Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.088
Filtrar
1.
Medicina (Kaunas) ; 57(9)2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34577911

RESUMO

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8-9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8-9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.


Assuntos
Asfixia Neonatal , Asfixia , Asfixia Neonatal/epidemiologia , Criança , Feminino , Humanos , Hipóxia/etiologia , Recém-Nascido , Gravidez , Qualidade de Vida , Instituições Acadêmicas
2.
BMC Health Serv Res ; 21(1): 931, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34493278

RESUMO

BACKGROUND: The Norwegian Board of Health Supervision aims to contribute to the improvement of quality and patient safety in the healthcare services. Planned audits were performed to investigate how 12 selected Norwegian obstetric units reported and analyzed adverse events as the part of their quality assurance and patient safety work. METHODS: Serious adverse events coded as birth asphyxia, shoulder dystocia and severe postpartum hemorrhage that occurred during 2014 (the most recent year for which the quality assured data were available) were obtained from the Medical Birth Registry of Norway. The obstetric units were asked to submit medical records, internal adverse events reports, and their internal guidelines outlining which events should be reported to the quality assurance system. We identified the adverse events at each obstetric unit that were reported internally and/or to the central authorities. Two obstetricians carried out an evaluation of each event reported. RESULTS: Five hundred fifty-three serious adverse events were registered among 17,323 births that took place at the selected units. Twenty-one events were excluded because of incorrect coding or missing information. Eight events were registered in more than one category, and these were distributed to the category directly related to injury or adverse outcome. Nine of twelve (75 %) obstetric units had written guidelines describing which events should be reported. The obstetric units reported 49 of 524 (9.3 %) serious adverse events in their internal quality assurance system and 39 (7.4 %) to central authorities. Of the very serious adverse events, 29 of 149 (19.4 %) were reported. Twenty-three of 49 (47 %) reports did not contain relevant assessments or proposals for improving quality and patient safety. CONCLUSIONS: This study showed that adverse event reporting and analyses by Norwegian obstetric units, as a part of quality assurance and patient safety work, are suboptimal. The reporting culture and compliance with guidelines need to be improved substantially for better safety in patient care, risk mitigation and clinical quality assurance.


Assuntos
Asfixia Neonatal , Hemorragia Pós-Parto , Feminino , Humanos , Recém-Nascido , Noruega/epidemiologia , Segurança do Paciente , Gravidez , Sistema de Registros
3.
BMC Pediatr ; 21(1): 394, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507527

RESUMO

BACKGROUND: Perinatal events which result in compromised oxygen delivery to the fetus can lead to Birth Asphyxia (BA). While the incidence, risk factors and outcomes of BA have been characterized, less is known in low resource settings. AIM: To determine the incidence of Birth Asphyxia (BA) in Nepal and to evaluate associated risk factors and outcomes of this condition. METHODS: A nested observational study was conducted in 12 hospitals of Nepal for a period of 14 months. Babies diagnosed as BA at ≥37 weeks of gestation were identified and demographics were reviewed. Data were analyzed using binary logistic regression followed by multiple logistic regression analysis. RESULTS: The incidence of BA in this study was 6 per 1000 term livebirths and was higher among women 35 years and above. Predictors for BA were instrumented vaginal delivery (aOR:4.4, 95% CI, 3.1-6.1), fetal distress in labour (aOR:1.9, 95% CI, 1.0-3.6), malposition (aOR:1.8, 95% CI, 1.0-3.0), birth weight less than 2500 g (aOR:2.0, 95% CI, 1.3-2.9), gestational age ≥ 42 weeks (aOR:2.0, 95% CI, 1.3-3.3) and male gender (aOR:1.6, 95% CI, 1.2-2.0). The risk of pre-discharge mortality was 43 times higher in babies with BA (aOR:42.6, 95% CI, 32.2-56.3). CONCLUSION: The incidence of Birth asphyxia in Nepal higher than in more resourced setting. A range of obstetric and neonatal risk factors are associated with BA with an associated high risk of pre-discharge mortality. Interventions to improve management and decrease rates of BA could have marked impact on outcomes in low resource settings.


Assuntos
Asfixia Neonatal , Asfixia , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/etiologia , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Nepal/epidemiologia , Gravidez , Fatores de Risco
4.
BMJ Open ; 11(8): e048506, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433598

RESUMO

OBJECTIVE: To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. DESIGN: Randomised controlled trial with 6-month follow-up (2018-2020). SETTING: Secondary and tertiary healthcare facilities. PARTICIPANTS: 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. INTERVENTIONS: eHBB VR simulation or neonatal resuscitation video. MAIN OUTCOMES: Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. RESULTS: Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. CONCLUSION: eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.


Assuntos
Asfixia Neonatal , Realidade Virtual , Competência Clínica , Eletrônica , Pessoal de Saúde/educação , Humanos , Lactente , Recém-Nascido , Ressuscitação
5.
AJNR Am J Neuroradiol ; 42(7): 1327-1333, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34255732

RESUMO

BACKGROUND AND PURPOSE: Cerebral venous oxygen saturation can be used as an indirect measure of brain health, yet it often requires either an invasive procedure or a noninvasive technique with poor sensitivity. We aimed to test whether cerebral venous oxygen saturation could be measured using quantitative susceptibility mapping, an MR imaging technique, in 3 distinct groups: healthy term neonates, injured term neonates, and preterm neonates. MATERIALS AND METHODS: We acquired multiecho gradient-echo MR imaging data in 16 neonates with perinatal asphyxia and moderate or severe hypoxic-ischemic encephalopathy (8 term age: average, 40.0 [SD, 0.8] weeks' gestational age; 8 preterm, 33.5 [SD, 2.0] weeks' gestational age) and in 8 healthy term-age controls (39.3 [SD, 0.6] weeks, for a total of n = 24. Data were postprocessed as quantitative susceptibility mapping images, and magnetic susceptibility was measured in cerebral veins by thesholding out 99.95% of lower magnetic susceptibility values. RESULTS: The mean magnetic susceptibility value of the cerebral veins was found to be 0.36 (SD, 0.04) ppm in healthy term neonates, 0.36 (SD, 0.06) ppm in term injured neonates, and 0.29 (SD, 0.04) ppm in preterm injured neonates. Correspondingly, the derived cerebral venous oxygen saturation values were 73.6% (SD, 2.8%), 71.5% (SD, 7.4%), and 72.2% (SD, 5.9%). There was no statistically significant difference in cerebral venous oxygen saturation among the 3 groups (P = .751). CONCLUSIONS: Quantitative susceptibility mapping-derived oxygen saturation values in preterm and term neonates agreed well with values in past literature. Cerebral venous oxygen saturation in preterm and term neonates with hypoxic-ischemic encephalopathy, however, was not found to be significantly different between neonates or healthy controls.


Assuntos
Asfixia Neonatal , Asfixia Neonatal/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Oxigênio , Placenta , Gravidez
6.
Mymensingh Med J ; 30(3): 678-683, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34226455

RESUMO

Cerebral palsy (CP) is the commonest movement disorder in childhood. Clinical spectrum of CP is variable and CT scan of brain is an important mode of diagnosis and prognosis in recourse limited set up. This study was done to categorize the CT scan findings and correlate them with the type of motor disturbances of CP patients. This was a cross sectional study done in 100 children diagnosed as CP carried out in Pediatric Neurology unit, BSMMU from July 2009 to July 2010. The patients were randomly selected and CT scan was done in all the patients. Detailed history and clinical examination was done to find out the baseline characteristics, risk factors and topographic type of CP patients. Among 100 patients 92% had abnormal CT scan finding. Most common abnormality was cerebral atrophy. Maximum number of abnormal CT scan was found in quadriplegic CP (92%). Highest number of children was in 13-24 months (29%) and a slight male predominance was found. Commonest risk factor was perinatal asphyxia (75%). The brain lesions are often associated with a clinical phenotype where specific needs may be anticipated and addressed. This is important for the planning of intervention in the child with CP.


Assuntos
Asfixia Neonatal , Paralisia Cerebral , Encéfalo , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 14(7)2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321259

RESUMO

Subcutaneous fat necrosis (SCFN) is inflammation and necrosis of adipose tissue associated with hypoxia and hypothermia. It leads to various metabolic abnormalities, of which the most dreaded is hypercalcaemia. We report a case of a 7-week-old boy with history of birth asphyxia (hypoxic ischaemic encephalopathy stage 3) who presented to us with features suggestive of hypercalcaemia with bilateral nephrocalcinosis. On examination, there were multiple subcutaneous nodules on both arms. Evaluation revealed suppressed parathyroid activity along with low levels of 25(OH)vitamin D3 and elevated 1,25-dihydroxyvitamin D3 Skin biopsy confirmed the diagnosis of SCFN. He was managed with intravenous fluids, single dose of intravenous furosemide and oral prednisolone. Hypercalcaemia responded within 14 days of admission, prednisolone was tapered and stopped in a month. SCFN, in our case, can be attributed to the underlying perinatal asphyxia along with use of therapeutic hypothermia. Through this case, we wish to sensitise practicing neonatologists for the need of screening and early identification of these abnormalities, which if missed can be fatal.


Assuntos
Asfixia Neonatal , Necrose Gordurosa , Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Asfixia Neonatal/complicações , Asfixia Neonatal/terapia , Necrose Gordurosa/complicações , Necrose Gordurosa/diagnóstico , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Masculino , Gordura Subcutânea
8.
BMC Pediatr ; 21(1): 302, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233637

RESUMO

BACKGROUND: The current neonatal mortality rate in Nigeria (37/1000) is among the highest in the world and the major causes have consistently been reported as sepsis, perinatal asphyxia and prematurity. However, case-specific fatality which defines the risk of dying from these and other neonatal morbidities is rarely emphasized. Determination of case-specific fatality rates (CSFR) may inform a change in our current approach to neonatal care interventions which may eventually bring about the much-needed reduction in our neonatal mortality rate. Our aim was to determine the case-specific fatality rates for the common causes of mortality among hospitalized neonates at the National Hospital Abuja (NHA). METHODS: Relevant demographic and clinical data on all neonates admitted into the NICU at the NHA over a period of 13 months (January 2017 to February 2018) were extracted from the Neonatal Registry database and analyzed using appropriate statistical methods with the SPSS version 20 software. The case-specific fatality rates were computed for the predominant morbidities in addition to determination of the neonatal mortality rates and associated risk factors. RESULTS AND CONCLUSION: A total of 730 neonates were admitted, out of which 391 (53.6%) were females, 396 (54.5%) were inborn and 396 (54.2%) were term. The three most prevalent morbidities were prematurity 272(37.2%), neonatal Jaundice 208(28.4%) and perinatal asphyxia 91(12.5%) while the most common causes of mortality were prematurity 47/113(41.6%), congenital malformations 27/113(23.9%) and perinatal asphyxia 26/113(23%). Congenital malformations had the highest case-specific fatality 27/83(32.5%) followed by Perinatal Asphyxia 26/91(28.6%) and prematurity 47/272(20.7%). The mortality pattern differed between inborn and out born babies. Implications of these case-specific fatality rates for targeted interventions are discussed.


Assuntos
Asfixia Neonatal , Doenças do Recém-Nascido , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Nigéria/epidemiologia , Gravidez
9.
BMC Pediatr ; 21(1): 304, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233643

RESUMO

INTRODUCTION: Perinatal asphyxia is a complicated newborn health problem and applies a high contribution to the increased proportion of newborn mortality. It occurs in newborns due to altered breathing or inadequate inhalation and exhalation resulting in reduced oxygen perfusion to certain body tissues and organs. Irrespective of the increased progress in health care towards newborns and implementations in reductions in under-five, infant, and neonatal mortality in the past 10 years, perinatal asphyxia remained as the most common severe newborn health challenge that causes a high number of morbidity and mortality. METHODS: A prospective cohort longitudinal study was implemented among 573 newborns admitted with perinatal asphyxia at public hospitals in Southern Ethiopia from 1st March 2018 to 28th February 2020. The perinatal survival time was determined using Kaplan Meier survival curve together with a log-rank test. The dependent variable was time to death and the independent variables were classified as socio-demographic factors, obstetrics related factors, newborn related factors and maternal medical related factors. The study subjects were entered in to the cohort during admission with perinatal asphyxia in the hospital and followed until 7 days of life. RESULTS: The cumulative proportion of survival among the newborns admitted with perinatal asphyxia was 95.21% (95%CI:91.00,97.48), 92.82% (95%CI:87.95,95.77), 92.02%(95%CI:86.84,95.22) and 90.78%(95%CI:84.82,94.48) at the end of first, second, third and fourth follow-up days respectively. The mean survival date was 6.55(95%CI: 6.33, 6.77) and cord prolapse (AHR:6.5;95%CI:1.18,36.01), pregnancy induced hypertension (AHR:25.4;95%CI:3.68,175.0), maternal iron deficiency anemia (AHR:5.9;95%CI:1.19,29.5) and having convulsion of the newborn (AHR:10.23;95%CI:2.24,46.54) were statistically significant in multivariable cox proportional hazard model. CONCLUSION: The survival status among newborns with perinatal asphyxia was low during the early follow-up periods after admission to the hospital and the survival status increased after fourth follow up days. In addition, cord prolapse, history of PIH, maternal iron deficiency anemia and newborns history of convulsion were the independent predictors of mortality.


Assuntos
Asfixia Neonatal , Asfixia , Asfixia/etiologia , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Hospitais Públicos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Fatores de Risco
10.
J Coll Physicians Surg Pak ; 30(7): 817-820, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271782

RESUMO

OBJECTIVE: To determine the effects of magnesium sulphate in term neonates with hypoxic ischemic encephalopathy (HIE) in reducing mortality and morbidity. STUDY DESIGN: Randomised clinical trial. PLACE AND DURATION OF STUDY: Department of Neonatology, Services Hospital, Lahore, Pakistan from April to December 2019. METHODOLOGY: Term babies (inborn or outborn), fulfilling the operational definition of hypoxic ischemic encephalopathy, reaching within 6 hours of delivery in Nursery Department of Pediatric Medicine Unit-II, Services Hospital, Lahore, were included. Sarnat score was used for staging the severity of HIE. Cases were administered magnesium sulphate (MgSO4) as intravenous infusion. Rest of the management was similar for cases and controls. Mortality was defined as death due to birth asphyxia; whereas, morbidity was assessed by comparing the following at discharge: the grade of hypoxic ischemic encephalopathy, presence and frequency of seizures, duration of seizures, ability to suck feed and neurological problems such as abnormalities of muscle tone and neonatal reflexes. Babies with prematurity, dysmorphism comorbidities or arriving after 6 hours of birth, were excluded. Chi-square test was used for comparison; and p value <0.05 was considered significant. RESULTS: Gender, mode of delivery, mode of resuscitation at birth, major risk factors (prolonged labour, premature rupture of membranes, presence of meconium-stained amniotic fluid) were comparable in both groups. The duration of seizures, ability to suck feed and presence of neurological problems at discharge were significantly better in magnesium sulphate group as compared to control group. CONCLUSION: Magnesium sulphate is better in establishing earlier suck feed and reducing the duration of seizures and neurological problems in babies with birth asphyxia. Key Words: Hypoxic ischemic encephalopathy, Magnesium sulphate, Outcome, Term, Low income country.


Assuntos
Asfixia Neonatal , Hipóxia-Isquemia Encefálica , Criança , Feminino , Humanos , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Hipóxia-Isquemia Encefálica/epidemiologia , Recém-Nascido , Sulfato de Magnésio , Paquistão , Fatores de Risco
11.
Neuroimage Clin ; 31: 102678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34082365

RESUMO

BACKGROUND: Myelination is a developmental process that begins during the end of gestation, intensifies after birth over the first years of life, and continues well into adolescence. Any event leading to brain injury around the time of birth and during the perinatal period, such as birth asphyxia, may impair this critical process. Currently, the impact of such brain injury related to birth asphyxia on the myelination process is unknown. OBJECTIVE: To assess the myelination pattern over the first month of life in neonates with neonatal encephalopathy (NE) developing brain injury, compared to neonates without injury (i.e., healthy neonates and neonates with NE who do not develop brain injury). METHODS: Brain magnetic resonance imaging (MRI) was performed around day of life 2, 10, and 30 in healthy neonates and near-term/term neonates with NE who were treated with hypothermia. We evaluated myelination in various regions of interest using a T2* mapping sequence. In each region of interest, we compared the T2* values of the neonates with NE with brain injury to the values of the neonates without injury, according to the MRI timing, by using a repeated measures generalized linear mixed model. RESULTS: We obtained 74 MRI scans over the first month of life for 6 healthy neonates, 17 neonates with NE who were treated with hypothermia and did not develop brain injury, and 16 neonates with NE who were treated with hypothermia and developed brain injury. The T2* values significantly increased in the neonates with NE who developed injury in the posterior limbs of the internal capsule (day 2: p < 0.001; day 10: p < 0.001; and day 30: p < 0.001), the thalami (day 2: p = 0.001; day 10: p = 0.006; and day 30: p = 0.016), the lentiform nuclei (day 2: p = 0.005), the anterior white matter (day 2: p = 0.002; day 10: p = 0.006; and day 30: p = 0.002), the posterior white matter (day 2: p = 0.001; day 10: p = 0.008; and day 30: p = 0.03), the genu of the corpus callosum (day 2: p = 0.01; and day 10: p = 0.006), and the optic radiations (day 30: p < 0.001). CONCLUSION: In the neonates with NE who were treated with hypothermia and developed brain injury, birth asphyxia impaired myelination in the regions that are myelinated at birth or soon after birth (the posterior limbs of internal capsule, the thalami, and the lentiform nuclei), in the regions where the myelination process begins only after the perinatal period (optic radiations), and in the regions where this process does not occur until months after birth (anterior/posterior white matter), which suggests that birth asphyxia, in addition to causing the previously well-described direct injury to the brain, may impair myelination.


Assuntos
Asfixia Neonatal , Hipóxia-Isquemia Encefálica , Adolescente , Asfixia , Asfixia Neonatal/complicações , Asfixia Neonatal/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Gravidez
12.
Afr J Reprod Health ; 25(1): 49-55, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077110

RESUMO

Bacterial Vaginosis (BV) has recently emerged as a global health issue especially in pregnant women because of its adverse outcomes. Various studies have shown the impact of BV on both mother and baby as well as overall reproductive health of women. The study intended to assess the prevalence of BV in pregnant women visiting our hospital and estimate the risk of associated complications. A retrospective study was done on pregnant women who underwent vaginal swab for BV during the period January 2018- July 2019. BV was diagnosed by Nugent score and obstetric details until delivery were noted for pregnancy outcomes. Out of 217 women included in the study, 44 were diagnosed as positive for BV. Variables were compared between BV positive and negative groups by Chi square and t- test and risk ratios calculated for adverse pregnancy outcomes. Statistical analysis was done using SPSS 20.0 version. Prevalence of BV was found to be 20.3%. BV was significantly associated with preterm labour, premature rupture of membranes, preterm delivery, miscarriage, birth asphyxia, low birth weight, and neonatal intensive care unit admission. The study substantiated the evidence from previous studies that pregnant women with BV are at much higher risk for adverse maternal and fetal outcomes. Early Screening and awareness amongst women may help to prevent this.


Assuntos
Aborto Espontâneo/microbiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Vaginose Bacteriana/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Vaginose Bacteriana/diagnóstico
13.
Int J Mol Sci ; 22(9)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062911

RESUMO

Hypoxic-ischemic encephalopathy (HIE) remains to be a major cause of long-term neurodevelopmental deficits in term neonates. Hypothermia offers partial neuroprotection warranting research for additional therapies. Kynurenic acid (KYNA), an endogenous product of tryptophan metabolism, was previously shown to be beneficial in rat HIE models. We sought to determine if the KYNA analog SZR72 would afford neuroprotection in piglets. After severe asphyxia (pHa = 6.83 ± 0.02, ΔBE = -17.6 ± 1.2 mmol/L, mean ± SEM), anesthetized piglets were assigned to vehicle-treated (VEH), SZR72-treated (SZR72), or hypothermia-treated (HT) groups (n = 6, 6, 6; Tcore = 38.5, 38.5, 33.5 °C, respectively). Compared to VEH, serum KYNA levels were elevated, recovery of EEG was faster, and EEG power spectral density values were higher at 24 h in the SZR72 group. However, instantaneous entropy indicating EEG signal complexity, depression of the visual evoked potential (VEP), and the significant neuronal damage observed in the neocortex, the putamen, and the CA1 hippocampal field were similar in these groups. In the caudate nucleus and the CA3 hippocampal field, neuronal damage was even more severe in the SZR72 group. The HT group showed the best preservation of EEG complexity, VEP, and neuronal integrity in all examined brain regions. In summary, SZR72 appears to enhance neuronal activity after asphyxia but does not ameliorate early neuronal damage in this HIE model.


Assuntos
Asfixia Neonatal/tratamento farmacológico , Isquemia Encefálica/tratamento farmacológico , Ácido Cinurênico/análogos & derivados , Neurônios/metabolismo , Animais , Asfixia Neonatal/metabolismo , Asfixia Neonatal/patologia , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patologia , Região CA1 Hipocampal/diagnóstico por imagem , Região CA1 Hipocampal/efeitos dos fármacos , Região CA3 Hipocampal/diagnóstico por imagem , Região CA3 Hipocampal/efeitos dos fármacos , Modelos Animais de Doenças , Eletroencefalografia , Potenciais Evocados Visuais/efeitos dos fármacos , Humanos , Ácido Cinurênico/farmacologia , Neurônios/efeitos dos fármacos , Neurônios/patologia , Ratos , Pesquisa Médica Translacional
14.
J Trop Pediatr ; 67(2)2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34131763

RESUMO

INTRODUCTION: Birth asphyxia may cause neuro-developmental impairment in the affected newborns especially those who had hypoxic-ischemic encephalopathy. Music therapy has been observed to help in reducing pain and stress in newborns and improve neurodevelopmental outcome. OBJECTIVES: The objective of this study is to determine the effects of music therapy on the outcomes of birth asphyxia. METHODS: A randomized controlled trial involving 3095 newborns born between January 2013 and August 2019 with birth asphyxia was conducted in the neonatal intensive care unit of Burdwan Medical College. They were distributed in two groups-A (received music therapy along with coventional management) and B (only received conventional management), using computer-generated randomization. Pain score was assessed during any painful procedure and the neurodevelopmental outcome was measured at 3rd, 6th, 12th, 18th and 24th months. p < 0.01 was considered statistically significant. RESULTS: A total of 3095 newborns were included with a mean gestation of 34.3 ± 2.1 weeks and 56.7% of them were male. Mean hospital stay, oxygen dependency, requirement of mechanical ventilation and incidence of apnea were significantly lesser among newborns of group A. Newborns of group B showed a significantly higher mean pain score, whereas newborns in Group A exhibited significantly greater mental and motor neurodevelopmental quotients. CONCLUSIONS: Music therapy was observed to help in reducing hospital stay, oxygen dependency, incidences of apnea, pain during procedures and also resulted in better neurodevelopmental outcome. However, before generalizing the findings, further multi-centric research should be undertaken.


Assuntos
Asfixia Neonatal , Hipóxia-Isquemia Encefálica , Música , Apneia , Asfixia , Asfixia Neonatal/terapia , Humanos , Recém-Nascido , Masculino
17.
Indian Pediatr ; 58(5): 491-492, 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33980737
18.
Neonatology ; 118(4): 487-499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34023837

RESUMO

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.


Assuntos
Asfixia Neonatal , Salas de Parto , Asfixia Neonatal/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Gravidez , Ressuscitação
19.
Eur J Pediatr ; 180(11): 3367-3377, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34046718

RESUMO

Aminophylline has been demonstrated to be effective in improving renal functions of the infants suffering from acute kidney injury (AKI) due to perinatal asphyxia. We aimed to evaluate the effect of a single-dose aminophylline on estimated glomerular filtration rate (eGFR), urine output (UO), and incidence and severity of AKI according to the pediatric-modified RIFLE and neonatal RIFLE criteria in newborns with perinatal asphyxia under therapeutic hypothermia. This was a single-center, retrospective cohort study including newborns (gestational age ≥36 weeks) who underwent therapeutic hypothermia due to hypoxic ischemic encephalopathy between 2016 and 2019. Demographic and clinical data were obtained from electronic medical records and patient files. Two patient groups were established: aminophylline group and control group which were only under therapeutic hypothermia. Twenty-one newborns were in the aminophylline group and 13 newborns were in the control group. Our study revealed that on the third day of life (DOL), eGFR was significantly higher in the control group (p=0.025), but UO was significantly higher in the aminophylline group (p=0.021). In the aminophylline group, eGFR on the first DOL was higher than the value on the second DOL (p=0.017) while UO was higher on the second and third DOL compared to the first DOL (1-2 DOL p=0.006, and 1-3 DOL p=0.004). However, in the control group, there was no statistically significant difference in UO over the four DOL. Both groups were similar in the presence, severity, and outcome of AKI.Conclusion: This study demonstrated that aminophylline increases UO even in the infants under therapeutic hypothermia. However, the eGFR did not significantly increase in the aminophylline group. Understanding how therapeutic hypothermia affects pharmacokinetics may help us improve our results in future studies. What is known: • Therapeutic hypothermia (TH) reduces the incidence of acute kidney injury in asphyxiated newborns. • Aminophylline is effective in improving renal functions in asphyxiated newborns. What is new: • This is the first study evaluating the effect of a single dose of aminophylline on renal functions in newborns under TH. • A single dose of aminophylline administration in newborns under TH was associated with increased urine output especially on the third day of life. However, no significant increase was detected in glomerular filtration rate associated with aminophylline administration.


Assuntos
Asfixia Neonatal , Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Aminofilina , Asfixia Neonatal/complicações , Asfixia Neonatal/terapia , Criança , Feminino , Taxa de Filtração Glomerular , Humanos , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Gravidez , Estudos Retrospectivos
20.
Epilepsia ; 62(6): 1460-1471, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33955541

RESUMO

OBJECTIVES: Bumetanide was suggested as an adjunct to phenobarbital for suppression of neonatal seizures. This suggestion was based on the idea that bumetanide, by reducing intraneuronal chloride accumulation through inhibition of the Na-K-2Cl cotransporter NKCC1, may attenuate or abolish depolarizing γ-aminobutyric acid (GABA) responses caused by birth asphyxia. However, a first proof-of-concept clinical trial failed. This could have had several reasons, including bumetanide's poor brain penetration, the wide cellular NKCC1 expression pattern in the brain, and problems with the general concept of NKCC1's role in neonatal seizures. We recently replicated the clinical failure of bumetanide to potentiate phenobarbital's effect in a novel rat model of birth asphyxia. In this study, a clinically relevant dose (0.3 mg/kg) of bumetanide was used that does not lead to NKCC1-inhibitory brain levels. The aim of the present experiments was to examine whether a much higher dose (10 mg/kg) of bumetanide is capable of potentiating phenobarbital in this rat model. Furthermore, the effects of the two lipophilic bumetanide derivatives, the ester prodrug N,N-dimethylaminoethylester of bumetanide (DIMAEB) and the benzylamine derivative bumepamine, were examined at equimolar doses. METHODS: Intermittent asphyxia was induced for 30 min by exposing male and female P11 rat pups to three 7 + 3 min cycles of 9% and 5% O2 at constant 20% CO2 . All control pups exhibited neonatal seizures after the asphyxia. RESULTS: Even at 10 mg/kg, bumetanide did not potentiate the effect of a submaximal dose (15 mg/kg) of phenobarbital on seizure incidence, whereas a significant suppression of neonatal seizures was determined for combinations of phenobarbital with DIMAEB or, more effectively, bumepamine, which, however, does not inhibit NKCC1. Of interest, the bumepamine/phenobarbital combination prevented the neurodegenerative consequences of asphyxia and seizures in the hippocampus. SIGNIFICANCE: Both bumepamine and DIMAEB are promising tools that may help to develop more effective lead compounds for clinical trials.


Assuntos
Anticonvulsivantes/farmacologia , Asfixia Neonatal/complicações , Asfixia Neonatal/tratamento farmacológico , Benzilaminas/uso terapêutico , Bumetanida/uso terapêutico , Hipocampo/patologia , Degeneração Neural/patologia , Fenobarbital/farmacologia , Convulsões/tratamento farmacológico , Convulsões/etiologia , Animais , Animais Recém-Nascidos , Anticonvulsivantes/farmacocinética , Benzilaminas/farmacocinética , Encéfalo/metabolismo , Bumetanida/análogos & derivados , Bumetanida/farmacocinética , Relação Dose-Resposta a Droga , Interações Medicamentosas , Feminino , Masculino , Fenobarbital/farmacocinética , Gravidez , Ratos , Membro 2 da Família 12 de Carreador de Soluto/biossíntese
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...