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Objective To observe the effect of recombinant human erythropoietin injection (RHEI) assisted with mild hypothermia on the clinical efficacy and safety of children with hypoxic-ischemic encephalopathy (HIE). Methods From January 2015 to December 2017, 110 children with HIE were treated in Shijiazhuang No.1 Hospital. Fifty-five children with routine treatment were taken as Western medicine routine treatment group. In addition, 55 children treated with mild hypothermia combined with RHEI were taken as mild hypothermia+RHEI group. Both groups were treated for 14 days and followed up for 10 months. The neonatal behavioral neurological assessment (NBNA) score, mental development index (MDI), psychomotor development index (PDI), myelin basic protein (MBP), S100B protein and neuron specific enolization enzyme (NSE), nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), insulin growth factor-1 (IGF-1), growth hormone (GH), and differences in clinical efficacy in two groups were compared, and the occurrence of adverse reactions was observed. Results The NBNA, MDI, PDI, NGF (μg/L), BDNF (ng/L), IGF-1 (pg/L), and GH (pg/L) of two groups after treatment were higher than those before treatment (the Western medicine routine treatment group: 33.72±3.19 vs. 26.81±2.38, 78.95±5.51 vs. 71.39±4.24, 79.62±4.93 vs. 71.84±4.15, 123.74±22.98 vs. 104.29±15.36, 1 518.35±174.92 vs. 1 197.28±148.43, 38.25±4.96 vs. 23.16±2.87, 39.27±5.24 vs. 20.97±3.15; the mild hypothermia+RHEI group: 39.82±3.36 vs. 26.78±2.53, 84.13±6.29 vs. 71.34±4.27, 85.26±5.74 vs. 71.88±4.13, 145.28±27.52 vs. 104.72±15.41, 1 925.71±204.37 vs. 1 192.61±150.26, 57.94±6.62 vs. 23.13±2.91, 56.43±7.14 vs. 20.94±3.17), NSE (μg/L), MBP (μg/L) and S100B (μg/L) were lower than those before treatment (the Western medicine routine treatment group: 17.05±2.26 vs. 24.96±2.83, 9.71±1.85 vs. 23.14±3.37, 0.93±0.12 vs. 1.49±0.24; the mild hypothermia+RHEI group:12.48±1.94 vs. 25.03±2.81, 5.48±1.42 vs. 23.17±3.35, 0.61±0.07 vs. 1.51±0.25). After treatment, the changes of each index in the mild hypothermia+RHEI group were more significant than those in the control group [NABA:39.82±3.36 vs. 33.72±3.19, MDI: 84.13±6.29 vs. 78.95±5.51, PDI: 85.26±5.74 vs. 79.62±4.93, NSE (μg/L):12.48±1.94 vs. 17.05±2.26, MBP (μg/L): 5.48±1.42 vs. 9.71±1.85, S100B (μg/L): 0.61±0.07 vs. 0.93±0.12, NGF (μg/L): 145.28±27.52 vs. 123.74±22.98, BDNF (ng/L): 1 925.71±204.37 vs. 1 518.35±174.92, IGF-1 (pg/L):57.94±6.62 vs. 38.25±4.96, GH (pg/L): 56.43±7.14 vs. 39.27±5.24, all P < 0.05]. The total effective rate of mild hypothermia+RHEI group was significantly higher than that of Western medicine routine treatment group [94.55% (52/55) vs. 81.82% (45/55), P < 0.05]. There were no serious adverse reactions in the two groups. Conclusion RHEI assisted with mild hypothermia therapy can significantly improve the clinical efficacy and NBNA, MDI, PDI scores of HIE children, reduce the degree of brain injury, and improve the neurological function, with good safety.
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Neonatal hypoxic-ischemic encephalopathy (HIE) can result in serious outcomes including death during the newborn period and later neuropsychological handicaps.So far,there have been no obvious effect on the improvement of prognosis with traditional treatments,and the cryogenic treatment is the most effective treatment for the past decade,while the clinical application is limited by age and disease course.At present,stem cell transplantation in the treatment of HIE is the new direction,of which the mesenchymal stem cells are outstanding by its easy materials,low immunogenicity and potential nerve regeneration properties.This paper reviews and updates the progress of mesenchymal stem cell transplantation for neonatal HIE.
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PURPOSE: To investigate the relationship between brain injury patterns on magnetic resonance imaging (MRI) and neurodevelopmental outcomes in neonates with postasphyxial hypoxic ischemic encephalopathy (HIE). METHODS: Clinical characteristics and brain MRI findings of 49 term neonates with postasphyxial HIE were retrospectively reviewed. Brain injury patterns in MRI were classified into five categories, along with evaluation of the posterior limb of internal capsule (PLIC). Neurodevelopmental outcomes were assessed by neurological examination combined with the Bayley Scales of Infant Development II between 1 and 2 years of age. RESULTS: Twenty-three neonates (46.9%) showed abnormal brain MRI finding associated with poor neurodevelopmental outcomes (odds ratio 9.7, 95% confidence interval 1.4, 67.4, P=0.022). The following injury patterns were seen in MRI: abnormality in the basal ganglia-thalamus (BGT) in 4 neonates (17.4%), watershed predominant (WP) pattern in 5 (21.7%), extensive global injury (EGI) in 3 (13.0%), lesions restricted to periventricular white matter (LPWM) in 4 (17.4%), and perinatal arterial ischemic stroke (PAIS) in 2 (8.7%). Additionally, 6 neonate (26.1%) showed lesion in the PLIC. Neonate with BGT and EGI injury patterns showed worse neurodevelopmental outcomes than those with WP and LPWM patterns (P<0.05). Neonate with PLIC lesion also showed poor outcomes (100%). CONCLUSION: Abnormal brain MRI findings in neonates with postasphyxial HIE were associated with the poor neurodevelopmental outcomes. BGT, EGI and PLIC patterns of injury are expected to have worse outcomes than white matter predominant injury patterns such as those in the WP and LPWM.
Subject(s)
Child , Humans , Infant, Newborn , Brain Injuries , Brain , Child Development , Extremities , Hypoxia-Ischemia, Brain , Internal Capsule , Magnetic Resonance Imaging , Neurologic Examination , Retrospective Studies , Stroke , Weights and Measures , White MatterABSTRACT
Neonatal hypoxic-ischemic encephalopathy has high mortality,high morbidity,as well as the lack of effective treatment,which remain difficult problem in the medical profession.Progesterone has been confirmed protective effect for neonatal hypoxic-ischemic encephalopathy as nerve steroid hormone,and has been used in clinical trials Ⅱ.We review the progess in progesterone in hypoxic-ischemic encephalopathy.
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Objective To study the gas analysis of umbilical cord artery blood and radial artery blood on predicating the prognosis of asphyxia neonate?Methods From September 2014 to September 2015, 328 neonates were divided into groups by Apgar score:290 patients in the control group and 27 patients in the mild asphyxia group,11 patients in the severe asphyxia group?After birth,umbilical artery blood,radial artery blood gas analysis was perfomed, oxygenation index was calculated, Outcome of neonatal behavioral neurological assessment ( NBNA) in neonates with asphyxia was regular follow?uped,the relationship between pH value and umbilical artery blood gas analysis was analyzed?Results The pH, PO2, PCO2 and oxygenation index of umbilical cord blood and radial artery blood in the severe asphyxia group was(7?11±0?25,(73?93±23?35) mmHg,(51?36±16?37) mmHg,206?23±98?12),significant different than the mild group(7?24±0?05,(86?35 ±12?56) mmHg,(45?89± 9?21) mmHg,411?22±57?94) and the control group(7?28±0?08,(87?80±12?07) mmHg,(43?68± 6?45) mmHg,426?23±73?30)(P<0?05)?The pH,PO2,PCO2 and oxygenation index of umbilical cord blood and radial artery blood in the severe asphyxia group was(7?25±0?18,(74?66±24?09) mmHg,(51?42±17?83) mmHg,332?03±65?19),significant different than the mild group(7?31±0?09,(87?24 ±11?75) mmHg,(45?73±10?21) mmHg,405?67±82?65) and the control group(7?32±0?06,(87?99±11?81) mmHg,(42?84± 9?32) mmHg,439?89±60?76)(P<0?05)?The NBNA scores of the severe asphyxia group was (34?09±5?02) points,lower than the mild group(36?62±2?04)(F=21?65,P<0?05)?The NBNA scores showed significant relationship with umbilical cord blood pH in the severe asphyxia group( r=0?877,P<0?01)?Conclusion The pH,PO2 and oxygenation index of umbilical cord blood and radial artery blood was lower while PCO2 was markedly high in the severe asphyxia group than other groups?For neonates, there is a correlation between umbilical cord blood pH and NBNAs core, neonates borned with hypoxia and acidosis should monitor blood gas analysis and oxygenation index dynamically
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OBJECTIVE:To investigate the clinical efficacy and safety of amoxicillin sodium and clavulanate potassium com-bined with cranial mild-moderate hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) complicating with pulmonary infection. METHODS:80 children with HIE complicating with pulmonary infection were randomly divided into ob-servation group(42 cases)and control group(38 cases). Control group received routine treatment under normal body temperature as lowering intracranial pressure,correcting acid-base balance,giving nutritional support and anticonvulsive treatment,and then was given amoxicillin sodium and clavulanate potassium 30 mg/kg intravenously,tid,more than 30 min each time,for consecutive 3 d. On the basis of control group,observation group was additionally given cranial mild-moderate hypothermia therapy:wearing cooling cap,at 10 ℃;keeping pharynx nasalis temperature at 34 ℃;keeping rectal temperature at 33-37 ℃;decreasing at rate of 1 ℃/h. They continued treatment for 3 d till body temperature decreased to 34.5 ℃;and then cooling cap was taken off to recover normal body temperature. Therapeutic efficacy of HIE and pulmonary infection were observed in 2 groups. NBNA score of 2 groups were recorded 1st,2nd and 4th week after birth,and the occurrence of ADR was observed. RESULTS:Total effective rate of HIE therapy (95.24% vs. 78.95%),cure rate of pulmonary infection (52.38% vs. 26.32%) and total effective rate (85.71% vs. 65.79%) in observation group were significantly higher than control group,with statistical significance (P0.05). Compared to 1st week after birth,NBNA score were significantly improved 2nd and 4th week after birth,and the observation group were significantly higher than the control group,with statistical significance(P0.05). CONCLUSIONS:Amoxicillin sodium and clavulanate potassium combined with cranial mild-moderate hypothermia is effec-tive for HIE complicating with pulmonary infection,and can effectively improve the prognosis of children with good safety.
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Objective To simulate the process of hypoxic?ischemic brain injury at high altitude in a simulated cabin with plateau low pressure environment, and to prepare a rat model of cerebral injuries at different high altitudes. Method Thirty?two 0?day?old neonatal SD rats were divided into four groups, namely group A ( control group) and three test groups:group B (2000 m group), group C (4000 m group), and group D (6000 m group). The rats of control group were reared in a barrier environment. The rats of test groups were placed in a simulated cabin with plateau low pressure environment, and to prepare neonatal cerebral ischemia?hypoxia model by sport activities. The sport movements were carried out in the cabin in a swimming groove 60 min/d, and not less than 20 hours a day at high altitude low pressure environment. Zea Longa 5 point scale standard was used to determine the behavioral scores at the 3 th 7 th 11 th 15 th days, and samples were collected on the 15th day to observe red blood cell morphology using HE and 2, 3, 5?triphenyltetrazolium chloride ( TTC ) staining and ultrastructure by scanning electron microscopy. Result ( 1 ) The neurological scores of the test groups A, B, C were significantly different from that of the control group (P<0?05), and the scores of test group D and control group were very significantly different ( P <0?01 ) . ( 2 ) The histopathological examination using HE staining showed inflammatory cell infiltration in all rats of the test groups, and the extent of inflammatory cell infiltration was positively correlated with the increase of altitude. ( 3 ) The histopathology with TTC staining revealed prominent ischemia in the cerebral cortex of rats in the plateau hypoxic environment. ( 4 ) Scanning electron microscopy showed that the rat erythrocytes were cap?like in the group B, irregular in the group C, and zigzag shape in the group D. Conclusions In this study, a rat model of neonatal hypoxic?ischemic encephalopathy ( HIE) is successfully established by hypoxic cabin combined with sport activity. This model is stable, reliable, more closely mimicking the pathogenesis and clinical manifestation of neonatal HIE than models prepared with other methods, therefore, may be used in related research.
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OBJECTIVE:To observe clinical efficacy and safety of naloxone hydrochloride combined with Danshen injection in the treatment of neonatal hypoxic ischemic encephalopathy(HIE). METHODS:104 patients with HIE were randomly divided into observation group and control group with 52 cases in each group. The control group was treated with Naloxone hydrochloride injec-tion 0.02 mg/kg,ivgtt,qd and conventional symptomatic treatment;while observation group was additionally treated with Danshen injection 4-6 ml+10% Glucose injection 20 ml,ivgtt,qd,on the basis of the control group. Treatment course of 2 groups lasted for 7 d. Clinical efficacy,symptom and sign recovery of 2 groups were compared,as well as levels of serum MMP-9,IL-6 and TNF-α,cerebral hemodynamic parameters and ADR. RESULTS:There was no statistical significance in MMP-9,IL-6,TNF-α and cerebral hemodynamic parameters before treatment(P>0.05). The total effective rate of observation group(92.31%)was signifi-cantly higher than that of control group (75.00%);after treatment,the recovery time of consciousness disturbance,primitive re-flex and muscle tension in the observation group were shorter than those in the control group;the levels of serum MMP-9,IL-6 and TNF-α in observation group were significantly lower than those in control group;peak systolic flow velocity(PSFV),end-dia-stolic flow velocity (EDTV) were higher in the observation group than in the control group,with statistical significance (P0.05). No ADR was ob-served in 2 groups. CONCLUSIONS:Naloxone hydrochloride combined with Danshen injection can significantly promote HIE and signs recovery,reduce the levels of serum MMP-9,IL-6 and TNF-α,and improve hemodynamic parameters with good safety.
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Objective To discuss the value of analysis of serum myocardial enzyme spectrum and cardiac troponin I(cTnI) in neonatal hypoxic ischemic encephalopathy(HIE) .Methods Serum level of myocardial enzyme spectrum in each people was deter-mined with Hitachi 7602 ,Serum levels of cTnI was determined by chemoluminescence method .Serum levels of myocardial enzyme spectrum and cTnI were collect from 65 neonates with HIE(HIE group) and 68 cases of helthy volunteers(control group) .Results The levels of glutamic oxalacetic transaminase(AST) ,creatine kinase(CK) ,creatine kinase MB isoenzyme(CK-MB) ,lactic dehy-drogenase(LDH) and alpha-hydroxybutyric dehydrogenase(HBDH) in HIE group were(98 .9 ± 9 .6)U/L ,(385 .4 ± 15 .5)U/L , (89 .3 ± 9 .6)U/L ,(300 .8 ± 19 .8)U/L ,(399 .1 ± 17 .9)U/L ,which were higher than those in control group(P<0 .05) .The level of cTnI was(1 .4 ± 0 .4)ng/mL in HIE group ,which was higher than that in control group(P<0 .05) .CK-MB sensitivity was 88 .6% , cTnI speciality rate was 86 .3% .Conclusion The assay of myocardial enzyme spectrum and cTnI is significant in diagnosis of neo-natal HIE .
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Objective To study the value of MRI and proton magnetic resonance spectroscopy(H 1-MRS)for neonatal hypoxic-is-chemic encephalopathy(HIE).Methods Magnetic resonance imaging (MRI)and proton magnetic resonance spectroscopy (H 1-MRS)were performed in 30 cases of full-term neonates with HIE,and 10 infant control group without evidence of birth asphyxia. Cerebral MRI and H 1-MRS were performed within 1 5 days after birth.The results of H 1-MRS such as subwave crest values of me-tabolites in lesion areas were recorded.The data were analyzed statistically.Results (1)MRI showed abnormal fetures of HIE such as diffuse cerebral edema,loss of hyperintensity in the posterior limb of the internal capsule on T1 WI,gyrus sign,diffuse parenchy-mal hemorrhage,which could predict the severity of brain damage.(2)On H 1-MRS,the ratio of Lac/Cr in HIE group was much higer than that in control group,which was statistically significant (P <0.05).The ratio of Lac/Cr showed a rising trend with clini-cal grading of HIE.The ratio of NAA/Cr and NAA/Cho were lower in HIE group than that in control group (P <0.05),which showed a trend of gradually reduce with clinical grading of HIE.The difference between ratio of Glx-α/Cr in HIE group and control group was also significantly,the moderate-severe group was much higher than the mild group and control group.There was no sig-nificant difference in the ratio of Cho/Cr between the 4 groups.Conclusion The combination of MRI and H 1-MRS can objectively re-flect brain morphology and metabolic changes of HIE,and evaluate the severity of the brain injury,and provide an effective evidence for clinical diagnosis and treatment.
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Objective To explore the key points of nursing for neonates with hypoxic-ischemic encephalopathy detected by 18F-fluorodeoxyglucose positron emission tomography.Methods The features of nursing for 58 cases neonates with hypoxic-ischemic encephalopathy detected by 18F-fluorodeoxyglucose positron emission tomography were analyzed and summarized.Results 55 cases with hypoxic-ischemic encephalopathy detected by 18F-fluorodeoxyglucose positron emission tomography smoothly with pertinent nursing,only 3 cases had not completed the procedures because of change of their conditions.Conclusions Pertinent nursing was important for neonates with hypoxic-ischemic encephalopathy detected by 18F-fluorodeoxyglucose positron emission tomography because it could help them complete the procedures smoothly and make the results more accurate and satisfying so it is worthy of wide use clinically.
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0.05),but the total expenses and cost of the main medical treatment were(2765.85?484.99)and(737.50?100.30)yuan;(4506.70?671.31)and(2648.80?331.10)yuan,respectively,which demonstrated significant difference(P
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Objective To study the CT diagnosis and differential diagnsis of hypoxic ischemic encephalopathy (HIE)in neonates.Methods 55 cases who had clear history of asphyxia in perinatal period and had clinical symptoms were scanned with CT.The complete clinical materials and CT data were analyzed.Results The clinical and CT grades were conducted according to references.The results showed that there was difference between CT grades and clinical manifestation.Subarachnoid hemorrhage was the most common complication.The density of the lesions was significantly different from that in normal sites.Conclusion In the CT diagnosis of HIE,clinical data and anatomical structure of neonates are both critical for the correct diagnosis.
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Objective To compare the curative effects between domestic and imported monosialotetrahexosyl ganglioside sodium (GM 1) on neonatal hypoxic ischemic encephalopathy(HIE).Methods 104 neonates with HIE were randomly divided into Shenjie group(domestic GM 1,53 cases )and Pharma group (imported GM 1,51 cases).At the basic of conventional therapy,the two groups received domestic or imported GM 1 20 mg /d intravenous infusion for 7～ 28 d,rspectively.The curative effects and adverse reaction were observed.Results The total effective rates in Shenjie group and Pharma group were 98.11% and 88.24%,respectively.There was no significant difference between the two groups.While,there was no obvious adverse reaction in the two groups.Conclusion Both the domestic and imported GM 1 have the same good curative effects and safety on neonatal HIE.