Renal failure in asphyxiated neonates.

A prospective case controlled study was conducted in the NICU of a tertiary level referral teaching hospital to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. Ninety-eight neonates were enrolled 70 asphyxiated babies and 28 healthy controls. Renal functions were assessed using urinary output, urine microscopy, biochemical parameters and sonographic findings. Babies having renal failure were managed on a protocolised plan and followed up till 6 months of age to detect any residual impairment. Blood urea and serum creatinine were significantly higher in asphyxiated babies compared to the control group. Biochemical derangements correlated well with HIE staging and Apgar scores. There was no significant difference in urine output in the control and the study group as significant oliguria was seen in only 7 of the 70 asphyxiated babies and the output did not correlate with severity of asphyxia. Serum sodium level and fractional excretion of sodium showed significantly different values in the asphyxiated babies compared to control. Of the 70 asphyxiated babies 33 (47.1 %) had renal failure, which was of the non-oliguric type in 78 % cases and oliguric type in 22 % cases. Sonographic abnormalities were seen more often in oliguric babies and was associated with a bad prognosis. Renal parameters normalized in all neonates by 6 months of age. Mortality was higher in babies with oliguric renal failure. We conclude that renal failure is a significant problem in asphyxiated neonates with majority of babies having nonoliguric failure. Severity of renal function abnormality correlates well with degree of asphyxia. Oliguria, hyponatremia and abnormal sonographic scan are bad prognostic signs in renal failure secondary to birth asphyxia.

Surfactante: uso en neonatos de la terapia infantil / Surfactant: use in newborn of the infant therapy

El uso del surfactante natural disminuye la necesidad de ventilación mecánica, la enfermedad pulmonar crónica y la estancia en la unidad, el objetivo de este trabajo es verificarlo. Durante el año de 1997 se ingresaron 46 pacientes de los cuales 26 [57 por ciento] eran neonatos. De éstos neonatos 14 [54 por ciento] eran pretérminos de 34-36 semanas, 7 [27 por ciento] eran preterminos extremos [menos de 1 kg, 28-30 semanas] y 5 [19 por ciento] a término. De éstos sólo 8 [31 por ciento] recibieron el surfactante [bien sea por disponibilidad o traslado tardío]. El uso del surfactante se realizó en base a: síndrome de dificultad respiratoria progresiva asociado a prematuridad, historia de asfixia perinatal moderada a severa, infección pulmonar adquirida in utero. Se les practicó a los pacientes: gasometrías, saturometría contínua y Rx de tórax de acuerdo a las necesidades del paciente, así como laboratorio de rutina. De los 8 pacientes que recibieron surfactante, todos permanecieron en ventilación mecánica por lo menos 72 horas; aunque su uso permitió el descenso progresivo de parámetros ventilatorios no así la extubación del paciente. Se evidenció una elevada incidencia de barotrauma [37 por ciento] probablemente debido a que la franca mejoría de la compliance pulmonar no fue asociada con el descenso de los parámetros o la obstrucción del tubo debido a la viscosidad del surfactante con mayor frecuencia en los varones. No se evidenció ningún caso de hemorragia pulmonar ni de inestabilidad hemodinámica

An Apgar score of three or less at one minute is not diagnostic of birth asphyxia but is a useful screening test for neonatal encephalopathy.

OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.