Evaluación renal y multiorgánica en el paciente con encefalopatía hipóxico-isquémica / Renal and multiorgan evaluation in infants with post-asphyxial hypoxic-ischaemic encephalopathy

Resumen Introducción: La encefalopatía hipóxico-isquémica (EHI) moderada-grave secundaria a asfixia perinatal puede afectar a cualquier órgano, empeorando el pronóstico. Objetivo: Evaluar la afectación renal y multiorgánica de estos pacientes. Material y método: Se incluyó a recién nacidos > 35 semanas con EHI moderada-grave tratados con hipotermia activa entre 2010 y 2020. Se evaluó la creatinina en tres periodos: 48-72 horas de vida, entre el 3.o y 7.o día de vida y del 7.o al 28.o día de vida. Resultados: Se incluyeron 135 pacientes: 112 con EHI moderada y 23 con EHI grave. Al comparar ambos grupos, se obtuvieron diferencias significativas a las 48-72 horas y entre 3.o-7.o día de vida. No hubo diferencias al comparar el método de hipotermia. Los pacientes con EHI grave presentaron mayor afectación hemodinámica, respiratoria y hepática. Conclusiones: Neonatos con EHI grave presentan aumento de los niveles de creatinina sérica y mayor afectación multiorgánica respecto a aquellos con EHI moderada.

Abstract Background: Hypoxic-ischemic encephalopathy (HIE) secondary to perinatal asphyxia can affect any organ, worsening the prognosis. Objective: To describe renal and multiorgan involvement in moderate-severe HIE. Material and method: Newborns > 35 weeks diagnosed with moderate-severe HIE who required active hypothermia between 2010-2020 were included. To assess renal involvement, serum creatinine was measured in three different periods: at 48-72 hours, between the 3rd and the 7th day, and from the 7th to the 28th day. Results: A total of 135 patients were included, 112 (83%) with moderate and 23 (17%) with severe HIE. Significant differences were obtained when comparing median creatinine levels at 48-72 hours and between 3-7 days in both groups. There were no differences in creatinine according to the hypothermia method. Patients with severe HIE presented greater hemodynamic, respiratory, and hepatic involvement. Conclusions: Neonates with severe HIE present increased serum creatinine levels and greater multi-organ involvement than those with moderate HIE.

Cord blood and serial lactate levels in predicting short-term outcome in term new-born babies with perinatal asphyxia

Introduction: Birth asphyxia is a leading cause of neonatal deaths across the globe. Clinical examination, Apgar score, pH, EEG/aEEG, Lactate are being used as markers for prediction of outcome. Serum Lactate is a better reflector of metabolic mechanism. We intend to study cord blood lactate and serial lactate levels in term birth asphyxia babies. Aim: To determine correlation between cord blood lactate, serial lactate levels and short term outcome in term new-born babies with perinatal asphyxia. Materials and Methods: It was a prospective, observational study. Thirty term babies with birth asphyxia were selected. Their Cord blood lactate, serum lactate at 6, 12, 24 hours of life were correlated to short term outcomes (NICU stay, shock, Acute kidney injury, mortality). Results: Eighteen babies with moderate asphyxia and 12 with severe asphyxia had mean cord blood lactate of 10.4mmol/L and 13.47mmol/L respectively. There was difference in mean lactate levels at 6, 12, 24 hours of life between the babies who survived and expired; also survivors had significant reduction in mean lactate levels at various time points. Babies with moderate asphyxia had no shock and AKI. Babies with severe asphyxia and shock had mean lactate levels of 12mmol/L in survivors and 13.8mmol/L in who expired. Babies with severe asphyxia and AKI had mean lactate of 14mmol/L in survivors and 14.6mmol/L in who expired. Babies with moderate asphyxia had no mortality. In babies with severe asphyxia, survivors had mean lactate of 12.74mmol/L and 14mmol/L in babies who expired. There was no correlation between the lactate levels and the length of the NICU stay. Conclusion: Serial lactate levels can be used to predictor the short term prognosis in term babies with perinatal asphyxia. There was significant difference in mean lactate levels between the babies who survived and expired. Serial lactate levels showed significant reduction in babies who survived.

Reanimación neonatal en sala de partos en Villa Clara / Neonatal resuscitation in the delivery room in Villa Clara province

Introducción: La pérdida de bienestar fetal perinatal es la situación que con mayor frecuencia condiciona la necesidad de reanimación cardiopulmonar del recién nacido en el momento del parto. Objetivo: Describir las características clínicas y epidemiológicas de los neonatos reanimados en la sala de partos. Métodos: Se realizó una investigación de desarrollo, descriptivo, observacional, retrospectivo, en el Hospital Provincial Universitario Ginecoobstétrico Mariana Grajales de Santa Clara desde enero de 2017 a diciembre de 2021. La muestra coincidió con el universo y estuvo compuesta por 106 neonatos que obtuvieron una puntuación de Apgar bajo (inferior a siete), evaluado al primer minuto después del nacimiento que requirieron alguna maniobra de reanimación neonatal en la sala de partos. Se empleó cálculo de frecuencias absoluta y relativa, además de contraste de proporciones mediante Chi-Cuadrado para las variables cualitativas como resultado de esta prueba. Resultados: Fueron más frecuentes los recién nacidos con peso normal (75,5 por ciento), al término de la gestación (65,1 por ciento) y del sexo masculino (61,3 por ciento). La cesárea como vía final del parto (51,9 por ciento) y la presencia de líquido amniótico meconial; fueron variables con mayor porcentaje dentro de las variables perinatales seleccionadas. El 8,5 por ciento de los neonatos reanimados fallecieron. Conclusiones: Las variables clínicas y epidemiológicas más frecuentes en el estudio coincidieron con la literatura consultada. La mayoría de los neonatos reanimados sobrevivieron(AU)

Introduction: Perinatal loss of fetal well-being is the situation that most frequently creates the need for newborn cardiopulmonary resuscitation at delivery. Objective: To describe the clinical and epidemiological characteristics of neonates resuscitated in the delivery room. Methods: A developmental, descriptive, observational, retrospective and descriptive research was carried out at Mariana Grajales Gynecobstetric University Provincial Hospital, of Santa Clara (Villa Clara Province, Cuba), from January 2017 to December 2021. The sample coincided with the universe and was made up of 106 neonates with low Apgar score (lower than seven), evaluated at the first minute after birth, who required some neonatal resuscitation maneuver in the delivery room. Calculation of absolute and relative frequencies was used, as well as contrast of proportions by chi-square for qualitative variables resulting from this test. Results: Newborns with normal weight (75.5 percent), at term (65.1 percent) and male (61.3 percent) were more frequent. Cesarean section as the final route of delivery (51.9 percent) and the presence of meconium amniotic fluid were the variables with the highest percentage from among the selected perinatal variables. 8.5 percent of the resuscitated neonates died. Conclusions: The most frequent clinical and epidemiological variables in the study coincided with the consulted literature. Most of the resuscitated neonates survived(AU)

Correlation of Clinical Profile and Electroencephalographic Finding in Hypoxic-Ischemic Encephalopathy in a Tertiary Care Hospital: A Single-Center Experience from Bangladesh

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.

Urinary uric acid or urinary creatinine ratio as a non-invasive marker for perinatal asphyxia

Background: Perinatal asphyxia is amongst the common problem of neonates and there exists a significant contribution to the neonatal morbidity and mortality. It is observed as a common and a vital cause of the preventable cerebral injury. The prediction of the perinatal asphyxial outcome is very important but dreadful. There is a limited role for APGAR score to predict the immediate outcome, like HIE and the long-term neurological sequelae observational error may happen in APGAR. But the biochemical parameters can truly be relied upon. This study was done to assess urinary uric acid/urinary creatinine ratio (UA/Cr) as a non-invasive marker for perinatal asphyxia and co-relate its absolute value to the degree of the perinatal asphyxia.Methods: In this prospective case control study conducted in the Pediatrics Department of Shri Ram Murti Smarak Institute of Medical Sciences between Nov 2017 to May 2019, 42 asphyxiated and 42 non-asphyxiated newborns were included. Detailed history and assessment were for all the enrolled newborns. Spot urine samples were sent for the uric acid and creatinine estimation. Results were documented, and statistical analysis was performed.Results: Urinary uric acid to creatinine ratio used as additional non-invasive, early and easy biochemical marker of the birth asphyxia that biochemically supports severity grading and clinical diagnosis of the asphyxia by APGAR score.Conclusions: The ratio of the urinary uric acid and creatinine enables rapid and early recognition of asphyxial injury and also the evaluation of its severity and potential for short-term morbidity or death.

A study to determine association of the interval between seizure and delivery with the APGAR scores and perinatal asphyxia of the neonates of eclamptic mothers of a rural tertiary care hospital in Eastern India

Background: Eclamptic seizure not only affects maternal health but may predispose low APGAR scores and development of perinatal asphyxia and thereby influence perinatal mortality too. This study was carried out to evaluate the correlation of the interval between the onset of seizure and delivery with the APGAR scores (at 1 minute and 5 minutes) and perinatal asphyxia of the neonates of the eclamptic mothers.Methods: A prospective, cross-sectional, observational, epidemiological study was conducted from April, 2012 to March, 2013 at a tertiary-care Government teaching hospital catering rural population of Eastern India. The participants comprised of 100 consecutive admitted eclamptic mothers and neonates born to them.Results: Majority of mothers were unbooked, primigravidae (86%), aged below 20 years (66 %). Significant inverse correlation was observed between seizure to delivery interval and Apgar scores (1 min and 5 minutes), while seizure to delivery interval >12 hours was found to be a significant risk factor for perinatal asphyxia (OR =16.824, 95% CI = 5.107-55.424, p <0.001).Conclusions: Measures to minimise the interval between the onset of seizures and delivery will decrease the incidence of perinatal asphyxia and perinatal mortality of neonates of eclamptic mothers in rural areas.

N-terminal pro brain natriuretic peptide as a marker of myocardial dysfunction in newborns with perinatal asphyxia

Background: Perinatal asphyxia refers to a condition during first and second stage of labour in which impaired gas exchange leads to foetal hypoxemia. Perinatal asphyxia causes cardiac dysfunction in 24 to 60 percent of the cases. The reduced cardiovascular reserve is associated with hypoxic brain damage and has high impact on neonatal mortality and adverse neurological outcomes. It has been challenging to diagnose myocardial dysfunction in resource constraint setting. Aim and objective of this study was to Determine N-Terminal Pro BNP concentrations in perinatal asphyxia and correlate with modified Sarnat stages of hypoxic ischemic encephalopathy.Methods: Among 120 Neonates admitted in neonatal intensive care unit with diagnosis of perinatal asphyxia were considered for the study. 2mL of venous blood drawn within 48hours of life was analyzed for quantitative N-Terminal Pro BNP and was correlated with modified Sarnat stages of hypoxic ischemic encephalopathy.Results: A Total of 120 cases of perinatal asphyxia were considered for the study, among which 44 cases had HIE stage 1, 48 had HIE stage 2 and rest 28 had HIE stage 3. The mean and standard deviation of N-Terminal Pro BNP concentrations in stage 1 was 1,502.86'3,581.170 pg/mL, stage 2 was 4,916.31'8,001.674 pg/mL and stage 3 was 8,912.41'13,927.152 pg/mL with significant p value of 0.003.Conclusions: Early N-Terminal Pro BNP concentrations may provide a useful marker for the anticipated severity of myocardial dysfunction.

Study of urinary uric acid and creatinine ratio as a marker for perinatal asphyxia

Background: Perinatal asphyxia refers to an impairment of the normal oxygenation during parturition and the ensuing adverse effects on the fetus/neonate.' In India, due to birth asphyxia, between 250,000 to 350,000 infants die each year, mostly within the first three days of life. Low APGAR score is commonly used to as a indicator of asphyxia in infants, but it may often be not available and may be reduced in premature infants. In present study we evaluated urinary uric acid and creatinine ratio as a marker for perinatal asphyxia, at our tertiary care hospital.Methods: Present study was a observational, case-control study, conducted in department of paediatrics, in case group consisted of 40 full-term neonates who were hospitalized with the diagnosis of perinatal asphyxia. The control group consisted of 40 healthy full-term newborns.Results: Male to female ratio was 1.5:1 in case group as compared to 1.22:1 in control group. Mean gestational age in case group was 286'10.32 days, while in control group it was 274'7.310 days. Mean birth weight was 2.72'0.51 kg & 2.88'0.49 kg in case & control group respectively. In 52.5 % neonates from case group, signs of intrapartum fetal distress were noted. A statistically significant difference (p<0.005) was noted in Apgar 5 min, Arterial blood pH, pO2 (mm Hg), pCO2 (mm Hg), Urinary uric acid (mg/dl) and Urinary uric acid/ creatinine ratio. Authors did not noted any significant difference in Urinary creatinine (mg/dl) values of cases and control group. Urinary UA/CR ratio is significantly higher in case group when compared with control group with t=11.19; P<0.001.Conclusions: The ratio of urinary uric acid to creatinine helps in rapidly recognizing asphyxia and assessing its severity, so it can be a good, simple screening test for early assessment of neonatal asphyxia.

Study on Etiological Factors, Clinical Pattern and Comorbidities in Cerebral Palsy Children of North Bihar Region.

Cerebral palsy (CP) is a form chronic motor disability in children. It is a non-progressive disorder of posture and movement, often associated with epilepsy and abnormalities of speech, vision and intellect. It results from a defect or lesion of growing brain before or during birth or in postnatal period. The damage to brain is permanent and cannot be cured but the consequences can be minimized. Cerebral palsy (CP) is a disorder of development in which abnormalities of motor function are the main characteristic features. Severity varies from mild to severe. Cerebral palsy is a very challenging disability for parents and professionals. Cerebral palsy is a heterogeneous group of disorders caused by intrapartum asphyxia and exposure to maternal infection such as chorioamnionitis, sepsis, urinary tract infection, and prematurity. The incidence of Cerebral Palsy is 2 to 2.5 per 1000 live births. During the past twenty years, there have been increases in the incidence and prevalence of CP that may be associated to enhanced records of cases, advances in neonatal health care and other factors.METHODSThis cross-sectional study was conducted in the Department of Paediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, from October 2018 to September 2019. A total of 100 Cerebral Palsy cases coming from various districts to inpatient and outpatient department of hospital were selected.RESULTSIn this study a total 100 CP children up to 12 years of age was included. 60% were boys and 40% were girls. The causes of CP included birth asphyxia (47%), prematurity (22%), pyogenic meningitis (8%), genetic (7%), neonatal sepsis (6%), intracranial bleed (5%), and idiopathic (5%). Among these cases, spastic type (65%), ataxic (15%), dyskinetic (10%) and mixed (10%) varieties were found. Among spastic, quadriplegic subtype was seen in 69%, diplegia in 23%, and hemiplegia in 8%. Comorbidities associated with CP patients were speech problem (80%), pain (75%), cognitive disability (50%), hip displacement (30%), seizure (25%), behavioural disorders (25%), sleep disturbances (20%), visual impairment (19%) and hearing impairment (4%).CONCLUSIONSPerinatal asphyxia is a leading and preventable cause of cerebral palsy. Spastic type was the most common type and in spastic type, quadriplegic subtype was most common. Mental retardation, speech problems, pain, cognitive disability, hip displacement and seizure were the major co-morbidities in children with cerebral palsy. Early diagnosis and appropriate management are important in such children to limit morbidity.

A prospective observational study to describe magnetic resonance imaging findings in perinatal asphyxia in terms of severity, outcome and neurological sequel in term and preterm babies

Background: Perinatal asphyxia is a significant cause of neonatal mortality and morbidity. MRI is useful for assessing the severity and pattern of brain injuries. There is less data of MRI findings of perinatal asphyxia from India and the subcontinents. This prospective observational study was done to describe MRI brain findings in neonates with perinatal asphyxia with respect to various determinants.Methods:' Initial MRI brain was done when babies were stable after fulfilling inclusion criteria. Immediate outcome was assessed at the end of hospital stay. They were followed up for presence of any sequel up to 1 year. Repeat MRI brain was done in few selected babies. Data was collected and statistically analyzed.Results: Total 55 babies were included in the study (term 27, preterm 28). There were 9 babies in stage 1, 17 babies in stage II and 22 babies in stage III. MRI brain findings were normal in 8 and abnormal in 47 patients. There were Deep gray matter injury (DG) in 22, Para Sagittal subcortical white matter injury (PS) in 6, Germinal matrix haemorrage (GMH), intraventricular haemorrage (IVH) and Periventricular leucomalacia (PVL) in 12 and Mixed pattern of injury in 7 babies. Findings among 9 expired babies were: 4 (44.4%) DG, 2 (22.2%) GMH+IVH and 3 (33.3%) mixed. There was neurological sequel in 13 babies (48.1%).' Babies with normal MRI initially had no sequel.Conclusion: Brain injury due to perinatal asphyxia follows several patterns according to gestational age and severity. Early and accurate recognition of these patterns with the help of MRI brain helps in managing the baby and predicting the prognosis.

A Clinical Study for Prediction of Perinatal Asphyxia using Nucleated Red Blood Cells as an Indicator in Umbilical Cord Blood of Newborns

Introduction: Perinatal asphyxia has become the leadingcause of death for newborns. Since the parameters that arebeing routinely used as a predictor for perinatal asphyxia suchas thick meconium stained liquor, non-reassuring fetal heartpatterns, low Apgar scores, fetal or cord blood pH do notshow consistent correlation with fetal acidosis but nucleatedred blood cell counts in umbilical venous blood of neonateshas been reported as a possible marker of perinatal asphyxia.The number of nucleated red blood cells (nRBCs)/100 whiteblood cells is variable but is rarely greater than 10 in normalneonates. The aim of this study was to study the using ofnucleated red blood cells in umbilical cord blood of newbornsas an indicator for perinatal asphyxia.Material and methods: The study comprised of intramuralterm neonates with and without asphyxia. It was a casecontrol study conducted in the Department of Pediatrics incollaboration with Department of Obstetrics and Gynaecology,Rohilkhand Medical College and hospital, Bareilly fromNovember 2017 to October 2018. There were 50 asphyxiatednewborns and 50 healthy newborns in the study. The meanlevels of nRBCs in cord blood were significantly higher(p value<0.001) in the asphyxial group (54.06+-22.42) ascompared to control group (10.32+-5.86).Results: Nucleated red blood cells were found to be stronglyassociated with perinatal asphyxia. The mean values of cordblood nRBCs in cases were 54.06+-22.42 and in controlgroup were 10.32+-5.86. The p value being <0.001 which wasstatistically significant indicating the correlation.Conclusions: Therefore it was concluded that nucleated redblood cells in umbilical cord blood of newborns can be used asan effective test for prediction of perinatal asphyxia.

Coagulation Profile in neonates with perinatal asphyxia

Background: Perinatal Asphyxia refers to a condition during the first and second stage of labour in which impaired gas exchange leads to fetal acidosis, hypoxemia and hypercarbia. It accounts for about 23 per cent of the four million newborn deaths worldwide.Methods: To estimate the magnitude of coagulation derangement in babies who suffered birth asphyxia and compare it with non-asphyxiated controls.Results: There were 61.9% and 64 % males in both the groups outnumbering females suggesting that the health care seeking behavior for male children is more than for their female counterparts. Birth weight and mode of delivery are comparable in both the groups. PT and APTT were significantly higher in the asphyxiated babies than in their respective control group. It may be noted , however, that PT and APTT values were higher in the control group also, when compared with the reference values. This may indicate that the hemostatic mechanisms are already compromised in the newborns and perinatal asphyxia further augment the situation tilting it in favour of bleeding. Thrombocytopenia is observed in the asphyxiated group which may be due to placental insufficiency. Severe bleeding is significant in asphyxiated group as compared to the control.Conclusion: Dyscoagulation should be considered in all asphyxiated babies, and they may present with clinically significant bleeding, which may require fresh frozen plasma to restore and maintain their coagulation status.

Spectrum of multi-organ system involvement in perinatal asphyxia in neonatal intensive care unit department of Pediatrics, King George hospital, Visakhapatnam, Andhra Pradesh, India

Background: The objective of the current study to find out the maternal risk factors associated and spectrum of involvement of multiorgan dysfunction in perinatal asphyxia.Methods: This is a prospective study comprises of 102 asphyxiated neonates. At the time of admission blood samples were taken for complete blood picture, random blood sugar, serum electrolytes, septic screen & blood culture. For the assessment of the central nervous system a neurosonogram would be carried out in all asphyxiated new-borns. Computed tomography scan was done who had abnormal neurosonogram. Chest x ray was done for all respiratory cases. Echocardiogram was done for cardiac assessment. Renal system evaluated by serum creatinine and urine output.Results: Of these 102 babies, 59 were males and 43 were females. Major risk factors in the study were meconium stained amniotic fluid cases, eclampsia, pregnancy induced hypertension, premature rupture of membranes and prolonged second stage of labour. central nervous system (CNS) involvement occurred in all 102 (100%) neonates. Hypoxic ischemic encephalopathy was the most common presentation of CNS involvement. Respiratory involvement was noted in 42 (41.5%). Renal involvement was seen in 27 (26.5%). Cardiovascular system involvement was observed in 26 (25.5%). Gastrointestinal involvement was observed in 16 (15.68%). Hematological abnormalities were seen in 14.7%.Conclusions: Multiorgan dysfunction is common in neonates with perinatal asphyxia. Overall mortality was 24.5%, which clearly indicates the need for early detection of maternal risk factors, better obstetric management and the prompt resuscitator measures.

Morbidity and mortality pattern of very low birth weight and extremely low birth weight neonates in a tertiary care hospital

Background: Although the mortality and morbidity rates for Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) neonates have improved over last few decades, they still remain highly vulnerable groups. This study determines the neonatal morbidity and mortality within first four weeks of life in VLBW and ELBW neonates.Methods: It was a hospital based prospective study conducted in the department of paediatrics at GB Pant hospital, an associated hospital of Government Medical College Srinagar. All included neonates were evaluated in neonatology section and were followed up to 4 weeks of life. Standard protocols were used for management of these neonates.Results: A total of 116 neonates were included in the study. Among the 116 neonates 82 (70.69%) were VLBW and 34 (29.31%) were ELBW. 28 (34.14%) VLBW and 18 (52.94%) ELBW neonates died. Among the morbidities Respiratory Distress Syndrome was found in 35.37% of VLBW and 70.59% of ELBW neonates, out of which 12.20% VLBW and 20.58% ELBW neonates developed Bronchopulmonary dysplasia. Perinatal asphyxia was found in 20.73% of VLBW and 29.41% of ELBW neonates and Pathological apnea occurred in 28.04% VLBW and 85.29% ELBW neonates. 40.24% VLBW and 73.53% ELBW neonates developed clinically significant jaundice requiring treatment. Clinical sepsis was found in 43.90% VLBW and 67.65% ELBW neonates while as culture proven sepsis was found in 26.83% VLBW and 41.18% ELBW neonates. Intra ventricular haemorrhage was found in 15.85% VLBW and 52.94% ELBW neonates. Necrotizing enterocolitis developed in 18.29% VLBW and 35.29% ELBW neonates. Retinopathy of prematurity was found in 21.95% VLBW and 26.47% ELBW neonates. Patent ductus arteriosus was found in 14.63% VLBW and 32.35% ELBW neonates.Conclusions: Present study has shown Respiratory distress syndrome, perinatal asphyxia and sepsis as the predominant causes of neonatal morbidity and mortality and these are preventable with a proper health care system and policy directed to the primary prevention.

A prospective study to evaluate influence of maternal, obstetric and fetal risk factors on the outcome of asphyxiated neonates born intramurally and extramurally

Background: The present study was planned to determine the influence of maternal, obstetric and fetal risk factors on the outcome of intramurally (born at a tertiary care centre) and extramurally (born at a peripheral centre, home or a private facility) born asphyxiated neonates.Methods: It was an observational clinical research with a prospective design and was conducted in Neonatal Intensive Care Unit (NICU), Paediatric Neurology Clinic attached to Department of Paediatrics and Department of Obstetrics and Gynecology, Dr S N Medical College Jodhpur, Rajasthan. A total of 160 asphyxiated neonates (80 intramural and 80 extramural) were included in the study. A detailed antenatal and perinatal history with obstetrical interventions were recorded. The progress or deterioration in the clinical status of child was noted in hours. Outcome was evaluated in terms of survival, severest Hypoxic Ischaemic Encephalopathy (HIE) stage, time taken to reach non encephalopathic state, requirement of vasopressors and anticonvulsants, ventilator support, hemodynamic stability, time period to attain full enteral feeding, neurological examination at time of discharge and time taken for discharge.Results: Significant difference was observed in the antenatal and perinatal profile, perinatal management and resuscitation, postnatal management, morbidity, mortality and neurodevelopment outcome of extramurally delivered neonates in a peripheral health centre or at home as compared to intramurally delivered neonates in a tertiary institute.Conclusions: It is of paramount importance to have an early referral of asphyxiated neonates to a well equipped NICU using an appropriate well equipped transport unit/ chain so as to improve their outcome.

A prospective study on cardiac changes (electrocardiographic, enzymatic and echocardiographic) in birth asphyxiated neonates admitted in tertiary care centre

Background: Reduced myocardial performance and cardiac output following perinatal asphyxia may significantly complicate perinatal management and may contribute to increased end-organ damage and mortality. Hence the present study was done with the aim to assess the usefulness of echocardiography, electrocardiography (ECG), and cardiac enzymes in evaluating myocardial damage in perinatal asphyxia neonates and to assess their correlation with different stages of hypoxic-ischemic encephalopathy (HIE) and outcome.Methods: The study was conducted in the NICU, Department of Pediatrics, Government Chengalpattu Medical college hospital between August 2017 and August 2018 using 70 birth asphyxiated term babies. The asphyxiated babies were resuscitated as per NRP guidelines and were stratified into HIE stages as per Levene system of classification and were managed as per clinical condition. ECG grading, echo changes were noted. Creatinine kinase-MB (CKMB) levels were measured and documented after 12 hours of life among these babies and were analysed.Results: Of 70 cases, 36 (51.4%) had mild, 26 (37.1%) moderate and 8 (11.4%) severe HIE. Abnormal ECG was observed in 63 cases. Raised CKMB levels were found in 67 (95.7%) and abnormal echo findings were noted in 46 (65.7%) babies. ECG, echo changes and CKMB levels showed increasing abnormalities with increasing severity of HIE (p=0.000, 0.030 and 0.001 respectively). 8 babies in present study expired.Conclusions: Cardiac abnormalities among asphyxiated neonates requires high index of suspicion. ECG abnormalities, echo changes, elevated CK-MB levels in babies with HIE can help us identify neonates at risk of complications and guide in timely intervention that can prevent mortality of these babies and help us achieve better neurological outcome in these babies.

A study on clinical correlation of EEG in neonates with perinatal asphyxia

Background: Perinatal asphyxia is the most common and important cause of preventable cerebral injury occurring in the neonatal period. The WHO has estimated that 4 million babies die during the neonatal period every year. According to WHO, perinatal asphyxia is defined as the failure to initiate and sustain breathing at birth. The objective is to study the electroencephalographic changes and correlation between severity of Perinatal asphyxia with EEG changes.Methods: It is prospective observational study, which includes 40 term neonates admitted in NICU with perinatal asphyxia in GMCH Aurangabad. EEG analysis focused on background activity and classified into four categories.Results: The EEG was normal in 45%, mild abnormal in 25%, intermediate in 15%, and severely abnormal in 15%.' Outcome at discharge was normal in 19(47.5%) and abnormal in 21(52.5%) including 1 death. Abnormal outcome was seen in 27% of newborns with normal EEG and 72% of abnormal EEG.Conclusions: Severity of perinatal asphyxia correlated well with abnormality of EEG. EEG changes and severity showed good correlation with immediate outcome of newborn in terms of duration of hospitalization and normal neurological examination.

Meconium-stained amniotic fluid as a risk factor for perinatal asphyxia

Background: The aim of this study was to find out immediate fetal outcome in meconium-stained amniotic fluid in relation to perinatal asphyxia.Methods: This retrospective study includes medical records of all neonates admitted to Neonatal Intensive Care Unit (NICU) between December 2016 and July 2018. The variables reviewed are age, sex, weight, mode of delivery, gestational age, presence of meconium aspiration syndrome (MAS) and perinatal asphyxia.Results: Out of 408 total admissions in NICU, 69.1% were male babies and remaining 30.9% were female babies. In the study out of 36 subjects with Perinatal Asphyxia, 38.9% had MAS and 61.1% had not MAS. Out of 372 subjects without perinatal asphyxia, 93.8% had no MAS and 6.2% had MAS. There was significant association between MAS and perinatal asphyxia. Odds ratio was 9.656. i.e. those with MAS had 9.656 times higher risk for perinatal asphyxia.Conclusions: The management of MAS, which is a perinatal problem, requires a well concerted and coordinated action by the obstetrician and pediatrician. Prompt and efficient delivery room management can minimize the sequelae of aspirated meconium and decrease the chance of perinatal asphyxia in the new born babies.

Comorbidities associated with cerebral palsy in children presenting at department of Pediatrics, K. T. children hospital Rajkot, India

Background: Cerebral palsy is a diagnostic term used to describe a group of motor syndromes resulting from disorder of early brain development. It describes a group of permanent disorders of the development of brain and posture causing activity limitation. The magnitude of cerebral palsy in our country is 2 to 2.5 per thousand live birth. The objective is to study co-morbidities associated in cerebral palsy patients.Methods: It was a hospital based cross sectional study carried out in KT Children Hospital, PDU Medical College, Rajkot for 1 year (April 2017-April 2018). Sample size: minimum 100 cases. Selection of subject: All the children suffering from cerebral palsy presenting at KT Children hospital, P.D.U. Medical college Rajkot, Gujarat. Cases were evaluated by history, clinical examination and necessary investigations.Results: From data collected in present study most common variety of Cerebral Palsy is spastic type (72.5%) followed by, dyskinetic (16%), ataxic (7%), and hypotonic (4.5%) type. Within spastic type; diplegic (48%) is the most common variety. Caesarean section delivered cases are more predisposed to Cerebral palsy in present study which might be due to other risk factors associated with it. Gender and consanguinity showed not major significance in association with CP child. Most of Cerebral palsy cases in present study were born full term (81.5%) and of normal birth weight (78.5%). The most common comorbidities in present study were cognitive impairment (77%) followed by epilepsy (38%), visual impairment (10%), hearing disability (9%) thyroid dysfunction (3%) and G.I. disturbances (2%). Perinatal asphyxia is the most common history finding in Cerebral palsy cases including in present study, followed by seizures during infancy, pathological jaundice, neonatal sepsis and history of NICU admission for any cause.Conclusions: Cerebral palsy in developing countries has a higher prevalence and different clinical profile regarding severity and associated disability. The perinatal and high-quality neonatal care together with physical therapy and rehabilitation programs have a significant role in preventing comorbidities in cerebral palsy cases, which is still lacking in developing countries.

Marcadores moleculares de la asfixia perinatal / Molecular markers of perinatal asphyxia

Introducción: la asfixia perinatal es un problema de salud que puede acarrear alteraciones del neurodesarrollo en los recién nacidos. Las determinaciones en suero de enolasa específica de neurona, lactato deshidrogenasa y aspartato amino transferasa han sido utilizadas como marcadores de asfixia perinatal. Objetivos: evaluar el valor de las determinaciones en suero de lactato deshidrogenasa, aspartato amino transferasa y enolasa específica de neurona como marcadores moleculares de la asfixia perinatal. Métodos: se realizó un estudio observacional descriptivo de corte transversal. Se trabajó con una muestra intencional de 41 recién nacidos asfícticos, clasificados con distintos grados de encefalopatía hipóxico-isquémica según los criterios de Sarnat. Se tomaron muestras de suero al momento del nacimiento y a las 72 horas siguientes. Las determinaciones en suero de enolasa específica de neurona se realizaron por ELISA. Se cuantificó lactato deshidrogenasa y aspartato amino transferasa por espectrofotometría. Resultados: todos los pacientes presentaron valores elevados en suero, de los tres analitos, a las 24 y 72 horas de nacidos. Los valores enzimáticos no variaron significativamente entre las 24 y 72 horas de nacidos sin tomar en cuenta el grado de encefalopatía hipóxico-isquémica. Existe correlación positiva entre los valores enzimáticos a las 24 y a las 72 horas de enolasa específica de neurona y lactato deshidrogenasa. No fue posible diferenciar el grado de encefalopatía hipóxico-isquémica a través de los niveles en suero de estas enzimas. Conclusiones: los valores de estas determinaciones enzimáticas contribuyen a describir desde el punto de vista bioquímico el cuadro del neonato con asfixia perinatal(AU)

Introduction: perinatal asphyxia is a health problem which may cause neurodevelopmental alterations in newborns. Serum determinations of neuron-specific enolase, lactate dehydrogenase, and aspartate aminotransferase have been used as markers of perinatal asphyxia. Objectives: evaluate the value of serum determinations of lactate dehydrogenase, aspartate aminotransferase and neuron-specific enolase as molecular markers of perinatal asphyxia. Methods: a cross-sectional observational descriptive study was conducted of 41 asphyxiated newborns classified as different grades of hypoxic-ischemic encephalopathy according to Sarnat's scale. Serum samples were taken at birth and 72 hours later. Serum determinations of neuron-specific enolase were obtained by ELISA. Lactate dehydrogenase and aspartate aminotransferase were quantified by espectrophotometry. Results: all the patients had high serum values of the three analytes 24 and 72 hours after birth. Enzyme values did not vary significantly from 24 to 72 hours after birth, not considering the grade of hypoxic-ischemic encephalopathy. A positive correlation was found between enzyme values for neuron-specific enolase and lactate dehydrogenase at 24 and 72 hours. It was not possible to differentiate the grade of hypoxic-ischemic encephalopathy via the serum levels of these enzymes. Conclusions: the values of these enzyme determinations contribute to describe the status of neonates with perinatal asphyxia from a biochemical point of view(AU)