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.

The Six-Hour Window: How the Community Hospital Nursery Can Optimize Outcomes of the Infant with Suspected Hypoxic-Ischemic Encephalopathy

2018 ◽  
Vol 37 (3) ◽  
pp. 155-163 ◽  
Author(s):  
Dafina Ibrani ◽  
Shanon Molacavage
Keyword(s):  
At Risk ◽  
Community Hospital ◽  
Hypoxic Ischemic Encephalopathy ◽  
Perinatal Hypoxia ◽  
Level Ii ◽  
Essential Components ◽  
The Family ◽  
Level I ◽  
Ischemic Encephalopathy ◽  
Resuscitation Team

Perinatal hypoxia is a devastating event before, during, or immediately after birth that deprives an infant’s vital organs of oxygen. This injury at birth often requires a complex resuscitation and increases the newborn’s risk of hypoxic-ischemic encephalopathy (HIE). The resuscitation team in a community hospital nursery may have less experience with complex resuscitation and post-resuscitation care of this infant than a NICU. This article provides the neonatal nurse in a Level I or Level II nursery with information about resuscitation and post-resuscitation care of an infant at risk of HIE while awaiting transport to a NICU for therapeutic cooling. The article describes the infant at risk for HIE, discusses pathophysiology and treatment of HIE, and lists essential components of post-resuscitation care while awaiting transport to an NICU, the importance of communication with the receiving NICU, and strategies for supporting the family.

scholarly journals Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study

2019 ◽  
Vol 60 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Anneleen Dereymaeker ◽  
Vladimir Matic ◽  
Jan Vervisch ◽  
Perumpillichira J. Cherian ◽  
Amir H. Ansari ◽  
...  
Keyword(s):  
At Risk ◽  
Pilot Study ◽  
Adverse Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Ischemic Encephalopathy

MRI IN HYPOXIC ISCHEMIC ENCEPHALOPATHY WITH CLINICAL FOLLOW UP

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.

scholarly journals 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

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.

Hypoxic Ischemic Encephalopathy in Neonates with Birth Asphyxia - A Hospital Based Study

2021 ◽  
Vol 18 (2) ◽  
pp. 22-26
Author(s):  
Jyoti Adhikari ◽  
Deepak Paudel
Keyword(s):  
Birth Asphyxia ◽  
College Teaching ◽  
Hypoxic Ischemic Encephalopathy ◽  
Obstructed Labor ◽  
Female Ratio ◽  
Live Births ◽  
Normal Birth ◽  
Risk Pregnancy ◽  
Clinical Presentations ◽  
Ischemic Encephalopathy

Introduction: Each year approximately 4 million babies are born asphyxiated, which results in 1 million deaths and an equal number of serious neurological sequelae. One of the commonest organs involved in birth asphyxia is brain which may lead to a syndrome of clinical manifestation called Hypoxic Ischemic Encephalopathy (HIE). Aims: To find out possible maternal and neonatal risk factors for Hypoxic Ischemic Encephalopathy, to analyze clinical presentations and outcome of HIE in asphyxiated newborns. Methods: Hospital based observational study was carried out among fifty newborns with Apgar score less than 7 at 1 minute of life admitted in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke. Results: The incidence of birth asphyxia and birth asphyxia with HIE were 37.2 per 1000 live births and 14 per 1000 live births with male: female ratio of 1.27:1. Most of the neonates 22(44%) were in HIE stage II. Meconium stained amniotic fluid 18 (36%) was the most common intrapartum risk factor followed by maternal use of intrapartum medications 14 (28%), Premature Rupture of Membrane (PROM) 8 (16%), prolonged labor 5 (10%) and obstructed labor 6 (12%). Four (8%) asphyxiated neonates with HIE had cord prolapse and 7 (14%) had cord around the neck. The most common resuscitation done was bag and mask ventilation (56%) (P<0.05). Majority of the studied neonates were of normal birth weight (76%) and head circumference (84%) (P<0.05) with clinical presentations of respiratory distress (88%), seizures (44%), apnea (22%), bradycardia (8%), tachycardia (6%) and bulged anterior fontanel (6%). The overall mortality of neonates with HIE was 20% of which most were of HIE stage III. Conclusion: Certain measures could be taken to prevent birth asphyxia: early detection and intervention of high risk pregnancy, prompt and effective resuscitation of asphyxiates newborns.

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.

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

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

2009 ◽  
Vol 30 (2) ◽  
pp. 122-126 ◽  
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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