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PubMed2001

[Analysis of early feeding and gastrointestinal dysfunction in neonates with asphyxia].

OBJECTIVE: This article was to investigate the effect of early initiation of enteral feeding in neonates with perinatal asphyxia on gastrointestinal function. METHODS: Eighty-four cases of enteral feeding of neonates with asphyxia were analysed. RESULTS: The common dysfunctions were vomiting and abdominal distension, gastric bleeding as well; the percentages of gastrointestinal dysfunction in the early four days were 65.2%, 24.1%, 8.9%, 1.12% respectively and presented a decreasing tendency following the increasing days after birth; The percentage of gastrointestinal dysfunction on the first day was the highest in the early three days (P < 0.05) and not only dextrose but also dilute milk resulted in the dysfunctions. Fasting caused the lower percentage of the dysfunction(2.15%, P < 0.05), but dextrose and dilute milk had no significant difference(P > 0.05). CONCLUSION: It's not optimal for neonates with asphyxia to initial early enteral feeding, especially in the early three days; it's optimal for the neonates with asphyxia not to be fed on the first day.

Asphyxia Neonatorum↗
PubMed2002

[Effect of folium ginkgo extract on the erythrocyte immunity function and serum lipid peroxide in asphyxia neonate].

OBJECTIVE: To observe the changes of erythrocyte immunity and serum lipid peroxide in asphyxia neonate, and to study the effect of Folium Ginkgo extract (FGE) on them. METHODS: Thirty asphyxia neonates were randomly divided into 2 groups, the treated group and the control group, 15 in each group. Erythrocyte C3b receptor rosette rate (E-C3bRR), erythrocyte immune complex rosette rate (E-ICR), blood superoxide dismutase (SOD) activity and serum lipid peroxide (LPO) level were determined at 24 hrs after birth. Conventional treatment was given to both groups and FGE (15 mg/kg.d) was given to the treated group additionally for 7-8 days, then the above-mentioned parameters were re-examined and neonatal behavioral neurological assessment (NBNA) was measured as well. RESULTS: E-C3bRR and SOD lowered, E-ICR and serum LPO increased in the asphyxia neonate significantly (P < 0.05). After treatment, comparison between the two groups showed that E-C3bRR and SOD were higher, E-ICR and serum LPO were lower in the treated group than those in the control group, and NBNA scoring was obviously higher in the former than that in the latter (all P < 0.05). CONCLUSION: Decrease of erythrocyte immunity in asphyxia neonate is related to the declined anti-oxidation ability and lipid peroxidase injury. FGE could suppress the free radical production, scavenge free radicals, antagonize the lipid peroxidation injury of cell membrane and up-regulate erythrocyte immunity. It displays the effects of nerve tissue protection and hypoxia-ischemic brain injury alleviation.

Asphyxia Neonatorum↗
PubMed2003

[Newborn asphyxia at term during delivery].

UNLABELLED: Recruitment, work load and morbidity linked to newborn asphyxia during delivery at term: a study from Pediatric Mobile Intensive Care Units. OBJECTIVE: In a population of term neonates transported by the mobile intensive care units (MICU), we aimed to determine the incidence of neonates with anoxic-ischemic encephalopathy related to asphyxia, to analyze in this population the difficulties of management, and to try to identify which of these newborns require new therapeutic strategies. METHODS: This retrospective study was performed over a 2-year period (2000 and 2001) in 3 paediatric MICU from the Ile de France area. During this period, 7,648 infants were transported including 3,301 newborns of more than 36 weeks of gestational age and less than 72 hours of life. These neonates came from 73 different hospitals. Among these 3,301 infants, 237 neonates (124 boys and 113 girls) with anoxic-ischemic encephalopathy related to asphyxia were selected in the present study. Inclusion criteria were association of one obligatory criterion of fetal distress during delivery and at least one criterion of neonatal asphyxia or one criterion of anoxic-ischemic encephalopathy. Data were compiled and analyzed with Epidata package and Epi info package, respectively. RESULTS: These 237 neonates with anoxic-ischemic represented 12% of MICU activity at the same gestational and postnatal ages. The mean gestational age was 39.5 + 1.5 weeks. The mean birth weight was 3,188 + 559 g. More than 50% of these neonates were born in level I maternities. Fifty-three percent of the infants were born by caesarean section. Eighty-three percent of the neonates had an Apgar score at 1 minute <3. Eighty-eight percent of the neonates received resuscitation care at 5 minutes of life and 34% of these had an Apgar score at 10 minutes <5. In 50% of the cases, the MICUs arrived at the maternity of delivery within 1 h 45 min of life and transportation of the neonates was completed after 3 hours of life. The neonates were transported to an intensive care unit in 88% of the cases (half to a polyvalent intensive care unit and half to a neonatal intensive care unit). Forty-four percent of transported neonates had no encephalopathy, 30% had a severe encephalopathy or seizures, 27% had multiple organ failure. Mortality reached 28% and encephalopathy accounted for two thirds of these deaths. Neonates who arrived in pediatric care units after 3 hours of life had more severe morbidity than neonates who arrived before 3 hours of life. CONCLUSION: Pediatric MICUs transport the most severely affected neonates. The initial clinical state is critical, and systemic and neurological complications are frequent and severe. Calls to the MICU should be made earlier in order to enable a better impact of new neuroprotective strategies.

Apgar Score↗
PubMed2003

Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?

OBJECTIVE: The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia. DESIGN: A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12-month period (13 March 2000 to 12 March 2001). SETTING: A local teaching hospital. SAMPLE: Six hundred and seventy deliveries. METHODS: A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery. MAIN OUTCOME MEASURES: Birth trauma and birth asphyxia. RESULTS: There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11-0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88-1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82-0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period. CONCLUSIONS: Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period.

Asphyxia Neonatorum↗
PubMed1992

[Changes in the parameters of respiratory mechanics after the aspiration reflex and asphyxia].

Parameters of respiration mechanics (dynamic compliance--Cdyn and total lung resistance--RL), ventilation, blood gases, and right-to-left pulmonary shunts were studied after aspiration reflex in experiments on 29 anesthetized cats. Attacks of aspiration reflex were induced without asphyxia (8 cats) and during two-minute asphyxia (9 cats). The control group consisted of 12 animals. A series of aspiration reflex attacks resulted in short-term improvement of the parameters of respiration mechanics with an increase in Cdyn and reduction of RL. A simultaneous elevation of PaO2 and a decrease of PaCO2 were recorded. In combination with asphyxia (hypoxemia and hyperkapnia), the aspiration reflex induced a reversed reaction, i.e. decreased Cdyn lasting till the end of experiment (3 hours) and an increase of functional alveolar right-to-left shunts. The results indicate that in cats impairment of respiration mechanics parameters is brought on only when deep inspiration is combined with asphyxia.

Airway Resistance↗
PubMed1992

Effect of thyroxine administration on renal functions in newborn infants with perinatal asphyxia.

The study was undertaken to assess the influence of thyroxine given to improve respiratory adaptation in asphyxiated neonates on the recovery of compromised renal functions. Two groups of infants with perinatal asphyxia were selected for the study. Group I consisted of 8 infants treated conventionally, while Group II included 7 infants who in addition to standard therapy were administered 50 micrograms thyroxine at admission and repeated 24 hours later. Their respective mean gestational ages were 38.7 weeks (range: 34-42 weeks) and 37.4 weeks (range: 34-41 weeks). The studies were performed on days 1, 7 and 14 and the results compared to those obtained in 13 healthy neonates with the gestational age of 39.2 weeks (range: 38-41 weeks) (Group III). Asphyxiated neonates had significantly higher plasma uric acid, xanthine, hypoxanthine and creatinine levels (p < 0.05), while their GFR proved to be markedly reduced (p < 0.01) when compared to the values of healthy controls. Moreover, there was a significant elevation of urinary excretion of NAGA (p < 0.001), urine osmolality (p < 0.05), PENa, FECa, RFI (p < 0.05) in infants presenting with perinatal asphyxia. Renal tubular responsiveness to aldosterone measured as TTKG was also found to be depressed (p < 0.025). In response to thyroxine therapy renal functional recovery appeared to be accelerated as indicated by the lower plasma creatinine level, lower rate of fractional electrolyte and urinary NAGA excretion and improved reactivity to aldosterone on days 7 and/or 14 as compared to those obtained in neonates presenting with asphyxia but without thyroxine therapy. The results seem to suggest that thyroid hormones may have an important role in the recovery of renal functions in newborn infants suffering from perinatal asphyxia.

Asphyxia Neonatorum↗
PubMed2004

Characterization of heart rate variability changes following asphyxia in rats.

OBJECTIVES: A non-invasive method to monitor the functioning of the autonomous nervous system consists in heart rate variability (HRV) analysis. The aim of this study was to investigate the changes on HRV after an asphyxia experiment in rats, using several linear (time and frequency domain) and nonlinear parameters (approximate entropy, SD1 and SD2 indices derived from Poincare plots). METHODS: The experiments involved the study of HRV changes after cardiac arrest (CA) resulting from 5 min of hypoxia and asphyxia, followed by manual resuscitation and return of spontaneous circulation. 5 min stationary periods of RR intervals were selected for further analysis from 5 rats in following distinct situations: 1) baseline, 2) 30 min after CA, 3) 60 min after CA, 4) 90 min after CA, 5) 120 min after CA, 6) 150 min after CA. The ANS contribution has been delineated based on time and frequency domain analysis. RESULTS AND CONCLUSIONS: The results indicate that the recovery process following the asphyxia cardiac arrest reflects the impaired functioning of the autonomic nervous system. Both linear and nonlinear parameters track the different phases of the experiment, with an increased sensitivity displayed by the approximate entropy (ApEn). After 150 min the ApEn RRI parameter recovers to its baseline value. The results forward the ApEn as a more sensitive parameter of the recovery process following the asphyxia.

Animals↗
PubMed1978

Transverse diameter of chest and heart after birth asphyxia in the newborn infant.

The transverse diameter of the chest and heart was measured in 745 newborn infants after birth asphyxia. Both diameters showed a good correlation with birth weight. The great individual variations of the measurements were due to different degrees of birth asphyxia observed in the infants and to their different responses to compensate asphyxia. A wet lung and an increased transverse diameter of the chest (above the 90th percentile) indicate a good, and a decreased transverse diameter of the chest (bellow the 10th percentile) indicate a bad prognosis for survival. The cardiomegaly usually disappears after the first 12 hours of life, but in some cases it persists for more than 5 days, depending on the severity of birth asphyxia.

Asphyxia Neonatorum↗
PubMedDate not supplied

Traumatic asphyxia during stadium stampede.

OBJECTIVES: To present a series of cases of survivors and non-survivors of traumatic asphyxia from a single mass casualty incident in Zimbabwe and a review of the literature. DESIGN: Descriptive case review. SETTING: Parirenyatwa Hospital is a tertiary referral 1 000 bed teaching hospital in Zimbabwe. RESULTS: Survivors (n = 4) displayed the classic signs of traumatic asphyxia of conjunctival haemmorhages, petechial blue-purple discoloration of head and neck and neurological findings of confusion or unconsciousness and convulsions. Non-survivors (n = 12) showed more varied signs but all showed petechiae and with a history of being crushed. On-site resuscitation and triage was absent, reducing the chance of identifying potential survivors at the scene. CONCLUSION: The outcome in traumatic asphyxia is improved by rapid restoration of ventilation and circulation. The epidemiology of traumatic asphyxia in Zimbabwe is unknown but the conditions predisposing to it are present. Closer integration between hospital and pre-hospital services will permit better management of major trauma patients and mass casualty events.

Adolescent↗
PubMedDate not supplied

Outcome of newborns with birth asphyxia.

Birth asphyxia is one of the common causes of mortality and morbidity in neonates and the incidence is 2-9 per 1,000 live borns. The present work is a retrospective hospital based observational study. Babies born at B.P. Koirala Institute of Health Sciences, Dharan, Nepal during the period from April 2002 to April 2003 with gestational age >or=37 weeks with Apgar score <or=6 at 5 minutes were included in the study. The aim was to study the clinical profile, the acid base parameters and the outcome of asphyxiated newborns. Babies with congenital defects, evidence of infection and maternal drug addiction were excluded from the study. All babies were resuscitated according to the guidelines of American Heart Association. Data on 50 birth asphyxia cases were tabulated and analysed. There were 10 (20%) cases of severe birth asphyxia (Apgar score: 1-3 ) and 40 (80%) cases of moderate birth asphyxia (Apgar score: 4-6). Staging of hypoxic ischaemic encephalopathy (HIE) was performed according to Sarnat's staging. Thirty percent of these cases presented with various stages of HIE and the incidence was higher in low Apgar score group. The common presentations of HIE cases had depressed neonatal reflexes, seizures, lethargy, and pupillary abnormalities. The common acid base disturbance was metabolic acidosis which was observed only in babies with HIE-3. Two neonates (4%) died during the hospital stay due to multiorgan failure and severe metabolic acidosis.

Acidosis↗
PubMed1991

Perspectives on perinatal asphyxia: pathophysiology, presentation, and prognosis.

Perinatal asphyxia is a common and potentially serious problem in the management of labor and delivery. Severe perinatal asphyxia can cause significant short- and long-term sequelae. While the pathophysiology and sequelae of perinatal asphyxia in animals is understood fairly well, asphyxiation cannot be reliably prevented or effectively treated once it occurs in the newborn human. However, with a better understanding of what perinatal asphyxia is and its expected clinical symptoms and outcomes, perinatal nurses can better care for asphyxiated infants.

Apgar Score↗
PubMed1990

ECG changes in asphyxia neonatorum.

Twenty five asphyxiated neonates had ECG changes consistent with degree of asphyxia. Equivocal changes were found in mild asphyxia and changes suggestive of myocardial infarction were seen with severe asphyxia. In most cases, the changes reverted to normal within two weeks signifying great ability of the neonatal heart to withstand hypoxic insult. Four babies with severe asphyxia having ECG changes suggestive of acute myocardial infarction expired within 48 hours of birth.

Asphyxia Neonatorum↗
PubMed1990

[Plasma concentration of atrial natriuretic peptide, vasopressin and aldosterone in the umbilical cord blood: its relation to perinatal asphyxia].

Aldosterone, vasopressin (AVP) and atrial natriuretic factor (ANF) plasmatic concentrations were determined in cord arterial blood from 42 newborns to term: 29 healthful and 13 with perinatal asphyxia. Control group showed plasmatic levels (pg/dl) AVP, aldosterone and ANF significantly lower than perinatal asphyxia newborns group (AVP: 2.27 +/- 1.43 vs 4.26 +/- 2.86; aldosterone: 1.113 +/- 384.79 vs 1,540.38 +/- 595.96; ANF: 2.27 +/- 1.43 vs 4.26 +/- 2.86, respectively (p less than 0.05). We found an inverse correlation between umbilical arterial pH vs AVP, aldosterone and AFN, and a direct correlation between ANF vs aldosterone. Perinatal asphyxia induces secretion of the three studied hormonal factors, likely as a physiologic mechanism of fetal adaptation to hydroelectrolytic and hemodynamic changes which occur during the asphyxia.

Aldosterone↗
PubMed1989

Effect of asphyxia on respiratory activity in fetal sheep.

Hypoxia in fetal sheep depresses respiratory activity. To determine if this effect is counterbalanced by hypercarbia we studied the effects of two levels of asphyxia produced by occlusions of the maternal uterine artery. Moderate asphyxia (PaO2 16.8 +/- 1.6 (SEM) PaCO2 48.9 +/- 1.0 torr) produced no changes in the percent time fetal breathing movements occupied each hour which ranged from 25.6 +/- 7.0 to 32.4 +/- 6.2%. However, a more marked asphyxia (PaO2 12.0 +/- 0.3, PaO2 57.0 +/- 1.6) resulted in a decrease in fetal respiratory activity to 8.7 +/- 3.7% during the first hour. This depression was sustained over the next 2 h but by the 5th hour breathing had returned to 26.2 +/- 7.3%. We concluded that hypercarbia can offset the respiratory inhibition of acute moderate hypoxia, but not that of a more marked lowering of PaO2 in fetal sheep. Severe asphyxia causes an initial inhibition of respiration which is followed by a return to normal respiratory activity.

Analysis of Variance↗
PubMed1988

Birth asphyxia: does the Apgar score have diagnostic value?

The current literature was reviewed to evaluate the Apgar score as a diagnostic test for the presence of asphyxia. Several studies were examined and the sensitivity, specificity, and predictive values of the Apgar scores calculated. Using an umbilical cord arterial pH below 7.2 as evidence of asphyxia, the one-minute Apgar score showed poor sensitivity as a marker of asphyxia. Therefore, we discourage reference to the term "asphyxia" when Apgar scores alone are used as supportive evidence.

Apgar Score↗
PubMed1987

Effects of asphyxia on telencephalic microvessels of premature beagle pups.

The authors identified alterations in the brain microvasculature of the premature Beagle pup that could be attributed to asphyxia and potentially associated with the etiology of intraventricular hemorrhage (IVH). Beagle pups were delivered by cesarean section six days before their predicted whelping date and exposed to an alternating protocol of asphyxial episodes known to produce IVH. Data from the telencephalic microvasculature at both the germinal matrix (an area susceptible to IVH) and the borderzone cerebral cortex (an area rarely involved in hemorrhage) were analyzed. The germinal matrix microvessels responded differently to asphyxia than the cortical vessels. The germinal matrix microvessels maintained junctional complexes and intraluminal microvilli, and increased in cross-sectional luminal area following asphyxia; however, total vessel cross-sectional area did not change. After the asphyxial insult, cortical microvessels no longer exhibited intraluminal microvilli and increased in both total cross-sectional area and luminal area. The number of junctional complexes in cross-sections of cortical vessels was significantly reduced due at least in part to the narrowing of the endothelial cell lateral borders. The data provide indirect evidence to substantiate vasodilation speculated to be due to an increased cerebral blood flow to telencephalic vessels (both the germinal matrix and cerebral cortex) following asphyxia. The data also suggest differential rates of maturation between germinal matrix and cortical microvessels.

Animals↗
PubMed1979

Regional cerebral blood flow changes during severe fetal asphyxia produced by slow partial umbilical cord compression.

We studied the effects of severe partial asphyxia on regional cerebral blood flow and arterial blood pressure in the unanesthetized, physiologically stable fetal lamb. Cerebral blood flow was measured by the microsphere technique before and during partial umbilical cord compression. Asphyxia sufficient to decrease pH from 7.40 to 7.04 and reduce oxygen saturation from 50% to 19% increased cerebral blood flow to all areas of the brain with the largest increases going to the brain stem (275% of control) and deep cerebral structures (240% of control). Fetal arterial blood pressures increased from a mean of 58 mm Hg to a mean of 71 mm. Hg during asphyxia. The blood pressure increases correlated closely with the regional cerebral blood flow increases. There was a poor correlation between cerebral blood flow increases and changes in Paco2' pH, or oxygen saturation. We conclude that during severe fetal asphyxia arterial blood pressure is the critical factor in determining cerebral blood flow.

Acidosis↗
PubMed1985

Maternal treatment with a cardioselective beta-blocking agent--consequences for the ovine fetus during intermittent asphyxia.

To evaluate the effect of chronic beta 1-adrenoceptor blockade on physiological adaptation to asphyxia a study was done on exteriorized sheep fetuses of 127-142 days gestational age. Eleven pregnant ewes were infused with metoprolol for 5 days prior to experiment. Another 10 ewes were infused with saline and served as controls. Asphyxia was induced by intermittent complete obstruction of maternal placental blood flow. Fetal electro-cardiogram, heart rate, cardiac output, myocardial contractility and cerebral blood flow were measured together with blood pH, lactate and hypoxanthine. Neurophysiological responses were evaluated by changes in somatosensory evoked electroencephalogram. The beta 1-blocked fetuses showed less responsiveness in myocardial contractility and heart rate during reoxygenation. This curtailed reaction resulted in accelerated lactic acidosis, increased break-down of intracellular energy rich substances and impaired cerebral function. Nine of the ten controls survived the experiment and 8 of them regained their somatosensory evoked EEG potentials, whereas 7 of the 11 beta-blocked fetuses survived and only 3 regained original somatosensory evoked EEG potentials. It is concluded that beta 1-adrenoceptor blockade impairs the adaptive responses to asphyxia in the ovine fetus and decreases its ability to survive severe asphyxia.

Animals↗