Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy

2020 ◽  
Author(s):  
Sabine Bousleiman ◽  
Dwight J. Rouse ◽  
Cynthia Gyamfi-Bannerman ◽  
Yongmei Huang ◽  
Mary E. D'Alton ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Apgar Score ◽  
Hypoxic Ischemic Encephalopathy ◽  
Apgar Scores ◽  
Fetal Heart Rate Monitoring ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Secondary Outcomes ◽  
Ischemic Encephalopathy ◽  
Umbilical Cord Ph

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

Lactate Dehydrogenase, Aspartate Aminotransferase, and Alanine Aminotransferase Cord Serum Levels as Early Markers of Hypoxic–Ischemic Encephalopathy in Babies with Severe Perinatal Asphyxia

2018 ◽  
Vol 17 (03) ◽  
pp. 105-110
Author(s):  
Tolulope Ogundele ◽  
Saheed Babajide A. Oseni ◽  
Joshua A. Owa ◽  
Olorunfemi Ogundele
Keyword(s):  
Lactate Dehydrogenase ◽  
Apgar Score ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Perinatal Asphyxia ◽  
Serum Levels ◽  
Hypoxic Ischemic Encephalopathy ◽  
Apgar Scores ◽  
Cord Serum ◽  
Ischemic Encephalopathy

AbstractPerinatal asphyxia is a major cause of morbidity and mortality among newborn babies. Severe perinatal asphyxia can be associated with multiple organ dysfunctions resulting in the release of a variety of intracellular enzymes. A major concern is how to identify newborns in need of prompt and aggressive management to minimize the risk of early severe neurological sequelae such as hypoxic–ischemic encephalopathy. The present study was performed to determine the relationship between cord serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and severity of perinatal asphyxia among Nigerian newborn babies. This was a prospective, comparative case–control study at the Obafemi Awolowo University Teaching Hospital, Ile-Ife. Cord blood was collected at delivery for serum levels of lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase. Each baby was evaluated for the severity of perinatal asphyxia at 1 minute of life using Apgar scores. Apgar score less than 7 at 1 minute was regarded as perinatal asphyxia. The Apgar scores were related to cord serum levels of the enzymes. The data were analyzed using Statistical Package for the Social Sciences for Windows, version 17.0. One hundred and forty babies, comprising 70 babies with and 70 babies without perinatal asphyxia were studied. Thirty-six (51.4%) of the neonates had severe perinatal asphyxia with Apgar score of 3 and below; 15 (41.7%) of the 36 had hypoxic–ischemic encephalopathy. The mean of values of each of the three enzymes was statistically significantly higher in babies with perinatal asphyxia compared with controls (p < 0.001 for each enzyme) and in babies with hypoxic–ischemic encephalopathy than in babies with severe perinatal asphyxia but without hypoxic–ischemic encephalopathy (p < 0.001). A very high proportion of babies with severe perinatal asphyxia developed hypoxic–ischemic encephalopathy. Based on the cord serum enzyme levels, almost all the babies who had hypoxic–ischemic encephalopathy would have been identified at delivery. Routine estimation of the cord serum levels of these enzymes among babies with severe perinatal may be used to identify babies who may develop acute serious neurological complications for anticipatory management.

Standardized Evaluation of Cord Gases in Neonates at Risk for Hypoxic Ischemic Encephalopathy

2021 ◽  
Author(s):  
Elizabeth Blecharczyk ◽  
Lucy Lee ◽  
Krista Birnie ◽  
Arun Gupta ◽  
Alexis Davis ◽  
...  
Keyword(s):  
At Risk ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Care Pathway ◽  
Clinical Care ◽  
Blood Gases ◽  
Hypoxic Ischemic Encephalopathy ◽  
Blood Gas ◽  
Clinical Care Pathway ◽  
Ischemic Encephalopathy

BACKGROUND: Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE. METHODS: A standardized clinical care pathway to screen inborn neonates ≥36 weeks with abnormal cord blood gases (a pH of ≤7.0 or base deficit of ≥10) for HIE was implemented in January 2016. Abnormal cord blood gases resulted in a direct notification from the laboratory to an on-call physician. Evaluation included a modified Sarnat examination, postnatal blood gas, and standardized documentation. The percentage of neonates in which physician notification, documented Sarnat examination, and postnatal blood gas occurred was examined for 6 months before and 35 months after implementation. RESULTS: Of 203 neonates with abnormal cord gases in the post–quality improvement (QI) period, physician notification occurred in 92%. In the post-QI period, 94% had a documented Sarnat examination, and 94% had postnatal blood gas, compared with 16% and 11%, respectively, of 87 neonates in the pre-QI period. In the post-QI period, of those evaluated, &gt;96% were documented within 4 hours of birth. In the post-QI period, 15 (7.4%) neonates were cooled; 13 were in the NICU at time of identification, but 2 were identified in the newborn nursery and redirected to the NICU for cooling. CONCLUSIONS: A standardized screening pathway in neonates with umbilical-cord acidemia led to timely identification and evaluation of neonates at risk for HIE.

scholarly journals hUC-MSCs Exert a Neuroprotective Effect via Anti-apoptotic Mechanisms in a Neonatal HIE Rat Model

2019 ◽  
Vol 28 (12) ◽  
pp. 1552-1559 ◽  
Author(s):  
Jianwei Xu ◽  
Zhanhui Feng ◽  
Xianyao Wang ◽  
Ying Xiong ◽  
Lan Wang ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Umbilical Cord ◽  
Rat Model ◽  
Caspase 3 ◽  
Neuroprotective Effect ◽  
Hypoxic Ischemic Encephalopathy ◽  
Human Umbilical Cord ◽  
Motor Functions ◽  
Ischemic Encephalopathy

In this study, we investigated how human umbilical cord mesenchymal stem cells exerted a neuroprotective effect via antiapoptotic mechanisms in a neonatal hypoxic-ischemic encephalopathy rat model. A total of 78 10-day old (P10) rats were used. After human umbilical cord mesenchymal stem cells were collected from human umbilical cords and amplified in culture, they were administered to rat subjects 1 h after induced hypoxic-ischemic encephalopathy treatment. The short-term (48 h) and long-term (28 day) outcomes were evaluated after human umbilical cord mesenchymal stem cells treatment using neurobehavioral function assessment. Triphenyltetrazolium chloride monohydrate staining was performed at 48 h. Beclin-2 and caspase-3 levels were evaluated with Western blot and real time polymerase chain reaction at 48 h. Human umbilical cord mesenchymal stem cells were collected and administrated to hypoxic-ischemic encephalopathy pups by intracerebroventricular injection. Hypoxic-ischemic encephalopathy typically induced significant delay in development and caused impairment in both cognitive and motor functions in rat subjects. Human umbilical cord mesenchymal stem cells were shown to ameliorate hypoxic-ischemic encephalopathy-induced damage and improve both cognitive and motor functions. Although hypoxic-ischemic encephalopathy induced significant expression of caspase-3 and Beclin-2, human umbilical cord mesenchymal stem cells decreased the expression of both of them. Human umbilical cord mesenchymal stem cells may serve as a potential treatment to ameliorate brain injury in hypoxic-ischemic encephalopathy patients.

Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy

2020 ◽  
Author(s):  
Abigail Flower ◽  
Daniel Vasiliu ◽  
Tianrui Zhu ◽  
Robert Andris ◽  
Maryam Abubakar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Frequency Domain ◽  
Arterial Blood Pressure ◽  
Apgar Score ◽  
Blood Pressure Variability ◽  
Hypoxic Ischemic Encephalopathy ◽  
Arterial Blood ◽  
The Mean ◽  
Minute Apgar Score ◽  
Ischemic Encephalopathy

Objective This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE). Study Design In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate–severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis. Results Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86. Conclusion Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE. Key Points

The relationships among the fetal biophysical profile, umbilical cord pH, and Apgar scores

1987 ◽  
Vol 157 (3) ◽  
pp. 627-631 ◽  
Author(s):  
Anthony M. Vintzileos ◽  
Sue Ellen Gaffney ◽  
Lauren M. Salinger ◽  
Vasilios G. Kontopoulos ◽  
Winston A. Campbell ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Apgar Scores ◽  
Biophysical Profile ◽  
Umbilical Cord Ph

Prognostic Markers in Term Infants with Hypoxic–Ischemic Encephalopathy: Comparative Analysis of MRI, EEG, and Apgar Scores

2017 ◽  
Vol 16 (01) ◽  
pp. 008-014 ◽  
Author(s):  
Elissa Yozawitz ◽  
Ajay Goenka
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Neurological Deficits ◽  
Term Infants ◽  
Term Outcome ◽  
Apgar Scores ◽  
Long Term Outcome ◽  
Perinatally Acquired ◽  
Magnetic Resonance Imaging Mri ◽  
Poor Outcomes ◽  
Ischemic Encephalopathy

AbstractHypoxic–ischemic encephalopathy (HIE) is a frequent cause of perinatally acquired brain injury resulting in abnormal neurological consequences. In this retrospective study, we evaluated 68 neonates with clinical evidence of HIE to investigate the utility of magnetic resonance imaging (MRI), electroencephalography (EEG), and Apgar scores, individually and in combination, as predictors of long-term outcome. Six infants died during treatment, and 46 of the remaining 62 infants (74%) received follow-up neurological assessments at ages 6 to 24 months. The outcome was dichotomously classified as good (reflecting “normal development”) or as poor (reflecting “neurological deficits” based upon attainment of developmental milestones or death). Abnormal Apgar scores, MRIs, and EEGs had sensitivities of 50, 84, and 95% for predicting “neurological deficit.” Corresponding specificities were 85, 66, and 18%. However, the combination of abnormal Apgar scores, MRIs, and EEGs in predicting poor outcomes (i.e., “neurological deficits” or death) had sensitivity and specificity of 100%. In addition, the combination of abnormal Apgar scores, MRIs, and EEGs provided a positive predictive value of 100% in assessing poor outcome as compared with 73% (p = 0.2) for Apgar scores, 71% (p = 0.01) for MRIs, and 56% (p = 0.001) for EEGs.

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