Prediction of hypoxic-ischemic brain damage in full-term neonates with acute encephalopathy, using two different brain proteins electroencephalogram and magnetic resonance imaging

The Objective of this study was to compare the usefulness of serum levels of two different brain proteins; Neuron specific enolase [NSE] and Creatinine brain specific kinase [CK-BB], electroencephalography [EEG], Conventional MRI imaging and diffusion-weighted MR imaging [DWMRI] for the early diagnosis of ischemic brain injury and prediction of hypoxic brain damage. The study was performed at Tanta University Hospitals, Neonatology Unit. The study design was a cross sectional one. A total of 30 term newborns, 20 with neonatal encephalopathy and 10 normal cases were included in the study. Clinical evaluation of neonatal condition and neurological outcomes was done. Serum estimation of NSE, CK-BB was done at 0, 12 and 24 hours after admission. Electroencephalography [EEG] was done at a median date of 1.17 days. Magnetic resonance imaging [MRI] both conventional and diffusion weighted were also done. EEG and MRI were done for the study group cases. The results showed that the Apgar score at 2 minutes has highest specificity with a good negative predictive value of severe brain injury. Arterial blood base deficit have the highest sensitivity and highest negative predictive values. The highest significance was evident at 12 hours values of both NSE and CK-BB. A combination of NSE at 12 h with arterial blood pH [cutoff value, <6.9] or arterial blood base deficit [cutoff value, >17 mM/L] increased the positive predictive value and specificity. Bad outcomes as severe degree or death are usually associated with the moderate to severe findings of both MRI and background trace of EEG. Bad outcomes as severe degree or death are usually associated with severe findings of both diffusion weighted MRI and background trace of EEG. The early EEG changes distinguish between those infants with a normal or abnormal outcome. MRI gives more specific information about the type of brain lesion. The 12 hour values of NSE and CK-BB have a good predictive power either alone or combined with other clinical tests or investigations. Combined biochemical testing and EEG may give very good indicators about neonatal outcomes. This early determination is becoming increasingly important with the advent of hypothermia and other potential neuroprotective therapies for the treatment of HI brain injury in the asphyxiated newborn

Plasma adrenomedullin and brain natriuretic peptide in children with chronic congestive heart failure

The goal of this study is to delineate the role of adrenomedullin [ADM] and brain natriuretic peptide in the pathophysiology of chronic heart failure [CHF] and the potential use of their circulating levels for diagnosis and treatment of heart failure. Fifty children [19 males and 31 females] with chronic congestive heart failure [CHF] were enrolled in this study. Plasma ADM and BNP levels were assayed by radioimmunoassay and ELISA respectively. Enrolled children were classified into four classes according to New York association functional class [NYHA]. Their age ranged between one year to fifteen years. Twenty-one children [8 males and 13 females] with age ranging from 3-13 years served as control group. The results showed that the plasma concentrations of adrenomedullin [ADM] in pg/ml increased progressively with advancing class of heart failure by NYHA; 3.45 +/- 0.59 for class I, 5.32 +/- 0.95 for class II, 7.29 +/- 1.18 for class III and 14.65 +/- 2.06 for class IV, that were significantly higher than in controls [1.97 +/- 0.46, P<0.001]. Also, plasma BNP concentrations in ng/l were 42.56 +/- 4.14, 129.4 +/- 18.85, 569.05 +/- 37.76 and 1039 +/- 359.57 respectively in children of NYHA class I, II, III and IV, that were higher than in controls [9.21 +/- 1.433, P<0.001]. there was a significant positive correlation, between ADM and BNP in relation to severity of heart failure. ADM and BNP concentrations were significantly reduced after treatment. Adrenomedullin and natriuetic peptide appears to participate actively in the pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new therapeutic channel for children with heart failure to prevent progression to chronicity and to those with already chronic heart failure through uses of ADM and BNP agonist specific for their receptors

Evaluation of endothelin-1 and Von Willebrand factor as biomarkers of pulmonary hypertension in children with congenital heart disease

This study was done to delineate the role of endothelin-1 [ET-1] and von willebrand factor [vWF] in the pathophysiology of pulmonary hypertension [PHT] secondary to congenital heart disease. Forty-three children [29 males, 14 females] with cyanotic and acyanotic congenital heart diseases were enrolled in this study. Their age ranged between 4 months 5.10 year. Plasma ET-1 levels and vWF:Ag activity were assayed by enzyme linked immunosorbent assay. Enrolled children were divided into three groups according to pulmonary artery pressure [PAP]. Group 1 with normal PAP [/= 50mmHg] [n=14]. Twelve perfectly matched healthy children were enrolled as a control group. The results of the present study showed that plasma ET-1 levels in group I were significantly higher than that in control group [P<0.001], on the other hand no significant differences were noted in vWF: Ag% in both groups. Plasma endothelin-1 and vWF:Ag were significantly elevatd in all groups with PHT Vs controls [P<0.001 and P<0.001]. Plasma endothelin-1 and vWF: Ag% were significantly elevated in group III Vs both group II and I [P<0.001]. plasma endothelin-1 and vWF:Ag% were significantly elevated in group II Vs group I [P<0.001 and P<0.001]. Plasma ET-1 levels and vWF:Ag% positively correlated with pulmonary artery pressure in group II and III [P<0.001 and P0.001]. Elevated ET-1 and vWF may contribute directly to development of pulmonary hypertension in children with congenital heart diseases. ET-1 and vWF estimation could be used as non-invasive early markers of pulmonary hypertension in such children, particularly in post-operative evaluation. Our data are in keeping with evidence of significant coagulation abnormalities in pulmonary hypertension and the need for chronic anticoagulant therapy may increase survival in children with pH. These facts opened the door for exploring therapeutic anti-ET-1 and anti- vWF agents in the treatment of pulmonary hypertension in children