Neonatal and maternal factors associated with hepatic dysfunction after birth asphyxia

Background: Liver cell injury commonly occurs after perinatal asphyxia. This study aimed to identify the neonatal and maternal factors related to hepatic dysfunction associated with birth asphyxia. Methods: A case control study was carried out in Basra comprising 43 asphyxiated newborns, and 57 healthy full terms enrolled as control. Serum levels of liver enzymes [alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP)] were measured and compared between the study and control groups. Levels beyond +2SD above the mean of control considered high. Statistical analysis was done using SPSS program version 20. Chi-Square test and ANOVA were used where appropriate, P-value <0.05 was considered as significant. Elevated levels of enzymes were studied in relation to selected neonatal and maternal variables. Results: Higher levels of liver enzymes were found related to gestational age > 40 weeks, newborn’s body weight > 4 Kg, mother’s age>35 years, parity > 4 children and maternal medical disease. The results were statistically significant (P<0.05). However, no statistical differences were detected regarding newborn’s gender and growth status, maternal education and mode of delivery. Conclusion: The study highlights the relationship between maternal and neonatal risk factors and perinatal asphyxia associated with hepatic dysfunction.

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Electrolyte abnormalities in asphyxiated newborns

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181537 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1036

Author(s):

Satheesh Kumar D. ◽

Thenmozhi M. ◽

Kumar .

Keyword(s):

Serum Sodium ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Postnatal Period ◽

P Value ◽

Sodium Potassium ◽

Neonatal Deaths ◽

Electrolyte Abnormalities

Background: Perinatal asphyxia is the most common cause of neonatal morbidity and mortality in worldwide. It accounts for 23% of all neonatal deaths. Electrolyte abnormalities are more common in the immediate post asphyxiated period and influence neonatal the outcome effectively. Aim of this study was to measure the serum sodium, potassium and calcium levels in immediate postnatal period of asphyxiated newborns and assess the correlation with different degree of birth asphyxia.Methods: The serum sodium, potassium and calcium levels were measured in asphyxiated newborns in the early post-natal period. Both intramural and extramural newborns were included irrespective of their mode of delivery but according to the Apgar score. The measured electrolyte values were compared with the different severity of asphyxia. Results: Out of 100 newborns 53 had hyponatremia, 10 had hyperkalemia and 3 had hypocalcemia. The serum sodium and potassium levels showed significant P value (<0.00) with the different degree of both asphyxia but calcium levels were not significant (p valve = 0.06). There was a negative linear correlation with sodium and calcium levels and positive correlation with the serum potassium levels.Conclusions: Hyponatremia was significant in all stages of birth asphyxia, hyperkalemia was significant with increased severity of birth asphyxia and hypocalcemia was only weakly significant even in severe birth asphyxia.

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Morbidity Pattern and Hospital Outcome of Neonates Admitted in Tertiary Care Hospital, Nepal

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v40i2.29469 ◽

2020 ◽

Vol 40 (2) ◽

pp. 107-113

Author(s):

Deepeshwara Nepal ◽

Sumit Agrawal ◽

Sushan Shrestha ◽

Ajit Rayamajhi

Keyword(s):

Birth Weight ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Extremely Low Birth Weight ◽

P Value ◽

Care Hospital ◽

Hospital Outcome ◽

Poor Outcome

Introduction: The first 28 days of life, neonatal period is crucial as neonates are susceptible to sepsis, birth asphyxia, hypoxic injuries and its consequences which may lead to lifelong morbidity. Knowing the causes of morbidity and mortality is an essential step to improve neonatal health. The aim of this study is to describe the pattern and causes of neonatal admission, immediate hospital outcome in the form of improved, died or left against medical advice and factors associated with its outcome. Methods: This was a retrospective hospital based study carried out in Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital, Kathmandu, Nepal over a period of six months (February 2019 to July 2019 AD). Neonatal details including age, sex, gestational age, birth weight, and maternal age and parity, mode of delivery, place of delivery, neonatal morbidities and neonatal outcomes were recorded in a predesigned performa. Results were expressed as mean, percentage and p value. P- value was calculated by using chi-square test. Results: A total of 163 neonates were admitted during the study period, among which 106 (65%) were males. The mean birth weight was 2483.96 ± 812.63 gm. Among admitted newborns 130 (79.8%) had good outcome, babies born to young mothers (< 20 years of age) had poor outcome which is statistically significant with p value of 0.002. Neonates whose birth weight were < 1000 gram had significantly poor outcome (0.001). Conclusion: Common causes of NICU admission were neonatal sepsis, neonatal hyperbilirubinemia, prematurity and perinatal asphyxia. Babies born to young primipara mothers, extremely low birth weight, extremely premature babies and babies undergoing mechanical ventilation had poor outcome.

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CLINICAL PROFILE OF DENGUE FEVER IN CHILDREN IN WESTERN BIHAR

10.36106/5702032 ◽

2021 ◽

pp. 53-54

Author(s):

Punam kumari

Keyword(s):

Serum Sodium ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Postnatal Period ◽

P Value ◽

Sodium Potassium ◽

Neonatal Deaths ◽

Negative Linear Correlation

Background: Perinatal asphyxia is the most common cause of neonatal morbidity and mortality in worldwide. It accounts for 23% of all neonatal deaths. Electrolyte abnormalities are more common in the immediate post asphyxiated period and inuence neonatal the outcome effectively. Aim of this study was to measure the serum sodium, potassium and calcium levels in immediate postnatal period of asphyxiated newborns and assess the correlation with different degree of birth asphyxia. The serum Methods: sodium, potassium and calcium levels were measured in asphyxiated newborns in the early post-natal period. Both intramural and extramural newborns were included irrespective of their mode of delivery but according to the Apgar score. The measured electrolyte values were compared with the different severity of asphyxia. Out of 100 newborns 53 had hyponatremia, 10 had hyperkal Results: emia and 3 had hypocalcemia. The serum sodium and potassium levels showed signicant P value (<0.00) with the different degree of both asphyxia but calcium levels were not signicant (p valve = 0.06). There was a negative linear correlation with sodium and calcium levels and positive correlation with the serum potassium levels. Hyponatremia was signicant in all stages of birth Conclusions: asphyxia, hyperkalemia was signicant with increased severity of birth asphyxia and hypocalcemia was only weakly signicant even in severe birth asphyxia.

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Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

Global Pediatric Health ◽

10.1177/2333794x20981304 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2098130

Author(s):

Ebissa Bayana Kebede ◽

Adugna Olani Akuma ◽

Yonas Biratu Tarfa

Keyword(s):

Gestational Age ◽

Medical Center ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Large For Gestational Age ◽

Systematic Sampling ◽

P Value ◽

Health Extension Workers ◽

Severe Problem ◽

Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

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MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

10.36106/ijsr/3731386 ◽

2021 ◽

pp. 48-50

Author(s):

Neha Agarwal ◽

Samta Bali Rathore ◽

Shivani Baberwal-

Keyword(s):

Caesarean Section ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Care Hospital ◽

Pregnancy Induced Hypertension ◽

Meconium Aspiration ◽

Induced Hypertension

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

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Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.2802 ◽

2014 ◽

Vol 52 (196) ◽

pp. 1005-1009

Author(s):

Sweta Kumari Gupta ◽

Bhawani Kanta Sarmah ◽

Damodar Tiwari ◽

Amshu Shakya ◽

Dipendra Khatiwada

Keyword(s):

Perinatal Asphyxia ◽

Tertiary Care ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Clinical Information ◽

Clinical Problem ◽

Presentation Mode ◽

Care Hospital ◽

Central Nepal ◽

Bag And Mask Ventilation

Introduction: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy. Methods: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol. Results: Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth. Conclusions: Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females. Keywords: birth asphyxia; HIE; mortality; measurement.

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TO STUDY THE CORRELATION OF URINARY URIC ACID AND CREATININE RATIO IN BIRTH ASPHYXIA

10.36106/ijsr/0127075 ◽

2021 ◽

pp. 53-54

Author(s):

B Revanth Reddy ◽

Gauri Chauhan ◽

Anand Kumar Bhardwaj ◽

Sasanka Chakrabarti

Keyword(s):

Uric Acid ◽

Apgar Score ◽

Perinatal Asphyxia ◽

Birth Asphyxia ◽

Control Group ◽

P Value ◽

Creatinine Ratio ◽

Spot Urine ◽

Spot Urine Sample ◽

And Control

Introduction: Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Feasible and early biochemical markers to diagnose and predict the neurologic outcome is a great need of time as APGAR score alone is inuenced by various factors. The present study was performed to determine the urinary uric acid to creatinine ratio in perinatal asphyxia and its correlation with APGAR score and compare urinary uric acid to creatinine ratio with Sarnat and Sarnat staging. Materials and Methods: This study was carried out on 100 term neonates with an equal number of cases and control 50 each, control group being the neonates with Apgar score ≥ 7 at 1 minute of life and cases being the neonates who suffered from perinatal asphyxia with Apgar < 7 at 1 minute of life. The spot urine sample was collected within 24 hours of birth and their uric acid and creatinine levels were measured and the ratio calculated. Asphyxiated neonates were classied according to Sarnat and Sarnat staging. We Compare UA/Cr ratio with Apgar score and HIE staging using Sarnat and Sarnat staging.Results: On comparison of UUA/Cr among cases and controls we found that ratio was signicantly higher in asphyxiated neonates as compared to non asphyxiate neonates. (Control vs. Cases Group: 2.4 ± 1 vs. 3.6 ± 1.5; p –value < 0.0001). On comparison of UUA/Cr among cases with Sarnat and Sarnat staging of HIE, there is a signicant difference observed in mean UA/Cr ratio across Sarnat and Sarnat staging of HIE (F – Value = 68.760; p – value = 0.0001). Conclusion: Urinary uric acid and creatinine ratio can be used as markers for perinatal asphyxia for screening in centers where other markers for assessing perinatal asphyxia are not available. Urinary uric acid and creatinine ratio is a non-invasive, cheap and easily available marker for assessing the severity perinatal asphyxia.

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Study of perinatal asphyxia and its outcome concerning nucleated RBC count in venous blood of term neonates

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2021.i01.08 ◽

2021 ◽

Vol 8 (1) ◽

pp. 54-63

Author(s):

Dr. Pradeep Kumar Jena ◽

◽

Dr. Himansu Parida ◽

Dr. Banashree Swain ◽

Dr. Mangal Charan Murmu ◽

...

Keyword(s):

Apgar Score ◽

Perinatal Asphyxia ◽

Venous Blood ◽

Surrogate Marker ◽

Birth Asphyxia ◽

Neurological Impairment ◽

Adverse Outcomes ◽

P Value ◽

Medical College ◽

Nucleated Red Blood Cells

Introduction: Perinatal asphyxia is a serious problem globally and is one of the common causes ofneonatal mortality. Worldwide each year four million infants suffer from birth asphyxia. Of these onemillion die and an equal number develop serious sequelae. Perinatal asphyxia ranks as the secondmost important cause of neonatal death after infections accounting for about 23% of mortalityworldwide. Aim & objective: To establish the level of nucleated red blood cells as an indicator ofpoor immediate outcome in perinatal asphyxia. Method: It was a case-control study done in thedepartment of pediatrics, S C B Medical College & S V P PG I P, Cuttack. Observation: The NRBCcount was significantly higher in neonates with adverse outcomes than in those with favourableoutcomes (p-value <0.001). NRBC count cut-off of >27/100 WBC had a sensitivity of 75% andspecificity of 95.2% in predicting adverse outcome defined as death, hemiplegia, hypertonia orsignificant hypotonia, unreliable sucking and seizures resistant to Phenobarbital. Conclusion:Nucleated red blood cell count can be used as a surrogate marker for birth asphyxia. It has asignificant negative correlation with Apgar score at one minute and Apgar score at 5minutes &significant positive correlation with severity of hypoxic ischemic-encephalopathy, time is taken forrecovery of neurological impairment following birth asphyxia and duration of NICU stay.

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Coagulation Profile in neonates with perinatal asphyxia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193627 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1922

Author(s):

Ruchi Jha ◽

Neelam Verma

Keyword(s):

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Fresh Frozen Plasma ◽

Control Group ◽

Severe Bleeding ◽

Care Seeking ◽

Second Stage Of Labour ◽

Care Seeking Behavior ◽

Fresh Frozen

Background: Perinatal Asphyxia refers to a condition during the first and second stage of labour in which impaired gas exchange leads to fetal acidosis, hypoxemia and hypercarbia. It accounts for about 23 per cent of the four million newborn deaths worldwide.Methods: To estimate the magnitude of coagulation derangement in babies who suffered birth asphyxia and compare it with non-asphyxiated controls.Results: There were 61.9% and 64 % males in both the groups outnumbering females suggesting that the health care seeking behavior for male children is more than for their female counterparts. Birth weight and mode of delivery are comparable in both the groups. PT and APTT were significantly higher in the asphyxiated babies than in their respective control group. It may be noted , however, that PT and APTT values were higher in the control group also, when compared with the reference values. This may indicate that the hemostatic mechanisms are already compromised in the newborns and perinatal asphyxia further augment the situation tilting it in favour of bleeding. Thrombocytopenia is observed in the asphyxiated group which may be due to placental insufficiency. Severe bleeding is significant in asphyxiated group as compared to the control.Conclusion: Dyscoagulation should be considered in all asphyxiated babies, and they may present with clinically significant bleeding, which may require fresh frozen plasma to restore and maintain their coagulation status.

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Maternal factors and feeding pattern in neonates admitted with dehydration

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182565 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1561

Author(s):

Suresh Goyal ◽

Sunny Malvia ◽

Lakhan Poswal ◽

Bhupesh Jain

Keyword(s):

Breast Feeding ◽

Birth Asphyxia ◽

Postnatal Period ◽

Feeding Pattern ◽

Control Group ◽

P Value ◽

Maternal Factors ◽

Medical College ◽

Delayed Initiation ◽

Education Status

Background: Some healthy breast-fed infants do not establish an adequate milk intake, continue to lose weight and may develop dehydration. The aim of the study is to find out the maternal factors and feeding pattern of neonates admitted with dehydration.Methods: Hospital based prospective study on neonates (>34 week gestation and >2kg birth weight) with signs/symptoms of dehydration and >10% weight loss after birth admitted in the NICU, MBGH, RNT Medical college, Udaipur, Rajasthan, India for period of 12 months from July 2015-June 2016. Sick neonates with sepsis, birth asphyxia and congenital anomalies were excluded. One apparently healthy neonate and mother selected randomly for each study group dehydrated neonate. Ethical clearance and informed consent for the study was taken.Results: 384 neonates with dehydration were enrolled. Most neonates (96.6%) with dehydration were admitted between Day 3-14 of birth. Dehydration was found in 2.5% caesarean section and 0.8% normal vaginal delivered neonates (p value<0.00001). Dehydrated neonates groups (n=384) was compared with non dehydrated healthy control group (n=384) neonates. Primiparous mothers (p value <0.00001), Pregnancy related complications (p value=0.02), delayed initiation of breast feeding (>1 hour) after birth (p value<0.00001), poor attachment during breast feeding (p value <0.00001), absent let down reflex (p value<0.00001), decreased (<8/day) breast feeding frequency (p value<0.00001), presence of nipple problems (p value<0.001) were more significantly present in dehydrated group as compared to control group. Socioeconomic status, education status and position of mother during breast feeding among mothers in dehydrated group were not significant. 379 neonates were discharged successfully, and 5 neonates expired.Conclusions: Dehydration is a serious problem in breastfed neonates, and early initiation of breast feeding, with proper counselling of breast feeding practices with breast examination in antenatal as well as postnatal period can help in its prevention.

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