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PubMed1992

Myocardial changes in neonates dying of asphyxia neonatorum.

Ten neonates, asphyxiated at birth, were studied by Apgar score, ECG ischaemic score grading (ECGisg), Cardiothoracic (CT) ratio, biochemical parameters like CPK, CPK-MB fraction during life; and they were subjected to postmortem study with particular attention to the changes in the heart. The study revealed that 7 out of 10 asphyxiated neonates showed variable evidences of myocardial damage; but the extent of damage though well correlated with biochemical parameters, did not correspond well with the extent of asphyxia and the survival period. In rest 3 cases, myocardial damage was not overt though there was evidence of asphyxia and evidence of myocardial damage in the form of elevated CPK-MB level. These patients probably had died of "Biochemical Lesion" as described by Rudolf Peter.

Asphyxia Neonatorum↗
PubMed2003

Inflicted compressional asphyxia of a child.

Compressional or traumatic asphyxia is a well recognized entity to most forensic pathologists. The vast majority of reported cases have been accidental. The case reported here describes the apparent inflicted compressional asphyxia of a small child. A review of mechanisms and related controversy regarding proposed mechanisms is discussed.

Asphyxia↗
PubMed2003

[Effects of hypothermia on cardiac function in neonates with asphyxia].

OBJECTIVE: To study the effects of hypothermia on cardiac function in neonates after birth asphyxia. METHODS: Fifty term newborns with Apgar score < 5 at 5 minutes were randomly divided into no cooling group (normothermia group, NG; rectal temperature = 36.5 degrees C +/- 0.5 degrees C, n = 27) and cooling group (hypothermia group, HG; rectal temperature = 34.5 degrees C +/- 0.3 degrees C, nasopharyngeal temperature = 34.0 degrees C +/- 0.5 degrees C, n = 23). The selective head cooling was applied to maintain nasopharyngeal temperature at 34 degrees C for 72 h in hypothermia group. Systolic and diastolic function was detected at the end of treatment by echocardiogram. RESULTS: (1) The heart rate was obviously decreased during the hypothermia treatment, and there was a significant difference between HG and NG [(103 +/- 15) bpm vs. (126 +/- 14) bpm, P < 0.05]. No cardiac arrhythmia and hypotension were found in all neonates. (2) There were no significant differences on the ejection fraction, stroke volume and cardiac output of left ventricle between the two groups (P > 0.05). No significant difference was found in the numbers of left and right ventricular diastolic dysfunction, pulmonary hypertension between the two groups (P > 0.05). (3) The level of cardiac troponin T (cTnT) in plasma was (0.47 +/- 0.15) ng/ml in HG, and (0.35 +/- 0.21) ng/ml in NG, and there was no significant difference between the two groups (P > 0.05). CONCLUSION: No significant cardiac dysfunction complication caused by the hypothermia treatment was found in term neonates after birth asphyxia.

Asphyxia Neonatorum↗
PubMed2004

[Intranatal asphyxia, prematurity and congenital infection--their role for brain damage in very low birth weight newborns].

The authors examined 273 newborns weighing less than 1500 g. Their birth weight was very low (1001-1500 g) in 179 but extremely low (< 1000 g) in 94 newborns. Neurological damage was proved in 101 cases (36.99%). The probable reasons for intra- (peri-) ventricular and cerebral hemorrhages in these newborns were the following: respiratory distress syndrome (in 11 cases or 10.89%), mother-fetal infection (in 16 cases or 15.84%), and combination of asphyxia and infection (in 10 cases or 9.9%). The severe degree of prematurity (and immaturity) remained the only causative factor in the rest 64 premature newborns (63.37% of the cases). The results from the distribution of the neurological lesions according to the gestational age were also considered. Usage of monofactorial regression models detected statistically significant differences between asphyxia, infection and brain damage in the newborns of different gestational age.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Determination of a mechanism of the coming of death by morphological methods in strangulation mechanical asphyxia].

Described in the paper are morphological data characterizing the tempo and type of thanatogenesis in strangulation asphyxia. The cerebral thanatogenesis was shown to prevail in mechanical asphyxia. The results of determination of a degree of hydration of the brain by drying its samples are described. Medullary substance was demonstrated to be hypohydrated in such death.

Adult↗
PubMed2004

Value of nucleated red blood cells in predicting severity and outcome of perinatal asphyxia.

The objective of the study was to assess nucleated red blood cell counts in cord blood in a group of asphyxiated infants, and to determine its predictive value for short-term outcome. A prospective case control study was undertaken on cord blood samples collected from fifty six term neonates with perinatal asphyxia and an equal number of normal appropriately matched controls for cord blood pH and nucleated RBC counts. Babies were followed up in nursery till discharge. Statistical analysis employed were ANOVA test, logistic and linear regression analysis. There was a significant increase in the number of nucleated red blood cells in cases as compared to controls. Low Apgar, cord blood pH and neonatal outcome correlated well with nucleated RBC counts. Nucleated red blood cell count at birth is a useful predictor of severity and short-term outcome of perinatal asphyxia.

Apgar Score↗
PubMed1991

Auditory brainstem response in neonates with hypoxic-ischemic-encephalopathy following perinatal asphyxia.

The technique of auditory brainstem evoked responses testing (ABR) was applied to twenty four new born infants with asphyxia complicated by hypoxic-ischemic-encephalopathy (HIE) in an attempt to study potential influence of HIE on hearing impairment. Twenty normal term neonates with no apparent neurological disorder, were also examined for comparison. Twenty two per cent (n = 5) of the patients with HIE showed some abnormality in the ABR pattern, the major one being a transient elevation in threshold of wave V (n = 4; 16.6%). ABR abnormalities, however, were found with greater frequency in neonates with Stage II HIE (75% vs 10%, p less than 0.001). Further ABR abnormalities were found in Stage II HIE only when duration of neurological abnormalities was greater than 5 days. There was no difference, however, between the ABR latencies of the asphyxiated and non-asphyxiated newborn infants (p greater than 0.05). One neonate (4%) with severe HIE, however, had persistent ABR abnormality in the form of bilateral absence of all waves in the later part of the ABR with preservation of wave I. This implied only cochlear functions and absence of any brainstem conduction. These results indicate that birth asphyxia complicated by HIE is a significant high risk factor for hearing impairment in the affected neonates. This justifies ABR testing of neonates with HIE (particularly Stage III), at the time of their discharge, as a screening procedure for early detection of permanent hearing loss.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Myocardial damage following neonatal severe asphyxia].

Sixteen newborn infants with severe asphyxia were prospectively studied for evidence of secondary myocardial damage and, in that case, their clinical findings. Myocardial damage was diagnosed in three term newborn infants of adequate weight for gestational age (18.7%) by means of serial electrocardiograms taken in the first 72 hours of life. Two of them showed evidence of diffuse subendocardial ischemia and a third one showed electrocardiographic signs suggesting necrosis of the left ventricular posteroinferior wall. Neither creatine-phosphokinase serum activity nor its muscle brain MB isoenzyme were useful in the identification of myocardial damage. All three affected neonates developed respiratory distress syndrome without signs of cardiac failure and one of them died. The histopathological study of this late one showed localized hemorrhage of the papillary muscles and interventricular septum. These finding underscore the need for serial electrocardiographic recordings in newborns with severe asphyxia, since cardiac dysfunction may inadvertently occur under the appearance of respiratory distress syndrome.

Asphyxia Neonatorum↗
PubMed1991

[Structural and functional aspects of erythrocyte membrane in children, delivered with asphyxia].

Serum and red blood cell membrane lipid peroxidation (LPO), antioxidative activity (AOA) of the ceruloplasmin/transferrin (CP/TF) system, and biophysical parameters of the structure of a red blood cell membrane lipid bilayer were examined in fetuses experienced acute hypoxia at birth and in babies born to healthy mothers with uncomplicated pregnancy. The intensity of LPO product accumulation in mild asphyxia was ascertained to be proportional to the duration of hypoxic exposure of a fetus. In severe asphyxia accompanied by lower formation of primary LPO products, the levels of secondary LPO products showed a rise. A slight increase of AOA in the CP/TF system was unable to adequately compensate a high intensity of LPO processes, which provides strong evidence for altered structural parameters in the lipid bilayer. It was concluded that it was essential to correct hypoxic states in children with antioxidants immediately after birth.

Antioxidants↗
PubMed1990

[Increase in glutamic-oxaloacetic and glutamic-pyruvic transaminases and lactic dehydrogenase as a diagnostic aid in perinatal asphyxia].

In order to determine the behavior of glutamic oxalacetic (GOT), glutamic-pyruvic (GPT) and lactic dehydrogenase (LDH) transaminases after a period of asphyxia, a study was conducted in 120 newborn children which were placed into two groups: group 1 of the asphyxiated children who were given oxygen at intermittent positive pressure for more than a minute and group 2 of healthy children with an Apgar greater than 7 after the first and five minutes and without any apparent pathology. The results showed a real increase in the quantities of all three transaminases among those in the group of asphyxiated children, which on the other hand did not occur in the healthy group of children where levels remained normal. There was statistical differences (P less than 0.001) by which we can conclude that the quantification of these enzymes can be useful as a diagnostic tool in cases of perinatal asphyxia.

Alanine Transaminase↗
PubMed1990

[Neonatal asphyxia in full-term infants].

This study includes 57 children born at term with asphyxia and admitted to Children's Department, Rikshospitalet, during the period 1981-85. The mortality in this study was 14% which proves that asphyxia represents a serious illness in newborn infants. The results of this investigation confirm that Apgar score is not a very precise parameter and offers limited information when estimating prognosis after birth. 17% of the newborn infants suffered from neonatal seizures during their first day in the neonatal period, and this symptom appears to indicate a high risk of subsequent mortality and morbidity. Nearly 44% of the newborns needed mechanical ventilation.

Asphyxia Neonatorum↗
PubMed1990

[Effect of intranatal asphyxia on the pattern of psychomotor development of children up to 7 years of age].

The paper is concerned with the psychophysical development of 460 children born in asphyxia of varying gravity. The establishment of psychomotor functions was traced over time, since the moment of birth to 7 years. The highest rate of complications was diagnosed in children aged 6-7 years. It should be mentioned, however, that gross disturbances were primarily detected at an early age, whereas at a late age different intellectual abnormalities were diagnosed. Children with a history of grave asphyxia need rehabilitation treatment aimed at the recovery of psychomotor functions.

Age Factors↗
PubMed1986

[Pathophysiology of circulatory regulation in hypoxia and asphyxia in the perinatal period].

Asphyxia is defined as hypoxia with hypercapnia; the physiology and pathophysiology of the O2-saturation-curve in maternal and fetal blood is given. Recent results about the redistribution of the cardiac output in chronically instrumented fetal lambs under the conditions of asphyxia, hypoxia and acidosis are reported. The life-threatening consequences of ischaemic situations in the regional circulations for liver, gut, kidney and lung are described, particularly in the newborn. It is stressed that in asphyxiated babies which show circulatory and/or cerebral disturbances, further organ functions (e.g. respiration, excretion) may be seriously damaged.

Animals↗
PubMed1989

Measurements of glutathione S-transferase B1 in plasma after birth asphyxia: an early indication of hepatocellular damage.

Concentrations of glutathione S-transferase (glutathione transferase; EC 2.5.1.18) B1 and B2 subunits (B1 and B2) and activity of alanine aminotransferase (ALT; EC 2.6.1.2) were measured in sequential plasma samples taken from 14 infants with birth asphyxia. Within 6 h of asphyxia, abnormal concentrations of B1 were found in 11 infants, whereas only seven infants showed abnormal ALT activities at this time. In plasma sampled 24 h after birth, values for ALT were abnormal in 10, whereas values for B1 were abnormal in six. Abnormal concentrations of B2 were found in relatively few of these infants, apparently because this monomer is poorly expressed in liver samples obtained up to 41 weeks after conception. We conclude that measurement of B1 may provide a useful index of hepatic impairment in birth-asphyxiated infants.

Asphyxia Neonatorum↗
PubMed1988

Educational readiness of survivors of neonatal encephalopathy associated with birth asphyxia at term.

Standardized individual psychoeducational school-readiness tests were completed by 127 nondisabled survivors of moderate (lethargy, hypotonia, and suppressed primitive reflexes) or mild (hyperalertness, hyperexcitibility) neonatal encephalopathy associated with term birth asphyxia. Application of the readiness test battery to the children with moderate or mild encephalopathy and a peer population, revealed that children with moderate encephalopathy had significantly lower scores for many tests than those in the other groups. Children with mild encephalopathy performed well. We found no significant differences due to social variables. For the moderate group, we found an increased number of types of anticonvulsants and abnormal findings on the neurologic examination at neonatal intensive care unit (NICU) discharge to be predictors of low achievement on school-readiness tests. Also for the nondisabled moderate group, multiple regression analysis of the independent variables with the 5.5-year scores added variables suggestive of intrauterine growth retardation to the prediction of lower scores on many school-readiness tests. We conclude that clinical categorizing of moderate neonatal encephalopathy associated with birth asphyxia in term infants selects a group of children with an increased percentage of school-readiness delay, and could be a useful indicator for clinicians and educators in defining those neonates who may need special preschool evaluation and benefit from a modified early school program.

Asphyxia Neonatorum↗
PubMed1988

[Information given by interneuronal junctions of the rat cerebral cortex during the post-asphyxia period].

Using PTA technique, the organization of subsynaptic units (paramembrane specialized formations of the cytoskeleton) was revealed in the molecular layer of the rat neocortex during post-asphyxia period. The density and summarized length of the active contact zone (ACZ) with different degree of maturity of subsynaptic units were calculated and the information was evaluated. It was revealed that the total length of ACZ synapses was restored to the control level on the 7th day after asphyxia and the information of the synaptic pool was 30.1% on the 14th day, in spite of a significant deficiency in the synapse density. The information of the synaptic pool was restored mainly due to hypertrophy of interneuronal contacts with well developed presynaptic grating.

Animals↗
PubMed1986

Apgar scores and asphyxia. Results of a study and proposal for a clinical grading system.

The Apgar score (AS) was devised in 1953 as a simple system for classifying neonatal condition at 1 minute and was later modified to include status at 5 minutes. However, studies have documented pitfalls, e.g. a poor correlation between AS and acid-base status. We studied 35 infants born at term. ASs were assigned by two nurses not involved in the delivery, and antepartum and postpartum events were noted. We confirmed the following: (i) labour ward staff tend to overestimate ASs; (ii) there is a poor correlation between the AS and acid-base status; and (iii) the labour ward staff's decision to resuscitate with intermittent positive-pressure respiration (IPPR) correlates with the AS but not with blood gas status. Infants with initially low ASs and/or a brief requirement for IPPR may be recorded by medical or nursing staff as being asphyxiated at birth. Our results show that low ASs may be associated with normal acid-base status and vice versa. In order further to define asphyxia, we therefore propose that a grading system which incorporates clinical data and the AS be used. Use of such a system would facilitate inter-area comparisons of grades of asphyxia encountered, efficacy of intervention programmes and developmental outcome of asphyxiated neonates.

Apgar Score↗
PubMed1985

A comparison of two resuscitators in the management of birth asphyxia.

Twenty newborn infants with birth asphyxia were alternately assigned to ventilation with either the Samson or the Laerdal infant resuscitator. During resuscitation significantly greater percentage changes in pH (1,1% v. 0,2%; P less than 0,05), hydrogen ion concentration (-15,6% v. -2,1%; P less than 0,05) and partial arterial carbon dioxide pressure (-24,5% v. -11,9%; P less than 0,02) were seen in the Laerdal group. There was also a tendency towards improved oxygenation and lung compliance and quicker establishment of spontaneous respiration in the Laerdal group. We therefore conclude that the Laerdal resuscitator is superior to the Samson one in the management of infants with birth asphyxia.

Asphyxia Neonatorum↗