Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated ...Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score < 7 at the 5<sup>th</sup> minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.展开更多
背景新生儿急性肾损伤(AKI)早期诊断困难,病死率高,而目前关于重度窒息并发新生儿AKI的相关研究相对缺乏。目的探讨新生儿重度窒息并发AKI的危险因素及近期预后情况,并分析相关因素的预测价值,以采取措施减少AKI的发生,并提高此类患儿...背景新生儿急性肾损伤(AKI)早期诊断困难,病死率高,而目前关于重度窒息并发新生儿AKI的相关研究相对缺乏。目的探讨新生儿重度窒息并发AKI的危险因素及近期预后情况,并分析相关因素的预测价值,以采取措施减少AKI的发生,并提高此类患儿的抢救成功率。方法纳入2016年1月—2023年1月于蚌埠医学院第一附属医院新生儿重症监护病房住院治疗的172例重度窒息新生儿为研究对象,根据患儿是否并发AKI,分为AKI组(n=43)和非AKI组(n=129)。收集患儿临床资料和实验室检查结果,并记录AKI患儿的近期预后情况(住院期间存活或死亡)。采用多因素Logistic回归分析探究新生儿重度窒息并发AKI的影响因素,采用受试者工作特征(ROC)曲线探究相关指标对新生儿重度窒息并发AKI的预测价值。结果AKI组患儿胎龄、出生体质量、5 min Apgar评分、血小板计数低于非AKI组,昏迷状态比例、有创机械通气比例、合并呼吸衰竭比例、血胱抑素C(Cys C)高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,5 min Apgar评分(OR=1.553,95%CI=1.193~2.021,P=0.001)、有创机械通气(OR=2.965,95%CI=1.021~8.611,P=0.046)、血Cys C值(OR=0.231,95%CI=0.109~0.487,P<0.001)是新生儿重度窒息并发AKI的影响因素。ROC曲线分析结果显示血Cys C预测AKI的ROC曲线下面积(AUC)为0.777(95%CI=0.701~0.854,P<0.05),5 min Apgar评分预测AKI的AUC为0.792(95%CI=0.715~0.869,P<0.05)。AKI组患儿住院病死率为51.2%(22/43),非AKI组患儿住院病死率为21.7%(28/129),AKI组患儿病死率高于非AKI组(χ^(2)=13.572,P<0.001)。结论低5 min Apgar评分、有创机械通气、出生后高血Cys C会增加重度窒息新生儿发生AKI的风险。5 min Apgar评分、出生后血Cys C是预测新生儿重度窒息并发AKI的可靠指标。展开更多
目的:分析不同断脐时间对新生儿窒息的影响。方法:检索PubMed、Web of science、Embase、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统(SinoMed)。由2名研究人员根据纳入和排除标准分别对文献进...目的:分析不同断脐时间对新生儿窒息的影响。方法:检索PubMed、Web of science、Embase、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统(SinoMed)。由2名研究人员根据纳入和排除标准分别对文献进行筛选和质量评价,使用RevMan 5.4软件进行分析。结果:最终纳入9篇随机对照试验(RCT)文献。Meta分析表明,延迟断脐提高了新生儿氧分压(PO_(2)),不同断脐时间对新生儿窒息率,血气分析pH值、碱剩余、二氧化碳分压(PaCO_(2)),新生儿1 min Apgar评分、5 min Apgar评分的影响差异均无统计学意义(P<0.05)。结论:正常足月新生儿延迟30 s至3 min断脐可以提高新生儿PO_(2)含量,不会对新生儿窒息率,血气分析中的pH值、碱剩余、PaCO_(2)以及Apgar评分造成影响。展开更多
INTRODUCTIONBirth asphyxia may lead to disturbances of gastroenteric motility of newborn infants[1.2] . The change of gut pressure and reflux are the major manifestations of the motor disturbance [3-9] . To evaluate t...INTRODUCTIONBirth asphyxia may lead to disturbances of gastroenteric motility of newborn infants[1.2] . The change of gut pressure and reflux are the major manifestations of the motor disturbance [3-9] . To evaluate the effects of perinatal asphyxia on the gastroenteric motility, gastric and esophageal pressure and double pH were measured in a group of asphyxiated newborns. And. their pathophysiological and anatomical effects on gastroenteric function were discussed.展开更多
Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and r...Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.展开更多
BACKGROUND: β-endorphin is the most actively endogenous substance of cerebral endorphin. When combined with opiate receptor specially,it manifests a strong morphine-like activity and can decrease sensitivity of centr...BACKGROUND: β-endorphin is the most actively endogenous substance of cerebral endorphin. When combined with opiate receptor specially,it manifests a strong morphine-like activity and can decrease sensitivity of central nervous system to carbon dioxide so as to inhibit breath. OBJECTIVE: To observe the changes of content of plasma β-endorphin in neonates with severe asphyxia after naloxone treatment in a large dosage. DESIGN: Randomized controlled observation. SETTINGS: Department of Pediatrics,Shenzhen Shajing People's Hospital; Center of Pediatrics,Guangzhou Zhujiang Hospital. PARTICIPANTS: A total of 97 neonates with severe asphyxia including 57 boys and 40 girls were selected from Neonatal Intensive Care Unit,Department of Pediatrics,Shenzhen Shajing People's Hospital from January 2004 to November 2005. Their gestational age was (38±3) weeks,body mass was (3.2±1.7) kg,and hospitalization duration was (2.8±2.3) hours. All neonates met the diagnostic criteria of with severe asphyxia and all their parents provided the confirmed consent. METHODS: All neonates were treated with inspired oxygen,sedation,stopping terror,decreasing cranial pressure,maintaining a well blood perfusion and normal level of blood glucose (about 5.0 mmol/L). After hospitalization,0.1 mg/(kg·d) naloxone hydrochloride (Beijing Sihuan Pharmaceutical Technology Co.,Ltd.; certification: H10900021; bullet preparation; 0.4 mg/ampoule) was intravenously dribbled into neonates for 4–6 hours,14 days in total. 2 mL blood was collected from radial artery in neonates at the beginning of hospitalization and at 3 days after naloxone treatment,put in aprotinin-pre-cool tube,mixed evenly,and centrifuged at hypothermia. Plasma was maintained in refrigerator at –70 ℃. The kit was provided by Neurobiology Department of Shanghai Second Military Medical University of Chinese PLA. Concentration of plasma β-endorphin was measured by using radio-immunity assay.All data were expressed as Mean± SD and results were compared with paired t test. MAIN OUTCOME MEASURE: Concentration of plasma β-endorphin. RESULTS: All 97 neonates were involved in the final analysis. Concentration of plasma β-endorphin in neonates with severe asphyxia was lower after treatment as compared with that before treatment,and there was significant difference (t =10.31,P < 0.01). CONCLUSION: Naloxone can decrease level of plasma β-endorphin in neonates with severe asphyxia.展开更多
Objective To study the application of positron emission tomography(PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation.Methods Thirty-t...Objective To study the application of positron emission tomography(PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation.Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest(VFCA) group(n=16) and an asphyxiation cardiac arrest(ACA) group(n=16).Cardiac arrest(CA)was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation(CPR) and defibrillation.At four hours and 24 h after spontaneous circulation was achieved,myocardial metabolism was assessed by PET.^(18)F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value(SUV_(max)) was measured.Results Spontaneous circulation was 100%and 62.5%in VFCA group and ACA group,respectively.PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA.The SUV_(max) was higher in VFCA group than in ACA group(P<0.01).In VFCA group,SUV_(max) at24 h after spontaneous circulation increased to the level of baseline.Conclusion ACA causes more severe cardiac metabolism injuries than VFCA.Myocardial dysfunction is associated with less successful resuscitation.Myocardial stunning does occur with VFCA but not with ACA.展开更多
文摘Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score < 7 at the 5<sup>th</sup> minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.
文摘背景新生儿急性肾损伤(AKI)早期诊断困难,病死率高,而目前关于重度窒息并发新生儿AKI的相关研究相对缺乏。目的探讨新生儿重度窒息并发AKI的危险因素及近期预后情况,并分析相关因素的预测价值,以采取措施减少AKI的发生,并提高此类患儿的抢救成功率。方法纳入2016年1月—2023年1月于蚌埠医学院第一附属医院新生儿重症监护病房住院治疗的172例重度窒息新生儿为研究对象,根据患儿是否并发AKI,分为AKI组(n=43)和非AKI组(n=129)。收集患儿临床资料和实验室检查结果,并记录AKI患儿的近期预后情况(住院期间存活或死亡)。采用多因素Logistic回归分析探究新生儿重度窒息并发AKI的影响因素,采用受试者工作特征(ROC)曲线探究相关指标对新生儿重度窒息并发AKI的预测价值。结果AKI组患儿胎龄、出生体质量、5 min Apgar评分、血小板计数低于非AKI组,昏迷状态比例、有创机械通气比例、合并呼吸衰竭比例、血胱抑素C(Cys C)高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,5 min Apgar评分(OR=1.553,95%CI=1.193~2.021,P=0.001)、有创机械通气(OR=2.965,95%CI=1.021~8.611,P=0.046)、血Cys C值(OR=0.231,95%CI=0.109~0.487,P<0.001)是新生儿重度窒息并发AKI的影响因素。ROC曲线分析结果显示血Cys C预测AKI的ROC曲线下面积(AUC)为0.777(95%CI=0.701~0.854,P<0.05),5 min Apgar评分预测AKI的AUC为0.792(95%CI=0.715~0.869,P<0.05)。AKI组患儿住院病死率为51.2%(22/43),非AKI组患儿住院病死率为21.7%(28/129),AKI组患儿病死率高于非AKI组(χ^(2)=13.572,P<0.001)。结论低5 min Apgar评分、有创机械通气、出生后高血Cys C会增加重度窒息新生儿发生AKI的风险。5 min Apgar评分、出生后血Cys C是预测新生儿重度窒息并发AKI的可靠指标。
文摘目的:分析不同断脐时间对新生儿窒息的影响。方法:检索PubMed、Web of science、Embase、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统(SinoMed)。由2名研究人员根据纳入和排除标准分别对文献进行筛选和质量评价,使用RevMan 5.4软件进行分析。结果:最终纳入9篇随机对照试验(RCT)文献。Meta分析表明,延迟断脐提高了新生儿氧分压(PO_(2)),不同断脐时间对新生儿窒息率,血气分析pH值、碱剩余、二氧化碳分压(PaCO_(2)),新生儿1 min Apgar评分、5 min Apgar评分的影响差异均无统计学意义(P<0.05)。结论:正常足月新生儿延迟30 s至3 min断脐可以提高新生儿PO_(2)含量,不会对新生儿窒息率,血气分析中的pH值、碱剩余、PaCO_(2)以及Apgar评分造成影响。
基金Project supported ty the Research Fund of the Ministry of Healty of China,No.96-2-170(1996)
文摘INTRODUCTIONBirth asphyxia may lead to disturbances of gastroenteric motility of newborn infants[1.2] . The change of gut pressure and reflux are the major manifestations of the motor disturbance [3-9] . To evaluate the effects of perinatal asphyxia on the gastroenteric motility, gastric and esophageal pressure and double pH were measured in a group of asphyxiated newborns. And. their pathophysiological and anatomical effects on gastroenteric function were discussed.
基金Supported by The Health Research Board CSA/2012/40a Science Foundation Ireland Research Centre Award(INFANT-12/RC/2272)
文摘Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.
文摘BACKGROUND: β-endorphin is the most actively endogenous substance of cerebral endorphin. When combined with opiate receptor specially,it manifests a strong morphine-like activity and can decrease sensitivity of central nervous system to carbon dioxide so as to inhibit breath. OBJECTIVE: To observe the changes of content of plasma β-endorphin in neonates with severe asphyxia after naloxone treatment in a large dosage. DESIGN: Randomized controlled observation. SETTINGS: Department of Pediatrics,Shenzhen Shajing People's Hospital; Center of Pediatrics,Guangzhou Zhujiang Hospital. PARTICIPANTS: A total of 97 neonates with severe asphyxia including 57 boys and 40 girls were selected from Neonatal Intensive Care Unit,Department of Pediatrics,Shenzhen Shajing People's Hospital from January 2004 to November 2005. Their gestational age was (38±3) weeks,body mass was (3.2±1.7) kg,and hospitalization duration was (2.8±2.3) hours. All neonates met the diagnostic criteria of with severe asphyxia and all their parents provided the confirmed consent. METHODS: All neonates were treated with inspired oxygen,sedation,stopping terror,decreasing cranial pressure,maintaining a well blood perfusion and normal level of blood glucose (about 5.0 mmol/L). After hospitalization,0.1 mg/(kg·d) naloxone hydrochloride (Beijing Sihuan Pharmaceutical Technology Co.,Ltd.; certification: H10900021; bullet preparation; 0.4 mg/ampoule) was intravenously dribbled into neonates for 4–6 hours,14 days in total. 2 mL blood was collected from radial artery in neonates at the beginning of hospitalization and at 3 days after naloxone treatment,put in aprotinin-pre-cool tube,mixed evenly,and centrifuged at hypothermia. Plasma was maintained in refrigerator at –70 ℃. The kit was provided by Neurobiology Department of Shanghai Second Military Medical University of Chinese PLA. Concentration of plasma β-endorphin was measured by using radio-immunity assay.All data were expressed as Mean± SD and results were compared with paired t test. MAIN OUTCOME MEASURE: Concentration of plasma β-endorphin. RESULTS: All 97 neonates were involved in the final analysis. Concentration of plasma β-endorphin in neonates with severe asphyxia was lower after treatment as compared with that before treatment,and there was significant difference (t =10.31,P < 0.01). CONCLUSION: Naloxone can decrease level of plasma β-endorphin in neonates with severe asphyxia.
基金supported by Beijing Science Foundation(C160203)Youth Science Foundation of Beijing Chaoyang Hospital
文摘Objective To study the application of positron emission tomography(PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation.Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest(VFCA) group(n=16) and an asphyxiation cardiac arrest(ACA) group(n=16).Cardiac arrest(CA)was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation(CPR) and defibrillation.At four hours and 24 h after spontaneous circulation was achieved,myocardial metabolism was assessed by PET.^(18)F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value(SUV_(max)) was measured.Results Spontaneous circulation was 100%and 62.5%in VFCA group and ACA group,respectively.PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA.The SUV_(max) was higher in VFCA group than in ACA group(P<0.01).In VFCA group,SUV_(max) at24 h after spontaneous circulation increased to the level of baseline.Conclusion ACA causes more severe cardiac metabolism injuries than VFCA.Myocardial dysfunction is associated with less successful resuscitation.Myocardial stunning does occur with VFCA but not with ACA.
