheong, Jeanie L Y; Doyle, Lex W; Davis, Peter G

    2017-04-22

    Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    DEFF Research Database (Denmark)

    Kristensen, Kim; Fisker, Niels; Haerskjold, Ann

    2015-01-01

    BACKGROUND AND OBJECTIVE:: Hospitalization for respiratory syncytial virus (RSV) infection and asthma share common determinants, and meta-analyses indicate that children delivered by caesarean section (CS) are at increased risk of asthma. We aimed to investigate whether birth by CS is associated...... regression with adjustment for prematurity, asphyxia, birth weight, multiple births, single parenthood, maternal smoking during pregnancy, older siblings, and asthma diagnoses up to 2 weeks before hospitalization for RSV infection, to compare the effects of acute or elective CS versus vaginal delivery...... infection in children born by acute CS and by elective CS were 1.09 (1.01 - 1.17) and 1.27 (1.19 - 1.36), respectively. The effect of elective CS remained unchanged throughout the first two years of life (p = 0.53), whereas the effect of acute CS was only present in the second year of life (p = 0...

  1. The feasibility of using a portable xenon delivery device to permit earlier xenon ventilation with therapeutic cooling of neonates during ambulance retrieval.

    Science.gov (United States)

    Dingley, John; Liu, Xun; Gill, Hannah; Smit, Elisa; Sabir, Hemmen; Tooley, James; Chakkarapani, Ela; Windsor, David; Thoresen, Marianne

    2015-06-01

    Therapeutic hypothermia is the standard of care after perinatal asphyxia. Preclinical studies show 50% xenon improves outcome, if started early. During a 32-patient study randomized between hypothermia only and hypothermia with xenon, 5 neonates were given xenon during retrieval using a closed-circuit incubator-mounted system. Without xenon availability during retrieval, 50% of eligible infants exceeded the 5-hour treatment window. With the transportable system, 100% were recruited. Xenon delivery lasted 55 to 120 minutes, using 174 mL/h (117.5-193.2) (median [interquartile range]), after circuit priming (1300 mL). Xenon delivery during ambulance retrieval was feasible, reduced starting delays, and used very little gas.

  2. A Fire Extinguisher Death: The Macklin Effect.

    Science.gov (United States)

    Blumenthal, Ryan; Hänert-van der Zee, Brigitte

    2017-12-22

    We present the case of an adult white man found dead in a psychiatric institution with fine white powder (monoammonium phosphate) deposited over the entire face after he insufflated the contents of a dry chemical fire extinguisher. Fine white powder was present within the mouth and sinuses and lined the upper airways. On opening the thoracic cavity, approximately 500 g of fine white powder was present within the right thoracic cavity. The esophagus was ruptured. Traumatic emphysema of the posterior sternum wall was present (pneumomediastinum). The ethmoid bones were fractured by the barotrauma. On polarization of the lung tissue, birefringent material was noted deposited along the bronchovascular sheaths and in a subpleural distribution. Death was probably due to a combination of barotrauma and asphyxia.This case study provides strong evidence in support of the etiology and pathophysiology of the Macklin effect. It also provides for the first visual evidence of the phenomenon.

  3. Curved reformat of the paediatric brain MRI into a 'flat-earth map' - standardised method for demonstrating cortical surface atrophy resulting from hypoxic-ischaemic encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Simpson, Ewan [Bristol Royal Hospital for Children, Department of Pediatric Radiology, Bristol (United Kingdom); Andronikou, Savvas [Bristol Royal Hospital for Children, Department of Pediatric Radiology, Bristol (United Kingdom); University of Bristol, CRICBristol, Bristol (United Kingdom); Vedajallam, Schadie; Chacko, Anith; Thai, Ngoc Jade [University of Bristol, CRICBristol, Bristol (United Kingdom)

    2016-09-15

    Hypoxic-ischaemic encephalopathy is optimally imaged with brain MRI in the neonatal period. However neuroimaging is often also performed later in childhood (e.g., when parents seek compensation in cases of alleged birth asphyxia). We describe a standardised technique for creating two curved reconstructions of the cortical surface to show the characteristic surface changes of hypoxic-ischaemic encephalopathy in children imaged after the neonatal period. The technique was applied for 10 cases of hypoxic-ischaemic encephalopathy and also for age-matched healthy children to assess the visibility of characteristic features of hypoxic-ischaemic encephalopathy. In the abnormal brains, fissural or sulcal widening was seen in all cases and ulegyria was identifiable in 7/10. These images could be used as a visual aid for communicating MRI findings to clinicians and other interested parties. (orig.)

  4. Proton magnetic resonance spectroscopy of the brain in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Scarabino, Tommaso; Popolizio, Teresa; Bertolino, Alessandro; Salvolini, Ugo

    1999-05-01

    H1-MRS is a non-invasive technique which provides different levels of information on brain tissue: the N-acetyl aspartate (NAA) is an indicator of neuronal development, the choline containing compound peak (Cho) provides information on myelination and on cell membrane turnover and gliosis, inositol (Ins) is considered a marker of neuronal degeneration. Lactate may be detected in presence of defective energy metabolism. In the perineonatal period, the brain is apt to be insulted by a variety of events including asphyxia, hypoxemia, hemorrhage, which may subsequently cause delay in development. It is clinically important to assess the degree of brain damage and to obtain the prognostic information in the neonatal and early infantile period. MRS has become available for clinical examinations of the brain during development and these techniques can be used to document improvement or the progression towards irreversible damage.

  5. Effect of maternal iron deficiency anaemia on foetal outcome.

    Science.gov (United States)

    Rusia, U; Madan, N; Agarwal, N; Sikka, M; Sood, S K

    1995-07-01

    One hundred and two pregnant women and their neonates were examined to evaluate the effect of maternal haemoglobin concentration (Hb. conc) and iron deficiency anaemia on the placental weight and the foetal outcome. Haematological and serum ferritin values were determined. It was observed that 34.3% of the pregnant women were anaemic. Maternal Hb conc. and serum ferritin showed a highly significant correlation (r = 0.40, p < 0.001) indicating that iron deficiency was the most important cause of anaemia amongst them. The maternal Hb conc. showed a significant correlation with placental weight (p < 0.05), birth weight (p < 0.01), Apgar score (p < 0.001) and birth asphyxia. Maternal serum ferritin also correlated positively with cord ferritin (p < 0.001). The study did not reveal any association between high Hb and adverse foetal outcome.

  6. Factors associated with and causes of perinatal mortality in northeastern Tanzania

    DEFF Research Database (Denmark)

    Schmiegelow, Christentze; Minja, Daniel; Oesterholt, Mayke

    2012-01-01

    , including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key....../26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly...... associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality....

  7. An infant with asymptomatic hepatic granuloma probably caused by bacillus Calmette-Guérin (BCG) vaccination found incidentally at autopsy: a case report

    Science.gov (United States)

    Tajima, Yutaka; Takagi, Rie; Nakajima, Tamiko; Kominato, Yoshihiko

    2008-01-01

    Introduction Bacillus Calmette-Guérin (BCG) is an attenuated strain of Mycobacterium bovis. Usually, systemic complications due to BCG vaccination are quite rare. However, since BCG is a live vaccine, there is still a possibility that it may cause an infection. Case presentation Hepatic granuloma was found incidentally in an asymptomatic 5-month-old infant who was found dead in his bed. The probable cause of death was asphyxia due to milk aspiration into the lungs. The granuloma was composed of epithelioid histiocytes with frequent multinucleated Langhans-type giant cells and a small number of lymphocytes. Conclusion The cause of the asymptomatic granuloma was not identified, but was considered likely due to BCG vaccination. PMID:19019255

  8. What Are the Factors That Interplay From Normal Pregnancy to Near Miss Maternal Morbidity in a Nigerian Tertiary Health Care Facility?

    Science.gov (United States)

    Adeoye, Ikeola A.; Ijarotimi, Omotade O.; Fatusi, Adesegun O.

    2015-01-01

    Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries. PMID:25119488

  9. Irish neonatal mortality statistics for 2004 and over the past 17 years: how do we compare internationally?

    LENUS (Irish Health Repository)

    Fleming, P

    2012-02-01

    In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9\\/1000 with a corrected NMR of 1.9\\/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.

  10. Recent Advances in Lactate Estimation and Lactate Sensors for Diagnosis of Diseases

    Directory of Open Access Journals (Sweden)

    Suman

    2008-09-01

    Full Text Available Lactate is one of the principle products of anaerobic metabolism in living organism. Determination of lactate (lactic acid is required in the diagnosis and medical management of various diseases such as tissue hypoxia, the individual causes include shock (hypovolemic, cardiogenic or endotoxic, systemic disorder (neoplastic diseases, liver or renal failure, diabetes mellitus, respiratory failure (asphyxia, severe congestive heart failure and also in food industry. Various methods are available for the measurement of lactic acid such as colorimetric, gas chromatography, mass spectrometry, ion exchange chromatography, near IR spectroscopy, HPLC, capillary electrophoresis, isotachophoresis, FIA, enzymic colorimetric and finally biosensor and biochip method. The principle, advantage and disadvantages of these methods have been compared and summarized in this review.

  11. Epileptic Encephalopathy in Children with Risk Factors for Brain Damage

    Directory of Open Access Journals (Sweden)

    Josefina Ricardo-Garcell

    2012-01-01

    Full Text Available In the study of 887 new born infants with prenatal and perinatal risk factors for brain damage, 11 children with West syndrome that progressed into Lennox-Gastaut syndrome and another 4 children with Lennox-Gastaut syndrome that had not been preceded by West syndrome were found. In this study we present the main findings of these 15 subjects. In all infants multifactor antecedents were detected. The most frequent risk factors were prematurity and severe asphyxia; however placenta disorders, sepsis, and hyperbilirubinemia were also frequent. In all infants MRI direct or secondary features of periventricular leukomalacia were observed. Followup of all infants showed moderate to severe neurodevelopmental delay as well as cerebral palsy. It is concluded that prenatal and perinatal risk factors for brain damage are very important antecedents that should be taken into account to follow up those infants from an early age in order to detect and treat as early as possible an epileptic encephalopathy.

  12. Imaging findings of avalanche victims

    Energy Technology Data Exchange (ETDEWEB)

    Grosse, Alexandra B.; Grosse, Claudia A.; Anderson, Suzanne [University Hospital of Berne, Inselspital, Department of Diagnostic, Pediatric and Interventional Radiology, Berne (Switzerland); Steinbach, Lynne S. [University of California San Francisco, Department of Radiology, San Francisco, CA (United States); Zimmermann, Heinz [University Hospital of Berne, Inselspital, Department of Trauma and Emergency Medicine, Berne (Switzerland)

    2007-06-15

    Skiing and hiking outside the boundaries remains an attractive wilderness activity despite the danger of avalanches. Avalanches occur on a relatively frequent basis and may be devastating. Musculoskeletal radiologists should be acquainted with these injuries. Fourteen avalanche victims (11 men and 3 women; age range 17-59 years, mean age 37.4 years) were air transported to a high-grade trauma centre over a period of 2 years. Radiographs, CT and MR images were prospectively evaluated by two observers in consensus. Musculoskeletal findings (61%) were more frequent than extraskeletal findings (39%). Fractures were most commonly seen (36.6%), involving the spine (14.6%) more frequently than the extremities (9.8%). Blunt abdominal and thoracic trauma were the most frequent extraskeletal findings. A wide spectrum of injuries can be found in avalanche victims, ranging from extremity fractures to massive polytrauma. Asphyxia remains the main cause of death along with hypoxic brain injury and hypothermia. (orig.)

  13. Two tracheal BALT lymphoma patients successfully treated with chemotherapy including rituximab.

    Science.gov (United States)

    Hiraishi, Yoshihisa; Iikura, Motoyasu; Kogure, Yoshihito; Hirashima, Junko; Izumi, Shinyu; Sugiyama, Haruhito

    2014-03-01

    Bronchus-associated lymphoid tissue (BALT) lymphoma of the trachea, an important differential diagnosis for tracheal tumors, is a rare disease with characteristic bronchoscopic findings. In this study, we reviewed 2 cases of patients who were symptomatic at the time of diagnosis, with tumors in the trachea and left main bronchus, putting them at high risk for asphyxia. Chemotherapies including rituximab were administered, and complete remission was confirmed in both cases. Because tracheal tumors often have a pernicious course, it might be beneficial to initiate a chemotherapeutic treatment regimen instead of adopting the "wait-and-see" approach in patients with symptomatic tracheal BALT lymphoma. © 2013 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  14. Homicide by a combination of three different asphyxial methods

    Directory of Open Access Journals (Sweden)

    Siddhartha Das

    2016-09-01

    Full Text Available A case of death of a healthy male in his early forties is described, where three different asphyxial methods, i.e., manual strangulation, smothering and traumatic asphyxia by thoracic compression were used. The interest in the case is generated because all this three methods were carried out by a single assailant. Nail scratch abrasions were present on the cheek and neck. Internal examination revealed haemorrhagic infiltration into the muscles of the neck, contusion of the inner wall of upper respiratory tract and fracture of the hyoid bone. The autopsy findings helped the forensic pathologist in reconstructing the sequence of events and the manner in which the act was carried out. This case highlights the possibility of the involvement of a single person only, in the homicide of a healthy adult male by the application of three different asphyxial methods.

  15. Virtual autopsy using multislice computed tomography in forensic medical diagnosis of drowning.

    Science.gov (United States)

    Ambrosetti, M C; Barbiani, C; El-Dalati, G; Pellini, E; Raniero, D; De Salvia, A; Pozzi Mucelli, R

    2013-06-01

    This study evaluated the usefulness of multidetector computed tomography (MDCT) in the postmortem diagnosis of death by drowning in fresh water by measuring the difference of blood density within the cardiac chambers. Twenty-two corpses including six cases of fresh-water drowning (group A) and 16 deaths by other causes (group B), among which were also different forms of mechanical asphyxia other than drowning, underwent MDCT and conventional autopsy. Blood density within the right and left heart chambers, the aorta and the pulmonary trunk was measured and values compared between groups and within each group between heart chambers. Blood density in all cardiac chambers was lower in group A than in group B. The difference was statistically significant within the left atrium and ventricle and was significantly lower in the left than in the right heart chambers in group A only. MDCT, together with conventional autopsy, may contribute to the diagnosis of drowning, by measuring blood density in the heart chambers.

  16. Compartment syndrome in a neonate

    Directory of Open Access Journals (Sweden)

    Magdalena Santosa

    2006-10-01

    Full Text Available A neonate born with severe asphyxia and considerable risk of infection was treated with intravenous sodium bicarbonate and intravenous antibiotics. At the age of five days he developed edema of the right forearm, tense on palpation, painful, hyperemic, and the hand was pallor, hypesthetic with maceration of the fifth finger. The diagnosis of compartment syndrome was established but it was delayed at least for about 48 hours. Decompression by fasciotomy using the volar Henry approach was performed; after which the pathologic changes rapidly subsided.  The cause of this syndrome wasprobably due to intravenous sodium bicarbonate and repeated intravenous antibiotics. From this experience it is strongly emphasized that we have to be aware and able to diagnose compartment syndrome at the earliest possible time in severely ill neonates and children who have multiple intravenous injection. Daily inspection and careful evaluation of the condition at the site of the intravenous line will be very crucial to detect the syndrome.

  17. Elevated Expression of KiSS-1 in Placenta of Chinese Women with Early-Onset Preeclampsia

    Science.gov (United States)

    Qiao, Chong; Wang, Chunhui; Zhao, Jiao; Liu, Caixia; Shang, Tao

    2012-01-01

    Preeclampsia (PE) is a heterogeneous syndrome affecting 2% to 8% of all pregnancies and is the world’s leading cause of fetal and maternal morbidity and mortality. In many cases of PE, shallow trophoblast invasion results in inappropriate maternal spiral artery remodeling and impaired placental function. Multiple genes have been implicated in trophoblast invasion, among which are KiSS-1 and GPR54. The gene product of KiSS-1 is metastin, which is a ligand for the receptor GPR54. Both metastin and GPR54 are expressed in the placenta of normal pregnancy and have been implicated in modulating trophoblast invasion through inhibiting migration of trophoblast cells. We have previously reported that the expression level of KiSS-1 was higher in trophoblasts from women with preeclampsia as compared to normal controls. Here, using quantitative RT-PCR, Western blot analysis and immunohistochemistry, we extend our analysis to demonstrate that elevated KiSS-1 expression occurs only in early-onset preeclampsia (ePE) and not late-onset preeclampsia (lPE). However, no difference in the expression levels of GPR54 is observed between ePE, lPE, and normal controls. Further, we show that KiSS-1 expression is also increased in placenta of intrauterine death and birth asphyxia in comparison to normal newborns of ePE and lPE. Our findings suggest that aberrant upregulation of KiSS-1 expression may contribute to the underlying mechanism of ePE as well as birth asphyxia. PMID:23145030

  18. Elevated expression of KiSS-1 in placenta of Chinese women with early-onset preeclampsia.

    Directory of Open Access Journals (Sweden)

    Chong Qiao

    Full Text Available Preeclampsia (PE is a heterogeneous syndrome affecting 2% to 8% of all pregnancies and is the world's leading cause of fetal and maternal morbidity and mortality. In many cases of PE, shallow trophoblast invasion results in inappropriate maternal spiral artery remodeling and impaired placental function. Multiple genes have been implicated in trophoblast invasion, among which are KiSS-1 and GPR54. The gene product of KiSS-1 is metastin, which is a ligand for the receptor GPR54. Both metastin and GPR54 are expressed in the placenta of normal pregnancy and have been implicated in modulating trophoblast invasion through inhibiting migration of trophoblast cells. We have previously reported that the expression level of KiSS-1 was higher in trophoblasts from women with preeclampsia as compared to normal controls. Here, using quantitative RT-PCR, Western blot analysis and immunohistochemistry, we extend our analysis to demonstrate that elevated KiSS-1 expression occurs only in early-onset preeclampsia (ePE and not late-onset preeclampsia (lPE. However, no difference in the expression levels of GPR54 is observed between ePE, lPE, and normal controls. Further, we show that KiSS-1 expression is also increased in placenta of intrauterine death and birth asphyxia in comparison to normal newborns of ePE and lPE. Our findings suggest that aberrant upregulation of KiSS-1 expression may contribute to the underlying mechanism of ePE as well as birth asphyxia.

  19. Geographical disparities of infant mortality in rural China.

    Science.gov (United States)

    Wang, Yanping; Zhu, Jun; He, Chunhua; Li, Xiaohong; Miao, Lei; Liang, Juan

    2012-07-01

    The purpose of the study was to investigate the trends and causes of regional disparities of infant mortality rate (IMR) in rural China from 1996 to 2008. A population-based, longitudinal study. The national child mortality surveillance network. Population of the 79 surveillance counties. IMR, leading causes of infant death and the RR of IMR. The IMR in coastal, inland and remote regions declined by 72.4%, 62.9% and 58.2%, respectively, from 1996 to 2008. Compared with the coastal region, the RR of IMR were 1.7 (95% CI 1.6 to 1.9), 1.9 (95% CI 1.7 to 2.0) and 1.8 (95% CI 1.6 to 2.0) for inland region and 2.6 (95% CI 2.4 to 2.7), 3.2 (95% CI 3.0 to 3.5) and 3.1 (95% CI 2.7 to 3.4) for the remote region during 1996-2000, 2001-2005 and 2006-2008, respectively. The regional disparities existed for both male and female IMRs. The postneonatal mortality showed the highest regional disparities. Pneumonia, birth asphyxia, prematurity/low birth weight, injuries and diarrhoea were the main contributors to the regional disparities. There were significantly more infants who did not seek healthcare services before death in the remote region relative to the inland and coastal regions. The results indicated persistent existence of regional disparities in IMR in rural China. It is worth noting that regional disparities in IMR increased in the remote and coastal regions during 2001-2005 in rural China. These disparities remained unchanged during 2006-2008. The results indicate that strategies to reduce mortality caused by pneumonia, birth asphyxia and diarrhoea are keys to reducing IMR.

  20. Perinatal health in developing countries.

    Science.gov (United States)

    Costello, A M

    1993-01-01

    In developing countries, child mortality declined during the 1980s, but neonatal mortality did not improve. Ministries of Health do not consider reduction of early neonatal mortality to be a priority. Underreporting of perinatal deaths is common (e.g., at least 40% of perinatal deaths). Researchers sometimes categorize perinatal deaths as other causes of infant mortality. Many people believe too technological or costly interventions are needed to reduce perinatal mortality, but simple, low-cost principles of newborn care do exist: keep the newborn warm, feed often, avoid infection, and keep the newborn close to the mother. A study in Zimbabwe shows that asphyxia, a preventable condition, occurred in 76% of cases. Prenatal care; education; improved treatment of syphilis, hypertension, diabetes, and amniotic fluid infection; closer monitoring of the fetal condition during labor; and proper management of abnormal labor would reduce perinatal deaths. Premature infants are at greater risk of death than are intrauterine growth retarded infants. Research is needed to learn more about the epidemiology, causes,, and sequelae of asphyxia as well as the most cost-effective interventions. 38% of newborns at a hospital in Kathmandu had mild or moderate hypoglycemia, 44% of whom experienced at least 3 hypoglycemic episodes in the first 2 days. Known hypoglycemic risk factors are low birth weight and hypothermia. Possible hypoglycemic risk factors are prelactal feeds and a delay in beginning breast feeding. Effective perinatal health care in developing countries requires a tired system of referral and a motivated community health worker trained to manage safe delivery and newborn care. Unfriendly staff and user charges are obstacles to primary perinatal health care, however. UNICEF's Baby Friendly Hospital initiative aims to stop distribution of free infant formula in maternity wards and to improve perinatal care.

  1. MATERNAL AND FETAL OUTCOME IN PREGNANCIES WITH SLE - A PROSPECTIVE STUDY OF 40 CASES

    Directory of Open Access Journals (Sweden)

    Menon Nalini

    2015-03-01

    Full Text Available Pregnancy and child birth in SLE patients can be complicated by disease activity, lupus nephritis, gestational diabetes, hypertensive disorders, intrauterine growth retardation, placental abruption, intrauterine and neonatal death, birth asphyxia, neonatal lupus and maternal mortality. AIMS AND OBJECTIVES : T o find out 1 T he most common complications and their incidence . 2 M aternal and fetal outcome in SLE patients during pregnancies. Study design; Prospective observational study. MATERIALS AND METHODS : Patients are enrolled for the study from pregnant mothers with known as well as newly diagnosed SLE who are attending outpatient department of obstetrics and gynecology department of Institute of maternal and child health, Calicut Government Medical college from 2011 February to 2012 June (18 months . Data collected from available past medical records, interview, physical examination, progress records and laboratory investigations of patients using predesigned profo r ma. RESULTS : Of the total 40 patients enrolled in the study, 45% were in the age group 26 - 30. 25% had one abortion in the past and 2 patients had 3 abortions. 65% had the disease for more than 6 years. Prior to the present pregnancy, 95% patients were in remission. During the present pregnancy 25 % patients had active lupus nephritis and 20% had flare. 25% and 75% patients had gestational diabetes mellitus and hypertensive disorders respectively. The incidence of intra uterine growth retardation was 45%. Placental abruption occurred in 10% pregnancies. The incidence of intrau terine death (25% was higher than that of neonatal deaths (10%. 20% babies had birth asphyxia and the incidence of low birth weight was very high (60%. 10% mothers had flare and 10% babies neonatal lupus. Maternal mortality was 5%. CONCLUSION : The study highlights the increased incidence of complications associated with pregnancies in SLE and thus the need for high quality care for better maternal and

  2. The 2008 annual report of the Regional Infant and Child Mortality Review Committee.

    Science.gov (United States)

    Randall, Brad; Wilson, Ann

    2009-12-01

    The 2008 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. This committee has as its mission the review of infant and child deaths so that information can be transformed into action to protect young lives. The 2008 review area includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties. Within our region in 2008, there were six infant deaths labeled as Sudden Unexpected Infant Deaths (SUID), of which two met the criteria for the Sudden Infant Death Syndrome (SIDS). The four non-SIDS SUID deaths all represented deaths where asphyxia from unsafe sleeping environments could not be excluded. In addition, there were two accidental deaths from asphyxia in unsafe sleeping enviroments. We need to continue to promote the "Back to Sleep" campaign message of not only placing infants to sleep on their backs, but also making sure infants are put down to sleep on safe, firm, sleeping surfaces and are appropriately dressed for the ambient temperature. Parents need to be aware of the potential hazards of bed-sharing with their infants. In both 2007 and 2008, four children died in motor vehicle crashes, none of which were alcohol-related. Three fire-related childhood deaths were associated with one house fire involving a nonfunctional smoke alarm and a sleeping arrangement without an easy egress from a fire. Since 1997, the RICMRC has sought to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives". For 2008, the committee reviewed 21 deaths from Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties that met the following criteria: Children under the age of 18 dying subsequent to hospital discharge following delivery. Children who either died in these counties from causes sustained in them, or residents who died elsewhere from causes sustained in the ten-county region.

  3. Cognitive elements in clinical decision-making: toward a cognitive model for medical education and understanding clinical reasoning.

    Science.gov (United States)

    Dunphy, Bruce C; Cantwell, Robert; Bourke, Sid; Fleming, Mark; Smith, Bruce; Joseph, K S; Dunphy, Stacey L

    2010-05-01

    Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for ambiguity, state-trait anxiety and metacognitive awareness were assessed for obstetricians (n = 12) who provided intra-partum care to 4,149 women. Outcome measures included delivery mode and intrapartum asphyxia. Analysis was carried out using logistic regression and tree-based classification. Obstetricians with high RC scores were more likely to perform a caesarean section (OR 1.59, p < 0.0001), less likely undertake a mid-forceps or low forceps delivery (OR 0.41, p < 0.0001; OR 0.49, p < 0.0001), and more likely to supervise a spontaneous vaginal delivery (OR 1.17, p = 0.08). Obstetricians with high NFC scores were more likely to perform a caesarean section (OR 1.53, p = 0.03), more likely to undertake a vacuum delivery (OR 5.8, p = 0.001), less likely undertake a mid-forceps delivery (OR 0.45, p = 0.02) and less likely to supervise a spontaneous vaginal delivery (OR 0.47, p < 0.0001). Obstetricians high in trait anxiety were more likely to perform a mid forceps delivery (OR 2.49, p = 0.01) or a vacuum delivery (OR 5.08, p = 0.003), and less likely to supervise a spontaneous vaginal delivery (OR 0.38, p < 0.0001). NFC was negatively associated (OR 0.10, p < 0.001) and trait anxiety was positively associated with intrapartum asphyxia (p < 0.05, rho = 0.582). In summary, physician cognitive processes and affect have a significant impact on patient outcomes, particularly in situations where there is a higher level of clinical unpredictability.

  4. Evaluation of a cluster-randomized controlled trial of a package of community-based maternal and newborn interventions in Mirzapur, Bangladesh.

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    Gary L Darmstadt

    Full Text Available BACKGROUND: To evaluate a delivery strategy for newborn interventions in rural Bangladesh. METHODS: A cluster-randomized controlled trial was conducted in Mirzapur, Bangladesh. Twelve unions were randomized to intervention or comparison arm. All women of reproductive age were eligible to participate. In the intervention arm, community health workers identified pregnant women; made two antenatal home visits to promote birth and newborn care preparedness; made four postnatal home visits to negotiate preventive care practices and to assess newborns for illness; and referred sick neonates to a hospital and facilitated compliance. Primary outcome measures were antenatal and immediate newborn care behaviours, knowledge of danger signs, care seeking for neonatal complications, and neonatal mortality. FINDINGS: A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm, respectively. High coverage of antenatal (91% visited twice and postnatal (69% visited on days 0 or 1 home visitations was achieved. Indicators of care practices and knowledge of maternal and neonatal danger signs improved. Adjusted mortality hazard ratio in the intervention arm, compared to the comparison arm, was 1.02 (95% CI: 0.80-1.30 at baseline and 0.87 (95% CI: 0.68-1.12 at endline. Primary causes of death were birth asphyxia (49% and prematurity (26%. No adverse events associated with interventions were reported. CONCLUSION: Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation, and improvements in targeted newborn care practices suggests the intervention did not adequately address risk factors for mortality. The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions. Programs must ensure skilled care during childbirth, including management of birth asphyxia and prematurity, and curative postnatal

  5. Heart donation in Japan before and after the revision of the Japanese Transplantation Act.

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    Fukushima, N; Ono, M; Saito, S; Saiki, Y; Kubota, S; Tanoue, Y; Konaka, S; Ashikari, J

    2014-01-01

    After the revision of the Organ Transplant Act in July 2010, brain dead organ donation increased from 13 to 45 per year, and heart donation increased. The purpose of this study was to review 166 consecutive brain dead heart donors to evaluate our strategies to identify and manage organ donors. This study reviewed 166 consecutive brain dead heart donors since the Act was issued. Whereas 69 heart donations were performed between October 1997 and July 2010 before the revision of the Act, 97 heart donations were performed for the 3 years after the revision. Since November 2002, special transplant management doctors were sent to donor hospitals to assess donor organ function and to identify which organs could be transplanted. They also intensively cared for the donors to stabilize hemodynamics and to improve cardiac function by giving intravenous antidiuretic hormones and by pulmonary toileting via bronchofiberscope. The mean heart donor age increased from 41.0 to 43.9 years after the revision. Notably, 11 hearts from donors more than 60 years old were transplanted successfully after the revision. Before the revision, the cause of death was 37 cerebrovascular disease (SAH 34, stroke 1, bleeding 2), 18 head trauma, 13 asphyxia, and 2 postresuscitation brain damage. After the revision, there were 49 cerebrovascular disease (SAH 37, stroke 2, bleeding 16, and other 4), 17 head trauma, 10 asphyxia, and 11 postresuscitation brain damage. A total of 58 donors had a history of cardiac arrest, 58 required a high dose of catecholamine drip infusion, and only 1 recipient died of primary graft dysfunction. Patient survival rate at 3 years after heart transplantation was not different before and after the revision of the Act (98.6% vs 92.2%). Although donor age was increased and donors who died of cerebral bleeding or postresuscitation after the revision of the Act increased, the outcome after heart transplantation was not changed. Copyright © 2014 Elsevier Inc. All rights

  6. The success of cardiotocography in predicting perinatal outcome

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    Alpaslan Kaban

    2012-06-01

    Full Text Available Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within 36-41 weeks of gestation.During a 20-min period of fetal monitoring, a change inFHR (fetal heart rate lasting for 15 s or two elevated runsof 15 beats was evaluated as a reactive NST (non-stresstest. The umbilical artery pH was used as the “gold standard”for assessing fetal asphyxia.Results: The mean age of the women included in thestudy was 27.82 ± 5.29 years, the average parity was1.09± 0.96. The pH was normal in 85 neonates, while 13 hadfetal asphyxia. No significant difference in umbilical cordblood pH, pO2, or pCO2 was observed between these twogroups (p = 0.497, p = 0.722, and p = 0.053, respectively.No significant difference in maternal age, parity, or birthweight was found between the group with fetal distressbased on CTG (cardiotocography and the normal group.Conclusion: Cardiotocography is an important test duringlabor for labor management, it is insufficient for predictingthe perinatal outcome. Therefore, labor should beevaluated on an individualized basis. J Clin Exp Invest2012; 3(2: 168-171

  7. Localised proton magnetic resonance spectroscopy of the brain after perinatal hypoxia: a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Chateil, J.F. [Service de Radiologie A, Hopital Pellegrin, Bordeaux (France)]|[Unite de Radiopediatrie, Hopital Pellegrin, Bordeaux (France); Quesson, B.; Thiaudiere, E.; Delalande, C.; Canioni, P. [Resonance Magnetique des Systemes Biologiques, CNRS, Bordeaux (France); Brun, M.; Diard, F. [Service de Radiologie A, Hopital Pellegrin, Bordeaux (France); Sarlangue, J.; Billeaud, C. [Service de Neonatalogie, Hopital Pellegrin, Bordeaux (France)

    1999-03-01

    Objectives. Perinatal hypoxic ischaemic injury is a significant cause of neurodevelopmental impairment. The aim of this study was to evaluate localised proton magnetic resonance spectroscopy ({sup 1}H-MRS) after birth asphyxia. Materials and methods. Thirty newborn infants suspected of having perinatal asphyxia (Apgar score < 3) were studied. The mean gestational age was 37 weeks, mean age at the MR examination was 18 days and mean weight was 2.9 kg. A 1.5-T unit was used for imaging and spectroscopy. None of the babies had mechanically assisted ventilation. No sedation was used. Axial T1-weighted and T2-weighted images were obtained. {sup 1}H-MRS was recorded in a single voxel, localised in white matter, using a STEAM sequence. Results. Image quality was good in 25 of 30 babies. {sup 1}H-MRS was performed in 19 of 30 subjects, with adequate quality in 16. Choline, creatine/phosphocreatine and N-acetylaspartate peaks and peak-area ratios were analysed. Lactate was detected in four infants. The N-acetylaspartate/choline ratio was lower in infants with an impaired neurological outcome, but the difference was not statistically significant. Conclusions. This study suggests that {sup 1}H-MRS may be useful for assessing cerebral metabolism in the neonate. A raised lactate level and decreased N-acetylaspartate/choline ratio may be predictive of a poor outcome. However, in our experience this method is limited by the difficulty in performing the examination during the first hours after birth in critically ill babies, the problems related to use of a monovoxel sequence, the dispersion of the ratios and the lack of determination of the absolute concentration of the metabolites. (orig.) With 3 figs., 2 tabs., 20 refs.

  8. Acute renal failure: Nephrosonographic findings in asphyxiated neonates

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    Mohd. Ashraf

    2011-01-01

    Full Text Available To determine the incidence of acute renal failure (ARF and nephrosonographic findings among asphyxiated neonates, and to correlate this with uric acid levels and the severity of hypoxic encephalopathy, we studied 80 full-term appropriate-for-date singleton neonates with perinatal asphyxia, and 30 healthy full-term neonates as controls from March 2006 to February 2007. A detailed history, thorough clinical examination along with investigations, including urine examination, 24-h urine collection, ultrasonography of abdomen and cranium, serum electrolytes, blood urea nitrogen, serum creatinine, and serum uric acid were obtained. ARF developed in 45% (36/80 of the asphyxiated neonates. Forty-eight (60% neonates showed significant elevation of blood urea and 41 (51.3% neonates had significant elevation of serum creatinine than the control group (P < 0.001. Sixty-two (77.5% neonates developed significant elevation of serum uric acid levels, and nephrosonography revealed hyperechogenicity in all of them, while only two among the healthy neonates showed the raised uric acid levels (P < 0.001. Nonoliguric renal failure was seen 28/36 (77.8% of the neonates with ARF, whereas eight (22.2% neonates had oliguric renal failure. Eight (27.8% patients among ARF patients maintained abnormal biochemical parameters after 2 weeks, and of whom four patients died after variable lengths of time with a mortality rate of 11.11%. Kidneys are the most common organs involved in perinatal asphyxia, and uric acid might be a causative factor for failure in addition to hypoxic insult. Routine use of kidney function test, along with abdominal ultrasonography form an important screening tool to detect any additional morbidity in these patients.

  9. Automated electroencephalographic discontinuity in cooled newborns predicts cerebral MRI and neurodevelopmental outcome.

    Science.gov (United States)

    Dunne, Jonathan M; Wertheim, David; Clarke, Paul; Kapellou, Olga; Chisholm, Philippa; Boardman, James P; Shah, Divyen K

    2017-01-01

    Prolonged electroencephalographic (EEG) discontinuity has been associated with poor neurodevelopmental outcomes after perinatal asphyxia but its predictive value in the era of therapeutic hypothermia (TH) is unknown. In infants undergoing TH for hypoxic-ischaemic encephalopathy (HIE) prolonged EEG discontinuity is associated with cerebral tissue injury on MRI and adverse neurodevelopmental outcome. Retrospective study of term neonates from three UK centres who received TH for perinatal asphyxia, had continuous two channel amplitude-integrated EEG with EEG for a minimum of 48 h, brain MRI within 6 weeks of birth and neurodevelopmental outcome data at a median age of 24 months. Mean discontinuity was calculated using a novel automated algorithm designed for analysis of the raw EEG signal. Of 49 eligible infants, 17 (35%) had MR images predictive of death or severe neurodisability (unfavourable outcome) and 29 (59%) infants had electrographic seizures. In multivariable logistic regression, mean discontinuity at 24 h and 48 h (both p=0.01), and high seizure burden (p=0.05) were associated with severe cerebral tissue injury on MRI. A mean discontinuity >30 s/min-long epoch, had a specificity and positive predictive value of 100%, sensitivity of 71% and a negative predictive value of 88% for unfavourable neurodevelopmental outcome at a 10 µV threshold. In addition to seizure burden, excessive EEG discontinuity is associated with increased cerebral tissue injury on MRI and is predictive of abnormal neurodevelopmental outcome in infants treated with TH. The high positive predictive value of EEG discontinuity at 24 h may be valuable in selecting newborns with HIE for adjunctive treatments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Evaluation of factors associated with elevated newborn 17-hydroxyprogesterone levels.

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    Anandi, V Shobi; Shaila, Bhattacharyya

    2017-05-24

    Measurement of 17-hydroxyprogesterone (17-OHP) in dried blood spots has been widely used as a newborn screening tool for congenital adrenal hyperplasia (CAH). Various maternal and neonatal factors can result in falsely high values of 17-OHP. There is a paucity of Indian studies in this regard because routine evaluation of newborn 17-OHP levels as a screening program is not widely practiced in India. Hence, this study was undertaken to evaluate the influence of various maternal and neonatal factors on newborn 17-OHP levels. The aim of the study was to determine the effect of various maternal and neonatal factors on the newborn 17-OHP values. Retrospective data related to a total of 3080 newborn 17-OHP values and clinical characteristics were collected for 3 years (2013-2015). The data were analyzed to determine the influence of various factors on 17-OHP values. The mean value of 17-OHP in our study was 5.486±3.96 ng/mL. Gender and mode of delivery did not significantly affect the 17-OHP levels. The levels were significantly higher in preterm and low birth weight babies as compared to term babies and babies with normal birth weight. Stress factors like pregnancy induced hypertension (PIH), early onset sepsis (EOS), neonatal seizures and birth asphyxia significantly increase the neonatal 17-OHP levels. The levels of 17-OHP in newborns was measured around day 3 of life are very sensitive to the influence of gestational age, birth weight and presence of stress factors like maternal PIH, birth asphyxia, neonatal sepsis and neonatal seizures and should be interpreted cautiously.

  11. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section. A prospective randomized study.

    Science.gov (United States)

    Kavak, Z N; Başgül, A; Ceyhan, N

    2001-12-10

    To compare general and spinal anesthesia with respect to the short-term outcome of newborns born by elective cesarean deliveries. Pregnant women admitted to our hospital from January 1999 to July 2000, for whom elective repeat cesareans were planned after 37 weeks gestation, were allocated randomly after their informed consent to spinal anesthesia or general anesthesia. Maternal age, gestational age, birth weight, Apgar's score, hospital stay duration, and duration of cesarean section time were all noted. The rate of the neonatal respiratory depression, perinatal asphyxia, and admittance to the neonatal intensive care unit of the infants were documented. We also studied arterial samples withdrawn from the cord for the pH, bicarbonate, PaO(2) (oxygen pressure, arterial), and PaCO(2) (carbon dioxide pressure, arterial). The serum levels of creatine kinase with myocardial-specific isoform, aspartate aminotransferase, alanine aminotransferase, and total cortisol levels of the newborns were measured and served in ruling out perinatal stress and in confirming the diagnosis of perinatal asphyxia (and of myocardial damage). Statistical analyses was performed with the use of an unpaired Student's t-test, Chi-square test, and a power calculation was done. From the randomly selected patients, we had 38 (45.2%) infants for general anesthesia and 46 (54.8%) for spinal anesthesia. None of our primary endpoints favored any of the study groups, and the clinical short-term outcome of the infants was similar in the neonates born both by spinal and general anesthesia (P>0.05). The biochemical assays did not rule out or confirm any differences in the occurrence of perinatal stress (P>0.05). Anesthesia type does not seem to influence the short-term outcome of the newborn infants for the elective cesarean deliveries. We believe that both spinal and general anesthesia could be performed in elective term cesarean deliveries without any risk to the newborn infants.

  12. Perinatal death associated with planned home birth in Australia: population based study

    Science.gov (United States)

    Bastian, Hilda; Keirse, Marc J N C; Lancaster, Paul A L

    1998-01-01

    Objective: To assess the risk of perinatal death in planned home births in Australia. Design: Comparison of data on planned home births during 1985-90, notified to Homebirth Australia, with national data on perinatal deaths and outcomes of home births internationally. Results: 50 perinatal deaths occurred in 7002 planned home births in Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2 to 9.1) according to Australian definitions and 6.4 per 1000 (4.6 to 8.3) according to World Health Organisation definitions. The perinatal death rate in infants weighing more than 2500 g was higher than the national average (5.7 versus 3.6 per 1000: relative risk 1.6; 1.1 to 2.4) as were intrapartum deaths not due to malformations or immaturity (2.7 versus 0.9 per 1000: 3.0; 1.9 to 4.8). More than half (52%) of the deaths were associated with intrapartum asphyxia. Conclusions: Australian home births carried a high death rate compared with both all Australian births and home births elsewhere. The two largest contributors to the excess mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress. Key messages In some countries there is a trend towards high risk home births This study examined perinatal death rates in Australian home births, including both high and low risk births The death rate in Australian home births was higher than comparable births nationally and home births in other countries The higher perinatal death rate in Australian home births was due to the inclusion of predictably high risk births and prolonged asphyxia during labour While home birth for low risk women can compare favourably with hospital birth, high risk home birth is inadvisable and experimental PMID:9694754

  13. Perinatal Mortality in a Northwestern Nigerian City: A Wake up Call

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    Suleiman, Mohammed Bello; Mokuolu, Olugbenga Ayodeji

    2014-01-01

    Background: In Nigeria, of the over 900,000 children under the age of 5 years that die every year, perinatal mortality is responsible for a little over 20%. Previous reports are largely from the southern part of the country. This is the first report of perinatal data from the northwest of Nigeria. Methods: A case control study of perinatal deaths in the three major public hospitals in Katsina metropolis was carried out to determine the pattern of perinatal deaths in the metropolis. Data were collected over a 6 week period on maternal socio-demographic, antenatal, and delivery variables. Data were similarly obtained on neonatal profile and morbidities. Results: There were 143 perinatal deaths (94 stillbirths and 49 early neonatal deaths) out of 1104 live and stillbirths during the study period. The perinatal mortality rate was thus 130 per 1000 births with a stillbirth rate of 85 per 1000 births and an early neonatal mortality rate of 49 per 1000 live births. Stillbirths during the intrapartum period were twice as frequent as macerated stillbirths (2:1). Maternal factors significantly associated with perinatal deaths included chorioamnionitis, ruptured uterus, multiple gestation, medically induced delivery, prolonged labor, unbooked pregnancies, antepartum hemorrhage, and prolonged rupture of membranes. Antepartum hemorrhage was the strongest determinant of perinatal death. Significant neonatal determinants were multiple gestation, severe birth asphyxia, apnea, and necrotizing enterocolitis. Apnea was the strongest neonatal determinant. The majority (83.2%) of perinatal deaths were due to severe perinatal asphyxia (SPA) (54.5%), normally formed macerated stillbirths (20.3%), and immaturity (8.4%). Conclusion: In conclusion, Perinatal Mortality in Katsina metropolis in northwest Nigeria is unacceptably high as we approach the timeline for the millennium development goals. Antepartum hemorrhage and SPA are major determinants. PMID:25340044

  14. Prevention of mental handicaps in children in primary health care.

    Science.gov (United States)

    Shah, P M

    1991-01-01

    Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap.

  15. [Variations in renal hemodynamics during acute renal insufficiency in anoxic neonates].

    Science.gov (United States)

    Proverbio, M R; Di Pietro, A; Coletta, M; Tammaro, V; Pescatore, L

    1996-01-01

    The purpose of this study is to verify if the increase of renal resistance, along with the consequent reduction of glomerular filtrate, and the activation of renina-angiotensin system, could be attributed to not only neonatal acute hypoxia but to other factors as well. These factors could provoke an increase in renal vascular resistance (R.V.R.), a reduction of renal blood flow (R.B.F.) and renal glomerular filtrate (R.G.F.) condition. These components are present in angiotensin as well as in endothelin (ET1), a potent peptide from vascular endothel with vasoconstricting action and whose secretion increases during hypoxia. The Authors have studied and compared two groups of newborns. The first group of newborns was affected by perinatal asphyxia or hypoxia of variable seriousness. It included 24 newborns with gestational age between 37 and 41 weeks and with a birth weight between 3.200 gms and 3.500 gms. The second, control group, was made of an identical number of newborns of the same gestational age with a weight adequate to the birth age. The dosage of the ET1 was evaluated on the plasma, using the RIA method. The diagnostic criteria for this evaluation included clinical and biohumoral evidence (tab. 1). Between the two groups, group 1 with anoxic syndrome showed the more intense increase of ET1. This increased is due to either an increase value of plasmatic creatinine that is present in normal situations or in physiopathologic role played by the ET1 in course of acute renal failure after asphyxia.

  16. Developmental Research in Space: Predicting Adult Neurobehavioral Phenotypes via Metabolomic Imaging

    Science.gov (United States)

    Schorn, Julia M.; Moyer, Eric L.; Lowe, M.; Morgan, Jonathan A.; Tulbert, Christina D.; Olson, John; Horita, David A.; Klevin, Gale A.; Ronca, April E.

    2017-01-01

    As human habitation and eventual colonization of space becomes an inevitable reality, there is a necessity to understand how organisms develop over the life span in the space environment. Microgravity, altered CO2, radiation and psychological stress are some of the key factors that could affect mammalian reproduction and development in space, however there is a paucity of information on this topic. Here we combine early (neonatal) in vivo spectroscopic imaging with an adult emotionality assay following a common obstetric complication (prenatal asphyxia) likely to occur during gestation in space. The neural metabolome is sensitive to alteration by degenerative changes and developmental disorders, thus we hypothesized that that early neonatal neurometabolite profiles can predict adult response to novelty. Late gestation fetal rats were exposed to moderate asphyxia by occluding the blood supply feeding one of the rats pair uterine horns for 15min. Blood supply to the opposite horn was not occluded (within-litter cesarean control). Further comparisons were made with vaginal (natural) birth controls. In one-week old neonates, we measured neurometabolites in three brain areas (i.e., striatum, prefrontal cortex, and hippocampus). Adult perinatally-asphyxiated offspring exhibited greater anxiety-like behavioral phenotypes (as measured the composite neurobehavioral assay involving open field activity, responses to novel object, quantification of fecal droppings, and resident-intruder tests of social behavior). Further, early neurometabolite profiles predicted adult responses. Non-invasive MRS screening of mammalian offspring is likely to advance ground-based space analogue studies informing mammalian reproduction in space, and achieving high-priority multigenerational research that will enable studies of the first truly space-developed mammals.

  17. Early cerebral hemodynamic, metabolic and histological changes in hypoxic-ischemic fetal lambs during postnatal life

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    Carmen eRey-Santano

    2011-09-01

    Full Text Available The hemodynamic, metabolic and biochemical changes produce during transition from fetal to neonatal life could be aggravated if asphyctic event occur during fetal life. The aim of the study was to examine the regional cerebral blood flow (RCBF, histological changes, and cerebral brain metabolism in preterm lambs, and to analyze the role of oxidative stress for the first hours of postnatal life following severe fetal asphyxia. 18 chronically instrumented fetal lambs were assigned to: hypoxic-ischemic group, following fetal asphyxia animals were delivered and maintained on intermittent-positive-pressure-ventilation for 3 hours, and non-injured animals that were managed similarly to the previous group and used as control group. During hypoxic-ischemic insult, injured group developed acidosis, hypoxia, hypercapnia, latacidaemia and tachycardia in comparison to control group, without hypotension. Intermittent-positive-pressure-ventilation transiently improved gas exchange and cardiovascular parameters. After HI injury and during ventilation-support, the increased RCBF in inner zones was maintained for hypoxic-ischemic group, but cortical flow did not exhibit differences compared to the control group. Also, the increase of TUNEL positive cells (apoptosis and antioxidant enzymes, and decrease of ATP reserves was significantly higher in the brain regions where the RCBF were not increased.In conclusion, early metabolic, histological and hemodynamic changes involved in brain damage have been intensively investigated and reported in premature asphyctic lambs for the first 3 hours of postnatal life. Those changes have been described in human neonates, so our model could be useful to test the security and the effectiveness of different neuroprotective or ventilatory strategies when are applied in the first hours after fetal hypoxic-ischemic injury.

  18. Objective differentiation of neonatal EEG background grades using detrended fluctuation analysis

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    Vladimir eMatic

    2015-04-01

    Full Text Available A quantitative and objective assessment of background electroencephalograph (EEG in sick neonates remains an everyday clinical challenge. We studied whether long range temporal correlations quantified by detrended fluctuation analysis (DFA could be used in the neonatal EEG to distinguish different grades of abnormality in the background EEG activity.Long-term EEG records of 34 neonates were collected after perinatal asphyxia, and their background was scored in 1h epochs (8h in each neonate as mild, moderate or severe. We applied DFA on 15 min long, non-overlapping EEG epochs (n=1088 filtered from 3-8Hz. Our formal feasibility study suggested that DFA exponent can be reliably assessed in only part of the EEG epochs, and in only relatively short time scales (10-60sec, while it becomes ambiguous if wider time scale are considered. This prompted further exploration whether paradigm used for quantifying multifractal DFA (MF-DFA could be applied in a more efficient way, and whether metrics from MF-DFA paradigm could yield useful benchmark with existing clinical EEG gradings.Comparison of MF-DFA metrics showed a significant difference between three visually assessed background EEG grades. MF-DFA parameters were also significantly correlated to interburst intervals quantified with our previously developed automated detector. Finally, we piloted the intra-patient application of MF-DFA metrics and showed their evolution during patient recovery from asphyxia. Our exploratory study showed that neonatal EEG can be quantified using multifractal metrics, which might offer a suitable parameter to quantify the grade of EEG background, or to monitor changes in brain state that take place during long-term brain monitoring.

  19. Objective differentiation of neonatal EEG background grades using detrended fluctuation analysis.

    Science.gov (United States)

    Matic, Vladimir; Cherian, Perumpillichira Joseph; Koolen, Ninah; Ansari, Amir H; Naulaers, Gunnar; Govaert, Paul; Van Huffel, Sabine; De Vos, Maarten; Vanhatalo, Sampsa

    2015-01-01

    A quantitative and objective assessment of background electroencephalograph (EEG) in sick neonates remains an everyday clinical challenge. We studied whether long range temporal correlations quantified by detrended fluctuation analysis (DFA) could be used in the neonatal EEG to distinguish different grades of abnormality in the background EEG activity. Long-term EEG records of 34 neonates were collected after perinatal asphyxia, and their background was scored in 1 h epochs (8 h in each neonate) as mild, moderate or severe. We applied DFA on 15 min long, non-overlapping EEG epochs (n = 1088) filtered from 3 to 8 Hz. Our formal feasibility study suggested that DFA exponent can be reliably assessed in only part of the EEG epochs, and in only relatively short time scales (10-60 s), while it becomes ambiguous if longer time scales are considered. This prompted further exploration whether paradigm used for quantifying multifractal DFA (MF-DFA) could be applied in a more efficient way, and whether metrics from MF-DFA paradigm could yield useful benchmark with existing clinical EEG gradings. Comparison of MF-DFA metrics showed a significant difference between three visually assessed background EEG grades. MF-DFA parameters were also significantly correlated to interburst intervals quantified with our previously developed automated detector. Finally, we piloted a monitoring application of MF-DFA metrics and showed their evolution during patient recovery from asphyxia. Our exploratory study showed that neonatal EEG can be quantified using multifractal metrics, which might offer a suitable parameter to quantify the grade of EEG background, or to monitor changes in brain state that take place during long-term brain monitoring.

  20. [Clinical outcome and placenta characteristics of spontaneous twin anemia-polycythemia sequence].

    Science.gov (United States)

    Wang, X J; Li, L Y; Wei, Y; Zhao, Y Y; Yuan, P B

    2017-03-25

    Objective: To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods: Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed, retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results: (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks (31-37 weeks) . The pregnancies were terminated because 3 cases were sIUGR type Ⅰ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1 797 g (940-2 620 g) , 1 648 g (980-2 500 g) ; P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient (P=0.000) and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was