Prognostic analysis of 55 neonates with severe asphyxia / 预防医学

Objective@#To analyze the prognosis of neonates with severe asphyxia, so as to provide insights into improvements of prognosis among neonates with severe asphyxia. @*Methods@#Neonates with severe asphyxia born in Hangzhou Women's Hospital from 2016 to 2021 were recruited, and neonates' birth weight, gender, Apgar score, arterial blood pH value within 30 minutes after birth and maternal delivery data were collected. Outpatient follow-up was performed among neonates one year after birth, and the prognosis was evaluated with the Gesell Developmental Scale. Death or development quotient (DQ) of <75 was defined poor prognosis, and the clinical characteristics were compared between the good prognosis group and the poor prognosis group.@*Results@#A total of 55 neonates with severe asphyxia were enrolled, including 26 boys and 29 girls, with a median birth weight of 2 845.00 g (interquartile range, 1 948.00 g). There were 52 lying-in women (3 women had twins), with a mean age of (30.56±4.08) years, including 35 women with dystocia (67.31%) and 37 primiparas (71.15%). Of 55 neonates with severe asphyxia, there were 40 neonates with good prognosis (72.73%) and 15 neonates with poor prognosis (27.27%), including 13 deaths and 2 cases with DQ of <75. The incidence of abnormal fetal position was higher in the good prognosis group than in the poor prognosis group (36.84% vs. 0%; P<0.05), and the incidence of uterine torsion or uterine rupture was higher in the poor prognosis group than in the good prognosis group (21.43% vs. 0%; P<0.05). The median Apgar score at 5 min after birth and arterial blood pH within 30 min after birth were lower in the poor prognosis group [3.00 (interquartile range, 4.00) points and (6.93±0.23)] than in the good prognosis group [6.00 (interquartile range, 4.00) points and (7.23±0.15)] (P<0.05).@*Conclusion@#Maternal uterine torsion or uterine rupture, low Apgar score at 5 min after birth, and low arterial blood pH within 30 min after birth may aggravate the poor prognosis among neonates with severe asphyxia.

Relation between immediate postpartum APGAR score with umblical cord blood pH and fetal distress

Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.

Association between clinical diagnosis of foetal distress with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress

Background: The risks of maternal morbidity and mortality associated with a caesarean section may not be reasonably justified by the degree of neonatal compromise at birth associated with caesarean section done for clinically diagnosed foetal distress. The aim was to study the association of clinical diagnosis of non-reassuring foetal status with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress and to evaluate outcomes in neonates born by caesarean section performed for foetal distress.Methods: Prospective observational study of all the women undergoing emergency caesarean section for foetal distress at a tertiary care teaching facility over 2 months. Criteria for diagnosis of foetal distress were thick meconium stained liquor only or foetal heart rate abnormality with or without meconium stained liquor. Testing for pH was done on arterial blood drawn from umbilical cord at the time of birth. Acidaemia was defined as cord blood pH less than 7.2.  Severe acidaemia was defined as cord blood pH less than 7.0.Results: Cord blood pH was analysed in 110 caesareans done for foetal distress. Incidence of neonatal acidaemia at birth in study population was 53.6%.Conclusions: Much lower incidence of actual acidaemia and low Apgar scores in neonates born by caesarean section done for clinical diagnosis of foetal distress than previously reported indicate the need for more stringent criteria and more objective tests for diagnosis of foetal distress.

Physiological Parameters in the Blood of a Murine Stress-Induced Depression Model before and after Repeated Passive Exercise

BACKGROUND: Animal models are necessary to study the mechanism underlying the effects of exercise on depression but an effective procedure for exercise treatment and exercise effects on physiological parameters in a specific depression model need to be characterized. METHODS: Physiological parameters including lactate, partial pressue of O2 (pO2) and CO2 (pCO2) saturated O2 (sO2), pH, HCO3, total CO2 (TCO2), and base excess extracellular fluid (BEecf) levels in the blood were measured after treatment with passive exercise in normal mice and a stress-induced depression model. RESULTS: Normal mice or mice that were subjected to daily 2-hour restraint for 14 days (2 hoursx14 days of restraint) were placed on a running wheel that was rotating at a speed of 9 m/min for 1 hour per day for 1 to 21 days. After repeated exercise in mice that were previously subjected to 2 hoursx14 days restraint, plasma lactate levels decreased, the levels of pO2, sO2, and pH tended to increase, and the levels of pCO2 decreased in the absence of significant changes in HCO3, TCO2, and BEecf. However, none of these changes were additive to the stress effects or were much more severe than those induced after repeated passive exercise in normal mice. CONCLUSION: These results suggest that passive exercise for 1 hour daily for 14 to 21 consecutive days on a running wheel rotating at a speed of 9 m/min may be used as an exercise protocol without inducing severe additive effects on physiological burdens.

The Guiding Sense of Umbilical Artery Blood pH in the Evaluation of Neonatal Asphyxia Diagnosis and Prognosis / 医学研究杂志

Objective To explore the effect of umbilical artery blood pH on the diagnosis of neonatal asphyxia and the evaluation of its prognosis. Methods Blood samples were obtained from 108 normal newborns and 51 asphyxial newborns,who were randomly chosen among newborns delivered in our hospital from november 2007 to may 2008. Umbilical artery blood gas was measured and compared with apgur rating. Results With the degression of umbilical blood pH, the incidence rate of neonatal asphyxia increased and the normal apgar rating decreased(P < 0.01), which suggesting that there was tight relevant between umbilical blood pH and neonatal asphyxia. Conclusion Compared with apgur rating, umbilical artery blood pH could reflect the asphyxia degree of newborns more objectively andsensitively and it might play a guiding role in the prognosis of neonatal asphyxia.

Studies of Various Salt Administrations on Changes in Blood pH and Serum Electrolytes of Rabbit / 대한비뇨기과학회지

The present study is an attempt to delineate the effect of various salt administrations on the changes of blood pH and electrolytes, especially the nature of serum calcium, total and ionic, and serum magnesium. Thirty five male rabbits weighing 1.9 to 2. 5kg were used in this experiment. At the end of the three days diet adjustment period, the animals were divided into seven groups; Group I; Control, Group II; Ammonium chloride oral administration, Group III; Oral administration of sodium bicarbonate, Group IV; Potassium chloride intraveneous injection, Group V; Sodium chloride intravenous injection, Group VI; Calcium chloride intravenous injection, and Group VII; Magnesium chloride intravenous injection. The blood pH was determined by the method by Astrup and bicarbonate in serum by the method of Van Slyke and Neill. Sodium and potassium in serum were determined with an EEL flame photometer. Chloride was determined by the method of Schales and Schales and inorganic phosphorous by the method of Fiske and Subbarrow. Serum total calcium and magnesium were determined according to the method of chelometric titration with Eriochrome blue S.E. Serum ionic calcium was determined by the method of Yanagisawa. The results of this study are as follows: 1. The oral administration of ammonium chloride produced a significant decrease in blood pH. The serum concentrations of bicarbonate, magnesium and potassium were steadily decreased, but serum chloride, serum total and ionic calcium concentrations were increased through the experiment. 2. Sodium bicarbonate ingestion increased the concentration of bicarbonate, magnesium and serum ionic calcium markedly and serum ionic calcium slightly. The blood pH was significantly increased but serum chloride concentration was markedly reduced after ingestion of sodium bicarbonate However, serum potassium and inorganic phosphorus concentrations were decreased slightly. 3. The blood pH was dropped in the first two hours of intravenous injection of potassium chloride and tended to rise again significantly. the concentration of sodium and chloride in serum was increased markedly in two hours of injection but reduced after six hours to control level. Serum phosphorus, total and ionic calcium were reduced steadily, but serum concentration of magnesium, potassium and bicarbonate concentrations were slightly increased through the experiment 4. After sodium chloride was given, intravenously, there was a sustained increase in the concentration of serum sodium, potassium, phosphorus and bicarbonate but the blood pH was decreased in the first two hours and significantly elevated through the experiment. The serum concentration of chloride, magnesium, total and ionic calcium was decreased slightly. 5. B100d pH was slightly increased and the concentration of chloride was elevated sharply after injection of calcium chloride intravenously in the first two hours and come to control level in twenty-four hours. Serum sodium concentration was elevated steadily through the experiment. The concentration of total and ionic calcium in serum was elevated after injection but come to control level in twenty four hours of injection. Serum potassium and magnesium concentrations were decreased slightly in the first two hours and increased in four hours of injection. 6. Magnesium chloride intravenous injection produced a decrease in blood pH and serum concentration of bicarbonate in the first few hours and increase after 6 hours of injection. Serum magnesium, and inorganic phosphorus levels were increased after injection but the concentration of inorganic phosphrous was decreased markedly in twenty four hours of injection. Serum concentration of chloride, ionic calcium and potassium wag markedly reduced.