Acute kidney injury in neonates with hypoxic ischemic encephalopathy based on serum creatinine decline compared to KDIGO criteria.

BACKGROUND: Neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia (HIE + TH) are at risk for acute kidney injury (AKI). The standardized Kidney Disease Improving Global Outcomes (KDIGO) criteria identifies AKI based on a rise in serum creatinine (SCr) or reduced urine output. This definition is challenging to apply in neonates given the physiologic decline in SCr during the first week of life. Gupta et al. proposed alternative neonatal criteria centered on rate of SCr decline. This study aimed to compare the rate of AKI based on KDIGO and Gupta in neonates with HIE and to examine associations with mortality and morbidity. METHODS: A retrospective review was performed of neonates with moderate to severe HIE + TH from 2008 to 2020 at a single center. AKI was assessed in the first 7 days after birth by KDIGO and Gupta criteria. Mortality, brain MRI severity of injury, length of stay, and duration of respiratory support were compared between AKI groups. RESULTS: Among 225 neonates, 64 (28%) met KDIGO, 69 (31%) neonates met Gupta but not KDIGO, and 92 (41%) did not meet either definition. Both KDIGO-AKI and GuptaOnly-AKI groups had an increased risk of the composite mortality and/or moderate/severe brain MRI injury along with longer length of stay and prolonged duration of respiratory support compared to those without AKI. CONCLUSIONS: AKI in neonates with HIE + TH was common and varied by definition. The Gupta definition based on rate of SCr decline identified additional neonates not captured by KDIGO criteria who are at increased risk for adverse outcomes. Incorporating the rate of SCr decline into the neonatal AKI definition may increase identification of clinically relevant kidney injury in neonates with HIE + TH.

Time to recovery of asphyxiated neonates and its' predictors among newborns admitted to neonatal intensive care unit at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

BACKGROUND: Neonatal asphyxia is a leading cause of early neonatal mortality, accounting for approximately 900,000 deaths each year. Assessing survival rates, recovery time and predictors of mortality among asphyxiated neonates can help policymakers design, implement, and evaluate programs to achieve the sustainable development goal of reducing neonatal mortality to 12/1,000 live births by 2030. The current study sought to ascertain the survival status, recovery time, and predictors of neonatal asphyxia. METHODS: A retrospective follow-up study conducted in Debre Berhan Comprehensive Specialized Hospital, which carried out from May 20th to June 20th, 2023 using records of asphyxiated babies in NICUs from January 1st, 2020 to December 31st, 2022, involving a sample size of 330. Pre-structured questionnaires created in Google Form were used to collect data, and STATA Version 14.0 was utilized for data entry and analysis, respectively. The Kaplan-Meier survival curve, log rank test, and median time were calculated. A multivariable Cox proportional hazards regression model was fitted in order to determine the predictors of time to recovery. Variables were statistically significant if their p-value was less than 0.05. RESULTS: Three hundred thirty admitted asphyxiated neonates were followed a total of 2706 neonate -days with a minimum of 1 day to 18 days. The overall incidence density rate of survival was 9.9 per 100 neonates' days of observation (95% CI: 8.85-11.24) with a median recovery time of 9 days (95% CI: 0.82-0.93). Prolonged labor (Adjusted hazard ratio (AHR: 0.42,95%CI:0.21-0.81), normal birth weight (AHR:2.21,95% CI: 1.30-3.70),non-altered consciousness (AHR:2.52,CI:1.50-4.24),non-depressed moro reflex of the newborn (AHR:2.40,95%CI: 1.03-5.61), stage I HIE (AHR: 5.11,95% CI: 1.98-13.19),and direct oxygen administration via the nose (AHR: 4.18,95% CI: 2.21-7.89) were found to be independent predictors of time to recovery of asphyxiated neonates.. CONCLUSION: In the current findings, the recovery time was prolonged compared to other findings. This implies early diagnosis, strict monitoring and provision of appropriate measures timely is necessary before the babies complicated into the highest stage of hypoxic -ischemic encephalopathy(HIE) and managing complications are the recommended to hasten recovery time and increase the survival of neonates.

Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023.

BACKGROUND: Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia. METHOD: A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables. RESULTS: The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia. CONCLUSIONS: In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.

The benefit of active management in true knot of the umbilical cord: a retrospective study.

PURPOSE: To compare perinatal outcomes between active and routine management in true knot of the umbilical cord (TKUC). METHODS: A retrospective study of singletons born beyond 22 6/7 weeks with TKUC. Active management included weekly fetal heart rate monitoring(FHRM) ≥ 30 weeks and labor induction at 36-37 weeks. Outcomes in active and routine management were compared, including composite asphyxia-related adverse outcome, fetal death, labor induction, Cesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), Apgar5 score < 7, cord Ph < 7, neonatal intensive care unit (NICU) admission and more. RESULTS: The Active (n = 59) and Routine (n = 1091) Management groups demonstrated similar rates of composite asphyxia-related adverse outcome (16.9% vs 16.8%, p = 0.97). Active Management resulted in higher rates of labor induction < 37 weeks (22% vs 1.7%, p < 0.001), CS (37.3% vs 19.2%, p = 0.003) and NICU admissions (13.6% vs 3%, p < 0.001). Fetal death occurred exclusively in the Routine Management group (1.8% vs 0%, p = 0.6). CONCLUSION: Compared with routine management, weekly FHRM and labor induction between 36 and 37 weeks in TKUC do not appear to reduce neonatal asphyxia. In its current form, active management is associated with higher rates of CS, induced prematurity and NICU admissions. Labor induction before 37 weeks should be avoided.

Metabolite Biomarkers for Early Ischemic-Hypoxic Encephalopathy: An Experimental Study Using the NeoBase 2 MSMS Kit in a Rat Model.

Hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of childhood disability. Hypothermic therapy is currently the only approved neuroprotective approach. However, early diagnosis of HIE can be challenging, especially in the first hours after birth when the decision to use hypothermic therapy is critical. Distinguishing HIE from other neonatal conditions, such as sepsis, becomes a significant problem in diagnosis. This study explored the utility of a metabolomic-based approach employing the NeoBase 2 MSMS kit to diagnose HIE using dry blood stains in a Rice-Vannucci model of HIE in rats. We evaluated the diagnostic fidelity of this approach in a range between 3 and 6 h after the onset of HIE, including in the context of systemic inflammation and concomitant hypothermic therapy. Discriminant analysis revealed several metabolite patterns associated with HIE. A logistic regression model using glycine levels achieved high diagnostic fidelity with areas under the receiver operating characteristic curve of 0.94 at 3 h and 0.96 at 6 h after the onset of HIE. In addition, orthogonal partial least squares discriminant analysis, which included five metabolites, achieved 100% sensitivity and 80% specificity within 3 h of HIE. These results highlight the significant potential of the NeoBase 2 MSMS kit for the early diagnosis of HIE and could improve patient management and outcomes in this serious illness.

Myocardial Work for Dynamic Monitoring of Myocardial Injury in Neonatal Asphyxia.

To assess the value of parameters of myocardial work for dynamic monitoring of myocardial injury after neonatal asphyxia. Fifty-three neonates with asphyxia admitted within 24 h after delivery were divided into a mild asphyxia group (n = 40) and severe asphyxia group (n = 13). Echocardiography was performed within 24 h post-birth, within 72 h post-birth (48 h after first echo), and during recovery. The left ventricular ejection fraction on M-mode echocardiography and by Simpson's biplane method (LVEF and Bi-EF, respectively), stroke volume (SV), cardiac output (CO), cardiac index (CI), global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), and other parameters were measured. Echocardiographic indicators were compared between groups and over time. GWI was significantly increased at 72 h in the mild asphyxia group (P < 0.05) but showed no significant change over time in the severe asphyxia group (P > 0.05). While GCW increased significantly over time in both groups (P < 0.05), it increased earlier in the mild asphyxia group. Time and grouping factors had independent effects on GWI and GCW (P > 0.05). The characteristics of differences in GWI and GCW between the two groups were different from those for LVEF, Bi-EF, SV, CO, CI, and GLS and their change characteristics with improvement from treatment. GWI and GCW changed significantly during recovery from neonatal asphyxia, and their change characteristics differed between mild and severe asphyxia cases. Myocardial work parameters can be used as valuable supplements to traditional indicators of left ventricular function to dynamically monitor the recovery from myocardial injury after neonatal asphyxia.

Oligodendrocyte progenitor cells' fate after neonatal asphyxia-Puzzling implications for the development of hypoxic-ischemic encephalopathy.

Premature birth or complications during labor can cause temporary disruption of cerebral blood flow, often followed by long-term disturbances in brain development called hypoxic-ischemic (HI) encephalopathy. Diffuse damage to the white matter is the most frequently detected pathology in this condition. We hypothesized that oligodendrocyte progenitor cell (OPC) differentiation disturbed by mild neonatal asphyxia may affect the viability, maturation, and physiological functioning of oligodendrocytes. To address this issue, we studied the effect of temporal HI in the in vivo model in P7 rats with magnetic resonance imaging (MRI), microscopy techniques and biochemical analyses. Moreover, we recreated the injury in vitro performing the procedure of oxygen-glucose deprivation on rat neonatal OPCs to determine its effect on cell viability, proliferation, and differentiation. In the in vivo model, MRI evaluation revealed changes in the volume of different brain regions, as well as changes in the directional diffusivity of water in brain tissue that may suggest pathological changes to myelinated neuronal fibers. Hypomyelination was observed in the cortex, striatum, and CA3 region of the hippocampus. Severe changes to myelin ultrastructure were observed, including delamination of myelin sheets. Interestingly, shortly after the injury, an increase in oligodendrocyte proliferation was observed, followed by an overproduction of myelin proteins 4 weeks after HI. Results verified with the in vitro model indicate, that in the first days after damage, OPCs do not show reduced viability, intensively proliferate, and overexpress myelin proteins and oligodendrocyte-specific transcription factors. In conclusion, despite the increase in oligodendrocyte proliferation and myelin protein expression after HI, the production of functional myelin sheaths in brain tissue is impaired. Presented study provides a detailed description of oligodendrocyte pathophysiology developed in an effect of HI injury, resulting in an altered CNS myelination. The described models may serve as useful tools for searching and testing effective of effective myelination-supporting therapies for HI injuries.

A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy.

OBJECTIVE: The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated. METHODS: A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated. RESULTS: UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases). CONCLUSION: A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.

Vortioxetine Exposure During Pregnancy and Lactation: A Japanese Case Study of Neonatal Implications and Quantitative Milk and Plasma Analyses.

Background: Information about influences of vortioxetine on pregnant women and neonates during perinatal period is almost unknown. Case Presentation: The case was a 28-year-old Japanese woman in her first pregnancy, treated for depression with vortioxetine (20 mg daily) among other medications. At 36 weeks of gestation, she was admitted for premature rupture of the membranes and delivered a girl with no apparent congenital anomalies. Immediately after birth, the neonate required brief respiratory support due to her dyspnea and poor muscle tone. Her respiratory condition improved in 6 days after delivery, and she demonstrated normal developmental progress afterward. Maternal plasma and breast milk samples, collected 4 days postpartum, revealed vortioxetine concentrations of 11.4 ng/mL and 9.3 ng/mL, respectively. The calculated relative infant dose (RID) was estimated at 0.32%. After discharge from hospital, the infant presented no detectable drug-related adverse effects, with over 50% of nutrition derived from breastfeeding. Conclusion: This case showed minimal transfer of vortioxetine into breast milk, reflected in a low RID. The findings suggest limited neonatal exposure to the drug, with no adverse developmental effects observed in the infant. However, the case also indicated the potential for vortioxetine use during pregnancy to contribute to the onset of severe neonatal asphyxia. Further research is needed for a comprehensive understanding of its impact on neonatal health.

Case Report: A neonatal case of cryopyrin-associated periodic syndrome with severe funisitis and neonatal asphyxia.

Cryopyrin-associated periodic syndrome (CAPS) is a genetic disorder and autoinflammatory disease characterized by chronic inflammation throughout the body. The most severe form of CAPS, Chronic Infantile Neurologic Cutaneous, and Articular (CINCA) syndrome, also known as Neonatal Onset Multisystem Inflammatory Disease (NOMID), has three main features: skin rash, CNS involvement, and joint symptoms. Although these symptoms are typically reported shortly after birth, there have been a few reports of prenatal inflammation. Here, we report our experience managing a case of a CAPS infant born in severe neonatal asphyxia due to a ruptured cord associated with severe funisitis. The baby was born at 38 weeks and 6 days of gestation, weighing 2,898 g, through an ultra-emergency Caesarian section prompted by variable deceleration. The Apgar score was 1 point at 1 min and 4 points at 5 min, necessitating intensive care due to hypoxic-ischemic encephalopathy. Upon delivery, it was observed that the umbilical cord had partially ruptured at the site of attachment to the baby, accompanied by arterial hemorrhage. Umbilical cord rupture was considered to be the cause of the sudden decrease in fetal heart rate. Pathological examination also showed that the inflammation of the cord was more severe on the side attached to the fetus and on the arterial side, suggesting that the inflammation had extended from the fetus. The father carried a genetic mutation associated with CINCA syndrome/NOMID (NLRP3 c.2068G>A p.Glu690Lys Hetero), which was also found in the child. Histopathologic examination of the placenta and umbilical cord can provide crucial insights into the intrauterine onset of inflammation, which is the first manifestation of CINCA syndrome/NOMID in newborns. It should be noted that births with a genetic predisposition to CAPS may have complications related to the placenta and umbilical cord.

An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report.

BACKGROUND: We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. It has been reported that congenital uterine anomalies latently affect the fetal position. The clinical pitfalls in childbirth with uterine anomalies are discussed here on the basis of clinical evidence. CASE PRESENTATION: At a perinatal medical center in Japan, a 29-year-old Japanese mother who had a history of bicornuate uterus, received tocolysis to prolong her pregnancy for 5 days during the late preterm period after preterm-premature rupture of the membrane. She gave birth to a 2304 g male neonate of the gestational age of 35 weeks and 5 days with severe asphyxia by means of crash cesarean section for fetal sustained bradycardia after sudden termination of tocolysis. We found the fetal position to reverse from cephalic to breech position during early labor. He ended up having severe cerebral palsy after brain cooling against hypoxic-ischemic encephalopathy for 3 days. The mechanism of inversion from cephalic to breech position without amnionic fluid remains unclear, although women with a known diagnosis of a uterine anomaly have higher risk of adverse outcomes such as malpresentation. CONCLUSIONS: When considering the clinical course of this case on the basis of the medical reports, we suspected that uterine anomalies and changes in intrauterine pressure could cause fetal malpresentation and adverse neonatal outcomes.

Association between Portal Vein Thrombosis after Umbilical Vein Catheterization and Neonatal Asphyxia.

INTRODUCTION: Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the variables associated to PVT in near- to full-term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE). METHODS: This is retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1,500 g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterization. RESULTS: Among 213 eligible patients, PVT was diagnosed in 57 (27%); among them, 54 (95%) were localized in the left portal vein branch. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95% CI: 1.12-1.64, p = 0.002) and duration of UVC placement (adjusted OR 1.36; 95% CI: 1.11-1.67, p = 0.004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95% CI: 1.08; 1.63, p = 0.01) and CTH (adjusted OR 1.94; 95% CI: 1.04-3.65, p = 0.04). CONCLUSION: Left PVT was frequently observed in near- to full-term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT.

The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor.

BACKGROUND: The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future. OBJECTIVE: This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor. STUDY DESIGN: This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score. RESULTS: The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia. CONCLUSION: The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.

Caracterización de neonatos con asfixia perinatal. Hospital Provincial Docente Ginecobstétrico José Ramón López Tabrane. 2016-2021

Introducción: La asfixia perinatal es un síndrome caracterizado por la suspensión o grave disminución del intercambio gaseoso a nivel de la placenta o de los pulmones. Objetivo: Caracterizar los neonatos con asfixia perinatal durante el trabajo de parto con la introducción de la gasometría de la arteria umbilical. Materiales y métodos: Se realizó un estudio descriptivo, transversal, de octubre de 2016 a diciembre de 2021. Se trabajó con la totalidad del universo: 75 neonatos asfícticos. Las variables fueron: edad materna, edad gestacional al nacimiento, enfermedades asociadas y dependientes del embarazo, tipo y tiempo de trabajo de parto, características del líquido amniótico, anomalías de la placenta y cordón umbilical, pH de la gasometría de la arteria del cordón, evolución clínica del recién nacido. Los datos se almacenaron y procesaron en una hoja de cálculo de Microsoft Excel, utilizando la estadística descriptiva. Resultados: Predominaron pacientes con edad materna menor de 20 años (56 %), y edad gestacional al nacimiento de 28 a 33,6 semanas (77,3 %). La hipertensión arterial fue la comorbilidad más común, así como la preeclampsia, entre las enfermedades dependiente del embarazo (30,7 %); 61,3 % tuvieron parto eutócico, con líquido amniótico claro (65,3 %), placenta previa (38,7 %) y circulares en cordón umbilical (30,7 %). En el 86,7 % el pH de la gasometría fue menor que 7, y el 92 % presentó evolución clínica favorable. Conclusiones: La asfixia perinatal estuvo predominantemente asociada a madres adolescentes, con tiempo gestacional entre 28 y 36 semanas, preeclampsia, placenta previa, circulares del cordón umbilical y predominio de gasometría con pH menor que 7.

Introduction: Perinatal asphyxia is a syndrome characterized by the suspension or severe decrease in gas exchange at the level of the placenta or lungs. Objective: To characterize neonates with perinatal asphyxia during labor with the introduction of umbilical arterial blood gas test. Materials and methods: A descriptive, cross-sectional study was carried out from October 2016 to December 2021. It dealt with the entire universe, 75 asphyxiated neonates. The variables were: maternal age, gestational age at birth, associated and pregnancy-dependent diseases, type and time of labor, characteristics of the amniotic fluid, anomalies of the placenta and umbilical cord, pH of the cord arterial blood gas test, clinical evolution of the newborn. The data were stored and processed in a Microsoft Excel spreadsheet, using descriptive statistics. Results: Patients with maternal age below 20 years (56%), and gestational age at birth from 28 to 33.6 weeks (77.3%) predominated. Arterial hypertension was the most common comorbidity, as well as preeclampsia, among pregnancy-dependent diseases (30.7%); 61.3% had eutocic delivery, with clear amniotic fluid (65.3%), previous placenta (38.7%) and umbilical cord circulars (30.7%). In 86.7%, the blood gas pH was less than 7 and 92% had a favorable clinical evolution. Conclusions: Perinatal asphyxia was predominantly associated with adolescent mothers, with gestational time between 28-36 weeks; preeclampsia, placenta previa, umbilical cord circulars, and blood gases pH lower than 7.

Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto / Quality care indicators for neonates with selected pathologies: pilot study

Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.

Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.

Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1) preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4) preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated (TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW), (BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA (cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA (ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001). Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.

Algunos factores perinatales relacionados con la asfixia neonatal / Some perinatal factors associated with neonatal asphyxia

Se realizó un estudio observacional y retrospectivo de 28 neonatos con asfixia al nacer en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero del 2009 hasta diciembre del 2011, con vistas a describir algunas variables prenatales, natales y posnatales relacionadas con la evolución clínica y supervivencia de ellos. En la serie 23 pacientes egresaron vivos y 5, fallecidos; asimismo, las muertes de los recién nacidos estuvieron mayormente asociadas a la hipertensión arterial en las madres y el nacimiento después de la semana gestacional 42, en tanto el líquido amniótico meconial y las alteraciones de la frecuencia cardíaca fetal, predominantemente la bradicardia, constituyeron los principales factores de riesgo intraparto. Con más frecuencia se observaron la hipotonía y las convulsiones como manifestaciones neurológicas, y el síndrome de aspiración de meconio y la disfunción renal como signos extraneurológicos.

A retrospective observational study was carried out in 28 infants with asphyxia at birth in "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital of Santiago de Cuba, from January 2009 to December 2011, in order to describe some prenatal, natal and postnatal variables related to clinical course and their survival. In the series 23 patients discharged alive and 5 died; also, deaths of newborns were mostly associated with hypertension in mothers and birth after 42 weeks, while meconium and alterations of the fetal heart rate, predominantly bradycardia, were the main intrapartum risk factors. Hypotonia and seizures as neurological manifestations were the most frequently observed, and meconium aspiration and renal dysfunction as extraneurological signs.

Encefalopatia hipóxico-isquêmica: aspectos clínicos de gravidade / Hypoxic-ischemic encephalopathy: clinical aspects of severity

Objetivo: Analisar a gravidade da asfixia perinatal e sua evolução baseada na classificação de Sarnat & Sarnat. Métodos: Estudo descritivo observacional, longitudinal, prospectivo, iniciado em maio de 2009 a partir da avaliação de todo recém-nascido com diagnóstico clínico e/ou laboratorial de asfixia, nas unidades de Neonatologia de hospital pediátrico de nível terciário de atenção (Hospital Infantil Albert Sabin/Fortaleza/CE). A classificação de gravidade da asfixia de Sarnat foi correlacionada com as variáveis: idade gestacional, sexo, peso de nascimento, Apgar do quinto minuto, necessidade de cuidados de terapia intensiva, suporte de ventilação mecânica, sinais e sintomas clínicos na primeira semana de vida, presença de convulsões, uso de anticonvulsivantes, presença de mal-epilético e desfecho. Foi aplicada análise estatística simples pelos programas Excel e SPSS v17.0. Aplicação de teste do Quiquadrado nas análises bivariadas. Resultados: Foram analisados 200 neonatos com asfixia perinatal. A amostra contou com 67% de pacientes do sexo masculino, 92% a termo e 64% com peso superior a 2,5 kg. Cerca de 75% tinham registros de reanimação ao nascimento. A crise convulsiva precoce foi a manifestação neurológica mais referida (55%), sobretudo no primeiro dia de vida (70%). A encefalopatia leve foi mais prevalente (45%), seguida pela moderada (41%). As alterações sistêmicas mais registradas foram: infecção sistêmica, acidose metabólica, sangramento, bradicardia e hipoglicemia. A disfagia foi a alteração neurológica mais comum a longo prazo (84%). Conclusão: A classificação neurológica de Sarnat & Sarnat se associa com risco de convulsão, estado de mal convulsivo, hiper-reflexia, hipotonia e necessidade de terapia intensiva.

Programa de follow-up de recém-nascidos de alto risco: relato da experiência de uma equipe interdisciplinar / Follow-up program of high risk neonates: report of the experience of an interdisciplinary team

O avanço da Neonatalogia nas últimas décadas trouxe grandes mudanças na assistência ao recém-nascido, levando a um aumento na sobrevida de neonatos que apresentarão um alto risco para o surgimento de sequelas no desenvolvimento neuropsicomotor. Quando se comparam crianças prematuras com as nascidas a termo, é possível observar diferenças marcantes nas habilidades cognitivas, na performance escolar, no comportamento, entre outras. Dessa forma, o acompanhamento clínico dessas crianças, durante os primeiros anos de vida, é essencial para que haja a detecção precoce de alterações no desenvolvimento e as intervenções necessárias, além da identificação das necessidades da família e a orientação dos pais quanto às dificuldades que enfrentarão nos cuidados com essas crianças. Esse tipo de serviço é chamado de follow-up e sua implantação é recomendada pela Organização Mundial de Saúde, mas, infelizmente, a rede de assistência prestada aos bebês que recebem alta das UTIs Neonatais ainda é deficiente em nosso país. Há cerca de sete anos, foi criado, no Hospital Universitário da Universidade Federal de Juiz de Fora, um programa de follow-up de recém-nascidos de alto risco, que atende crianças egressas das UTIs Neonatais de Juiz de Fora e Zona da Mata. Desde sua criação, o programa cadastrou 356 pacientes. As crianças são acompanhadas até os cinco anos de idade por uma equipe interdisciplinar, composta por médicos (Pediatras Neonatalogistas), enfermeiros, fisioterapeutas,fonoaudiólogo, nutricionista, assistente social, psicólogos e profissionais afins. O presente artigo tem por objetivo relatar a experiência dessa equipe interdisciplinar no atendimento dessas crianças.

The advance of Neonatology in the last decades has brought great changes to neonatal care, leading to an increase in the survival rates of neonates which will present a high risk of neurodevelopmental impairment. When we compare premature children with those born at term, it is possible to observe clear differences in cognitive abilities, school performance,behavior, etc. Thus, clinical assessment of these children during the first years of life is essential. This strategy can provide early detection of neurodevelopmental disabilities, propose timely interventions, identify psychological needs of families and parents, and provide advice regarding the difficulties that they will face in the care of their children. This service is called follow-up, and the World Health Organization recommends its implantation, but unfortunately the chain of care provided to the babies who have received high-quality care in Neonatal Intensive Care Units is defficient in Brazil. About seven years ago, the University Hospital/Health Care Center of the Federal University of Juiz de Fora created a follow-up program for high-risk neonates, which attends children from Neonatal Intensive Care Units in Juiz de Fora and region. Since its creation, the program registered 356 patients. Follow-upoccurs up to the age of five years, and is provided by an interdisciplinary team, composed of physicians (Pediatricians),nurses, physical therapists, audiologists and speech therapists, nutritionists, social workers, psychologists and other professionals. The aim of this article is to reportthe experience of this interdisciplinary team in the care of these children.

Análise da evasão em serviço de follow-up de recém-nascidos de alto risco / Drop-out in high-risk neonate follow-up service

O presente estudo verificou os motivos para a evasão do serviço de Follow-up de Recém-Nascidos de Risco do HU - Centro de Atenção à Saúde (CAS) /UFJF, além de traçar o perfil das famílias e crianças evadidas. Foi realizado um levantamento nos prontuários do programa, identificando-se a evasão de 161 crianças. Seus prontuários foram analisados na busca de dados sobre condições de nascimento, intercorrências no período neonatal, idade na evasão e tempo de seguimento, e situação socioeconômica. Foi feito contato telefônico com as famílias para aplicação de questionário acerca dos motivos para a evasão, opinião e acesso ao serviço. As crianças acompanhadas apresentaram altos índices de intercorrências perinatais com risco potencial de alterações futuras no desenvolvimento neuropsicomotor. A idade média na evasão foi de 14,73 meses e o tempo de acompanhamento de 11,39 meses. Apenas 42 famílias puderam ser contatadas por problemas de dados desatualizados no prontuário. Destas, 47,62% relataram dificuldade de acesso e 11,90% insatisfação com o serviço. Os principais motivos para evasão foram acompanhamento em outro serviço, não remarcação de consulta após uma falta e o fato de a família não julgar necessário o acompanhamento. Neste tipo de serviço, deve-se dedicar maior atenção para o esclarecimento dos pais sobre a importância do acompanhamento de seus filhos e deve haver uma sistemática mais eficaz de busca ativa das crianças ausentes e de identificação desituações que dificultem o acesso da criança e seus familiares ao serviço.

The aim of this study was identify the reasons underlying drop-out from the High-Risk Neonate Follow-up Service of the University Hospital (HU)/Health Care Center (CAS) of the Federal University of Juiz de Fora (UFJF), and determine the profile of these children and their families. The service medical files were searched and 161 drop-outs identified. These files were analyzed for information concerning birth conditions, neonatal events, age at drop-out, length of the followup period and socioeconomic status. The families were contacted by telephone and a questionnaire applied to investigate the reasons for the drop-out and their opinion about and accessibility to the service. The children followed up had higher rates of perinatal events, with potential risk of future neuropsychomotor impairment. The mean age at drop-out was 14.73 months, and the length of follow-up was 11.39 months. Because of outdated information, only 42 families could be contacted, 47.62% reporting access difficulties and 11.90% showing dissatisfaction with the service. The main reasons for drop-out were follow-up in another service, failure to book again after missing an appointment and the family judgment that follow-up was not necessary. In this type of service, more attention should be paid to educating parents about the importance of follow-up, with a clear need of a more effective case search strategy with identification of situations hampering access.