Resultado perinatal y obstétrico en embarazadas mayores a 35 años y menores a 15 años: (Estudio descriptivo retrospectivo. realizado en el Departamento de Ginecoobstetricia del hospital General San Juan de Dios) / Perinatal and obstetric outcome in pregnant women older than 35 years and younger than 15 years: (Retrospective descriptive study. Performed in the Department of Gynecology and Obstetrics of the Hospital General San Juan de Dios)

En Guatemala, el embarazo en la adolescencia es un problema social, que repercute seriamente en el desarrollo de los adolescentes. El fenómeno se vincula, directamente, con los factores económicos y, sobre todo, con el acceso a la educación y la información, aspectos que de ser accesibles ayudarían a promover un cambio favorable entre las personas con menos recursos. La edad avanzada en el embarazo representa un factor de riesgo de morbimortalidad materna, perinatal e infantil. Se realizo un Estudio descriptivo retrospectivo, se revisaron las papeletas médicas de todas las pacientes embarazadas que cumplieron con los criterios de inclusión. Dentro del estudio se incluyeron 289 pacientes, se observó mayor prevalencia de pacientes >35 años, respecto a los antecedentes prenatales, la edad gestacional más prevalente fue 37 a 41 semanas, el promedio de número de citas de control prenatal fue de 2.98, las complicaciones más frecuentes fueron infección y trabajo de parto pretérmino. En cuanto a los antecedentes natales, la Cesárea trans peritoneal fue la vía de resolución más prevalente y la asfixia perinatal fue la complicación más frecuente. Se observó asociación estadísticamente significativa entre complicaciones pre, natales y post natales edad materna mayor a 35 años. El hallazgo de sobrepeso y obesidad en pacientes mayores a 35 años se puede asociar con la prevalencia de complicaciones y el bajo promedio del número de controles prenatal. La falta de asociación entre edad materna menor a 15 años y complicaciones puede ser atribuida a que estas pacientes llevan un mejor control prenatal, debido al seguimiento especializado que se cuenta por parte del MSPAS. (AU)

In Guatemala, teenage pregnancy is a social problem, which seriously affects the development of adolescents. The phenomenon is directly linked to economic factors and, above all, to access to education and information, aspects that if accessible would help promote a favorable change among people with fewer resources. Advanced age in pregnancy represents a risk factor for maternal, perinatal and infant morbidity and mortality. A retrospective descriptive study was carried out, the medical records of all pregnant patients who met the inclusion criteria were reviewed. The study included 289 patients, a higher prevalence of patients> 35 years of age was observed, with respect to prenatal history, the most prevalent gestational age was 37 to 41 weeks, the average number of prenatal control appointments was 2.98, complications the most frequent were infection and preterm labor. Regarding the natal history, trans peritoneal caesarean section was the most prevalent means of resolution and perinatal asphyxia was the most frequent complication. A statistically significant association was observed between prenatal and postnatal complications, maternal age greater than 35 years. The finding of overweight and obesity in patients older than 35 years can be associated with the prevalence of complications and the low average number of prenatal check-ups. The lack of association be-tween maternal age less than 15 years and complications can be attributed to the fact that these patients have better prenatal control, due to the specialized follow-up provided by the MSPAS. (AU)

Hipotermia terapêutica na encefalopatia hipóxico-isquêmica neonatal: revisão integrativa / Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: integrative review / Hipotermia terapéutica em la encefalopatía hipóxico-isquémica neonatal: revisión integrativa

Objetivo: identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método: revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta:"Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?".Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados:o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida.São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão: a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

Objective: to identify the evidence on safe use of therapeutic hypothermia in newborns. Method: integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: "What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?". Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results: cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion: the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

Objetivo: identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método: revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: "¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?". Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados: el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión: la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

Conocimientos y actitudes sobre encefalopatía hipóxico-isquémica e hipotermia terapéutica: Resultados de una intervención educativa / Knowledge and attitudes on hypoxic-ischemic encephalopathy and therapeutic hypothermia: Results of an educational intervention

Antecedentes: La asixia perinatal, producida al feto/neonato por hipoxia y/o hipoperfusión tisular, puede llevar a ence-falopatía hipóxico-isquémica (EHI). La hipotermia terapéutica (HT) es eicaz para tratar EHI moderada/severa. Objetivo: Determinar conocimientos y actitudes sobre EHI e HT del personal sanitario y estudiantes antes y después de una intervención educativa, Departamento de Pediatría, Hospital Escuela (HE), Tegucigalpa, 2019. Métodos: Estudio cuasi experimental. Médicos, enfermeras, estudiantes de grado y posgrado fueron invitados a participar mediante consentimiento informado. El ensayo consistió en evaluación pre-intervención (Fase 1), seguida de intervención educativa, video y documento enviados por aplicación WhatsApp, y evaluación post-intervención (Fase 2). Se registraron características sociodemográicas. Se evaluó conocimientos (Excelente, Muy bueno, Bue-no, Deiciente) y actitudes (Buena, Regular, Mala, Muy mala). Se midió el cambio (Delta Porcentaje) entre proporción de participantes de acuerdo a conocimientos y actitudes pre y post-intervención. Resultados: De 181 potenciales participantes, en Fase 1 participaron 147 (81.2%) y en Fase 2, 127 (70.2%). Inicialmente, 93.2% (137) demostró un conocimiento deiciente y actitud buena 38.0% (56), regular 28.0% (41), mala 32.0% (47). El conocimiento bueno aumentó en 561.2% (3.1% versus 20.5%), conocimiento muy bueno aumentó en 185.1% (4.7% versus 13.4%), conocimiento deiciente disminuyó en 35.9% (92.2% versus 59.1%). La actitud regular au-mentó en 37.0% (27.0% versus 37.0%), actitud mala disminuyó 30.4% (32.8% versus 22.8%). Discusión: La intervención educativa mejoró conocimiento y actitud en relación a HT y EHI. La HT disponible en HE puede mejorar el desenlace de EHI. Se recomienda fortalecer las medidas educativas institucionales sobre el protocolo de HT...(AU)

Encefalopatía hipóxica-isquémica neonatal / Neonatal hypoxic-ischemic encephalopathy

La encefalopatía hipóxica-isquémica es un síndrome bien definido que afecta a los recién nacidos a término debido a asfixia fetal al nacer. La incidencia es 1-8 de cada 1000 nacidos en países desarrollados y asciende hasta 25 cada 1000 nacidos en países en desarrollo. Las causas más frecuentes son desprendimiento de la placenta, prolapso del cordón umbilical y rotura uterina. El criterio diagnóstico incluye incapacidad parcial o total del recién nacido para llorar y respirar al ser estimulado que requiere ventilación asistida en la sala de partos, Apgar < 5 en 5 y 10 minutos, acidemia (pH ≤ 7 y/o déficit de bases ≥ 12 mmol/l), alteraciones del estado de vigilia/sueño, de los reflejos primitivos y estiramiento muscular y tono muscular. En la forma leve la recuperación es total en tres días y sin (o con mínimas) secuelas de neurodesarrollo. En las formas moderadas y graves existen déficits neurológicos permanentes y alteraciones del neurodesarrollo (48%), 27% mueren y 25% son normales. El EEG regular o amplitud integrada y la resonancia magnética y espectroscópica realizados entre las 24 y las 96 horas y los 7 y 21 días de nacido respectivamente tienen un gran valor diagnóstico y pronóstico. Se recomienda hipotermia corporal (33.5 °C por 72 horas) antes de las 6 horas de nacido en las formas moderadas y graves. El resultado es una disminución de la mortalidad (de 35% a 27%) y de la morbilidad (de 48% a 27%).

Hypoxic-ischemic encephalopathy is a clearly recognizable clinical syndrome of in term newborns due to fetal asphyxia at birth. The incidence is 1.5 (95% CI 1.3 to 1.7) but it ranges from 1-8 and 25 out of every 1000 born in developed and developing countries, respectively. The most frequent causes are detachment of the placenta, prolapse of the umbilical cord and uterine rupture. The diagnostic criteria include partial or total incapacity for the newborn to cry and breath at birth even when stimulated, requiring assisted ventilation in the delivery room, Apgar < 5 in 5 and 10 minutes, acidemia (pH ≤ 7 and / or bases deficit ≥ 12 mmol/l), alterations of the conscience and the reflexes of Moro, grasping and suction, muscular stretching and muscle tone. The clinical forms are mild, moderate and severe. In the mild forms, the recovery is total in three days without, or with minimal, neurodevelopmental alterations. The moderate and severe forms cause permanent neurological deficits and neurodevelopmental alterations (48%) or death (27%). The regular or amplitude integrated EEG and the magnetic and spectroscopic magnetic resonance imaging performed between 24 and 96 hours and 7 and 21 days after birth, respectively, have a high diagnostic and prognostic value. Induced hypothermia (33.5° C for 72 hours) is recommended before 6 hours old. The result is a decrease in mortality (from 35% to 27%) and morbidity (from 48% to 27%).

Factores asociados a epilepsia en niños en México: un estudio caso-control / Factors associated with epilepsy in children in Mexico: A case-control study

Resumen: Introducción: La epilepsia es la enfermedad neurológica crónica más común en el mundo. En México es considerada dentro de las principales enfermedades vinculadas a la mortalidad por enfermedades no infecciosas de la población infantil. El objetivo del estudio fue identificar los factores asociados a epilepsia en niños derechohabientes del Instituto Mexicano del Seguro Social (IMSS), en Acapulco, México. Métodos: Estudio de casos y controles realizado entre abril de 2010 y abril de 2011. Fueron seleccionados 118 casos de la consulta externa de neurología pediátrica, con criterios diagnósticos de epilepsia de acuerdo a la Liga Internacional Contra la Epilepsia, con máximo dos años de evolución. Los controles fueron seleccionados de las Unidades de Medicina Familiar de donde procedieron los casos. En una encuesta a las madres, se obtuvo información sobre antecedentes heredofamiliares, prenatales, perinatales y posnatales. El análisis bivariado y multivariado se realizó mediante el procedimiento de Mantel-Haenszel. Resultados: Tres factores estuvieron asociados con la epilepsia: el antecedente familiar de epilepsia en familiares de primer grado (Razón de Momios ajustada (RMa) 2.44, IC95% 1.18 - 5.03), la asfixia al nacimiento (RMa 2.20, IC95% 1.16-34.18) y la infección de la vía urinaria en la etapa prenatal (RMa, 1.80 IC95% 1.0 - 3.24). Conclusiones: La asfixia al nacimiento y el reporte de infecciones de vías urinarias durante la gestación fueron factores asociados a epilepsia independientemente del antecedente de epilepsia en familiares de primer grado.

Abstract: Background: Epilepsy is the most common chronic neurological disease in the world. In Mexico, epilepsy is among the diseases more related to mortality due to non-infectious diseases in children. The objective of the study was to identify the factors associated with epilepsy in children entitled to the Mexican Social Security Institute (IMSS), in Acapulco, Mexico. Methods: We carried out a case-control study from April 2010 to April 2011. We selected 118 cases from the database of outpatient pediatric neurology with epilepsy diagnostic with two year of evolution according to the International League Against Epilepsy criteria. We selected 118 controls from the same Medical Units where cases were detected. Data collected throughout an interview with the mothers included information on history of epilepsy among relatives, prenatal, perinatal and postnatal history. Bivariate and multivariate analysis was performed using Mantel-Haenszel process. Results: Multivariate analysis identified three factors associated with epilepsy: family history of epilepsy in first-degree relatives (adjusted Odds ratio (ORa) 2.44, 95%CI 1.18 -5.03), birth asphyxia (ORa 2.20, 95%CI 1.16-34.18), and urinary tract infection in the prenatal stage (ORa, 1.80, 95%CI 1.0 - 3.24). Conclusions: Preventing birth asphyxia and urinary tract infections during pregnancy reduces the risk of epilepsy regardless of the history of epilepsy in first-degree relatives.

Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1) preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4) preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated (TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW), (BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA (cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA (ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001). Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.

Desarrollo psicomotor de niños con asfixia neonatal en el Hospital Leonardo Martínez / Psychomotor development of children with asphyxia neonatorum, Hospital Leonardo Martínez

La asfixia neonatal sigue siendo un problema frecuente en la práctica pediátrica y causa importante de morbimortalidad, puede ocurrir antes del nacimiento, durante el trabajo de parto o en el período neonatal. La incidencia de la asfixia varía según los diferentes centros y la definición diagnóstica usada. Objetivo: Identificar las secuelas en el neurodesarrollo de los nacidos con asfixia perinatal, en el Hospital Leonardo Martínez Valenzuela (HLMV) entre julio de 2010 y junio 2012, en la ciudad de San Pedro Sula, Honduras. Métodos: Estudio longitudinal, descriptivo, prospectivo. En el puerperio inmediato se identificaron las madres de los Recién Nacido (RN) con algún grado de depresión respiratoria. Se elaboró un instrumento tipo cuestionario que recopilaba datos maternos y neonatales (basado en las guías de la Secretaria deSalud), se revisaron los expedientes clínicos para completar información y se midió el pH del cordón umbilical en los primeros 10 minutos, a los 3 días se evaluó el bienestar de los recién nacidos, se les citó a la clínica de seguimiento del hospital a los meses 1, 6, 12, 18 y 24 para aplicar el test de Denver. Los criterios de inclusión fueron; haber nacido en el HLMV, con depresión respiratoria y asistido por lo menos a un seguimiento. Resultados: Se realizó seguimiento en 72 neonatos, 8 fallecieron en la primera semana y únicamente uno presentó alteraciones del lenguaje a los doce meses; fue referido a Teletón. Conclusión: Los resultados se consideraron no concluyentes, ya que en el seguimiento, los pacientes perdidos fue mayor que aquellos que asistieron a las citas, por lo tanto, la única afectación encontrada fue alteración en el desarrollo del lenguaje, y la letalidad fue 11.1% (8/72 casos). Recomendaciones: Repetir este estudio mejorando el control y seguimiento de los niños con esta afección. Extender el presente hasta los cinco años de edad para verificar o descartar más afectaciones en el desarrollo psicomotor...

Retinal Hemorrhage Associated with Perinatal Distress in Newborns

PURPOSE: To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses. METHODS: A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted. RESULTS: Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infant's dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye. CONCLUSIONS: In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Retinal Hemorrhage Associated with Perinatal Distress in Newborns

PURPOSE: To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses. METHODS: A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted. RESULTS: Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infant's dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye. CONCLUSIONS: In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Hipotermia en recíen nacidos con asfixia perinatal / Hypothermia in newborns with perinatal asphyxia

Se ha demostrado que la hipotermia controlada puede reducir la muerte o discapacidad grave, la mortalidad y los trastornos del neurodesarrollo en recién nacidos que han sufrido asfixia perinatal. Con el objetivo de implementar la realización de hipotermia se analizó su aplicación en 10 recién nacidos de término que cumplieron con criterios de inclusión en dos centros neonatales de Montevideo en un período de dos años. Se alcanzó la temperatura objetivo (33,5°C) en las primeras 6 horas de vida de los pacientes y se mantuvo en ese rango durante 72 horas en 7/10 pacientes. En 8/10 pacientes se utilizó un gorro con agua fría circulante y en 2/10 placas de gel congelado para el enfriamiento encefálico directo y de todo el cuerpo en forma indirecta. Tres pacientes se retiraron del protocolo luego de 48 horas de hipotermia por alteraciones de la coagulación, bradicardia mantenida y paro cardiorrespiratorio, respectivamente. El recalentamiento se logró en todos los casos en seis horas sin alteraciones. El 60% de los pacientes presentaron convulsiones durante su internación y el 100% recibieron fenobarbital. En el grupo analizado se produjeron dos muertes, uno de ellos próximo a la supresión de la terapia y otro en la evolución alejada. De manera complementaria se presentó la caracterización del impacto de la hipoxia severa y de la inducción de hipotermia sobre las variables más relevantes en un modelo de cerdo recién nacido. Se concluye que el desarrollo de hipotermia controlada es una estrategia terapéutica posible y segura, que brinda una oportunidad a los pacientes que han sufrido asfixia perinatal

Multiple risks and early language development.

Objective. To examine the relationship between cumulative biological and environmental risk factors and the language development of children less than 3 years. Methods. A sample of 253 children aged 2 to 35 months, from an urban centre in north India were evaluated for language development. The main outcome measure was the language quotient (LQ) of the child as evaluated by the Clinical Linguistic Auditory Milestone Scale (CLAMS). Twelve possible risk factors, 4 biological and 8 environmental, were selected. Biological risk factors included preterm birth, low birth weight, history of birth asphyxia, and history of neonatal jaundice. The environmental risk factors included low income, large family size, minimal father’s and mother’s education, disadvantaged caste, low level of occupation of head of the household, absence of father, and higher birth order. A multiple risk score was created and categorized into 3 groups: low risk (0 to1), moderate risk (2 to 3) and high risk (4 and above). Results. There was a significant (F=4.80, p<.000) general downward linear trend in the LQ of the child as the number of risk factors increased. The difference in the LQ of the children with no risk factor and those with 8 risk factors was 21.21 LQ points and each risk factor reduced the LQ of the children by 2.63 points. Conclusion. Children experience many risk factors but the most detrimental effects on language development are caused when multiple biological and environmental risk factors act on a single child.

Electrocardiographic and echocardiographic changes in perinatal asphyxia.

OBJECTIVE: To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS: Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS: Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION: C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Risk factors and clinical profiles in Iraqi children with cerebral palsy

The aim is to assess the significant of risk factors in cerebral palsy [CP], clinical profiles and gross motor function level of Iraqi children with CP and significances of brain congenital anomalies in Iraqi CP. 475 children with CP were in the neurosciences hospital during the period from the first of May 2005 to the first of September 2008. 303 [64%] were males and 172[36%] were females. Age range between 10 months to 150 months [mean age 80 months]. 43% of the cases were spastic diplegic CP,19% were hemiplegic CP,15% were quadriplegic CP,7% were athetoid CP and 16% were other or unclear[mixed or ataxic cp].The most frequently encountered risk factor were preterm delivery, birth asphyxia consanguinity and neonatal jaundice in consequence. Prematurity and birth asphyxia are the most important risk factors

Theophylline for prevention of kidney dysfunction in neonates with severe asphyxia

Recent studies have suggested theophylline for prevention of kidney dysfunction in asphyxia. This study was designed to determine whether theophylline could prevent or ameliorate kidney dysfunction in term neonates with perinatal asphyxia. We assigned 36 severely asphyxiated term infants [Apgar score

Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia.

OBJECTIVE: To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS: Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS: Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION: C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Post-resuscitation management of asphyxiated neonates.

Inspite of major advances in monitoring technology and knowledge of fetal and perinatal medicine, perinatal asphyxia is one of the significant causes of mortality and long term morbidity. Data from National Neonatal Perinatal Database suggests that perinatal asphyxia contributes to almost 20% of neonatal deaths in India. "Failure to initiate or sustain respiration after birth" has been defined as criteria for the diagnosis of asphyxia by WHO. Perinatal asphyxia results in hypoxic injury to various organs including kidneys, lungs and liver but the most serious effects are seen on the central nervous system. Levene's classification is a useful clinical tool for grading the severity of hypoxic ischemic encephalopathy. Good supportive care is essential in the first 48 hours after asphyxia to prevent ongoing brain injury in the penumbra region. Strict monitoring and prompt correction is needed for common problems including temperature maintenance, blood sugars, blood pressure and oxygenation. Phenobarbitone is the drug of choice for the treatment of convulsions.

Cerebral palsy in Jordan: clinical and neuroimaging characteristics

To evaluate the diagnostic findings of neuroimaging in patients with cerebral palsy and if there is any specific finding correlated to certain types of Cerebral Palsy. Case records of 158 patients diagnosed to have cerebral palsy attending the pediatric neurology and neurodevelopmental clinics at King Hussein Medical Center and King Abdullah University Hospital over 2 years period, 2006 and 2007, were studied retrospectively with reference to their clinical characteristics and their correlation to the neuroimaging [MRI and CT scan] findings. A total of 158 cases with cerebral palsy were included in the study, 84 [53%] males, 74 [47%] females, 41 [26%] preterm and 117 [74%] full- term babies. Spastic cerebral palsy was seen in 112[70.8%] with spastic quadriplegia being the commonest seen in 63[40%]. Hypotonic ataxic type present in 22[14%], dyskinetic 15[9.4%] and mixed cerebral palsy in 9[5.6%]. Abnormal neuroimaging findings were seen on MRI in 125[79%], while in CT scan in 113[71%]. Specific neuroimaging findings were seen suggesting brain asphyxia in 40[25%], congenital brain anomaly in 22[14%], intracranial hemorrhage in 10[6%], vascular and infectious causes in 29[18.5%], unknown/Isolated brain atrophy in 26[16.5%], and periventricular leukomalacia in 31[20%]. The most common single etiology identified was birth asphyxia 40[25%], and the second is periventricular leukomalacia which was identified in 31 patients [20%]. Nonspecific brain atrophy was considered as nonspecific finding, that was found most often in patients with dyskinetic CP 5/15[33%], and in patients with spastic quadriplegia 15/63[24%] as compared to other groups. The principle contribution of imaging is to the understanding of etiology and pathogenesis, including ruling in or out conditions that may have implicated a genetic counseling, such as malformations. MRI is a more sensitive test than CT in detecting brain abnormalities

Auditory evaluation of high risk newborns by automated auditory brain stem response

The objective of this study was to assess the prevalence of hearing impairment by automated auditory brain stem response [AABR] in newborns admitted to an intensive and intermediate care unit and to analyze the associated risk factors. An observational cross-sectional study was conducted between January 2005 and January 2006. 834 newborns [62% boys and 38% girls] were assessed. Newborns had a mean [SD] gestational age of 36 [2.1] weeks with a mean [SD] birth weight of 2950 [1250] grams. The presence of the following neonatal pathologies was investigated: craniofacial malformations, hyperbilirubinemia [total bilirubin 20 mg/dl for all newborns], neonatal asphyxia, congenital infections, septicemia, birth weight [