Liver laceration presented as intraabdominal bleeding in a newborn with hypoxic-ischemic encephalopathy

Abstract Objectives Birth injuries usually occur with two different mechanisms: trauma due to mechanic stress during labor and hypoxic-ischemic injury. Sometimes these two mechanisms can occur at the same time with a complex clinical picture. Case presentation The baby girl was born at 372/7 weeks after a prolonged second stage of labor, weighing 3,725 g, and was admitted to the Neonatal Intensive Care Unit with the diagnosis of hypoxic-ischemic encephalopathy. During follow up she developed multiorgan failure and severe anemia. On the third postnatal day, abdominal bleeding was detected. Laceration in the liver capsule was found and appeared to be the source of bleeding. Conclusions Abdominal bleeding secondary to mechanical laceration of the liver is hard to diagnose and may coexist with perinatal asphyxia.

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Monitoring the effectiveness of hypothermia in perinatal asphyxia infants by urinary S100B levels

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1094 ◽

2019 ◽

Vol 57 (7) ◽

pp. 1017-1025

Author(s):

Iliana Bersani ◽

Fabrizio Ferrari ◽

Licia Lugli ◽

Giorgio Ivani ◽

Alessandra Conio ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Time Window ◽

Perinatal Asphyxia ◽

Hypoxic Ischemic Encephalopathy ◽

Longitudinal Assessment ◽

Retrospective Case ◽

Mortality And Morbidity ◽

Hypothermia Treatment ◽

Normal Ranges ◽

Ischemic Encephalopathy

Abstract Background Perinatal asphyxia is a major cause of mortality and morbidity in neonates: The aim of the present study was to investigate, by means of longitudinal assessment of urinary S100B, the effectiveness of hypothermia, in infants complicated by perinatal asphyxia and hypoxic-ischemic encephalopathy. Methods We performed a retrospective case-control study in 108 asphyxiated infants, admitted to nine tertiary departments for neonatal intensive care from January 2004 to July 2017, of whom 54 underwent hypothermia treatment and 54 did not. The concentrations of S100B protein in urine were measured using an immunoluminometric assay at first urination and 4, 8, 12, 16, 20, 24, 48, 72, 96, 108 and 120 h after birth. The results were correlated with the achievement of S100B levels within normal ranges at 72 h from hypothermia treatment. Routine laboratory parameters, longitudinal cerebral function monitoring, cerebral ultrasound and neurologic patterns were assessed according to standard protocols. Results Higher S100B concentrations were found in hypothermia-treated infants in both moderate (up to 12 h) and severe (up to 24 h) hypoxic-ischemic encephalopathy. S100B levels returned to normal ranges starting from 20 h of hypothermia treatment in moderate and from 36 h in severe hypoxic-ischemic encephalopathy. Conclusions The present results offer additional support to the usefulness of longitudinal neuro-biomarkers monitoring in asphyxiated infants treated by hypothermia. The pattern of S100B concentrations during hypothermia supports the need for further investigations aimed at reconsidering the time-window for patient recruitment and treatment, and the optimal duration of the cooling and rewarming phases of the hypothermia procedure.

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Prognostic Risk Factors for Severe Outcome in the Acute Phase of Neonatal Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study

Children ◽

10.3390/children8121103 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1103

Author(s):

Agnese Suppiej ◽

Giovanna Vitaliti ◽

Giacomo Talenti ◽

Vittoria Cuteri ◽

Daniele Trevisanuto ◽

...

Keyword(s):

Apgar Score ◽

Neonatal Intensive Care ◽

Perinatal Asphyxia ◽

Univariate Analysis ◽

Mode Of Delivery ◽

Epileptic Seizures ◽

Final Analysis ◽

Hypoxic Ischemic Encephalopathy ◽

Risk Of Death ◽

Ischemic Encephalopathy

In the first days after birth, a major focus of research is to identify infants with hypoxic-ischemic encephalopathy at higher risk of death or severe neurological impairment, despite therapeutic hypothermia (TH). This is especially crucial to consider redirection of care, according to neonatal outcome severity. We aimed to seek associations between some neonatal routine parameters, usually recorded in Neonatal Intensive Care Units, and the development of severe outcomes. All consecutive patients prospectively recruited for TH for perinatal asphyxia, born between February 2009 and July 2016, were eligible for this study. Severe outcome was defined as death or major neurological sequelae at one year of age. Among all eligible neonates, the final analysis included 83 patients. Severe outcome was significantly associated with pH and base excess measured in the first hour of life, mode of delivery, Apgar score, Sarnat and Sarnat score, electroencephalogram-confirmed neonatal epileptic seizures, and antiepileptic therapy. Studying univariate analysis by raw relative risk (RR) and 95% confidence intervals (CI), severe outcome was significantly associated with pH (p = 0.011), Apgar score (p = 0.003), Sarnat score (p < 0.001), and Caesarian section (p = 0.015). Conclusions. In addition to clinical examination, we suggest a clinical-electroencephalographic protocol useful to identify neonates at high neurological risk, available before rewarming from TH.

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Incidence and Predictors of Mortality Among Neonates with Perinatal Asphyxia, Northwest Ethiopia, 2021: An Institution Based Retrospective Cohort Study.

10.21203/rs.3.rs-1013476/v1 ◽

2021 ◽

Author(s):

Aster Tadesse Shibabaw ◽

Getaneh Mulualem Belay ◽

Bogale Kassahun Desta ◽

Fasil Wagnew Shiferaw ◽

Ayenew Molla Lakew

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Preterm Birth ◽

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Perinatal Asphyxia ◽

Predictors Of Mortality ◽

Specialized Hospital ◽

Ischemic Encephalopathy

Abstract Background: - Perinatal asphyxia is the third leading cause of neonatal mortality globally, which usually happens within the first week of life. Therefore, evidence-based estimation of neonatal mortality is a cornerstone for tracking progress towards child survival goal and identifying priority areas to improve progress towards eliminating preventable deaths due to perinatal asphyxia. Objective: To assess incidence and predictors of mortality among neonates with perinatal asphyxia admitted to the neonatal intensive care unit of Debre Markos Comprehensive Specialized Hospital, 2021.Methods: An institutional-based retrospective follow-up study was conducted among 402 neonates with perinatal asphyxia (PNA) admitted to the neonatal intensive care unit (NICU) of Debre Markos Comprehensive Specialized Hospital from January 1st, 2018 to the 30th of December, 2020. A simple random sampling technique was used to select the estimated sample. Data were entered using Epi data Version 4.6.0.0 and analyzed using Stata Version 14. The Kaplan–Meier and log-rank test were used to estimate and compare the survival time. Both the bi-variable and multivariable Weibull regression models were fitted to identify predictors of mortality. Finally, the Hazard ratio with a 95%CI was computed, and variables with p-values <0.05 were considered as statistically significant predictors of mortality. Results: A total of 125 (31.09%) neonates died during the follow-up period. The overall incidence rate of mortality was found to be 53.49 per 1000 neonate-days of observations (95%CI: 44.89-63.74). Neonatal sepsis (AHR=2.13;95%CI: 1.38-3.27), preterm birth (AHR= 3.42 95%CI; 2.13- 5.48), Hypoxic Ischemic Encephalopathy stage II (AHR=6.65 95%CI: 2.57-17.26), and III (AHR=16.8 95%CI; 6.28- 44.9), Antepartum hemorrhage (AHR=2;95%CI: 1.13-3.92), the induced onset of labor (AHR=3.90;95%CI; 1.83-8.27), and post-partum hemorrhage (AHR=2.12;95%CI: 1.32-3.38) were significant predictors of mortality among neonates with perinatal asphyxia.Conclusion: The study found that the overall incidence rate of mortality among neonates with PNA remains high. Neonatal sepsis, Hypoxic-ischemic encephalopathy stage II and III, preterm birth, antepartum hemorrhage, postpartum hemorrhage and induced onset of labor were independent predictors of mortality. Therefore, early anticipating high-risk pregnancies and newborns with the respective intervention could reduce neonatal due to perinatal asphyxia.

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Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy

The Journal of Pediatrics ◽

10.1016/j.jpeds.2013.04.043 ◽

2013 ◽

Vol 163 (4) ◽

pp. 949-954 ◽

Cited By ~ 36

Author(s):

Vishal S. Kapadia ◽

Lina F. Chalak ◽

Tara L. DuPont ◽

Nancy K. Rollins ◽

Luc P. Brion ◽

...

Keyword(s):

Perinatal Asphyxia ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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MRI IN HYPOXIC ISCHEMIC ENCEPHALOPATHY WITH CLINICAL FOLLOW UP

10.36106/ijar/7611680 ◽

2021 ◽

pp. 43-48

Author(s):

M R Shashikumar ◽

Narasipur Lingaiah Rajendrakumar ◽

Sanjay P ◽

Nanjaraj Chakenalli Puttaraj ◽

Shruti Shruti ◽

...

Keyword(s):

Clinical Outcome ◽

Mr Imaging ◽

Developmental Disorders ◽

Brain Mri ◽

Birth Asphyxia ◽

Hypoxic Ischemic Encephalopathy ◽

Preterm Neonates ◽

Diffusion Restriction ◽

Ischemic Encephalopathy

Introduction: HIE is often clinically suspected in the setting of a known perinatal stress event arising from a complicated or difcult delivery. The most sensitive and specic imaging technique for examining infants with suspected hypoxicischemic brain injury is MR imaging. It also gives information about the timing and specic patterns of injury and also suggest diagnoses other than HIE such as metabolic disorders and developmental disorders of the brain. MRI is also a useful tool in the determination of prognosis and also follow-up of HIE. Aim: This study was undertaken to evaluate the various MRI appearances of hypoxic ischemic encephalopathy in term and preterm neonates and to correlate the MRI appearances with clinical outcome. Materials and Methods: All neonates with history of birth asphyxia, referred for MRI examination to the Department of Radio-Diagnosis, K. R. Hospital attached to Mysore Medical College and Research Institute, during January 2018 to January 2019. All MRI scans were performed on GE optima MR360 1.5 Tesla. Sequences used were T1W axial, T1 FLAIR axial, T2W axial, T2 FLAIR axial, T1W sag, T2W coronal, T2W GRE axial, DWI axial and ADC maps. Results: 30 babies with clinically suspicion of HIE and positive ndings on MR imaging were evaluated in our study. Out of 30 babies, 18 were term and 12 babies were preterm. Periventricular luecomalacia is most common MRI pattern in preterm and central pattern in term neonates. 16 babies had abnormal developmental outcome at 6 months follow up study. 16 babies with diffusion restriction in corpus callosum, 12 had abnormal outcome. 7 out of 10 babies with loss of normal signal in internal capsule had abnormal outcome. Babies with diffusion restriction in basal ganglia had gross developmental delay. Conclusion: MRI is the modality of choice for evaluation of HIE because of excellent gray – white matter resolution, well-depiction of myelination pattern and multi-planar imaging capabilities. There is a strong relation between the MRI appearances of birth asphyxia and the clinical outcome. Therefore MRI has a strong role in prognosticating lesions.

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The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy

10.21203/rs.3.rs-244271/v1 ◽

2021 ◽

Author(s):

Osman Baştuğ ◽

Bahadır İnan ◽

Ahmet Özdemir ◽

Binnaz Çelik ◽

Funda Baştuğ ◽

...

Keyword(s):

Urinary Excretion ◽

Therapeutic Hypothermia ◽

Perinatal Asphyxia ◽

Serum Levels ◽

Hypoxic Ischemic Encephalopathy ◽

Control Group ◽

P Value ◽

Electrolyte Disturbances ◽

Significant Difference ◽

Ischemic Encephalopathy

Abstract Background: Hypocalcemia, hypomagnesemia, and hyperphosphatemia are common electrolyte disturbances in perinatal asphyxia(PA). Different reasons have been proposed for these electrolyte disturbances. This study investigated the effect of the urinary excretion of calcium(Ca), magnesium(Mg), and phosphorus(P) on the serum levels of these substances in babies who were treated using therapeutic hypothermia for hypoxic ischemic encephalopathy(HİE) caused by PA. This study sheds light on the pathophysiology that may cause changes in the serum values of these electrolytes.Method: This study included 21 healthy newborns(control group) and 38 patients(HİE group) who had undergone therapeutic hypothermia due to HİE. Only infants with a gestational age of 36 weeks and above and a birth weight of 2000 g and above were evaluated. The urine and serum Ca, Mg, P, and creatinine levels of all infants were evaluated at 24, 48, and 72 hours.Results: The lower serum Ca value and the higher serum P value of the HİE group were found to be statistically significant compared to the control group. There was no significant difference in serum Mg values between the groups. However, hypomagnesemia was detected in five patients from the HİE group. The urine excretions of these substances, which were checked at different times, were found to be significantly higher in the HİE group compared to the control group.Conclusion: This study determined that the urinary excretion of Ca, Mg, and P has an effect on the serum Ca, Mg, and P levels of infants with HİE.

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Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Journal of Clinical Medicine ◽

10.3390/jcm8081247 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1247

Author(s):

Domenico M. Romeo ◽

Sarah Bompard ◽

Francesca Serrao ◽

Giuseppina Leo ◽

Gianpaolo Cicala ◽

...

Keyword(s):

Neurological Examination ◽

Motor Impairment ◽

Hypoxic Ischemic Encephalopathy ◽

Neurological Assessment ◽

Neurodevelopmental Outcomes ◽

Good Tool ◽

Motor Disabilities ◽

High Risk Infants ◽

Ischemic Encephalopathy

Early neurological assessment in infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia has not been systematically explored. The aims of the present study were to assess whether the Hammersmith Infant Neurological Examination (HINE) is a good tool to predict later neurodevelopmental outcomes at 2 year from birth in this population of infants. A total of 41 term born infants with HIE treated with hypothermia performed the HINE at 12 months and a neurodevelopmental assessment at 24 months. All the infants who had a global HINE score between 67 and 78 were able to walk independently at 2 years and reported a normal developmental quotient; language disorders were observed in a limited number of infants. HINE scores <67 were always associated with motor impairment. In conclusion, the HINE confirms its role as one of the early neurological examination tools for the diagnosis of high risk infants, even in infants with HIE treated with hypothermia. These results can be useful for clinicians involved in the follow up of these infants for early identification of motor disabilities and in planning appropriate intervention.

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Quantitative EEG in babies at risk for hypoxic ischemic encephalopathy after perinatal asphyxia

Journal of Perinatology ◽

10.1038/jp.2009.130 ◽

2009 ◽

Vol 30 (2) ◽

pp. 122-126 ◽

Cited By ~ 4

Author(s):

M Hathi ◽

D L Sherman ◽

T Inder ◽

N S Rothman ◽

M Natarajan ◽

...

Keyword(s):

At Risk ◽

Perinatal Asphyxia ◽

Quantitative Eeg ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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Exploring Perinatal Asphyxia by Metabolomics

Metabolites ◽

10.3390/metabo10040141 ◽

2020 ◽

Vol 10 (4) ◽

pp. 141 ◽

Cited By ~ 2

Author(s):

Emanuela Locci ◽

Giovanni Bazzano ◽

Roberto Demontis ◽

Alberto Chighine ◽

Vassilios Fanos ◽

...

Keyword(s):

Perinatal Asphyxia ◽

Relevant Literature ◽

Hypoxic Ischemic Encephalopathy ◽

Health Concern ◽

Resonance Spectroscopy ◽

Industrialized Countries ◽

Human Infants ◽

Therapeutic Tools ◽

Effective Use ◽

Ischemic Encephalopathy

Brain damage related to perinatal asphyxia is the second cause of neuro-disability worldwide. Its incidence was estimated in 2010 as 8.5 cases per 1000 live births worldwide, with no further recent improvement even in more industrialized countries. If so, hypoxic-ischemic encephalopathy is still an issue of global health concern. It is thought that a consistent number of cases may be avoided, and its sequelae may be preventable by a prompt and efficient physical and therapeutic treatment. The lack of early, reliable, and specific biomarkers has up to now hampered a more effective use of hypothermia, which represents the only validated therapy for this condition. The urge to unravel the biological modifications underlying perinatal asphyxia and hypoxic-ischemic encephalopathy needs new diagnostic and therapeutic tools. Metabolomics for its own features is a powerful approach that may help for the identification of specific metabolic profiles related to the pathological mechanism and foreseeable outcome. The metabolomic profiles of animal and human infants exposed to perinatal asphyxia or developing hypoxic-ischemic encephalopathy have so far been investigated by means of 1H nuclear magnetic resonance spectroscopy and mass spectrometry coupled with gas or liquid chromatography, leading to the identification of promising metabolomic signatures. In this work, an extensive review of the relevant literature was performed.

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