Reciprocal assessment of urinary beta-2-microglobulin and BUN levels in renal dysfunction of neonates with birth asphyxia.

OBJECTIVE: Asphyxia at birth is one of the major causes of morbidity and mortality in all neonates due to various organ dysfunctions, for example, kidneys. Recent advances in this area have suggested new urinary proteins for the assessment of renal damage, including beta-2 microglobulin (ß2-MG). The aim of this study was to investigate the changes of urinary ß2-MG in asphyxiated neonates and to evaluate the value of combined detection of multiple biomarkers in the early diagnosis of acute kidney injury (AKI) in asphyxiated neonates. STUDY DESIGN: This case-control study was performed on 84 term neonates in two control and case groups who were hospitalized at the neonatal intensive care unit. Using the Sarnat scoring system, the asphyxiated neonates were neurologically divided. Renal function tests and urinary ß2-MG (uß2-MG) levels of participants who registered based on inclusion criteria were measured. The data analyzed using descriptive and inferential statistical tests. The diagnostic value of the biomarker was determined using receiver operating characteristic (ROC) curves. RESULTS: This study showed that uß2-MG was not a statistically significant difference in both asphyxiated neonates with AKI and non-AKI (p = .085). Whereas, uß2-MG levels were statistically significant in neurological grading of asphyxiated infants to two groups (p = .013). A new predictor, uß2-MG and blood urea nitrogen (BUN); named BB1, was substituted as the diagnostic value in neonates with asphyxia with an area under the receiver operating characteristic curve (AUC) (95% CI) of 0.88 (0.76-1.0). This AUC was significantly greater than the value for uß2-MG associated with AKI (p = .003). CONCLUSION: Our findings showed that mutual detection of uß2-MG levels with BUN should be an early indicator for the diagnosis of renal injury with greater specificity and improved prognostic accuracy after neonatal asphyxia.

The incidence and implications of cerebral palsy following potentially avoidable obstetric complications: a preliminary burden of disease study.

OBJECTIVE: To determine the extent of cerebral palsy attributable to adverse obstetric events, and estimate the lifetime mortality and morbidity expectations of these individuals relative to age-matched members of the UK general population. DESIGN: Simulation model. SETTING UK POPULATION: All projected live births during 2014. METHODS: Using published data regarding the incidence and aetiology of cerebral palsy, we simulated the outcomes of a hypothetical cohort of UK live births. Survival and quality of life (QoL) for those with cerebral palsy were compared with age-matched individuals representative of the UK general population, in order to estimate the number of quality-adjusted life years (QALYs) lost following asphyxia-related cerebral palsy. MAIN OUTCOME MEASURES: Incidence of asphyxia-related cerebral palsy, QALYS, QoL, and survival. RESULTS: A total of 207 (95% CI 169-245) cases of asphyxia-related cerebral palsy were projected amongst UK children born during the year 2014, with approximately 15.2 QALYs lost per case. If these results held true in a real birth cohort, 3142 (95% CI 2321-3963) QALYs would be lost as a consequence of asphyxia-related cerebral palsy, a loss valued by the UK National Health Service at £62.9 m (95% CI £46.4-79.3 m). CONCLUSIONS: Cerebral palsy following intrapartum asphyxiation leads to significant reductions in QoL and survival; however, this may often be prevented. For those with GMFCS 1 and GMFCS 2 cerebral palsy (Gross Motor Function Classification System), lifetime QALYs accrued largely resemble those experienced by the UK general population, whereas for GMFCS 3 and GMFCS 4 QALYs are reduced considerably, and are negative in the case of GMFCS 5.

Quantitative assessment of somatosensory-evoked potentials after cardiac arrest in rats: prognostication of functional outcomes.

OBJECTIVE: High incidence of poor neurologic sequelae after resuscitation from cardiac arrest underscores the need for objective electrophysiological markers for assessment and prognosis. This study aims to develop a novel marker based on somatosensory evoked potentials (SSEPs). Normal SSEPs involve thalamocortical circuits suggested to play a role in arousal. Due to the vulnerability of these circuits to hypoxic-ischemic insults, we hypothesize that quantitative SSEP markers may indicate future neurologic status. DESIGN: Laboratory investigation. SETTING: University Medical School and Animal Research Facility. SUBJECTS: : Sixteen adult male Wistar rats. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: SSEPs were recorded during baseline, during the first 4 hrs, and at 24, 48, and 72 hrs postasphyxia from animals subjected to asphyxia-induced cardiac arrest for 7 or 9 mins (n = 8/group). Functional evaluation was performed using the Neurologic Deficit Score (NDS). For quantitative analysis, the phase space representation of the SSEPs-a plot of the signal vs. its slope-was used to compute the phase space area bounded by the waveforms recorded after injury and recovery. Phase space areas during the first 85-190 mins postasphyxia were significantly different between rats with good (72 hr NDS >or=50) and poor (72 hr NDS <50) outcomes (p = .02). Phase space area not only had a high outcome prediction accuracy (80-93%, p < .05) during 85-190 mins postasphyxia but also offered 78% sensitivity to good outcomes without compromising specificity (83-100%). A very early peak of SSEPs that precedes the primary somatosensory response was found to have a modest correlation with the 72 hr NDS subscores for thalamic and brainstem function (p = .066) and not with sensory-motor function (p = .30). CONCLUSIONS: Phase space area, a quantitative measure of the entire SSEP morphology, was shown to robustly track neurologic recovery after cardiac arrest. SSEPs are among the most reliable predictors of poor outcome after cardiac arrest; however, phase space area values early after resuscitation can enhance the ability to prognosticate not only poor but also good long-term neurologic outcomes.

Ahogamiento incompleto, valoración de la injuria cerebral al ingreso: terapia intensiva pediátrica / Nearly drowning, valuation of the cerebral injury when entering the hospital: intensive pediatric therapy

Se realizó una investigación descriptiva retrospectiva que incluyó a todos los pacientes que fueron ingresados en el Servicio de Terapia Intensiva del Hospital Eliseo Noel Caamaño, en el período comprendido desde junio de 1982 hasta junio de 2004, con el diagnóstico de Ahogamiento Incompleto, con el propósito de determinar el estado neurológico y su relación con diferentes variables que pueden haber influido en la intensidad del daño, así como la sobrevivencia final de los mismos. Los resultados obtenidos nos permitieron conocer el manejo del paciente pediátrico que ha sufrido este tipo de accidentes, así como su estado a la llegada al Servicio. El 68 por ciento de los pacientes tuvieron una afección de moderada a severa según las escalas de Conn y Glasgow, además existió una correlación de hasta un 97 por ciento entre dichos métodos de evaluación. Dentro de las variables que influenciaron en el estado de los niños al ingreso se destacó un tiempo de inmersión mayor de 5 minutos para los clasificados como severos, 70 por ciento de la muestra, fallecieron el 7 por ciento de todos los pacientes estudiados, todos ellos clasificados como severos.

We carried out a descriptive retrospective study including all the patients that were entered in the Service of Intensive Therapy of the hospital Eliseo Noel Caamaño, in the period from June 1982 to June 2004, with the diagnosis of nearly drowning, with the purpose of determining the neurological state and its relation with different variables that might have influence in the intensity of the damage, as well as in the final surviving of the patients. The obtained results allowed us knowing the managing of the paediatrics patient that have suffered this kind of accidents, as well as their state at the arrival to the service; 68 percent of the patients had a moderated to severe affection according to the Conn and Glasgow scales; moreover, there was a correlation of up to 97 percent between these evaluation methods. Among the variables that influenced in the state of the children at the entering, there was an immersion time of more than 5 minutes for those classified as severe, 70 percent of the sample; 7 percent of all the studied patients died, all of them classified as severe.

On-site triage of avalanche victims with asystole by the emergency doctor.

Asystole in avalanche victims is generally due to asphyxia and not primarily to hypothermia. Hence, on-site establishment of death by asphyxiation would avoid evacuation risks to the rescue party, as well as high costs of transport to, and treatment at, frequently distant specialist centres in cases with a hopeless prognosis. This paper presents a novel differential diagnosis scheme based on burial duration (critical time 45 min) and core temperature (critical level 32 degrees C) of the person on extrication, as well as the presence or absence of an air pocket, facilitating on-site identification of asphyxiated victims. When information regarding an air pocket is uncertain in victims buried longer than 45 min, determination of serum potassium (critical level 10 mmol/l) at the nearest hospital becomes an alternative criterion for triage. The proposed guidelines aim to clarify field decision-making for the emergency doctor with respect to discontinuation of resuscitation and limitation of transferral for cardiopulmonary bypass core rewarming to those patients with presumptive reversible hypothermia.