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[Relations between the cortical DC potentials and the K+ concentration of the blood and cerebral cortex extracellular space in reversible asphyxia].

The relationship between changes of the cortical DC potential and the K+ concentration gradient across the blood-brain barrier (BBB) was studied in the rat brain during short ventilatory arrest. For this purpose K+ concentrations were measured simultaneously in the extracellular space of the cerebral cortex and in the streaming blood of the carotid artery and the superior sagittal sinus. For measurements ion-selective micro- and macro-electrodes based on the K+ ionophore valinomycin were used. During reversible asphyxia free K+ concentrations in the circulating blood and in the extracellular fluid of the brain tissue increased and re-decreased with different time courses. The resulting difference between the electromotive forces of the ion-selective signals resembled the course of the cortical DC potential during the initial phase of the ventilatory arrest during the post-asphyxiation period. The results suggest that during these events the cortical tissue including the BBB behaves like a K+-selective membrane which is probably located at the blood-brain interface. It is concluded that the capillary-glial complex may principally contribute to the generation of DC shifts associated with the asphyxiation process.

Animals↗

[Reduction of cerebral hemorrhage and respiratory distress syndrome in premature infants by avoiding perinatal asphyxia].

Intra- and periventricular haemorrhage (IVH/PVH) and, under certain conditions, the respiratory distress syndrome (RDS) seem to be typical sequelae of perinatal asphyxia in preterm born infants. Therefore, an association of IVH/PVH and RDS can be expected. We have retrospectively analyzed the data of 118 premature infants born between 1982 and 1986, weighing between 750 and 1499 g. 11 of these had experienced a severe IVH/PVH and a severe RDS at the same time, whereas 75 infants did not develop either of those. (2 of the 118 showed a severe IVH/PVH without evidence of severe RDS whereas 29 developed severe RDS without signs of serious IVH/PVH. 1 could not be evaluated due to missing data). This association of severe intracerebral haemorrhage and severe respiratory distress syndrome was statistically significant (p less than 0.005). The number of severe IVH/PVH has decreased during 1984-1986 in comparison to 1982/83 (4/76 vs. 9/42; p less than 0.05); the incidence of severe RDS has slightly declined. Comparing the perinatal conditions we found that the infants of the years 1984-1986 were more rarely delivered after an interval exceeding 24 h after premature rupture of the membranes (p less than 0.05), were more often delivered by caesarean section (p less than 0.005), and were nearly always primarily cared for by an experienced paediatrician (p less than 0.01). There were no significant differences between these two groups as far as dexamethasone-prophylaxis, mean birth weight, percentage of small-for-gestational-age infants and mean Apgar scores were concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Asphyxia Neonatorum↗

[Preventive treatment of convulsions in perinatal asphyxia].

A double blind randomized study has been performed in 17 newborn infants bearing a diagnosis of perinatal asphyxia and treated with phenobarbital (FB) or phenytoin (DPH) to prevent the onset of seizures. The initial dose for both drugs was 12 m/kg IM the first day, followed by 6 mg/kg/day through the seventh day. Patients were clinically assessed daily and drug blood levels were also determined daily by enzyme immunoassay (EMIT). Mean FB levels along the seven days were 17.6, 23.7, 25.6, 31.6, 31.4, 36.7, and 44.6 micrograms/ml. One child treated with FB exhibited seizures on the second day and six children showed drowsiness and bradycardia on the last two days, that were attributable to high levels of FB. Mean (DPH) levels along the study were: 4.6, 7.0, 9.7, 6.5, 4.5, and 5.2 micrograms/ml. Seizures occurred in one of the DPH-treated patients and signs of therapeutic inefficacy such as hypertonus and abnormal movements appeared in four children.

Asphyxia Neonatorum↗

Asphyxia neonatorum.

Various biochemical and structural changes affecting the newborn's wellbeing develop as a result of perinatal asphyxia. Central nervous system abnormalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or massive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid electrolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out effective resuscitation measures on the depressed infant at the time of delivery.

Acute Kidney Injury↗

[Electric activity of hippocampal neurons during asphyxia].

The unit activity was studied in the dorsal and ventral hippocampus of anesthetized and immobilized cats. The state of asphyxia was caused by disconnection of artificial respiration for 3-9 min. The hypoxia induced phasic changes of the neuronal activity. Hippocampal neurons revealed a higher resistance against oxygen deficiency as compared to other brain areas.

Action Potentials↗

Homicidal asphyxia by pepper aspiration.

As punishment for lying, the foster mother of a five-year-old white male poured pepper into his throat. He immediately became dyspneic, then apneic, and was pronounced dead about 1 h later. At autopsy, the main stem and several smaller bronchi were occluded with pepper. Mechanisms of asphyxia by pepper include mechanical obstruction of the tracheobronchial tree and mucosal edema caused by the irritant effect of volatile oils in pepper. This rare circumstance represents the second reported fatal case of pepper aspiration and the third reported case overall.

Airway Obstruction↗

Fetal cardiovascular responses to asphyxia induced by decreased uterine perfusion.

Cardio-respiratory responses to asphyxia produced by decreased uterine perfusion were studied in 15 sheep fetuses. In chronic (spinal-anesthetized) and acute (inhalation-anesthetized) preparations, we measured fetal PO2, PCO2, pH, heart rate, arterial and umbilical venous pressures at rest and 5 min after controlled reductions of maternal aortic blood flow. Umbilical blood flow was determined by electromagnetic flow transducer on the fetal descending aorta with the iliac arteries ligated, in conjunction with radionuclide-labelled microspheres. In contrast to previous studies in which fetal hypoxaemia was produced by decreased maternally inspired O2 concentrations, decreasing degrees of uterine perfusion were associated with increasing degrees of hypercapnea and acidemia, as well as hypoxaemia. In chronic experiments, heart rate and umbilical blood flow fell significantly in response to decreased uterine perfusion with all degrees of hypoxaemia studied. In acute experiments, during the control period, PO2 values were similar to those of chronic experiments while values for pH and umbilical blood flow were lower and those for umbilical vascular resistance were higher. In the acute experiments, hypoxic stresses identical to those in the chronic studies failed to produce significant hemodynamic changes, except for bradycardia in response to severe hypoxaemia. These differences were apparently due to the pharmacologic effects of halothane and the operative stresses.

Anesthesia↗

[Change in the physicochemical properties of the cerebral cortical proteins in dying and resuscitation after mechanical asphyxia].

The physicochemical properties of protein postmitochondrial supernatant after gray substance of the brain homogenization undergo changes during clinical death caused by mechanical asphyxia. The shift on the densitogram occurs after protein electrophoresis in polyacrilamide gel. After sedimentation the total concentration of proteins and total activity of lactate dehydrogenase (LDH) decrease. Followiing adsorption on a DEAE-Sephadex A-50 the total fraction of nonadsorbed beta- and gamma-globulins also decreases, and the activity of LDH (3+4+5) isoenzymes falls significantly. Disturbed behavior pattern of proteins in the sedimentation and electrophoretic fields as well as changes in the sorption properties specific for varying times of clinical death, play a certain role in the development of irreversible changes in the gray substance of the brain. The adsorption and sedimentation properties of the proteins return to normal during early postresuscitation period, whereas the electrophoretic mobility of protein fractions in polyacrylamide gel remains unchanged within the first day.

Animals↗

Perinatal asphyxia I: Pathogenesis of multisystemic sequelae.

This paper describes the clinical and pathologic sequelae of perinatal asphyxia manifested by 17 neonates treated at Howard University Hospital over an 18-month period. Multiple systemic complications, occurring in 76.5 percent of the patients, were the rule rather than the exception. All vital organs were involved, singly or in combination. Understanding the pathogenesis and extent of these complications is of utmost importance not only to those rendering health care to acutely ill newborns, but also to those responsible for prenatal and maternal intrapartum care.

Asphyxia Neonatorum↗

[Insulin activity of blood plasma in fetuses and newborn infants with asphyxia. Effect of insulin on the course of hypoxia and elimination of its sequelae under experimental conditions].

In this clinico-experimental work data are presented concerning the blood plasma insulin activity in mature fetuses and neonates in asphyxia; the influence of insulin on the course of hypoxia and elimination of its sequelae under experimental conditions on the newborn and sexually mature rats was also noted. The blood plasma insulin activity proved to increase in the neonates born of mothers with normally coursing pregnancy. A statistically significant reduction of the insulin activity was noted in neonates whose mothers suffered from toxemia of the second half of pregnancy. The death of fetuses and neonates was accompanied by a marked reduction of the blood plasma insulin activity. Preliminary administration of insulin increased the tolerance of experimental animals to hypoxia. Administration of insulin at the period of normalization of physiological functions after hypoxia produced a positive influence on the animal revival. Data are presented on the mechanism of insulin action in hypoxia.

Animals↗

[Activation of lipid peroxidation and its prevention with ionol during mechanical asphyxia followed by resuscitation].

It was shown in experiments on random-bred male rats that during mechanical asphyxia, lipid peroxidation in the brain, heart, lungs and skeletal muscles experiences activation. At the beginning of the resuscitation measures under elevated tissue oxygenation there is a further increase in the intensity of lipid peroxidation, whereas the content of lipid hydroperoxides and Schiff's bases approaches the initial values only after 3 months. It is assumed that excessive activation of lipid peroxidation plays the key role in the pathogenesis of the postresuscitation disease. Preliminary administration of the synthetic antioxidant ionol in a dose of 30 mg/kg reduces activation of lipid peroxidation in all the organs and tissues under study, improves energy supply of the brain and heart, and decreases 3-fold the lethality in the early postresuscitation period.

Animals↗

The evolution of cerebral hemispheric lesions due to pre- or perinatal asphyxia (clinical and neuroradiological correlation).

The clinical, neurophysiological and neuroradiological data of 10 babies who, at the age of three months showed a severe leucomalacia usually combined with cortical atrophy, are presented. All had shown signs of intrauterine asphyxia and were severely hypotonic and suffered from seizures in the neonatal period. At the age of 3 months, all patients were hypo- or hypertonic and had infantile spasms. Computed tomography (CT) in the neonatal period showed unspecific hypodensities and at the age of 3 months the complete CT picture of leucomalacia. Thereafter, CT remained unchanged. An angiographic examination in two cases showed a very marked rarefication of the leptomeningeal vessels and circulatory delay in the medial cerebral artery. The risk factors leading to this clinical and neuroradiological picture are discussed.

Asphyxia Neonatorum↗

[Intracranial hemorrhage and asphyxia in newborn infants studied further with the Doppler ultrasonic method].

The article discusses the results of an investigation by Doppler ultrasound on newborn infants, who were admitted at the neonatal intensive care unit of the 'Onze Lieve Vrouwe Gasthuis' at Amsterdam. The 'pulsatility index' (PI) of the Aa cerebri anteriores was measured in five groups of infants. The results of this investigation may contribute to a better understanding of the patho-physiology of asphyxia and intra-cranial hemorrhages in neonates. Further it appears that this method has a certain diagnostic and prognostic value concerning intra-ventricular hemorrhages. There is also evidence that increasing cerebral volume can be detected by this method.

Asphyxia Neonatorum↗

[Possible mechanisms of rat liver peroxidation of lipids in the recovery period after mechanical asphyxia].

Lipid peroxidation was stimulated in rat liver tissue after mechanical asphyxia due to inhibition of the antiradical and antiperoxidase systems simultaneously with an apparent increase in production of free radicals. Lipid peroxidation in liver membranes was maintained at the high level after reanimation despite of normalization (and occasional increase) of the activities of superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase.

Animals↗

CSF lactate levels in high risk neonates with and without asphyxia.

Determination of CSF lactate levels were performed in 150 nonasphyxiated and 46 asphyxiated high risk neonates. Statistical analysis of log lactate levels of nonasphyxiated infants showed significant relationship to gestational and postnatal ages (P < .0001 and < .0002, respectively). CSF lactate elevation was seen in 16/29 infants studied within eight hours of asphyxia in contrast to 0/17 infants studied after eight hours (P < .001). Higher incidence of CSF lactate elevation was seen in term infants (7/8), infants with fetal distress (13/17), and very low Apgar scores (11/18). Seven of eight infants with markedly elevated lactate levels had both fetal distress and very low Apgar scores. CSF lactate determination in the immediate postasphyxial period appears to be an objective way of assessing the severity of cerebral hypoxia.

Apgar Score↗

[Severe cardiac arrhythmia secondary to perinatal asphyxia].

A complex case of heart arrhythmia, probably, secondary to perinatal asphyxia is described. It was not possible to confirm a diagnosis from among the most common types of arrhythmias that develop during the neonatal period, such as congenital AV blockage, supraventricular paroxysmal tachycardia or ventricular paroxysmal tachycardia because of the changing pattern of the pacemaker and the rhythm.

Arrhythmias, Cardiac↗

Patterns and implications of MR contrast enhancement in perinatal asphyxia: a preliminary report.

PURPOSE: To determine the presence and location of MR contrast enhancement in infants with perinatal asphyxia and to evaluate the utility of enhancement in assessing extent of brain damage. METHODS: Precontrast and postcontrast MR examinations within the first 10 days of life were evaluated in 10 infants with suspected hypoxic-ischemic birth injury. Findings were correlated with clinical birth history and short-term neurologic follow-up. RESULTS: All four infants with MR signal abnormalities and contrast enhancement in the basal ganglia and brain stem had early seizures and profound neurologic deficits at early follow-up. Two infants had abnormal scans but no contrast enhancement; one with MR signal abnormality within the basal ganglia is neurologically healthy at 10-month follow-up, whereas the other, in status epilepticus at the time of imaging at age 2 days, died. Two infants with minimal parasagittal subcortical white matter enhancement had no early seizure activity and only mild developmental delay at early follow-up. Two infants with normal precontrast and postcontrast MR had no early seizures and remain healthy at early follow-up, despite initial clinical parameters similar to more severely injured infants. CONCLUSION: Although the number of patients is small, our results indicate that the presence of contrast enhancement in asphyxiated neonates may indicate more severe brain damage and, hence, a poorer prognosis.

Acid-Base Equilibrium↗

The management of traumatic asphyxia: case report and literature review.

Traumatic asphyxia is not as benign as has been indicated in the literature (2, 4) and may represent a life-threatening process. A thorough understanding of the involved pathophysiology coupled with aggressive cardiopulmonary management is essential for patient survival. In cases with severe pulmonary injury, the judicious employment of respirator and PEEP therapy is emphasized.

Asphyxia↗