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PubMed2004

Negligent homicide by traumatic asphyxia.

We presented an unusual case of negligent homicide by thorax compression, which is the expanded concept of traumatic asphyxia. A 58-year-old man was restrained in the prone position by six prison officers. They were ordered by their superiors to continue restraining him for about 15 min and the victim died. At the forensic autopsy, typical findings of thorax compression with intramuscular hemorrhages on the back and multiple fractures of the ribs were observed. No evidence of neck compression/smothering or other fatal issues likely to occur by chest compression was found. The reconstruction of the scene corresponded exactly with the localization of the injuries found in the victim. This is the first case of death by pure thorax compression without other fatal factors during intentional restraint, in which the force causing the chest compression was distinctly determined by the autopsy and reconstruction.

Asphyxia↗
PubMed1998

Outcome of neonatal stroke in full-term infants without significant birth asphyxia.

UNLABELLED: Seven children with neonatal stroke were identified and six were followed for 13 months to 5 years (mean 28 months). Gestational age ranged between 39 and 42 weeks and none had hypoxic ischaemic encephalopathy. Focal clonic seizures were the presenting feature in six, and one presented with apnoea. The age of the first seizure ranged between 8 and 48 h (mean 26). The total number of seizures ranged between 3 and 10 (mean 5), and all seizures resolved by day 3 in all cases. CT scan showed an ischaemic infarct in six cases, and one child had a haemorrhagic infarct in the right anterior cerebral artery distribution. Phenobarbital was maintained for 3 weeks to 6 months (mean 11 weeks). None had recurrent seizures beyond the 3rd day of life and all were developing normally with no significant focal neurological deficits on follow up assessment. CONCLUSIONS: Full-term infants with neonatal stroke unrelated to significant birth asphyxia have a favourable neurological outcome. Seizures appear to be restricted to the first 3 days of life. We recommend short-term treatment with anticonvulsants.

Anticonvulsants↗
PubMed1999

Myocardial ischaemia in neonates with perinatal asphyxia. Electrocardiographic, echocardiographic and enzymatic correlations.

In asphyxiated neonates, hypoxia is often responsible for myocardial ischaemia. To evaluate cardiac involvement in neonates with respiratory distress, ECG and echocardiographic recordings were performed, and cardiac enzymes determined. These data were related to clinical presentation and patient outcome. Three groups of neonates were studied: 22 healthy newborn infants (group I) with 5 min Apgar scores > 9 and pH > 7.3; 15 neonates with moderate respiratory distress (group II) which had Apgar scores ranging between 7 and 9, and pH between 7.2 and 7.3; and 13 neonates with severe asphyxia, Apgar scores < 7, and pH < 7.2 (group III). The ECGs were evaluated according to the 4-grade classification proposed by Jedeikin et al. [8]. On the echocardiograms, fractional shortening and aortic flow curve parameters were taken into account. Serum creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB) and lactate dehydrogenase were determined. All of groups I and II survived, but 5 out of 13 in group III died within the 1st week. Grade 3 or 4 ECG changes were observed only in group III patients, while all group II and 3 patients of group I showed grade 2 ECG changes. Fractional shortening, peak aortic velocity and mean acceleration were significantly reduced in group III, whereas the only abnormality found in group II was a reduced fractional shortening. CK, CK-MB, CK-MB/CK ratio and lactate dehydrogenase were all increased in group III, while in group II only CK-MB and the CK-MB/CK ratio were abnormal. Severely asphyxiated newborn infants reflect relevant ischaemic electrocardiographic changes, depressed left ventricular function and marked cardiac enzyme increase. These alterations are far less pronounced in neonates with mild respiratory distress.

Asphyxia Neonatorum↗
PubMed1986

Birth asphyxia, trauma, and mortality in twins: has cesarean section improved outcome?

The outcome of two populations of twins delivered at the same hospital, numbering 554 in 1963 to 1972 and 614 in 1978 to 1984, was reviewed to determine the factors contributing to depression at birth, trauma, and mortality in each period. The cesarean section rate had increased from 3% in the early period to 51% in the later period, with 92% of the later cases in which the first twin presented abnormally being delivered by cesarean section. Among infants of greater than 28 weeks' gestation the incidence of severe depression at birth was not reduced with the increased cesarean rate, remaining at 2% in both populations; none developed encephalopathy or died as a result of birth asphyxia or trauma. Neonatal mortality was markedly reduced in the second period, primarily because of a reduction in deaths resulting from respiratory distress syndrome. It is not possible to show that the marked increase in the rate of cesarean delivery has improved the condition of twin infants at birth.

Asphyxia Neonatorum↗
PubMed1991

"Meconiumcrit" and birth asphyxia.

Determination of the percent by volume of the solid component of meconium (the "meconiumcrit") provides a more objective method of characterizing the type of meconium. In a study of 106 women with meconium-stained amniotic fluid, 61 (58%) had thin meconium, 36 (34%) had moderate meconium, and nine (8%) had thick meconium. There was no correlation between the type of meconium and newborn acidemia (umbilical artery pH, less than 7.20)--13%, 19%, and 11%, respectively. None of the newborns with either thin or thick meconium had 1-minute Apgar scores of less than or equal to 3 and only two with moderate meconium had such Apgar scores; none had an Apgar score of less than or equal to 3 at 5 minutes. None of the newborns with thin or moderate meconium had meconium aspiration syndrome, although two of nine infants with thick meconium did have meconium aspiration syndrome. All newborns subsequently did well and left the hospital in good condition. There would appear to be no correlation between the consistency of meconium and recently reported criteria for defining birth asphyxia.

Apgar Score↗
PubMed1995

Elevation of activity of creatine phosphokinase (CK) and its isoenzymes in the newborn is associated with fetal asphyxia and risk at birth.

OBJECTIVE: To investigate the relationship of creatine phosphokinase and its isoenzymes with fetal asphyxia and risk at birth. METHODS: Thirty-five pregnant women with high-risk pregnancy were studied. RESULTS: In 21 patients, fetal distress was diagnosed by interpretation of the fetal heart rate tracing (FHR). The remaining 14 women, having normal fetal cardiotocography, were considered as the control group. Total CK and its isoenzymes activity was measured in cord sera and 24 h after birth in peripheral blood. Abnormal FHR patterns correlate well with elevated enzyme activities. Total CK and its isoenzymes (CK-MM, CK-MB, and CK-BB) exhibited higher values in asphyxiated infants as compared to normal neonates. Electrocardiographic ischemia occurred in seven newborns who had elevated CK-MB and CK-BB levels, both at birth and within 24 h postpartum. Chromatographic study showed in normal neonates that the predominant isoenzyme was CK-MM, whereas CK-BB activity was negligible. In the newborns with abnormal FHR, CK-MB and CK-BB were increased with predominance of CK-MB. CONCLUSIONS: Antepartum fetal distress is associated with release of CK-BB, and particularly CK-MB; therefore, these biochemical markers may indicate either brain or myocardial damage.

Asphyxia Neonatorum↗
PubMed1978

Spinal evoked potential in the cat: effects of asphyxia, strychnine, cord section and compression.

Averaged evoked potentials to sciatic nerve stimulation and to direct stimulation of the cervical spinal cord were recorded from the dura and skin over the spinal cord and cauda equina in bipolar and common reference leads in cats and compared. Response waveform and conduction characteristics are described. The effects of increasing stimulus intensity, asphyxia and strychnine on these potentials are related. Alterations in these potentials produced by spinal cord at one or two levels are also described. These potentials are compared to similar potentials which have been recorded in man and the possible clinical application of some of these methods is discussed.

Animals↗
PubMed1990

Birth asphyxia and obstetric care in Curaçao Netherlands Antilles.

Out of the 223 fetal and neonatal deaths that occurred on the island of Curaçao in a 2-year period (1984-1985), 35 were due to birth asphyxia (15.7%). In order to evaluate the quality of obstetric care, the circumstances surrounding each asphyxiated death were scrutinized. On the whole, patients' compliance with antenatal care was satisfactory. However, when the woman presented in labor the attending physician or midwife often lacked information on maternal antecedents and the course of pregnancy. Inadequate intrapartum surveillance together with failure to respond appropriately to abnormalities in labor constituted the principle factors which were associated with asphyxiated deaths. In addition, asphyxial conditions during labor were often preceded by inappropriate administration of oxytocic agents.

Adolescent↗
PubMed1991

Left ventricular systolic and diastolic function in term neonates after mild perinatal asphyxia.

To assess possible changes in myocardial contractile function and relaxation occurring after mild perinatal asphyxia, maximal blood pressure and M-mode echocardiograms were registered simultaneously in 32 normal full-term neonates and in 22 full-term asphyxiated neonates. The slope of the end-systolic pressure-dimension relation (ESPDR) was used as a reliable index for evaluation of myocardial contractility. A nonpharmacological afterload increase was performed to calculate this relation. The following most prominent changes were observed in asphyxiated neonates: slope of ESPDR 5.9 vs 14.4 mmHg/(cm/m2); normalized peak rate of left ventricular (LV) filling 2.14 vs. 4.11 s(-1); LV isovolumic relaxation period 63 vs 36 ms. These results suggest that ESPDR and parameters of LV relaxation and filling may serve as early and sensitive signs of hypoxic myocardial dysfunction.

Asphyxia Neonatorum↗
PubMed1994

Intractable asphyxia at birth: analysis of the underlying conditions.

A review of clinical and pathological data on 10,000 consecutive deliveries revealed that the incidence of unexpected and intractable asphyxia at birth despite adequate resuscitation was 0.24%. Lung hypoplasia appeared to be the underlying non-viable condition in 22 out of 24 infants. Attention is drawn to congenital neuromuscular disorders which were found to be the cause of lung hypoplasia in at least 4 out of 22 infants. Some helpful hints for diagnosis are given which may contribute to the final decision making.

Asphyxia Neonatorum↗
PubMed1994

The validity of the Apgar scores in the assessment of asphyxia at birth.

A prospective study was performed in 613 consecutively live born infants to investigate the validity of 1- and 5-min Apgar scores as an index for asphyxial assessment at birth. The independent and combined relationship between Apgar scores, metabolic acidemia, pulse oximeter (SaPO2) measurements and neonatal outcome were determined. In the term infants 1-min Apgar score was more influenced by the mode of delivery and by gestational age than by asphyxia. Instead, 5-min Apgar score had a high concordance with metabolic acidemia. Infants with low Apgar scores, metabolic acidemia and arterial desaturation have the highest incidence of neonatal intensive care unit admission and poor neonatal outcome. The study suggests that the 5-min Apgar score is useful for immediate clinical assessment and care of the neonate.

Acidosis↗
PubMed1990

A comparison of typical death scene features in cases of fatal male and autoerotic asphyxia with a review of the literature.

Autoerotic asphyxia is an increasingly recognised syndrome in which accidental death occurs during solitary sexual activity due to failure of an apparatus that was designed to produce hypoxic augmentation of the victim's sexual response. Evidence of repetitive, secretive behaviour utilizing ropes and ligatures characterizes cases involving either males or females. Here the similarity in reported cases ends with males tending to utilize a far greater range of elaborate devices and props, often designed to cause real or simulated pain with pornographic material and evidence of cross-dressing and fetishism. Females, on the other hand, have usually been found naked with only a single ligature and no unusual or bizarre equipment. To further clarify the similarities and differences between typical cases involving males and females and to assist in the diagnosis of less obvious cases, the literature is reviewed and characteristic findings in both sexes compared and contrasted.

Accidents↗
PubMed1990

Histological examination of the temporal bone in medicolegal cases of asphyxia.

Histological findings of the temporal bone in 23 autopsy cases of various asphyxial fatalities were studied. The temporal bones of 12 cases who died of tumors including mammary cancer, gastric cancer, myxoma of heart and craniopharyngioma, the bones of 3 cases of heart attack and the bones of 17 cases who died of various poisoning (barbiturate, amphetamine, paraquat and alcohol) were used as controls. In drowning, the primary finding was hemorrhage in the mastoid air cells of the bilateral temporal bones. In cases of strangulation by ligature, hemorrhage and edema of the cochlear duct in the inner ear as well as hemorrhage in the mastoid air cells were demonstrated bilaterally. In contrast, congestion and edema in the mastoid air cells and inner ear were found in cases of manual strangulation but there was no hemorrhage. From these results, the histological examination of the temporal bone is useful as an adjunct procedure for diagnosing the cause of asphyxia. Differentiation between drowning, strangulation by ligature and manual strangulation may be possible by observing hemorrhages or their absence in the mastoid air cells and inner ear.

Adolescent↗
PubMed1994

An unusual case of suicidal asphyxia.

A case is presented of a psychiatric in-patient who committed suicide on the first day of admission to hospital by entrapping his neck in the hydraulic device used for raising and lowering a hospital bed. Death most likely was due to mechanical asphyxia, from persistent compression of the neck. The danger of such potential self-harming devices in psychiatric wards is emphasized.

Adult↗
PubMed1990

Traumatic asphyxia: an indicator of significant pulmonary injury.

Traumatic asphyxia has often been described as a rare syndrome with little prognostic significance. In the authors' series, however, all cases secondary to deceleration injury or compression of the anterior thorax were associated with pulmonary injury. The signs of venous congestion of the face and anterior thorax are not always recognized in the emergency department where they should be most clinically evident. Increased awareness of this syndrome by emergency physicians will result in better reporting and understanding of its clinical implications.

Adult↗
PubMed1991

Traumatic asphyxia and blunt cardiac injury: case report and selected review.

An unusual case is described featuring traumatic asphyxia and blunt cardiac injury. An association between these is possible but not previously described. Coronary artery contusion, malignant arrhythmias, and a normal electrocardiogram were also noted and discussed. The relevant literature was reviewed.

Asphyxia↗
PubMedDate not supplied

Cortical visual impairment following birth asphyxia.

Visual defects are often poorly recognized in children with multiple neurologic problems due to perinatal hypoxic-ischemic encephalopathy. We report the clinical, radiologic, and electrodiagnostic characteristics of 20 children with cortical visual impairment secondary to birth asphyxia. Clinical diagnosis often was delayed. Ten patients recovered vision during the first two years of life. Four infants had coexisting damage to the pregeniculate visual pathway. Useful investigations included cranial computed tomography and visual evoked potential mapping. Electroencephalographic abnormalities were nonspecific. The classical definition of cortical blindness must be modified for children.

Adolescent↗
PubMedDate not supplied

Beagle puppy model of perinatal asphyxia: blockade of excitatory neurotransmitters.

The N-methyl-D-aspartate receptor antagonist MK801 has been reported to prevent neuronal change in models of ischemia in adult animal systems. We studied the hypothesis that blockade of the N-methyl-D-aspartate receptor would prevent the depression of cerebral high-energy phosphates found in perinatal asphyxia without producing alterations in cerebral blood flow, and thus prevent neuropathologic damage. Newborn beagle puppies were anesthetized, tracheotomized, ventilated, and randomized to asphyxial insult (I = discontinuation of ventilatory support for 5 min) or no insult (NI) and drug treatment with MK801 (10 mg/kg intravenously) or an equal volume of saline (S). Puppies received MK801 or saline 15 min prior to I/NI. In S/I pups during insult, blood flow increased to brainstem structures but decreased elsewhere. MK801 had no effect on cerebral blood flow in either control or insulted puppies. 1H NMR studies demonstrated no effect of the MK801 on NI brains. Phosphocreatine levels were 1.7 +/- 0.1, 0.6 +/- 0.1, and 0.9 +/- 0.1 mmole/kg (mean: +/- S.D.) for the S/NI, S/I, and MK801/I pups, respectively. Cerebral lactate was 1.3 +/- 0.2, 3.0 +/- 0.7, and 2.0 +/- 0.4, respectively. The pH fell 0.8 units in the S/I puppies, compared to 0.4 units in the MK801/I puppies. We conclude that pretreatment with the N-methyl-D-aspartate receptor antagonist MK801 in part protects the developing brain against severe metabolic insult.

Animals↗