scholarly journals A comparison between two methods to predict low Apgar scores and hypoxic-ischemic encephalopathy (HIE) in fetal scalp blood

1999 ◽  
Vol 45 (6) ◽  
pp. 895-895
Author(s):  
B Hallberg ◽  
K Kruger ◽  
M Blennow ◽  
M Kublickas ◽  
M Westgren
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Apgar Scores ◽  
Fetal Scalp ◽  
Ischemic Encephalopathy

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

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.

scholarly journals Apgar Scores at 10 Minutes and Outcomes in Term and Late Preterm Neonates with Hypoxic-Ischemic Encephalopathy in the Cooling Era

2018 ◽  
Vol 36 (05) ◽  
pp. 545-554 ◽  
Author(s):  
Marina Ayrapetyan ◽  
Kiran Talekar ◽  
Kathleen Schwabenbauer ◽  
David Carola ◽  
Kolawole Solarin ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Hypoxic Ischemic Encephalopathy ◽  
Preterm Neonates ◽  
Short Term ◽  
Apgar Scores ◽  
Significant Difference ◽  
The Brain ◽  
Ischemic Encephalopathy

Objective To determine the short-term outcomes (abnormal brain magnetic resonance imaging [MRI]/death) in infants born with a 10-minute Apgar score of 0 who received therapeutic hypothermia and compare them with infants with higher scores. Study Design This is a retrospective review of 293 neonates (gestational age ≥ 35 weeks) born between November 2006 and October 2015 admitted with hypoxic-ischemic encephalopathy who received therapeutic hypothermia. Results of brain MRIs were assessed by the basal ganglia/watershed scoring system. Short-term outcomes were compared between infants with Apgar scores of 0, 1 to 4, and ≥5 at 10 minutes. Results Eight of 17 infants (47%) with an Apgar of 0 at 10 minutes survived, having 4 (24%) without abnormalities on the brain MRI and 7 (41%) without severe abnormalities. There was no significant difference in the combined outcomes of “death/abnormal MRI” and “death/severe abnormalities on the MRI” between infants with Apgar scores of 0 and 1 to 4. Follow-up data were available for six of eight surviving infants, and none had moderate or severe neurodevelopmental impairment. Conclusion In the cooling era, 47% of infants with no audible heart rate at 10 minutes and who were admitted to the neonatal intensive care unit survived; 24% without abnormalities on the brain MRI and 41% without severe abnormalities.

scholarly journals Perinatal events associated with birth asphyxia and hypoxic-ischemic encephalopathy in a middle-income country: A multicenter, observational study.

2021 ◽  
Author(s):  
Ratchada Kitsommart ◽  
Nirucha Thamwiriyakul ◽  
Rawee Asawakitipong ◽  
Usakorn Taesiri ◽  
Thananjit Wongsinin ◽  
...  
Keyword(s):  
At Risk ◽  
Low Income ◽  
Birth Asphyxia ◽  
Hypoxic Ischemic Encephalopathy ◽  
P Value ◽  
Fisher Exact Test ◽  
Perinatal Hypoxia ◽  
Apgar Scores ◽  
Middle Income ◽  
Ischemic Encephalopathy

Abstract Background: Risk factors for neonatal encephalopathy differ across high- and low-income countries. Evidence of demographic characteristics and factors associated with perinatal hypoxia of infants who are at-risk for HIE in Southeast Asia is needed. Our primary objective was to investigate the intrapartum characteristics of infants ≥32 weeks’ gestational age (GA) born with low Apgar scores. Secondary objectives were to determine perinatal hypoxic events, and the characteristics and outcomes of infants ≥35 weeks GA with hypoxic-ischemic encephalopathy (HIE). Methods: A multicenter, retrospective, study was conducted. Individual charts were reviewed of infants with 5-minute Apgar scores ≤5 who were admitted to 4 tertiary centers in Thailand over 5 years. Events associated with perinatal hypoxia and outcomes were extracted. Variables were compared using chi-square, Fisher-exact test, two-independent sample t tests, ANOVA and Mann-Whitney. Data were analyzed using SPSS Statistics version 18.0. A p-value <0.05 was considered statistically significant.Results: Among 120235 infants, 454 had 5-mintue Apgar scores ≤5 (average: 3.8 per 1000 live births). The estimated frequency of HIE in ≥32 weeks’ GA infants was 1.5 per 1000 livebirths. Ninety-seven percent of the mothers’ received antenatal care. After exclusions, 316 infants and 314 mothers comprised the final sample. Common intrapartum complications were abnormal fetal heart rate (38.5%) and meconium-stained amniotic fluid (19.1%). Infants ≥35 weeks GA had mean ± standard deviation (SD) birthweight of 3003.4 ± 590.5 g; 10% were small-for-GA. Among ≥35 weeks GA infants with HIE, 42% had metabolic acidosis, 53% experienced sentinel, hypoxic perinatal events and advanced resuscitation was instituted in 92%. The severity of encephalopathy was reported in 99% of subjects. Eighty-five infants (62.5%) met all eligibility criteria for therapeutic hypothermia (TH) and 48 (56.5% of eligible infants) received treatment. The overall mortality rate was 29.4%.Conclusion: Maternal and intrapartum characteristics of infants at-risk for perinatal asphyxia in Thailand were comparable to reports from high-income countries. To improve recruitment for TH in middle-income, South-East Asian countries, strategies to raise HIE awareness among practitioners and more simplified TH eligible criteria are warranted to encourage timely transfer to referral centers for treatment.

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.

scholarly journals Outcome of Term Infants Using Apgar Scores at 10 Minutes Following Hypoxic-Ischemic Encephalopathy

PEDIATRICS ◽  
2009 ◽  
Vol 124 (6) ◽  
pp. 1619-1626 ◽  
Author(s):  
A. R. Laptook ◽  
S. Shankaran ◽  
N. Ambalavanan ◽  
W. A. Carlo ◽  
S. A. McDonald ◽  
...  
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Term Infants ◽  
Apgar Scores ◽  
Ischemic Encephalopathy

Outcome of Term Infants Using Apgar Scores at 10 Minutes Following Hypoxic-Ischemic Encephalopathy

2010 ◽  
Vol 65 (4) ◽  
pp. 217-218
Author(s):  
Abbot R. Laptook ◽  
Seetha Shankaran ◽  
Namasivayam Ambalavanan ◽  
Waldemar A. Carlo ◽  
Scott A. McDonald ◽  
...  
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Term Infants ◽  
Apgar Scores ◽  
Ischemic Encephalopathy

scholarly journals The Association between NOS3 Gene Polymorphisms and Hypoxic-Ischemic Encephalopathy Susceptibility and Symptoms in Chinese Han Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Yongqin Wu ◽  
Zhiling Zhu ◽  
Xiaoxia Fang ◽  
Ling Yin ◽  
Yuxia Liu ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Clinical Characteristics ◽  
Chinese Han Population ◽  
Hypoxic Ischemic Encephalopathy ◽  
Genotype Distribution ◽  
Chinese Han ◽  
Apgar Scores ◽  
Han Population ◽  
Nos3 Gene ◽  
Ischemic Encephalopathy

Endothelial NOS (NOS3) has a potential role in the prevention of neuronal injury in hypoxic-ischemic encephalopathy (HIE). Thus, we aimed to explore the association between NOS3 gene polymorphisms and HIE susceptibility and symptoms in a Chinese Han population. Three single nucleotide polymorphisms (SNPs) in the NOS3 gene, rs1800783, rs1800779, and rs2070744, were detected in 226 children with HIE and 212 healthy children in a Chinese Han population. Apgar scores and magnetic resonance image scans were used to estimate the symptoms and brain damage. The association analyses were conducted by using SNPStats and SPSS 18.0 software. The genotype and allele distributions of rs1800779 and rs1799983 displayed no significant differences between the patients and the controls, while the rs2070744 allele distribution was significantly different (correctedP=0.009). For clinical characteristics, the rs2070744 genotype distribution was significantly different in patients with different Apgar scores (≤5, TT/TC/CC = 6/7/5; 6~7, TT/TC/CC = 17/0/0; 8~9, TT/TC/CC = 6/2/0; 10, TT/TC/CC = 7/1/0; correctedP=0.006) in the 1001 to 1449 g birth weight subgroup. The haplotype test did not show any associations with the risk and clinical characteristics of HIE. The results suggest that NOS3 gene SNP rs2070744 was significantly associated with HIE susceptibility and symptom expression in Chinese Han population.

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