Umbilical cord blood NGAL concentration as an early marker of perinatal asphyxia in neonates

Background: Nucleated RBCs are a common observation in the circulating blood of newborn. Number of nRBC in cord blood and perinatal asphyxia shows good correlation. Perinatal asphyxia ranks as the second most important cause of neonatal death after infections accounting for about 30% mortality worldwide. Objective of the present study was designed to find the relation between umbilical cord blood nRBC count and perinatal asphyxia.Methods: The present one-year prospective case control study was carried out. A total of 100 babies divided into two groups of 50 each as cases and controls. Term babies with perinatal asphyxia were enrolled as cases and term babies without perinatal asphyxia born during same period were included as control.Results: The distribution of cord blood pH in cases showed maximum babies (80%) with pH value of <7 and 38% of the children were detected to have HIE stage II followed by 26% with stage I and 4% with stage III. At admission, 48 hours and 72 hours, significantly higher number of babies were found to have higher cord blood nRBC count (p<0.001) and the mean cord blood nRBC count was found to be significantly high at all the intervals (p <0.001). Comparison of mean cord blood nRBC count among cases in stage III was significantly high compared to stage II and I (p<0.001) at admission, 48 hours and 72 hours.Conclusions: Cord blood nRBC can be used as surrogate marker for asphyxia. The clearance of nRBC from the circulation may be of help in prognosticating the outcome of asphyxiated babies.

Download Full-text

Cord Blood IL-16 Is Associated with 3-Year Neurodevelopmental Outcomes in Perinatal Asphyxia and Hypoxic-Ischaemic Encephalopathy

Developmental Neuroscience ◽

10.1159/000471508 ◽

2017 ◽

Vol 39 (1-4) ◽

pp. 59-65 ◽

Cited By ~ 10

Author(s):

Caroline E. Ahearne ◽

Ruby Y. Chang ◽

Brian H. Walsh ◽

Geraldine B. Boylan ◽

Deirdre M. Murray

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Roc Curve ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Prospective Longitudinal

Activation of the inflammatory pathway is increasingly recognized as an important mechanism of injury following neonatal asphyxia and encephalopathy. This process may contribute to the poor prognosis seen in some cases, despite therapeutic hypothermia. Our group has previously identified raised interleukin (IL)-6 and IL-16, measured in umbilical cord blood at birth, to be predictive of grade of hypoxic-ischaemic encephalopathy (HIE). Our aim in this study was to examine the ability of these cytokines to predict the 3-year neurodevelopmental outcome in the same cohort. As part of a prospective, longitudinal cohort study set in a single tertiary maternity unit, term infants with biochemical and clinical evidence of perinatal asphyxia were recruited at birth. Umbilical cord blood was collected and analyzed for IL-6 and IL-16 using a Luminex assay. The neurodevelopmental outcome of these infants was assessed at 3 years using the Bayley Scales of Infant and Toddler Development (Edition 3). Early cord blood measurement of IL-6 and IL-16 and long-term outcome were available in 33/69 infants. Median (IQR) IL-16 differentiated infants with a severely abnormal outcome (n = 6) compared to all others (n = 27), (646 [466-1,085] vs. 383.5 [284-494] pg/mL; p = 0.012). IL-16 levels were able to predict a severe outcome with an area under the receiver-operating characteristic (ROC) curve of 0.827 (95% CI 0.628-1.000; p = 0.014). Levels ≥514 pg/mL predicted a severe outcome with a sensitivity of 83% and a specificity of 81%. IL-16 also outperformed other routine biochemical markers available at birth for the prediction of severe outcome. APGAR scores at 1 and 10 min were also predictive of a severe outcome (p = 0.022 and p = 0.036, respectively). A combination of IL-16 with these clinical markers did not improve predictive value, but IL-16 combined with electroencephalogram grading increased the area under the ROC curve. IL-6 did not show any association with 3-year outcome. This is the first report studying the association of IL-16 measured at birth with long-term outcome in a cohort of neonates with perinatal asphyxia. IL-16 may be an early biomarker of severe injury and aid in the long-term prognostication in infants with HIE.

Download Full-text

Umbilical Cord Blood Lactate Levels in Newborns with Perinatal Asphyxia

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.04.01.3 ◽

2019 ◽

Vol 4 (1) ◽

Keyword(s):

Cord Blood ◽

Blood Lactate ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Perinatal Asphyxia ◽

Cutoff Point ◽

Lactate Levels ◽

Blood Lactate Levels

Objectives: This present study аims to evаluаte whether increаsing levels of cord blood lаctаte is аssociаted with perinаtаl аsphyxiа by using the commonly prаctised АPGАR score аs the gold stаndаrd. Methods: We performed а descriptive cross sectionаl study between Аpril 2014 аnd Аpril 2015 аt Hue Medicаl University Hospitаl, Vietnаm. 106 newborn bаbies (41 аsphyxiааnd 65 normаl bаbies) were included in the study. Umbilicаl cord blood is sаmpled for lаctаte аnаlysis. Results: Umbilicаl cord blood lаctаte levels were significаntly higher аmong infаnts born with аsphyxiа (meаn 7.71± 0.27, rаnge 4.74 – 11.96) compаred to thаt with normаl infаnts (meаn 5.56± 1.71, rаnge 1.32 – 10.82). Оverаll аccurаcy wаs very gооd, with аreа under RОC curve оf 0.803 (95% CI: 0.750–0.936). The optimаl cutoff point for umbilicаl cord blood lаctаte level of 6.97 mmol/l to diаgnose аsphyxiа hаd а sensitivity 58.5% (95% CI: 42.1 - 73.7), specificity 89.2% (95% CI: 79.1 - 95.6), +ve LR (likelihood rаtio) 5.44, -ve LR 0.46. Conclusion: Umbilicаl cord blood lаctаte is very good in confirming the diаgnosis of asphyxia and following up in newborn bаbies.

Download Full-text

Activin A and Acvr2b mRNA from Umbilical Cord Blood Are Not Reliable Markers of Mild or Moderate Neonatal Hypoxic–Ischemic Encephalopathy

Neuropediatrics ◽

10.1055/s-0041-1725012 ◽

2021 ◽

Author(s):

Marc Paul O'Sullivan ◽

Niamh Denihan ◽

Klaudia Sikora ◽

Mikael Finder ◽

Caroline Ahearne ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Whole Blood ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Activin A ◽

Hypoxic Ischemic Encephalopathy ◽

Enzyme Linked Immunosorbent Assay ◽

Ischemic Encephalopathy

Abstract Background Activin A protein and its receptor ACVR2B have been considered viable biomarkers for the diagnosis of hypoxic–ischemic encephalopathy (HIE). This study aimed to assess umbilical cord blood (UCB) levels of Activin A and Acvr2b messenger RNA (mRNA) as early biomarkers of mild and moderate HIE and long-term neurodevelopmental outcome. Methods One-hundred and twenty-six infants were included in the analyses from the BiHiVE2 cohort, a multi-center study, recruited in Ireland and Sweden (2013 to 2015). UCB serum Activin A and whole blood Acvr2b mRNA were measured using enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively. Results Activin A analysis included 101 infants (controls, n = 50, perinatal asphyxia, n = 28, HIE, n = 23). No differences were detected across groups (p = 0.69). No differences were detected across HIE grades (p = 0.12). Acvr2b mRNA analysis included 67 infants (controls, n = 22, perinatal asphyxia, n = 23, and HIE, n = 22), and no differences were observed across groups (p = 0.75). No differences were detected across HIE grades (p = 0.58). No differences were detected in neurodevelopmental outcome in infants followed up to 18 to 36 months in serum Activin A or in whole blood Acvr2b mRNA (p = 0.55 and p = 0.90, respectively). Conclusion UCB Activin A and Acvr2b mRNA are not valid biomarkers of infants with mild or moderate HIE; they are unable to distinguish infants with HIE or infants with poor neurodevelopmental outcomes.

Download Full-text

Predictions of Hypoxic-Ischemic Encephalopathy by Umbilical Cord Blood Lactate in Newborns with Birth Asphyxia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.581 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3564-3567

Author(s):

Ton Nu Van Anh ◽

Tran Kiem Hao ◽

Nguyen Thi Diem Chi ◽

Nguyen Huu Son

Keyword(s):

Cord Blood ◽

Blood Lactate ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Perinatal Asphyxia ◽

Birth Asphyxia ◽

Hypoxic Ischemic Encephalopathy ◽

Early Predictors ◽

Ischemic Encephalopathy

AIM: The aim of the study was to investigate the role of umbilical cord blood lactate as early predictors of hypoxic ischemic encephalopathy in newborns with perinatal asphyxia and to evaluate their sensitivity and specificity for the early identification of hypoxic ischemic encephalopathy infants. METHODS: We performed а descriptive cross sectionаl study between Аpril 2014 аnd Аpril 2015 аt Hue Central Hospital, Vietnаm. 41 аsphyxiа newborns (Apgar score ≤ 7) were included in the study. Umbilicаl cord blood is sаmpled for lаctаte аnаlysis. RESULTS: Umbilicаl cord blood lаctаte levels were significаntly higher аmong infаnts born with HIE (meаn 8.72 ± 1.75, rаnge 5.12 – 11.96) compаred to thаt with asphyxic infаnts without HIE (meаn 6.86 ± 1.33, rаnge 4.74 – 10.30), p = 0.00. With the optimаl cutoff point for umbilicаl cord blood lаctаte level of 8.12 mmol/l to susspected of HIE (аreа under the curve 0.799) hаd а sensitivity 73.7% (95% CI: 48.8-90.9), specificity 86.4% (95% CI: 65.1-97.1). CONCLUSION: Umbilical cord blood lactate could be used as early predictors in diagnosis of hypoxic ischemic encephalopathy in newborns with asphyxia.

Download Full-text

Correlation between umbilical cord blood pH and meconium stained deliveries

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200698 ◽

2020 ◽

Vol 7 (3) ◽

pp. 670

Author(s):

Shilpa Deborah Lysander ◽

Chandrakala P. ◽

Jayalalitha .

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Perinatal Asphyxia ◽

Neonatal Morbidity ◽

Developed Countries ◽

Blood Ph ◽

Significant Difference ◽

Study Population ◽

Acid Base Status

Background: Among all live births approximately 13% neonates are born through meconium-stained amniotic fluid and out of these 5-10% developed MAS, which increases neonatal morbidity and mortality. The incidence increases as the gestational age advances with reported frequencies at 37, 40, and >42 weeks being 3%, 13%, and 18% respectively. Although there is a significant decrease in the occurrence of MAS and associated mortality in developed countries, MAS remains a major problem in developing countries. The objective was to study the correlation between umbilical cord blood PH and Meconium stained amniotic fluid.Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.Results: In present study population, among those with MSAF, 72% had acidemia and 28% did not have acidemia. The mean (SD) of pH in the group with MSAF was 7.16 (0.10). The median (IQR) of pH in the group with MSAF was 7.14 (0.12). There was no significant difference between the groups (those with MSAF and those without MSAF but other risk factors) in terms of pH (W = 867.500, p = 0.580).Conclusions: The presence of acidosis in the umbilical cord blood, used as a biochemical marker for perinatal asphyxia can be used to evaluate the significance of intrauterine passage of meconium. But a normal acid-base status at delivery present in many cases of MSAF, suggests that either a pre-existing injury or a non-hypoxic mechanism is often involved. MSAF is not always secondary to an acute hypoxic event.

Download Full-text

THE CORRELATION BETWEEN PARAMETERS OF UMBILICAL CORD BLOOD COUNT AND BRAIN DAMAGE IN NEWBORNS WITH PERINATAL ASPHYXIA

Acta Medica Saliniana ◽

10.5457/ams.325.14 ◽

2014 ◽

Vol 42 (1) ◽

Author(s):

Amela Selimović ◽

Fahrija Skokić ◽

Selma Muratović ◽

Selmira Brkić ◽

Nermina Dedić ◽

...

Keyword(s):

Cord Blood ◽

Brain Damage ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Count ◽

Perinatal Asphyxia

Download Full-text

Study of relationship between umbilical cord blood hemoglobin percentage and perinatal asphyxia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204297 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4114

Author(s):

Sambedna . ◽

Amit Kumar ◽

Rita Chakore

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Perinatal Asphyxia ◽

Health Centre ◽

Control Group ◽

Study Group ◽

Pathophysiological Mechanism ◽

Blood Hemoglobin ◽

Number Of Patients

Background: Perinatal asphyxia may be caused by perinatal anemia. The pathophysiology and neurodevelopment effects are theoretically different from other causes of fetal asphyxia. Severe asphyxia can occur in infants around the time of birth by various reasons. The aim of this study to find the relationship between cord blood hemoglobin and perinatal asphyxia.Methods: This was a retrospective comparative study in department of OBG In tertiary care health centre. Umbilical cord blood samples were collected from 100 newborns with asphyxia at birth as study group and 100 newborns with non asphyxia as control group. Hemoglobin was measured colorimetrically.Results: This study finds that maximum number of patients in both the control and study group had hemoglobin in the range of 16.3-17.3 gm/dl. The difference was not statistically significant. P value>0.05.Conclusions: Hematological changes observed early after delivery can determine the duration of hypoxemia (acute versus chronic) Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed no abnormalities in neurodevelopment in contrast to children who were born asphyxiated due to various another causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.

Download Full-text