The role of myocardial work parameters in early identification of myocardial injury in neonatal asphyxia / 中国新生儿科杂志

Objective:To study the role of myocardial work parameters in early identification of myocardial injury in neonatal asphyxia.Methods:From July 2020 to December 2021, neonates diagnosed with mild neonatal asphyxia admitted to the Department of Neonatology of our hospital within 24 h after birth were prospectively enrolled into the asphyxia group. Neonates without asphyxia during the same period were selected as the control group and matched with the asphyxia group for gender, gestational age and birth weight at a ratio of 1:1~1:2. The asphyxia group was subgrouped into preterm asphyxia group and term asphyxia group. All neonates received echocardiography within 24 h after birth. Multiple parameters were measured including M-mode, two-dimensional image, Doppler image, global longitudinal strain (GLS) and myocardial work parameters [global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)]. The level of serum N-terminal pro brain natriuretic peptide (NT-proBNP) was recorded in the asphyxia group. The data were compared between the asphyxia group and the control group. Correlations between myocardial work parameters and other parameters were analyzed.Results:A total of 33 cases were in the asphyxia group and 43 cases were in the control group. The preterm asphyxia group (18 cases) showed significantly lower GWI and GCW than the preterm control group (18 cases) [GWI: (702±153) mmHg vs. (879±205) mmHg, GCW: (1 016±221) mmHg vs. (1 200±271) mmHg] ( P<0.05). No differences existed in GLS, GWW and GWE. The term asphyxia group (15 cases) showed significantly lower GWW than the term control group (25 cases) [45.0 (30.0, 65.0) mmHg vs. 71.0 (35.5,85.5) mmHg] ( P<0.05). No differences existed in GLS, GWI, GCW and GWE. GWI was negatively correlated with serum NT-proBNP level ( r=-0.327, P<0.05). Conclusions:GWI and GCW may indicate myocardial injury in preterm neonates with mild asphyxia.

Prediction of short term clinical outcomes in low Apgar score neonates using umbilical artery blood gas analysis plus amplitude integrated electroencephalography / 中国新生儿科杂志

Objective:To study the predictive values of umbilical artery blood gas analysis(UABG) plus amplitude-integrated electroencephalography(aEEG) monitoring within 6 h after birth for early complications and short term neurological outcomes in low Apgar score neonates.Methods:From January 2020 to February 2022, neonates with gestational age (GA) ≥35 weeks and 1 min or 5 min Apgar score ≤7 admitted to NICU of our hospital were retrospectively reviewed. According to UABG pH values, the neonates were assigned into pH<7.2 group and pH ≥7.2 group, and further grouped into abnormal aEEG group and normal aEEG group. The ttest, rank sum test and χ2 test were used to compare laboratory results, incidences of diseases, physical growth and neurological prognosis at 6 month of age. Results:A total of 105 neonates with low Apgar scores were enrolled, including 73 cases in the pH<7.2 group and 32 cases in the pH≥7.2 group. In the pH<7.2 group, 52(71.2%) had abnormal aEEG and 21 had normal aEEG. In the pH≥7.2 group, 6(18.8%) had abnormal aEEG and 26 had normal aEEG. The incidence of abnormal aEEG in the pH<7.2 group was higher than the pH≥7.2 group ( P<0.001). The degree of aEEG abnormality was negatively correlated with UABG pH ( r=-0.463, P<0.001). In the pH<7.2 group, the levels of creatine kinase isozymes (CK-MB), activated partial thromboplastin time and the incidence of hypoxic-ischemic encephalopathy (HIE) in neonates with abnormal aEEG were significantly higher than those with normal aEEG, and the head circumference (HC) at 6 month was significantly smaller in neonates with abnormal aEEG (all P<0.05). In the pH≥7.2 group, the level of CK-MB, incidences of HIE and respiratory failure in neonates with abnormal aEEG were higher than those with normal aEEG, HC at 6 month was smaller and the incidence of adverse neurological prognosis was higher in neonates with abnormal aEEG (all P<0.05). Conclusions:UABG plus aEEG monitoring within 6 h after birth shows predictive values for early complications and short term neurological outcomes in low Apgar scores neonates.

Application of PDCA cycle in quality improvement of neonatal resuscitation / 中国新生儿科杂志

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.@*METHODS@#A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.@*RESULTS@#Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.@*CONCLUSIONS@#The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

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.

Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto / Quality care indicators for neonates with selected pathologies: pilot study

Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.

Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.

Clinical application of umbilical artery blood gas analysis / 中国实用妇科与产科杂志

Umbilical arterial blood gas is an important indicator for assessing fetal oxygenation and acid-base metabolism abnormalities. Furthermore, it is an important supplement for diagnosing neonatal asphyxia.We recommend routine umbilical arterial blood gas analysis in high-risk pregnant women with post-partum and intra-partum suspicion of fetal distress. The follow-up and treatment of high-risk infants based on blood gas results can reduce the incidence of neurological dysfunctions such as ischemic hypoxic encephalopathy and long-term cerebral palsy in the near future.

Application of plasma CK-MB ,NT-proBNP and CT-1 in diagnosis of neonatal asphyxia complicating myocardial injury / 国际检验医学杂志

Objective To investigate the application of plasma creatine kinase isoenzyme (CK-MB) ,N-ter-minal pro-brain natriuretic peptide(NT-proBNP)and myocardial nutrient-1(CT-1)in the diagnosis of neonatal asphyxia complicating myocardial injury .Methods Eighty cases of neonatal asphyxia in the hospital from Jan-uary to December 2016 were selected ,including 28 cases in the asphyxia non-myocardial injury group ,32 cases in the mild asphyxia myocardial injury group and 20 cases in the severe asphyxia myocardial injury group .Oth-er 80 healthy neonates were selected as the control group .The levels of plasma CK-MB ,NT-proBNP and CT-1 on 1 ,3 ,5 d after birth were measured by adopting the ELISA method .The relationship between plasma CK-MB ,NT-proBNP and CT-1 levels with prognosis in neonatal asphyxia was analyzed .Then the application value of plasma CK-MB ,NT-proBNP and CT-1 in the prognosis evaluation of neonatal asphyxia complicating myo-cardial injury was analyzed by using the receiver operating characteristic (ROC) curve .Results Plasma NT-proBNP ,CK-MB and CT-1 levels in the control group had no statistically significant difference among 1 ,2 ,3 d after birth (P>0 .05) ,but plasma CK-MB ,NT-proBNP and CT-1 levels on postnatal 3 d in the neonatal as-phyxia group reached the peak value ,plasma CK-MB ,NT-proBNP and CT-1 level on postnatal 1 ,3 d in the se-vere asphyxia myocardial injury group and mild asphyxia myocardial injury group were significantly higher than those in the non-myocardial injury group and control group ,and w hich in the non-myocardial injury group were higher than those in the control group ,the differences were statistically significant (P<0 .05) .Plasma NT-proBNP ,CK-MB and CT-1 levels on postnatal 5 d in the non-myocardial injury group and mild asphyxia myocardial injury group returned to normal levels ,w hile w hich in the severe asphyxia myocardial injury group were still higher than those in the other groups ,the differences were statistically significant (P<0 .05) .The levels of plasma CK-MB ,NT-proBNP and CT-1 in the death neonates with neonatal asphyxia were higher than those in the survival neonates ,and the difference was statistically significant (P<0 .05) .The sensitivity and specificity of combined detection of plasma CK-MB ,NT-proBNP and CT-1 for the prognosis diagnosis in neo-nates with asphyxia complicating myocardial injury were higher than that of single index .Conclusion The early determination of plasma CK-MB ,NT-proBNP and CT-1 levels will be helpful to effectively evaluate the myocardial injury severity and prognosis in asphyxia neonates and has an important clinical value .

Changes and Significances of Serum Cystatin C and Transforming Growth Factor-β1 Levels in the Neonatal Asphyxia / 现代生物医学进展

Objective:To investigate the changes and significances of serum cystatin C and transforming growth factor-β1 levels for the neonatal asphyxia.Methods:Forty-six asphyxia newborns were chosen as the asphyxia group,and thirty healthy newborns were selected as the control group.The TGF-β1,CysC,BUN,Scr,and GFR levels of both groups were detected on the 1st,3rd,7th day after hospitalization.According to the renal injury,the 46 newborns were divided into normal group and asphyxia group,and the serum indexes were detected and analyzed.Results:On the 1st,3rd,7th day after hospitalization,the TGF-β1,GFR of asphyxia group was obviously increased and was lower than those of the control group (P＜0.05);the level of CysC,BUN,Scr in both groups were decreased,and the change degree in asphyxia group were higher than that of the control group (P＜0.05);the CysC,BUN,Scr in renal injured group were higher than those of normal group,and TGF-β1,GFR were much lower (P＜0.05).Additionally,TGF-β1 level of renal injured group was negatively correlated to the BUN and Scr,and positively correlated with the GFR (P＜0.05).The level of serum CysC in renal injured group was positively correlated to BUN and Scr and negatively correlated to GFR (P＜0.05).Conclusion:The serum TGF-β1,CysC in asphyxia newborns had significant changes compared with the healthy newborns and was correlated to the renal injured indexes,which had clinical directive significance on the early diagnosis,condition judgment,and prognosis of neonatal asphyxia with renal injury.

The level of glycogen phosphorylase isoenzyme BB and ischemia modified albumin in newborn with asphyxia and myocardial injury and its clinical significance / 国际检验医学杂志

Objective To explore the clinical significance of early biomarkers in neonatal asphyxia diagnosis with myocardial damage by detection of ischemia modified albumin in neonatal serum(IMA) and glycogen phosphorylase isoenzyme BB(GPBB) for screening sensitive markers with direct myocardial injury.Methods 166 neonates were selected in our hospital as the research object,in which 136 cases with myocardial injury dividend into the experimental group and 30 cases into the control group.The experimental group were divided into mild group and severe group according to the degree of asphyxia.All the children were tested for GPBB and IMA 1 h after admission.Results The levels of GPBB in neonatal asphyxia myocardial injury group and severe asphyxia group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).The sensitivity of GPBB in diagnosis of asphyxia was higher than that of IMA,the difference was statistically significant(P<0.05).Conclusion The degree of asphyxia is closely related to serum IMA,GPBB level in neonatal asphyxia complicated with myocardial injury.The sensitivity and specificity of GPBB in diagnosis asphyxia is better than IMA in children complicated with myocardial damage.

Clinical Outcome Analysis of Twin Pregnancies in Women Over the Age of 40 Years / 中国医科大学学报

Objective To examine perinatal complications and outcomes of twin pregnancies in women aged over 40 years.Methods A retrospective study was performed on the clinical data of 3 127 twin pregnancies,managed in 12 national hospitals from January2013-December 2013,to analyze differences in perinatal complications and outcomes between women aged over 40 years,and those aged 35 to ＜40 years and 18 to ＜35 years.Results For twin pregnancies,the incidence of postpartum hemorrhage,abortion,early preterm birth,termination of gestation,very low birth weight infants,mild neonatal asphyxia,and preterm births in women aged over 0 years was significantly higher than in women aged 35 to ＜40 years and 18 to ＜35 years (P ＜ 0.05).Among women aged over 40 years and those aged 35 to ＜40 years,the incidence of gestational hypertension was not significantly higher than in women aged 18 to ＜35 years for twin pregnancies (P ＞ 0.05).Conclusion Women aged over 40 years with twin pregnancies were more likely to develop maternal complications and poor perinatal outcomes.Therefore,twin pregnancies in women aged over 40 years should receive comprehensive perinatal management to extend the gestation and improve the perinatal prognosis.

Effect of coenzyme Q10 combined with Shenmai injection on serum enzymes after hypoxic injury of neonatal asphyxia induced by meconium / 中国生化药物杂志

Objective To investigate the effect of coenzyme Q10 combined with Shenmai injection on serum enzyme in the treatment of brain hypoxic injury after asphyxia by meconium in newborn.Methods 64 cases with brain hypoxic injury after asphyxia by meconium from Medical University of Tianjin Jinghai Clinical College were selected and randomly divided into 2 groups, 32 cases in each group.The control group received maintained ventilation and circulation function and routine drug therapy adequate, and the experiment group received more with coenzyme Q10 combined with Shenmai injection for 7 days.Serum enzymes and myocardial injury markers, oxidative stress and inflammation related factors and the clinical effect and complications were compared after the treatment.Results Compared with before treatment, levels of CK-MB, AST, LDH, CK and α-HBDH decreased in two groups after the treatment, levels of CT-1, CTnI and Mb decreased, levels of SOD and MDA decreased, contents of GSH-Px, APN, IGF-1 increased, contents of Leptin decreased (P<0.05).Compared with the control group, the levels of CK-MB, AST, LDH, CK and α-HBDH in the experiment group were lower, levels of CT-1, CTnI and Mb were lower, levels of SOD and MDA were lower, contents of GSH-Px, APN, IGF-1 were higher, contents of Leptin were lower(P<0.05).The clinical curative effect rate of control group(65.63%) was lower than the experiment group (87.50%)(P<0.05).Conclusion Coenzyme Q10 combined with Shenmai injection in the treatment of brain hypoxic injury after asphyxia by meconium in newborn is curative effective with high safety, and it can reduce serum enzyme and myocardial injury.

Comparative study of B type brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in ;the auxiliary diagnosis of heart failure after neonatal asphyxia / 中国小儿急救医学

Objective To observe and compare the value of B brain natriuretic peptide( BNP)and N-terminal pro-brain natriuretic peptide( NT-proBNP)in the diagnosis of heart failure after neonatal asphyxia, and to optimize early clinical diagnosis. Methods A retrospective analysis was conducted on 124 neonatal asphyxia cases from January 2013 to October 2015,who were divided into heart failure group(53 cases)and control group(71 cases)according to whether complicated with heart failure. Comparison was conducted on BNP,NT-proBNP,cardiac troponin T( cTnT),creatine kinase isoenzyme( CK-MB)through blood sam-pling from femoral vein puncture within 48 h. And Logistic regression analysis was introduced into explore effecting factors of heart failure,besides,correlations between BNP,NT-proBNP and left ventricular ejection fraction( LVEF)of asphyxia children were calculated,and receiver operating characteristic curve( ROC)was introduced into analyzing of BNP and NT-proBNP for diagnostic efficacy of heart failure after neonatal asphyxia. Results Heart failure group whose BNP[(835. 8 ± 154. 7)pg/ml vs. (235. 4 ± 38. 5)pg/ml], NT-proBNP(25 903. 8 pg/ml vs. 6 974. 5 pg/ml),cTnT[(0. 21 ± 0. 06)ng/ml vs. (0. 11 ± 0. 03)ng/ml], CK-MB[(61. 3 ± 11. 7)U/L vs. (40. 8 ± 9. 5)U/L]were significantly higher than those of control group ( P﹤0. 05). Logistic regression analysis indicated BNP and NT-proBNP were closely related with newborn heart failure(ORBNP =3. 013,P﹤0. 001;ORNT-proBNP =3. 808,P=0. 006). BNP and NT-proBNP were both significantly negatively correlated with LVEF(rBNP = -0. 650,P=0. 007;rNT-proBNP = -0. 721,P﹤0. 001). The ROC curve indicated the diagnostic efficacy of BNP and NT-proBNP for heart failure after neonatal as-phyxia were 0. 868,0. 911,with the highest diagnosis cut-off value were 268. 8 pg/ml,3 972. 3 pg/ml,respec-tively. Conclusion BNP and NT proBNP are specific indicators reflecting heart failure after neonatal as-phyxia,and NT-proBNP with higher auxiliary diagnostic efficacy comparatively.

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.

Encefalopatia hipóxico-isquêmica: aspectos clínicos de gravidade / Hypoxic-ischemic encephalopathy: clinical aspects of severity

Objetivo: Analisar a gravidade da asfixia perinatal e sua evolução baseada na classificação de Sarnat & Sarnat. Métodos: Estudo descritivo observacional, longitudinal, prospectivo, iniciado em maio de 2009 a partir da avaliação de todo recém-nascido com diagnóstico clínico e/ou laboratorial de asfixia, nas unidades de Neonatologia de hospital pediátrico de nível terciário de atenção (Hospital Infantil Albert Sabin/Fortaleza/CE). A classificação de gravidade da asfixia de Sarnat foi correlacionada com as variáveis: idade gestacional, sexo, peso de nascimento, Apgar do quinto minuto, necessidade de cuidados de terapia intensiva, suporte de ventilação mecânica, sinais e sintomas clínicos na primeira semana de vida, presença de convulsões, uso de anticonvulsivantes, presença de mal-epilético e desfecho. Foi aplicada análise estatística simples pelos programas Excel e SPSS v17.0. Aplicação de teste do Quiquadrado nas análises bivariadas. Resultados: Foram analisados 200 neonatos com asfixia perinatal. A amostra contou com 67% de pacientes do sexo masculino, 92% a termo e 64% com peso superior a 2,5 kg. Cerca de 75% tinham registros de reanimação ao nascimento. A crise convulsiva precoce foi a manifestação neurológica mais referida (55%), sobretudo no primeiro dia de vida (70%). A encefalopatia leve foi mais prevalente (45%), seguida pela moderada (41%). As alterações sistêmicas mais registradas foram: infecção sistêmica, acidose metabólica, sangramento, bradicardia e hipoglicemia. A disfagia foi a alteração neurológica mais comum a longo prazo (84%). Conclusão: A classificação neurológica de Sarnat & Sarnat se associa com risco de convulsão, estado de mal convulsivo, hiper-reflexia, hipotonia e necessidade de terapia intensiva.

Analysis the correlation factors of neonatal lenticulostriate vasculopathy / 实用医学杂志

Objective To investigate the correlation factors of neonatal lenticulostriate vasculopathy. Method Four hundred and forty-seven newborns from Guangdong Women and Children Hospital were enrolled in this study. Clinical data of the newborns were obtained . Brain ultrasound studies of lenticulostriate artery were performed on the newborns. The logistic regression was performed for screening the correlation factors of neonatal lenticulostriate vasculopathy (P < 0.05). Results Results of the univariate logistic regression reveal the correlation factors tcontributing to LSV include congenital cytomegalovirus infection、neonatal asphyxia、congenital heart disease (CHD),hypertensive disorder in pregnancy (P < 0.05, respectively). Multivariate logistic regression analysis was performed on these factors. The congenital cytomegalovirus infection, neonatal asphyxia, CHD,hypertensive disorder in pregnancy were significantly associated with LSV (P < 0.05). Conclusion The congenital cytomegalovirus infection,neonatal asphyxia,CHD,hypertensive disorder in pregnancy are the correlation factors of neonatal lenticulostriate vasculopathy. LSV could be a predictive marker for the future development of neuropsychiatric disorders. The brain ultrasound studies of lenticulostriate artery is suggested to be performed on all infants with the correlation factors.

Clinical Observation of Vitamin C with Large Dose Combined with Diphosphate in the Treatment of Myocar-dial Injury after Neonatal Asphyxia / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of vitamin C with large dose combined with diphosphate in the treatment of myocardial injury after neonatal asphyxia and the effects on creatine kinase isoenzyme (CK-MB) level. METH-ODS:Totally 76 children with myocardial injury after neonatal asphyxia were randomly divided into control group and observation group. Control group was given routine treatment,including oxygen inhalation,sedation,cardiotonic,Danshen injection and ener-gy mixture,etc. Based on the treatment of control group,the observation group was added diphosphate 100-150 mg/(kg·d),iv infu-sion,qd;and vitamin C 250 mg/(kg·d)adding into 10%glucose injection 20 ml,iv infusion,qd. 10 d was a course. The clinical ef-ficacy,cardiac troponin T(cTnI),CK-MB level and incidence of adverse reactions before and after treatment were observed. RE-SULTS:The total effective rate in observation group was significantly higher than control group,with significant difference(P<0.05). After treatment,the cTnI and CK-MB level in 2 groups were significantly lower than before,and observation group was low-er than control group,with significant differences (P<0.05). There were no adverse reactions in 2 groups during the treatment. CONCLUSIONS:Based on the routine treatment,Vitamin C with large dose combined with diphosphate has good efficacy in the treatment of myocardial injury after neonatal asphyxia and can effectively reduce the CK-MB level,with good safety.

A study on the effects of four major neonatal diseases on thyroid function / 中国新生儿科杂志

Objective To study the effects of preterm birth, infection, pathological jaundice and asphyxia on neonatal thyroid function. Methods From April 2012 to April 2014,neonates within 7 days after birth admitted to the neonatal department of our hospital were recruited. The neonates with one or more of the 4 aforementioned conditions were assigned to the observation group; the full-term newborns without any diseases to the control group. 2 ml of venous blood from each patient was collected 5-7 days after birth to determine the levels of serum free iodine thyroid original glycine ( FT3 ) , free thyroxine ( FT4 ) and thyroid stimulating hormone ( TSH ) . The thyroid function of newborns in the observation group were re-examined after recovery, and compared among different groups and conditions. Results A total of 220 newborns were recruited in the observation group and 34 in the control group. FT3 in the observation group was significantly lower than the control group ( P＜0. 05 ) . As for FT4 and TSH, no statistically significant differences existed between the two groups ( p＞0. 05 ) . FT3 and FT4 in neonates with severe infection were significantly lower than mild infection ( P＜0. 05 ) . FT3 in the preterm group with gestational age ( GA ) ≤32 weeks was significantly lower than GA＞32 weeks, and FT3 in the jaundice group, serum bilirubin level ≥ 342 mol/L group significantly lower than ＜342 mol/L group (P＜0. 05) . In the observation group, the re-examined FT3 concentration was significantly higher (P＜0. 05) than the result tested 5-7 days after birth while FT4 and TSH didn′t show significant differences. And no significant differences existed between the observation group and the control group in re-examined thyroid functions ( P＞0. 05 ) . The multivariate analysis showed that GA, pathological jaundice, infection and asphyxia were associated with FT3 concentration 5-7 days after birth (P＜0. 05), while the delivery method and gender not (P＞0. 05). Conclusions The main effect of preterm birth, infection, pathological jaundice and asphyxia on thyroid function was to decrease FT3 temporarily. Severe infection might decrease FT4 temporarily. However, the thyroid function would return to normal with recovery.

The value of amplitude integrated electroencephalographic monitoring in early neonatal brain injury and prediction prognosis of asphyxia neonatal / 中国小儿急救医学

Objective To discuss the value of amplitude integrated electroencephalographic(aEEG) monitoring in early neonatal brain injury and prognosis of asphyxia neonatal.Methods Seventy-two subjects of asphyxia children were divided into mild asphyxia group and severe asphyxia group.We selected 45 cases of full-term healthy children born in our hospital as control group in the same term.All the objects were observed by aEEG monitoring within 6 hours.According to the aEEG results,all the samples were redivided into normal aEEG group,mildly abnormal aEEG group and severely abnormal aEEG group.All subjects were followed-up to observe their physical growth and the nervous system development at one-year-old.Results Incidence of abnormal aEEG in mild asphyxia group and severe asphyxia group was significantly higher than that of control group(x2 =26.996,47.07,P ＜ 0.01,respectively),and incidence of abnormal aEEG in severe asphyxia group was significantly higher than that of mild asphyxia group (x2 =7.76,P ＜ 0.05).There was no significant difference in all subjects about physical development (height and weight) (P ＞ 0.05),all of their mental index and developmental quotient were lower in severely abnormal aEEG group (x2 =13.450,15.285,P ＜ 0.01,respectively).Conclusion aEEG can be used to assess the early neonatal brain injury of asphyxia neonatal,and it can be used to predict the prognosis of neonatal asphyxia based on the abnormal degree of aEEG.

Correlation analysis of risk factors for persistant pulmonary hypertension after resuscitation in neonatal asphyxia / 中华实用儿科临床杂志

Objective To analyze of the risk factors for persistent pulmonary hypertension of newborn(PPHN) after resuscitation in neonatal asphyxia.Methods Total 92 cases of PPHN in neonatal asphyxia were admitted in NICU,Beijing Children's Hospital Affiliated to Capital Medical University from Jan.2009 to Dec.2013 as PPHN group.According to patients condition,to case-control study method were randomly selected 92 cases without PPHN in neonatal asphyxia in the same period as control group.Except for other serious complications with PPHN,such as respiratory distress syndrome,meconium inhalation,pulmonary hemorrhage,neonatal severe pulmonary infection and diaphragmatic hernia.Apgar score and rescue measures after asphyxia based on the newborn perinatal questionnaire and body temperature,blood sugar,arterial blood gas and echocardiography on admission were recorded.Results Respiratory treatment of PPHN group and control group were 71 cases (77.2％) vs 28 cases (30.4％),respectively.There was significant difference (x2 =6.380,P =0.012).On admission,mean arterial pressure [(32.36 ± 11.52) mmHg],temperature [(34.3 ±0.28) ℃],blood sugar [(2.56 ±0.77) mmol/L] and arterial blood pH value (7.16 ±0.21) in PPHN group were lower than those of the control group [(38.55 ± 9.18) mmHg,(36.5 ± 0.71) ℃,(3.46 ± 0.53) mmol/L,7.21 ±0.14].For mild and severe asphyxia cases in the PPHN group,blood gas and pulmonary hypertension had no statistical difference after rescucitation in the delivery hospital.Conclusions Acidosis,hypothermia,low blood pressure and hypoglycaemia after resuscitation in neonatal asphyxia are major risk factors for genesis of PPHN.This research shows that rescue after asphyxia timely,early and respiratory support effectively,monitoring closely,treatment of hypoglycemia and hypothermia,correct acidosis and maintain blood pressure can play a positive role in decreasing the morbidity of PPHN in neonatal asphyxia.