Factores predominantes de encefalopatía neonatal: hipoxia e isquemia, un problema global / Predominant factors of neonatal encephalopathy: hypoxic and ischemia, a global problem

Si una dificultad sobreviene durante el nacimiento de un niño, por una anomalía materna o fetal, aguda o crónica, la asfixia del cerebro fetal constituye un riesgo mayor, porque ella podría dar como resultado la destrucción de las neuronas y la posibilidad de evolucionar hacia una encefalopatía hipóxico isquémica con secuelas a largo plazo. En esta revisión se resaltan los aspectos científicos más recientes pero a la vez se ofrece un margen de conocimiento imprescindible en cuanto a la patofisiología, diagnóstico y tratamiento, así como también se ofrece una perspectiva sobre el futuro de la atención clínica de la encefalopatía hipóxico isquémica.

If a difficulty arises during birth, due to a maternal or fetal anomaly, acute or chronic, asphyxia of the fetal brain constitutes a greater risk, because it could result in the destruction of neurons and the possibility of evolving towards a Ischemic Hypoxic Encephalopathy with long -term sequelae. This review highlights the most recent scientific aspects but at the same time it offers an essential margin of knowledge regarding pathophysiology, diagnosis and treatment, as well as offering a perspective on the future of clinical care of ischemic hypoxic encephalopathy.

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%).

Clinical hypoxic-ischemic encephalopathy score of the Iberoamerican Society of Neonatology (Siben): A new proposal for diagnosis and management / Escore clínico de encefalopatia hipóxico-isquêmica da Sociedad Iberoamericana de Neonatología (Siben): uma nova proposta para seu diagnóstico e manejo perinatal

Summary Hypoxic ischemic encephalopathy is a major complication of perinatal asphyxia, with high morbidity, mortality and neurologic sequelae as cerebral palsy, mostly in poor or developing countries. The difficulty in the diagnosis and management of newborns in these countries is astonishing, thus resulting in unreliable data on this pathology and bad outcomes regarding mortality and incidence of neurologic sequelae. The objective of this article is to present a new clinical diagnostic score to be started in the delivery room and to guide the therapeutic approach, in order to improve these results.

Resumo A encefalopatia hipóxico-isquêmica é a principal complicação da asfixia perinatal, com alta morbidade, mortalidade e incidência de sequelas neurológicas, como a paralisia cerebral, principalmente em países pobres e/ou em desenvolvimento. Nessas regiões, as dificuldades no diagnóstico e no manejo desses recém-nascidos é surpreendente, o que resulta em dados pouco confiáveis e em péssimos desfechos tanto no que se refere à mortalidade como à incidência de sequelas neurológicas. O objetivo deste artigo é apresentar um novo escore para o diagnóstico clínico ser iniciado na sala de parto e uma abordagem terapêutica com o intuito de melhorar esses resultados.

Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury / Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica

OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn. .

OBJETIVO: testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo. MÉTODOS: estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem. RESULTADOS: dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neurológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convulsões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento. CONCLUSÕES: em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEEGocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN. .

Encefalopatias: etiologia, fisiopatologia e manuseio clínico de algumas das principais formas de apresentação da doença / Encephalopathies: etiology, pathophysiology, and clinical management of some major forms of disease presentation

JUSTIFICATIVA E OBJETIVOS: As encefalopatias compõem um grupo heterogêneo de etiologias, onde a pronta e correta atuação médica direcionada à causa da doença, pode modificar o prognóstico do paciente. O objetivo deste estudo foi rever os aspectos fisiopatológicos das diferentes encefalopatias bem como seus principais fatores desencadeantes e manuseio clínico.CONTEÚDO: Foram selecionadas as mais frequentes encefalopatias observadas na prática clínica e discutir sua fisiopatologia, bem como sua abordagem terapêutica, destacando: encefalopatia hipertensiva, hipóxico-isquêmica, metabólica, Wernicke-Korsakoff, traumática e tóxica.CONCLUSÃO: Trata-se de uma complexa condição clínica que exige rápida identificação e preciso manuseio clínico com o intuito de reduzir sua elevada taxa de morbimortalidade. O atraso no reconhecimento dessa condição clínica poderá ser extremamente prejudicial ao paciente que estará sofrendo lesão cerebral muitas vezes irreversível.

BACKGROUND AND OBJECTIVES: Encephalopathies comprise a heterogeneous group of clinical conditions, in which the prompt and adequate medical intervention can modify patient prognosis. This paper aims to discuss the pathophysiological aspects of different encephalopathies, their etiology, and clinical management.CONTENTS: We selected the main encephalopathies observed in clinical practice, such as hypertensive, hypoxic-ischemic, metabolic, Wernicke-Korsakoff, traumatic, and toxic encephalopathies, and to discuss their therapeutic approaches.CONCLUSION: This is a complex clinical condition that requires rapid identification and accurate clinical management with the aim of reducing its high morbidity and mortality rates. Delay in recognizing this condition can be extremely harmful to the patient who is suffering from often irreversible brain injury.

Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome / Baixos índices de Apgar no quinto minuto de vida em população de baixo risco: fatores maternos e obstétricos e resultados pós-natais

OBJECTIVE: To evaluate the association between Apgar scores of less than seven at five minutes (AS5min < 7) and antenatal factors and postnatal outcomes. METHODS: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS5min < 7 (n = 121; 0.4%) and 363 cases with AS5min > 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. RESULTS: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS5min < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS5min < 7 (p > 0.05). CONCLUSION: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

OBJETIVO: Avaliar a associação entre índice de Apgar menor que sete no 5º minuto, os fatores pré-natais e resultados pós-natais. MÉTODOS: Trata-se de estudo retrospectivo com 27.252 recém-nascidos em maternidade escola com população de baixo risco obstétrico, de janeiro de 2003 a dezembro de 2010. Prontuários de todos os casos com índice de Apgar < 7 no 5º minuto (n = 121; - 0,4%) e de 363 casos com Apgar > 7 no 5º minuto, escolhidos ao acaso, foram revisados. Os principais desfechos estudados foram: óbito neonatal, insuficiência respiratória neonatal, necessidade de intubação orotraqueal e de unidade terapia intensiva (UTI) neonatal e encefalopatia hipóxico-isquêmica. RESULTADOS: Após análise de regressão múltipla, desacelerações tardias (DIP II) (OR: 2,4; IC95%: 1,4-4,1) e período expulsivo prolongado (OR: 3,3; IC 95%: 1,3-8,3) se associaram com Apgar < 7 no 5º minuto; assim como com insuficiência respiratória ao nascimento (OR: 3,0; IC 95%: 1,3-6,9), intubação traqueal (OR: 2,5; IC 95%: 1,2-4,8), necessidade de UTI neonatal (OR: 9,5; IC 95%: 6,7-16,8) e encefalopatia hipóxico-isquêmica (OR: 14,1; IC 95%: 3,6-54,7). Nenhuma outra variável prénatal se associou com Apgar < 7 no 5º minuto (p < 0,05). CONCLUSÃO: DIP II e período expulsivo prolongado estão associados com Apgar < 7 no 5º minuto em população obstétrica de baixo risco; situação essa relacionada com maior risco de insuficiência respiratória no parto, necessidade de suporte ventilatório e encefalopatia hipóxico-isquêmica.

Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome / Valor prognóstico da espectroscopia de prótons em vítimas de quase-afogamento: reversibilidade das anormalidades metabólicas precoces relacionou-se com bom prognóstico

In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy (¹H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) ¹H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early ¹H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome.

Em duas criancas vítimas de quase-afogamento com encefalopatia hipóxico-isquêmica, que apresentaram ressonância magnética por imagem normal, a espectroscopia de prótons por ressonância magnética (¹H MRS) na fase aguda mostrou alterações bioquímicas que corretamente indicaram o prognóstico e ajudaram a guiar o manejo terapêutico. Elevação dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce realizada com 72 horas previu um mau prognóstico. Relacionaram-se com bom prognóstico; a ausência dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce, e a reversibilidade no exame de controle (3 meses) das discretas anormalidades metabólicas encontradas no primeiro exame.

[ threshold assessment of ischemic tolerance induced by normobaric hyperoxia in rat stroke model]

Recent studies suggest that normobaric hyperoxia [HO] results in ischemic tolerance to reduce ischemia brain injury. In this research, attempts were made to assess threshold of ischemic tolerance induced by normobaric hyperoxia in rat stroke model. Rats were divided into two groups and each group into four experimental groups, each containing 21 animals. The first four groups were exposed to 95% inspired Ho for 4h, 8h, 16h, and 24 hr. The second four groups acted as controls, and were exposed to 21% oxygen in the same chamber [room air, RA] continuously for 4h, 8h, 16h, and 24h. All animals were subjected to 60 min right middle cerebral arterial occlusion [MCAO] 24h after pretreatment. After 24h reperfusion, each main group was subdivided to three subgroups [n=7] for assessment of neurologic deficit score [NDS], infarct volume, Evans blue [EB] extravasations, and brain water contents. Preconditioning with 16HO and 24HO decreased NDS and infarct volume significantly. Ischemic tolerance induced by 24 HO decreased EB extravasations significantly. Preconditioning with 4HO, 8HO, 16HO and 24 HO could not decrease brain water content significantly. Although further studies are necessary to clarify the mechanisms of ischemic tolerance, the lowest Ho duration for ischemic tolerance induction is 16h, but appropriate Ho duration for ischemic tolerance induction is 24 HO

Importância clínica da dosagem de lactato e contagem de eritroblastos no sangue colhido no segmento placentário da veia umbilical para o diagnóstico de hipóxia-isquemia em prematuros / Clinical value of lactate measurement and nucleated red blood cell counts in the placental segment of the umbilical vein of premature newborns for diagnosis of hypoxia-ischemia

OBJETIVO: Determinar a validade clínica das dosagens de lactato e contagem de eritroblastos quando comparados com o excesso de bases (EB) em sangue do segmento placentário da veia umbilical de prematuros. MÉTODOS: foram colhidas amostras de 25 prematuros, após ligadura e dequitação. Os prematuros foram seguidos até a alta. Estatística incluiu regressão linear, correlação de Spearman, curvas ROC, Teste de Fisher. RESULTADOS: Lactato mostrou boa correlação com pH e EB (p < 0,0001). Níveis de lactato de 4,04 mmol/L mostraram sensibilidade de 62,5 por cento e especificidade de 91,1 por cento em discriminar pH < 7,2 e EB < -10 mmol/L. Contagens de eritroblastos mostraram boa correlação com o EB (p = 0,0095), mas sensibilidade de 37,5 por cento e especificidade 82,4 por cento em discriminar EB < 10 mmol/L. CONCLUSÕES: Lactato é um marcador válido para hipóxia fetal, em amostras do segmento placentário das veias umbilicais. Contagens de eritroblastos apresentaram baixa sensibilidade na discriminação da acidose.

OBJECTIVE: To evaluate the clinical value of lactate measurement and nucleated red blood cell (NRBC) counts when compared to base excess (BE) in the blood collected from the placental segment of the umbilical vein. METHODS: 25 umbilical cords from premature babies were sampled after placental delivery and cord clamping. Babies were followed until discharge. Statistics involved linear regression, Spearman's correlation, ROC curves, and Fisher's exact test. RESULTS: The relationship between lactate in the umbilical vein blood and pH and BE was significant (p < 0.0001). A 4.04 mmol/L lactate level showed a sensitivity of 62.5 percent and a specificity of 94.1 percent in detecting pH <7.2 and BE < -10 mmol/L. NRBC counts were related to BE (p = 0.0095), but with a sensitivity of 37.5 percent and specificity of 82.4 percent in detecting BE < -10 mmol/L. CONCLUSIONS: Lactate is a valuable marker of fetal hypoxia when sampled from placental segment veins. NRBC counts demonstrated low sensitivity for the detection of acidosis.

The etiology and outcome analysis of neonatal burst suppression EEG / 华中科技大学学报（医学）（英德文版）

The neonatal burst suppression is a severe EEG pattern and always demonstrates serious damage of nerve system. But the outcome of these patients depends on the different etiology. A total of 256 cases of video EEG recordings were analyzed in order to summarize the etiology and outcome of burst suppression. The results showed that some patients in all 17 cases of burst suppression showed EEG improvement. The etiology was the dominant factor in long term outcome. It was suggested that effective video EEG monitoring is helpful for etiologic study and prognosis evaluation.

S100B protein related neonatal hypoxia

A participação de marcadores bioquímicos na avaliação de quadros de asfixia neonatal é cada vez mais relevante. A proteína S100B é de particular importância neste campo. O objetivo deste estudo foi procurar destacar a importância da proteína S100B na avaliação de recém-nascidos a termo com quadro de encefalopatia hipóxico-isquêmica, assim como correlacionar com outras substâncias que também participam do processo isquêmico. Foram analisados 21 casos de recém nascidos a termo que desenvolveram encefalopatia hipóxico-isquêmica no período de setembro de 2003 a outubro de 2004. Realizadas coletas no 1º e 4º dia de vida e dosadas, por método imunocitoquímico, a proteína S100B e o lactato. Observou-se correlação positiva entre as duas substâncias, assim como quando comparadas entre si nas suas respectivas dosagens, obteve-se significância estatística.

Urinary S-100B protein as an early biochemical indicator of hypoxic-ischemic encephalopathy after birth asphyxia in term newborn infants

Measurements of serum and cerebrospinal fluid concentrations of S-100B protein has been used to detect brain distress, and in the perinatal period are correlated with brain maturation and are used to assess cerebral damage after perinatal asphyxia. As S-100B protein is eliminated by the kidneys, and because collecting urine is a simpler procedure than collecting cerebrospinal fluid or blood, especially in high-risk infants in whom anemia attributable to repeated blood sampling is common, we aimed to investigate the relation of urinary S-100B protein to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Routine laboratory variables neurologic patterns, ultrasound imaging, and urine concentrations of S-100B protein were determined at first urination and at 24 hours after birth in 34 infants with perinatal asphyxia and in 25 control subjects. The concentrations of S-100B protein in urine were measured using an immunoluminometric assay. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results were correlated with the degree of HIE, and the presence or absence of neurologic abnormalities at age 12 months. Urinary levels of S-100 protein [micro g/L] were significantly higher in asphyxiated infants with favorable outcome [group I] [0.93 +/- 0.31 at 2 hours, and 1.05 +/- 0.30 at 24 hours] and in asphyxiated infants with adverse outcome [group II] [2.62 +/- 0.92 at 2 hours and 4.78 +/- 2.11 at 24 hours] compared to controls [0.18 +/- 0.04 at 2 hours and 0.24 +/- 0.08 at 24 hours, P=0.001 for all]. Also, these levels were significantly higher in asphyxiated infants with severe HIE than infants with moderate HIE, and those with no or mild HIE, with P <0.001 [at 2 hr] and P <0.003 [at 24 hr]. S-100 levels were negatively correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. For prediction of neonatal outcome measured as severe HIE, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92.3%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97.4%. For prediction, of adverse outcome at 12 months, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97%. The use of S-100B as a pathologic marker in urine offers a tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae, and provide a new perspective for improving the monitoring and care of newborns

Gobierno del parto en el Hospital Padre Hurtado: un modelo para contener la tasa de cesárea y prevenir la encefalopatía hipóxico-isquémica / Management of labor in the Padre Hurtado Hospital: an model for the reduction of the cesarean sections and to prevent the hypoxic ischemic encephalopathy

La tasa de cesáreas en Chile se ubicó entre las más altas del mundo en el año 2000: 39 por ciento a 83 por ciento en la práctica privada y 20 por ciento a 28 por ciento en los hospitales públicos. El objetivo de nuestro estudio es comunicar el impacto que ha tenido en la tasa de cesáreas y el resultado neonatal la aplicación de Guías Clínicas para el manejo del trabajo de parto y monitoreo fetal. Entre el 1 de enero de 1999 y el 31 de diciembre de 2004, la tasa global de cesáreas del período fue de 23,2 por ciento y la tasa de fórceps osciló entre 7,5 y 9,7 por ciento. La incidencia de encefalopatía hipóxico-isquémica (EHI) para el período de estudio fue de 3,5/1.000 nacidos vivos, con una progresiva tendencia a la disminución. Las tasas de cesárea y de EHI son comparables a las reportadas en la literatura internacional. Luego de revisar la literatura, ésta es la primera comunicación nacional sobre el impacto de Guías Clínicas en la atención del parto.

Serum protein S-100 and serum ionized calcium as early prognostic markers for the severity of hypoxic - ischemic encephalopathy after birth asphyxia

This study was performed at Al Ansar Hospital in Jeddah during the period from September 2004 to September 2005. Our objective was to identify whether moderate or severe hypoxic-ischemic encephalopathy [HIE] after birth asphyxia can be predicted by measuring serum protein S-100 or serum ionized calcium concentrations soon after birth. The study included two groups, asphyxia group and control group. The asphyxiated group included 21 full term asphyxiated newborn infants, who were subdivided clinically into: 10 asphyxiated newborns with no HIE, 5 asphyxiated newborns with mild HIE, 3 asphyxiated newborns with moderate HIE, and 3 newborns with severe HIE. The control group included 10 full term healthy normal newborn infants. Neurological examinations were performed during the first 3 days after birth, and Apgar score was estimated at 1 and 5 min after birth. Blood samples were collected from cord blood and 4 h after birth to estimate serum protein S-100, serum ionized calcium, pH, and base deficit. At 4 h after birth, there was a significant increase in serum protein S-100 and a significant decrease in serum ionized calcium in asphyxiated newborns compared with controls, and also a significant difference between asphyxiated newborns with moderate or severe HIE and asphyxiated newborns with no or mild HIE. Both markers had a high positive predictive value and a high specificity, which in case of serum protein S-100 became more higher when combined with serum ionized calcium, cord blood pH, cord blood base deficit, and Apgar score at 1 min. We concluded that serum protein S-100 and serum ionized calcium are early markers for moderate or severe HIE after asphyxia, which help us to initiate and continue or stop the neuroprotective therapy. We concluded also that these markers are of high positive predictive value and of high specificity