[Neonatal asphyxia--prognosis based on clinical findings during delivery and the first day of life. A retrospective study of 54 newborn infants with asphyxia]. / Neonatal asfyksi--prognose ud fra kliniske fund under fødselsforløb samt første levedøgn. En retrospektiv undersøgelse af 54 asfyktiske nyfødte.

A retrospective study of a cohort of 54 term infants with perinatal asphyxia admitted to the neonatal intensive care unit at Hvidovre University Hospital i 1995 is described. The purpose of the study was to find clinical markers for prediction of outcome after perinatal asphyxia. Neither complications of pregnancy, gestational age, the sex of the infant, passage of meconium before delivery, abnormal fetal heart rate nor birth weight seemed to have any interrelationship with outcome. The Apgar score was more depressed, and the metabolic acidosis worse among the infants with poor outcome. The best predictor of outcome after intrapartum asphyxia was the severity of postasphyxial encephalopathy. No infant with mild or moderate postasphyxial encephalopathy died or developed any handicap. All with severe postasphyxial encephalopathy either died or developed minor handicaps.

Role of cytokines in the mechanism of action of amlodipine: the PRAISE Heart Failure Trial. Prospective Randomized Amlodipine Survival Evaluation.

OBJECTIVES: We sought to determine whether the beneficial effects of amlodipine in heart failure may be mediated by a reduction in tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels. We postulated that TNF-alpha and IL-6 levels may also have predictive value in patients with congestive heart failure (CHF). BACKGROUND: The molecular mechanism for progression of CHF may involve cytokine overexpression. The effect of amlodipine on cytokine levels in patients with CHF is unknown. METHODS: In the Prospective Randomized Amlodipine Survival Evaluation (PRAISE) trial, we used enzyme-linked immunosorbent assay to measure plasma levels of TNF-alpha in 92 patients and IL-6 in 62 patients in New York Heart Association functional classes III and IV randomized to receive amlodipine (10 mg/day) or placebo. Blood samples were obtained for cytokine measurement at baseline and at 8 and 26 weeks after enrollment. RESULTS: The baseline amlodipine and placebo groups did not differ in demographics and cytokine levels. Mean (+/- SD) plasma levels of TNF-alpha were 5.69 +/- 0.32 pg/ml, and those of IL-6 were 9.23 +/- 1.26 pg/ml at baseline. These levels were elevated 6 and 10 times, respectively, compared with those of normal subjects (p < 0.001). Levels of TNF-alpha did not change significantly over the 26-week period (p = 0.69). However, IL-6 levels were significantly lower at 26 weeks in patients treated with amlodipine versus placebo (p = 0.007 by the Wilcoxon signed-rank test). An adverse event-CHF or death-occurred more commonly in patients with higher IL-6 levels. CONCLUSIONS: Amlodipine lowers plasma IL-6 levels in patients with CHF. The beneficial effect of amlodipine in CHF may be due to a reduction of cytokines such as IL-6.