Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Asphyxia”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

Neuronal death after perinatal asphyxia.

During perinatal asphyxia several mechanisms aim to limit cerebral damage. However, when the degree of asphyxia passes beyond a certain threshold, brain damage is inevitable. This review focuses on the various factors determining the final cerebral outcome. Metabolic and biochemical events, such as the intracellular level of calcium, the formation of oxygen derived free radicals, the release of excitotoxic neurotransmitters and the interrelationship of these parameters are discussed. Furthermore, steps possibly useful to pharmacologic intervention aiming to reduce cerebral damage are presented.

Asphyxia Neonatorum↗

The influence of transient asphyxia on receptor potentials in inner hair cells of the guinea pig cochlea.

Intracellular recordings were made from inner hair cells in the basal turn of the guinea pig cochlea during transient asphyxia. During these periods the endocochlear potential was reversibly reduced, the hair cell resting membrane potential was slightly hyperpolarized and the cochlear microphonic potential was decreased, all with similar time courses. The eighth nerve compound action potential and DC and AC components of the inner hair cell receptor potential were strongly attenuated and with similar slow time courses. The asymmetrical low frequency receptor potentials became symmetrical, and this change was attributed to alterations in the mechanical properties of the organ of Corti. The desensitization of the cochlea during transient asphyxia was associated with the loss of asymmetry of the inner hair cell receptor potential.

Animals↗

Immunohistochemical characterization of alveolar macrophages and pulmonary giant cells in fatal asphyxia.

UNLABELLED: It is in dispute whether the occurrence of numerous alveolar macrophages and in particular pulmonary giant cells in cases of fatal asphyxia is associated with agonal activation and proliferation. The nature of these alveolar cells was investigated in selected fatalities with protracted final oxygen lack using immunohistochemistry (APAAP method) and a semi-quantitative graduation. The study included opiate-involved deaths (n = 22), fatal strangulations (n = 10) and a control group of sudden cardiovascular deaths (n = 10). Positive immunohistochemical reactions were observed with the monoclonal antibodies PG-M1 (general marker of macrophages, detection of nearly 100% of pulmonary macrophages and giant cells in all subgroups) and 25 F 9 (late stage inflammation marker, detection of pulmonary macrophages/giant cells in 70%/50% of opiate-involved fatalities, 70%/20% of strangulations and 40%/30% of control cases). The antibodies LN-4 (macrophages), 27 E 10 (early stage inflammation marker), AMH 152 (activated macrophages) and MIB 1 (proliferation marker) did not react with these cell populations. CONCLUSIONS: pulmonary giant cells and numerous alveolar macrophages are not restricted to asphyxia. Their appearance is not of pathognomonic value for this diagnosis. Both cell types seem to be of heterogeneous nature (different functional state) as only one marker was expressed by all cells. The results do not suggest prefinal immigration, mobilization or proliferation of alveolar cells, but rather point to a longer pre-existence of macrophages and giant cells in pulmonary tissue (25 F 9 as late stage inflammation marker positive).

Antibodies, Monoclonal↗

Temporary blindness associated with traumatic asphyxia.

Traumatic asphyxia is an uncommon syndrome of craniocervical cyanosis, facial petechiae, and subconjunctival hemorrhages following severe crush injury to the thorax. Ocular manifestations of the syndrome have rarely been reported. A 42-year-old male sustained temporary blindness in association with traumatic asphyxia. Completely normal vision returned within 24 hours of injury. The pathogenesis of this unique finding probably involves transient retinal vein hypertension and reflex vasospasm in the retina.

Adult↗

Beagle puppy model of perinatal asphyxia: alterations in cerebral blood flow and metabolism.

Perinatal asphyxia remains a major cause of neurodevelopmental handicap. The neuropathologic and clinical sequelae of perinatal asphyxia are likely attributable to alterations in cerebral blood flow (CBF) to the developing brain with uncoupling of CBF and metabolism. The newborn beagle puppy model was used to study the control of CBF in physiologic and pathologic conditions in the developing brain. Pups, 2-10 days of age, were randomized to asphyxial insult (i.e., ventilator lines clamped for 5 min) or no insult. In the first series, pups underwent radioactive microsphere determinations of CBF immediately prior to insult (t = 0), at the end of insult (t = 5), and after 60 min of observation (t = 65). In the second series, utilizing a 2.0 tesla superconducting magnet, pups underwent continuous serial in vivo 31P nuclear magnetic resonance spectral analysis of cerebral hemispheric metabolic state. Animals exposed to insult had significant alterations in PO2, PCO2, pH, and mean arterial pressure at the end of insult compared to control pups (all pups: p less than 0.001). Serial CBF data demonstrated decreases in flow in cortical gray and white matter regions during insult and return to baseline 1 hour later; brainstem structures were hyperemic during insult. Analysis of phosphorylated metabolites inorganic phosphorus (Pi), phosphocreatine (PCr), and ATP demonstrated that during insult both the PCr/Pi and ATP/Pi ratios were depressed but by 20-30 min following insult, these ratios of cerebral phosphorylated metabolites had almost returned to baseline values. These data demonstrate that even after a severe asphyxial episode which results in electrocerebral silence, CBF and metabolism may return to normal.

Acid-Base Equilibrium↗

Neonatal asphyxia: vulnerability of basal ganglia, thalamus, and brainstem.

Two infants who suffered acute intrapartum asphyxia resulting in severe neonatal encephalopathy are described. Although computed tomography revealed no abnormalities, magnetic resonance imaging documented unequivocal lesions in the thalamus, basal ganglia, parasagittal cortex, brainstem tectum, and midline cerebellum in one patient and in the basal ganglia and parasagittal cortex in the other. Thus, magnetic resonance imaging was more sensitive than computed tomography in detecting acute brain damage after neonatal asphyxia and may become an important tool in improving our understanding of the relationship between adverse perinatal events, neonatal encephalopathy, and neurologic morbidity.

Asphyxia Neonatorum↗

Excitatory amino acids in cerebrospinal fluid in neonatal asphyxia.

Of the excitatory amino acids, glutamic and aspartic acid were studied in the cerebrospinal fluid of six infants 4-32 hours after a documented episode of severe neonatal asphyxia. Aspartic acid concentration was definitely increased in the cerebrospinal fluid of these patients, whereas glutamic acid concentration varied considerably. Aspartic acid was always increased, even hours after the period of asphyxia, but values were greater in samples taken less than 12 hours after the asphyxial event. The patients with the highest cerebrospinal fluid aspartic acid concentrations had more severe outcomes.

Aspartic Acid↗

Clinical, neurophysiologic, and neuropathological features of an infant with brain damage of total asphyxia type (Myers).

An infant who demonstrated clinical features compatible with total asphyxia is reported. Immediately after birth, the patient manifested severe hypotonia and total absence of cranial nerve functions. Magnetic resonance imaging revealed abnormal intensity of the thalamus and putamen, and atrophy of the brainstem. Late components of brainstem auditory evoked potential were absent, but electroencephalography was normal. Postmortem autopsy revealed destructive lesions of the brainstem tegmentum, thalamus, basal ganglia, and spinal cord, but preserved cerebral cortex; findings consistent with those of total asphyxia as reported by Myers, and attributable to prenatal insult.

Asphyxia Neonatorum↗

How often is a low 5-min Apgar score in term newborns due to asphyxia?

OBJECTIVE: To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia. STUDY DESIGN: A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed. RESULTS: After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001). CONCLUSIONS: In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.

Acidosis↗

Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.

In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. Autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.

Accidental Falls↗

Sensorineural hearing loss in patients with cerebral palsy after asphyxia and hyperbilirubinemia.

The location of lesions causing hearing loss in patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia has remained unclear. We performed behavioral audiometry, distortion product otoacoustic emission (DPOAE) and auditory brainstem evoked response (ABR) in six patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia in order to determine the lesion location causing their hearing impairment. In all cases, behavioral audiometry revealed a threshold elevation of 50-75 dB and ABR were no response. DPOAE were totally absent in five patients and normal in one patient. Our study suggests that lesions causing hearing loss potentially include the organ of Corti especially at the outer hair cells and the cochlear nerve.

Adolescent↗

Value of biochemical markers for outcome in term infants with asphyxia.

The aim of this study was to define the predictive values of serum and cerebrospinal fluid concentrations of interleukin-6 and neuron-specific enolase and urinary uric acid/creatinine ratio for outcome in term infants with perinatal asphyxia. All biochemical markers were measured simultaneously within the 24-72 hours of life in 21 infants. The infants were monitored with a standardized neurologic and developmental evaluation protocol over the 2 years of life. The overall outcome at 2 years of age was categorized as "favorable" or "adverse". According to Sarnat and Sarnat classification, 12 infants had mild encephalopathy and 9 infants had moderate to severe encephalopathy. Seven of 9 (78%) infants with moderate to severe encephalopathy had adverse outcome. However, all infants with mild encephalopathy had favorable outcome. Interleukin-6 and neuron specific enolase levels in cerebrospinal fluid and serum interleukin-6 levels were significantly correlated with the degree of encephalopathy, as well as the outcome. Interleukin-6 in cerebrospinal fluid (cutoff value, 25.9 pg/mL) had the highest predictive value among the biochemical markers. The predictive factors identified in this study should be examined for their ability in a fresh clinical sample in the neonatal intensive care unit before these markers can be applied to the routine clinical of infants with perinatal asphyxia.

Asphyxia Neonatorum↗

The influence of asphyxia on fetal lidocaine toxicity.

Local anesthetics have played an important role in modern obstetrics. Although reasonably safe, these agents have been shown to have detrimental effects in some fetuses. In the present study we examined the influence of acute asphyxia in the fetal lamb on the distribution and cerebral uptake of maternally infused lidocaine. Results demonstrate that asphyxia is associated with higher lidocaine concentrations in the fetal plasma, increased presentation of the drug to the fetal brain, and increased cerebral lidocaine uptake. These findings underscore the importance of evaluation of fetal status when considering the risks and benefits of maternal drug use.

Animals↗

Has an increased cesarean section rate for term breech delivery reduced in incidence of birth asphyxia, trauma, and death?

To evaluate whether the dramatic rise in the cesarean section rate for breech presentation (from 22% in the decade 1963 to 1973 to 94% in 1978 and 1979) has been justified, 770 term breech deliveries at the Royal Victoria Hospital during the period 1963 to 1973 and during 1978 and 1979 have been reviewed. Neonatal outcome, as determined by one neonatologist during the entire period of this study, was analyzed according to vaginal or cesarean section breech deliveries of primiparous and multiparous women. For each method of delivery and state of parity the occurrence of asphyxia neonatorum, abnormal cerebral signs, postasphyctic congenital heart failure or renal failure, and intrapartum and neonatal deaths was studied. The most severe cases were individually reviewed. While breech presentation has become a virtual indication for cesarean section in many centers, to date , there has not been an evaluation of how effective this procedure is in reducing birth asphyxia and trauma. In this study we assessed whether the trend to perform cesarean section in all term breech presentations is justified and whether neonatal morbidity and mortality rates have actually improved as a result.

Acute Kidney Injury↗

Indicators of perinatal asphyxia.

Creatinine phosphokinase and its isoenzymes (myocardial-specific MB and brain-specific BB) are elevated in the presence of specific tissue injury. The value of this serum marker as an objective indicator of perinatal asphyxia was studied. Forty-nine patients with gestational ages ranging from 36 to 42 weeks were prospectively studied. Patients who by interpretation of the fetal heart rate tracing alone were diagnosed as having fetal distress demonstrated significantly lower pH (p = 0.001) and base excess (p less than 0.0001) in umbilical venous blood. Umbilical venous cord MB (p less than 0.05) and BB (p less than 0.01) were increased in this group. Abnormal fetal heart rate patterns correlate well with acid-base abnormalities and elevated creatinine phosphokinase values. These tests may demonstrate more efficient and improved indicators of tissue injury and damage from perinatal asphyxia than clinical observation alone.

Acid-Base Equilibrium↗

Intrapartum fetal asphyxia: definition, diagnosis, and classification.

Evidence of a significant metabolic acidosis, an umbilical artery base deficit > 12 mmol/L, confirms that an asphyxial exposure has occurred. This is observed at delivery in approximately 2% of all pregnancies. Classification of the severity of the asphyxial exposure is difficult because the duration and nature of the exposure and the characteristics of the fetal cardiovascular response to the asphyxia in the affected fetus is usually not known. A classification is proposed in which the exposure to asphyxia is confirmed by a blood gas and acid-base assessment with evidence of a significant metabolic acidosis and the severity is defined by newborn encephalopathy and other organ system complications. Outstanding issues that may enhance this classification are identified.

Acid-Base Equilibrium↗

Neonatal asphyxia. II. Neonatal mortality and long-term sequelae.

Neonatal asphyxia, defined in this study as delay of greater than 1 minute in onset of spontaneous respiration at birth, occurred in 1% of 13,221 live-born infants of birth weight greater than 500 gm between 1970 and 1971. Seventy-five (56%) of 133 asphyxiated infants survived the neonatal period. Survival was directly related to gestational age. The 65 survivors of asphyxia available for study were seen at a mean age of 4.8 years to determine the incidence and extent of neurologic and developmental abnormalities. Twelve children (18.5%) had severe impairment: nine had both neurologic and intellectual handicaps, two had neurologic impairment alone, and one had intellectual impairment alone. The incidence and severity of impairment were not related to gestational age. Postasphyctic seizures were associated with poor outcome.

Asphyxia Neonatorum↗

Use of barbiturate therapy in severe perinatal asphyxia: a randomized controlled trial.

The possible cerebral sparing effect of thiopental was evaluated in 32 severely asphyxiated neonates randomly assigned to either a thiopental treatment or control group. All infants had neurologic manifestations of asphyxia and required assisted ventilation. Thiopental was begun at a mean age of 2.3 hours and was given as a constant infusion that delivered 30 mg/kg over 2 hours. Treatment was continued at a lower dose for 24 hours. Seizure activity occurred in 76% of infants given thiopental and 73% of control infants at a mean age of 1.5 and 2.5 hours, respectively. Although initial arterial blood pressure was similar in both groups, hypotension occurred in 88% of treated and 60% of control infants. The amount of blood pressure support required was significantly greater (P less than 0.005) in the thiopental treatment group. Three infants died in the control group, and five in the treatment group. Developmental assessment was performed at a minimum of 12 months of age in 22 infants. There were no significant differences in neurologic, cognitive, or motor outcome between groups. Deteriorating performance over time was a consistent trend in both groups. These findings indicate that treatment of severe perinatal asphyxia with thiopental does not appear to have a cerebral sparing effect and may be associated with significant arterial hypotension.

Apgar Score↗