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PubMed1997

[Traumatic asphyxia and continuous venovenous hemofiltration. Report of a case].

A 32-year-old man was admitted with traumatic asphyxia, with aspiration to the bronchi after being buried under sand. The condition progressed to respiratory distress syndrome and systemic inflammatory response. Because ventilatory and hemodynamic deterioration was rapid and severe, in spite of mechanical ventilation and vasoactive drugs, we instated early continuous arteriovenous hemofiltration, which also allowed us to meet the patient's full nutritional needs. We believe that the patient's very satisfactory progress can be attributed to the early use of this procedure, along with appropriate specific treatment.

Accidents, Occupational↗
PubMedDate not supplied

Anterior cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia.

During a five-year period, 47 term neonates with a history of asphyxia were investigated on the first day of life using intracranial Doppler ultrasonography to measure the Pourcelot resistance index (RI) of anterior cerebral artery. Another 30 healthy term neonates were also studied as controls. The results showed no significant differences in the gestational age and birth body weight between these two groups. However, the RI value of the Asphyxiated Group was significantly lower than that of the Control Group (mean +/- SD: 0.61 +/- 0.09 vs 0.71 +/- 0.03, respectively). End diastolic flow velocity (mean +/- SD: 10.8 +/- 3.1 vs 8.8 +/- 1.4 cm/sec) and mean flow velocity (mean +/- SD: 18.0 +/- 4.2 vs 15.6 +/- 2.1 cm/sec) of the Asphyxiated Group were significantly higher than those of the Control Group. The asphyxiated patients were divided into three groups according to RI values. There were significant differences among Group A (RI < 0.55). Group B (0.55 < or = RI < 0.6) and Group C (RI > or = 0.6). These patients were followed up clinically for 15 to 65 months (mean: 39 months). Twenty patients in the Asphyxiated Group had neurodevelopmental delay with mild to moderate handicaps, whereas none in the Control Group had neurological sequelae in the follow-up period. This study demonstrates that, on the first day of life, a low RI value for asphyxiated neonates is associated with an adverse prognosis and may be considered as one of the earliest indicators for poor neurodevelopmental outcome.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Reversal of a right-left shunt and permanent improvement of oxygenation by inhalation of nitrogen monoxide in a premature infant with lung hypoplasia and asphyxia].

We report the case of a 29 weeks gestation female premature infant who suffered from severe postnatal asphyxia following spontaneous vaginal delivery. Prenatally lung hypoplasia due to prematurely ruptured membranes with subsequent oligohydramnios was suspected sonographically. Echocardiography revealed right-to-left shunting via PDA and foramen ovale, in addition to that tricuspid incompetence with a pulmonary arterial pressure gradient of 40 mmHg was demonstrated. At an oxygenation index (OI) of 34, an arterio-alveolar oxygen difference (AaDO2) of 639 mmHg, an FiO2 of 1.0 and a maximal paO2 of 37 mmHg during high frequency ventilation (HFV), we applied inhaled nitric oxide (up to 70 ppm) for a duration of approximately 30 hours. Within two hours the inspiratory oxygen concentration could be weaned to an FiO2 of 0.21, mean airway pressures were reduced markedly. Echocardiographically tricuspid incompetence had disappeared, the PDA was closed and now left-to-right shunting across the foramen ovale was demonstrated. The infant was extubated on day 5 and subsequently had oxygen requirements up to an FiO2 of 0.3 during spontaneous breathing for 20 days.

Administration, Inhalation↗
PubMed1977

[Rate of excitation spread along a peripheral nerve in healthy infants in the 1st year of life and in infants who have had intrauterine hypoxia and asphyxia at birth].

The velocity in the extension of excitation through the peripheral nerves was studied in 99 normal babies of the first year and in 135 children with intrauteral hypoxia and asphyxia during delivery. In children with perinatal lesions of the CNS there were changes in the absolute volumes of the velocity of excitation and the rate of its increase compared with the group of normal children. The data correlate with the results of histological studies of the peripheral nerve.

Afferent Pathways↗
PubMedDate not supplied

[Neuropsychological consequences of perinatal asphyxia].

Perinatal asphyxia has been classically related to important neurological diseases such as cerebral palsy, but it it also stated that a high percentage of child with a good outcome did not show any sequelae. We reviewed cerebral lesions demonstrated by post-mortem analysis and the structural MRI contributions to the anatomo-functional correlates. The most frequent neuropsychological disturbances showed by these patients in the general intelligence, perceptive functions, memory and emotional and social behavior were also summarized.

Asphyxia Neonatorum↗
PubMed1996

[Asphyxia of the newborn delivered by elective cesarean section and gastroesophageal reflex and aspiration].

OBJECTIVE: To analyse the causes, clinical manifestation, management and prevention of gastroesophageal reflex and aspiration (GER-A) in the infants delivered by cesarean section. METHOD: The clinical data of 6 infants with asphyxia resulted from GER-A, delivered by elective cesarean section were retrospectively analysed. RESULTS: GER-A occurred during the period from 5 to 12 minute after birth, and its main clinical manifestation was airway obstruction. Among the patients, four cases recovered completely after treatment, one was diagnosed as having aspiration pneumonia and the other died of severe bronchospasm. CONCLUSIONS: The occurrence of this complication was probably related to the mode of delivery by cesarean section, the underdevelopment of effective barrier for preventing GER-A at very early stage and the inadequate management of the newborn. It is suggested that the prevention and proper treatment of GER-A was important in lowering neonatal morbidity and mortality.

Asphyxia Neonatorum↗
PubMed1998

Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems.

PURPOSE: We developed a scoring system for the assessment of perinatal asphyxia as depicted on MR images. METHODS: Four scoring systems were derived to evaluate MR images obtained in asphyxiated neonates: the basal ganglia (BG) score, the watershed (W) score, the combined basal ganglia/watershed (BG/W) score, and the sum of the BG and W scores, the summation (S) score. In addition, three MR sequences, T1-weighted, first-echo T2-weighted, and second-echo T2-weighted, were assessed for each patient for each scoring system. Neuromotor examinations were performed at ages 3 and 12 months, and cognitive development was tested at age 12 months. Statistical analysis was then performed to test the relationship between the MR scores and the outcome scores. RESULTS: The BG/W score, obtained with the first-echo T2-weighted sequence, was the most useful overall score for predicting neuromotor outcome at 3 and 12 months and cognitive outcome at 12 months. T1-weighted and first-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the first postnatal week, whereas second-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the second postnatal week. CONCLUSION: It appears that, with the use of the BG/W score, MR imaging discriminates accurately between patients with good and poor neuromotor and cognitive outcome at 3 and 12 months. In terms of our scoring systems, the first-echo T2-weighted sequence appears to discriminate best between patients with good and poor 3- and 12-month outcomes. Proper use of the imaging sequences and scoring systems described in this article can increase the knowledge base upon which treatment decisions are made in asphyxiated neonates.

Asphyxia Neonatorum↗
PubMed1976

Experiments on placental circulation and transplacental transfer in exteriorized foetuses in hypoxia and after asphyxia in guinea pigs.

Experiments were carried out on near term pregnant guinea pigs. Cesarean section was performed and by exteriorization of the foetuses the placental stage of labor was simulated. In one group of foetuses, chosen at random, we induced hypoxia, and in an another series of experiments asphyxia, each group with its own control. The results of acid-base values, experimental antipyrine transplacental transfer studies and the survival rate of foetuses, showed that it is advantageous for the newborn animal if we preserve the placental function in such conditions immediately post partum. Further study is necessary to determine to what degree and under what conditions our experimental observations are applicable to human perinatology.

Animals↗
PubMed1997

[Clinical and prognostic value of cardiovascular symptoms in perinatal asphyxia].

OBJECTIVE: The myocardium, while selected as a preferred organ for perfusion in the asphyxiated fetus or newborn, nevertheless may suffer damage. The objectives of this study were: (1) to analyze the frequency and type of cardiovascular (CV) manifestations in perinatal asphyxia (PA); (2) to evaluate the perinatal differences in asphyxiated term infants with and without CV involvement; and (3) to know the importance of CV manifestations in relationship to neurological sequelae in PA. PATIENTS AND METHODS: One hundred and fifty-six consecutive asphyxiated full-term newborns were studied prospectively. During the neonatal period, systematic CV evaluations, including clinical examination, heart rate and blood pressure monitoring, and complementary procedures (chest X-rays, electrocardiograms and echocardiograms), were performed on every infant with PA. Those with CV involvement were classified into two groups: "minor" (dysrhythmias and mild hypotension) and "major" (transient tricuspid insufficiency, myocardial ischemia, cardiogenic and/or hypovolemic shock). CV involvement was analyzed with regard to severity of PA, hypoxic-ischemic encephalopathy (based on the classification of Levene) and neurologic sequelae after a follow-up period of at least 12-months (based on the classification of Finer and Amiel-Tison). RESULTS: CV manifestations were observed in 31 (19.8%) of the infants and classified as minor in 27 cases (mainly mild hypotension and bradycardia) and major in 4. CV involvement was found significantly more frequently in asphyxiated newborns with severe PA (p < 0.001) and those with neurological and other extraneurological manifestations (p < 0.001). In relation to neurologic sequelae at follow-up, the only significant extraneurologic involvement in PA was CV involvement (univariant analysis by Cox's regression; RR = 3.96, CI95% = 1.50-10.45). CONCLUSIONS: A significant association was found between CV manifestations and all of the neurological and extraneurological dysfunctions in PA, based on the severity of the hypoxic-ischemic lesion. The incidence of severe CV damage is low, although less severe manifestations may be frequent (mainly mild hypotension and bradycardia). The results of this study indicate the need for CV assessment in asphyxiated term newborn infants based on its clinical and prognostic value in relationship to neurological sequelae.

Asphyxia Neonatorum↗
PubMed1976

Differences between elevations of plasma and serum potassium in pentobarbital-narcotized cats during asphyxia.

During acute asphyxia in pentobarbital-narcotized cats, the elevation in plasma potassium level was parallel to that of PCO2. From the time when PO2 reached its minimum, the elevation in serum potassium was higher than that of plasma potassium. The increase of the difference between serum and plasma potassium values seems therefore to be more related to hypoxia than hypercapnia; it could be due to membrane alteration of blood cells.

Animals↗
PubMed1988

Studies on asphyxia: on the changes of the alveolar walls of rats in the hypoxic state. II. The hypoxic state produced by carbon dioxide and methane gases.

Experimental studies were presented here concerning death by asphyxia due to the inhalation of carbon dioxide and methane gases. The morphological changes were almost the same as those demonstrated in our previous report. The authors concluded that the morphological changes in the lung tissue were not attributable to the chemical specificity of gases used in the experiment but to the decrease of oxygen.

Animals↗
PubMedDate not supplied

Cyanide-induced chronic partial asphyxia in vitro: neurochemical abnormalities and reversal by magnesium.

Neuronal cortical cell cultures obtained from fetal mice were subjected to increasing concentrations of sodium cyanide (10-500 microM) for 6 days in order to simulate prolonged partial asphyxia. Various neurochemical assays were performed to determine if certain cell types were preferentially more affected. Choline acetyltransferase activity was reduced significantly from control values at cyanide concentrations greater than 100 microM; there were similar reductions on a percentage basis in high-affinity uptake of beta-alanine and GABA and in clonazepam-displaceable benzodiazepine (BDZ) binding which reflected the neuronal BDZ receptor population. Ro5-4864-displaceable BDZ binding, a nonneuronal marker, was increased significantly. More modest reductions were apparent in specific BDZ binding and in protein content. Although a particular vulnerability of a specific cell type was not demonstrated, there was more neurochemical than morphologic evidence of cellular dysfunction. Co-exposure of the cultures to magnesium along with the highest concentrations of cyanide substantially prevented both neurochemical and morphologic abnormalities. These results lend further support to the concept that excitatory neurotransmitters may be implicated in the neuronal damage produced by hypoxia.

Animals↗
PubMed2004

Use of oxytocin in penned sows and its effect on fetal intra-partum asphyxia.

The objective of the present study was to evaluate in penned sows the effect of two commercial oxytocin products on umbilical cord pathology, degree of asphyxia and intra-partum mortality. This study included 120 sows divided in three groups of 40 animals with eight animals for parities one to five per subgroup, respectively. Group 1 (G(1)) or control received saline solution while oxytocin groups (G(2)) and (G(3)) were injected at the onset of fetal expulsion with two oxytocin products. The doses of oxytocin were as follow: Primiparous sows weighing less than 130 kg received 20 IU; multiparous sows weighing 130-180 g received 30 IU, and those above 250 kg, 40 IU. Piglets born alive and/or dead were classified at birth using a subjective scale based on the degree of meconium staining on skin. Umbilical cords of intra-partum stillbirths (IPS) were classified as adhered or ruptured and subdivided into four categories: without pathological changes, edematous, congested and hemorrhagic. Result analyses revealed significant differences (P < 0.01) between groups 1 and 2, and 1 and 3 regarding the following traits: expulsion interval (min) (X: G(1) 27.7; G(2) 22.6; G(3) 22.2), IPS with a severe stain degree (X: G(1) 0.10; G(2) 0.45; G(3) 0.50), IPS with ruptured umbilical cords (X: G(1) 0.07; G(2) 0.42; G(3) 0.47), and detectable heartbeats in IPS (X: G(1) 0.27; G(2) 0.25; G(3) 0.22). Treatment with oxytocin reduced the duration of the expulsion of the fetus, increased the number of IPS with ruptured umbilical cords and with severe meconium-stain degree and reduced the number of fetuses with inspiration attempts. Furthermore, the use of this hormone increased the need for obstetric assistance due to increased frequency of dystocia.

Animals↗
PubMed2005

Uterine and fetal asphyxia monitoring in parturient sows treated with oxytocin.

Oxytocin is used to induce and control parturition, nevertheless, the increase of uterine contractions decreases blood flow and gaseous exchange through the womb predisposing to intra-partum mortality. The objective of the present study was to evaluate the effect of oxytocin on myometrial activity, fetal intrauterine hypoxia and postnatal asphyxia in sows during farrowing. Hybrid (n = 120) sows approaching the time of farrowing were randomly assigned in two groups of 60 animals each. Group I (G(1): control) was treated IM with saline solution and Group II (G(2)) was injected IM with oxytocin (1IU/6kg LW) as a single dose at birth of the first piglet. Both average number of myometrial contractions and intensity in G(2) were greater (P < 0.01) as compared with G(1). The mean of intra-partum stillbirths (IPS's) and those where fetal cardiac frequency (FCF) or heart beats, could not be detected after birth, were greater (P < 0.01) in G(2) as compared with G(1). The average decelerations of FCF known as dips II, which indicate severe hypoxia, was greater in G(2) (P < 0.01) as compared with that of G(1). There was a greater (P < 0.01) number of intra-partum stillbirths, stained with severe meconium in G(2) when compared with G(1). Oxytocin treatment increased (P < 0.01) the number of pigs born alive with ruptured umbilical cords and those with different grades of meconium staining on their skin. It was concluded that administration of oxytocin at the onset of parturition increased the myometrial activity, decreased fetal cardiac frequency, predisposed the rupture of umbilical cords and the degree of meconium staining, and increased intra-partum mortality.

Animals↗
PubMed2000

Nucleated red blood cells as a marker in acute and chronic fetal asphyxia.

OBJECTIVE: To investigate the variations of nucleated red blood cell (NRBC) counts in acute and chronic fetal hypoxia and to examine if it could be possible to establish a cutoff value for the number of NRBCs for prediction of fetal acidosis. METHOD: We prospectively studied 77 pregnant women. Patients were grouped as acute (n=11) and chronic fetal distress (n=21) and controls (n=45). At delivery the umbilical cord was double clamped and blood samples were collected. RESULTS: The mean NRBC counts in chronic fetal distress group was higher than acute fetal distress. NRBC counts were found to be correlated with umbilical cord pH (r=-0.57; P<0.001). The cutoff value predicting fetal acidosis was determined as 14/100 leukocytes (sensitivity 87%, specificity 81%) by using ROC analysis. CONCLUSION: The duration and the severity of fetal asphyxia may be predicted by the number of NRBCs per leukocyte.

Acidosis, Respiratory↗
PubMed2000

The effect of asphyxia on superior mesenteric artery blood flow in the premature sheep fetus.

BACKGROUND/PURPOSE: The aim of this study was to determine superior mesenteric artery blood flow changes during and after an asphyxial insult in utero in chronically instrumented unanaesthetised premature fetal sheep. METHODS: Fetal sheep at 0.7 gestation (103 to 104 days) underwent 25 minutes of complete umbilical cord occlusion (n = 6) or sham occlusion (n = 6). Fetal heart rate, blood pressure, superior mesenteric artery (SMA) blood flow and vascular resistance, electroencephalographic activity, and nuchal electromyographic activity were measured from 6 hours before occlusion until 3 days after occlusion. Fetal gastrointestinal tissue was taken for histological assessment. RESULTS: During occlusion, cardiovascular response was characterised by 3 phases: initial redistribution of blood flow away from the gut to maintain vital organ function, subsequently partial failure of this redistribution, and finally near terminal cardiovascular collapse with profound hypotension and gastrointestinal hypoperfusion. Postasphyxia there was a secondary period of hypoperfusion that was mediated by increased vascular resistance, not hypotension. There was no evidence of injury on standard histological assessment after 3 days of recovery. CONCLUSIONS: SMA blood flow is not only significantly reduced during asphyxia, but also for several hours after an asphyxial insult. The authors speculate that these perturbations of gastrointestinal blood flow could compromise gut wall integrity potentially leading to increased vulnerability to necrotising enterocolitis.

Animals↗
PubMed1980

Fetal lamb lung phosphatidylcholine: response to asphyxia and recovery.

Acute fetal asphyxia resulting from maternal blood loss and hypotension causes a reduction in the incorporation of precursors into disaturated phosphatidylcholine, the principal lipid in the pulmonary surfactant. Treatment of the maternal hypotension is associated with return of fetal lung DSPC synthesis to control levels by 72 hours.

Acidosis, Respiratory↗
PubMed1992

Erythroblastosis in birth asphyxia.

The pH and erythroblast count in umbilical venous blood were measured in 27 term neonates with normal birth weights. In seven cases, infants were admitted to the neonatal intensive care unit because of birth asphyxia, and the findings in these cases were compared to the values of the 20 non-asphyxiated neonates that were delivered either vaginally (n = 10) or by elective Cesarean section (n = 10). The umbilical venous blood pH in the asphyxiated group was significantly lower than that in the control group of infants that were delivered by Cesarean section, but not significantly different from the controls that were delivered vaginally. In contrast, the erythroblast count in the asphyxiated group was significantly higher than that in the controls, irrespective of the mode of delivery. These findings suggest that cord blood erythroblast count at delivery may provide a better measure of fetal tissue hypoxia than umbilical venous pH.

Journal Article↗