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Background: Perinatal asphyxia and resultant hypoxic-ischemic encephalopathy (HIE) is not an uncommon phenomenon in a developing country, like Bangladesh. Electroencephalogram (EEG) is regarded as an effective prognostic tool. Correlation of clinical profiles and EEG findings of HIE patients arenot commonly observed in Bangladesh. The aim of the study was to observe the clinical profile and EEG changes in different stages of hypoxic-ischemic encephalopathy and compare them in a tertiary care hospital.Material & Methods:This is a cross-sectional observational study conducted for a period of six months in Dhaka Medical College Hospital, Dhaka. Sarnat and Sarnat score was used to classify HIE. 20 asphyxiated neonates without HIE were selected as the control group (group II) while 30asphyxiated neonates with HIE, were selected as the case group (group I) by purposive sampling. Clinical profiles, EEG findings, and immediate outcomes were observed and compared between the two groups.Results:73.3% patients were delivered at term and 30% patients were delivered at home in group I. 70% patients’ delivery were conducted by doctor in group I and 75% in group II. 63.3% patients had meconium stain in group I and 25% in group II, which was found significant. 46.7% had prolong labor in group I and 20% in group II, 40% had premature ruptured membrane (PROM) in group I and 40% in group II. Hypothermia, weak primitive reflexes, hypotonia, lethargy and seizure were significantly higher in group I. Changes in EEG correlated between the two groups and was found significant. Also, patients in group I, needed prolong hospital stay.Conclusions:The clinical profiles and EEG changes in patients with hypoxic ischemic encephalopathy was concluded that there is significant association with meconium stain, seizure, hypothermia, weak primitive reflexes, lethargic, miosis, hypotonia, poor APGAR score, burst suppression & SET findings in EEG and prolonged hospital stay in prenatal asphyxia with hypoxic ischemic encephalopathy.
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OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn. .
OBJETIVO: testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo. MÉTODOS: estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem. RESULTADOS: dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neurológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convulsões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento. CONCLUSÕES: em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEEGocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN. .
Subject(s)
Female , Humans , Infant, Newborn , Male , Electroencephalography/methods , Hypoxia-Ischemia, Brain/physiopathology , Respiratory Distress Syndrome, Newborn/physiopathology , Confidence Intervals , Hypoxia-Ischemia, Brain/diagnosis , Intensive Care Units, Neonatal , Predictive Value of Tests , Prospective Studies , Risk Factors , Respiratory Distress Syndrome, Newborn/diagnosis , Sensitivity and Specificity , Seizures/diagnosis , Term Birth , Time FactorsABSTRACT
Objective:Searching after the regularity of the expressions the insulin-like growth factors(IGF-1) inside the neonatal rabbits with chronic intrauterine anoxemia give to brain Tissues and serums. Methods: Choosing 24 Zelanian rabbits that have been in afternoon pregnancy,we divide them into three stochastic contratest group by chance: the control group,the anoxic group and the group interfered with Chinese traditional medicine. Then we contrast the expressions and changes of these groups with IGF-1 in brain tissues and in serums. Results: Contrasting IGF-1 in brain tissues,checked up with ?2. In three different groups,we have found that the differences of their expressions have some statistical significance (P
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@#ObjectiveTo discuss the effect of neonatal behavioral neurological assessment (NBNA) and developmental screening test (DST) on newborns with hypoxic ischemic encephalopathy (HIE). MethodsNBNA was performed for 60 newborns with HIE within 12-14 days and DST was also performed at 6th month after birth.ResultsMild and severe degree HIE newborns with low NBNA scores had unfavorable prognosis. Conclusions NBNA and DST can provide evidence for early interference for newborn's HIE.
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Objective:To study the change of tumor necrosis factor-?(TNF-?) , interlukin-1?(IL-1?) and interluldn-6(IL-6) in neonates with hypoxic-ischemic encephalopathy(HIE) ,and analyze the relation between their levels and the severity of HIE. Methods :TNF-?,IE-? and IL6 in the plasma and in the supernatant of cultured peripheral blood mononuclearcytes(PBMC) were mesured in 50 neonates with HIE and 30 normal term neonates by enzyme-linked immunosorbent assay. Results: TNF-?and IL-?plasma levels and the production by PBMC in neonates with FILE were markedly elevated than those in normal controls Levels of TNF-?,IL-?and IL-6 both in the plasma and the supernatant of PB-MC were much higher in acute stage of severe HIE compared with the control group and mild HIE, and plasma levels of TNF-a and IL-? were significantly decreased in convalescence stage, but IL-6 levels were still much higher than those in normal controls. Conclusion:TNF-? and IL-? plasma levels and the production by PBMC in neonates with I-LIE axe related to the severity of HIE, and IL-6 may participate in the repair of neurons after ischemic brain injuly. These cytokines can be indicators of the brain damage degree of IDE.