Effect of therapeutic hypothermia on chromosomal aberration in perinatal asphyxia

Abstract Objectives Neonates who develop moderate to severe encephalopathy following perinatal asphyxia will benefit from therapeutic hypothermia. Current National Institute of Child Health and Human Development (NICHD) criteria for identifying encephalopathic neonates needing therapeutic hypothermia has high specificity. This results in correctly identifying neonates who have already developed moderate to severe encephalopathy but miss out many potential beneficiaries who progress to develop moderate to severe encephalopathy later. The need is therefore not just to diagnose encephalopathy, but to predict development of encephalopathy and extend the therapeutic benefit for all eligible neonates. The primary objective of the study was to develop and validate the statistical model for prediction of moderate to severe encephalopathy following perinatal asphyxia and compare with current NICHD criteria. Methods The study was designed as prospective observational study. It was carried out in a single center Level 3 perinatal unit in India. Neonates>35 weeks of gestation and requiring resuscitation at birth were included. Levels of resuscitation and blood gas lactate were used to determine the pre-test probability, Thompson score between 3 and 5 h of life was used to determine post-test probability of developing encephalopathy. Primary outcome measure: Validation of Prediction of Encephalopathy in Perinatal Asphyxia (PEPA) score by Holdout method. Results A total of 55 babies were included in the study. The PEPA score was validated by Holdout method where the fitted receiver-operating characteristic (ROC) area for the training and test sample were comparable (p=0.758). The sensitivity and specificity of various PEPA scores for prediction of encephalopathy ranged between 74 and 100% in contrast to NICHD criteria which was 42%. PEPA score of 30 had a best combination of sensitivity and specificity of 95 and 89% respectively. Conclusions PEPA score has a higher sensitivity than NICHD criteria for prediction of Encephalopathy in asphyxiated neonates.

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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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PECULIARITIES OF THE RADIATION PATTERN OF THE BRAIN AND INTERNAL ORGANS OF NEWBORNS WHO UNDERWENT SEVERE PERINATAL ASPHYXIA AND UNDERWENT GENERAL THERAPEUTIC HYPOTHERMIA, ACCORDING TO THE PILOT STUDY RESULTS

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-1-30-35 ◽

2021 ◽

Vol 100 (1) ◽

pp. 30-35

Author(s):

N.S. Vorotyntseva ◽

◽

V.V. Orlova ◽

A.N. Motina ◽

A.D. Novikova ◽

...

Keyword(s):

Therapeutic Hypothermia ◽

Perinatal Asphyxia ◽

Control Group ◽

Internal Organs ◽

X Ray ◽

Abdominal Organs ◽

Study Results ◽

Negative Effect ◽

Chest X Ray ◽

The Brain

Objective of the research: to study the features of the radiological picture of the brain and internal organs of newborns with severe perinatal asphyxia, who underwent general therapeutic hypothermia (GTH). Materials and methods: the study included 116 newborns with severe perinatal asphyxia. GTH was performed in 72 patients (group 1), 44 children did not receive hypothermia in the 2 (control) group. In the first 6 hours of life, children of groups 1 and 2 underwent ultrasound of the brain and abdominal organs and chest x-ray. The complex ultrasound scan was repeated at 3–5, 7–10, 14–16 and 21–28 days. Repeated chest x-ray was carried out strictly according to the indications. Results: GTH reduced the incidence of organic brain lesions by 18% in children with severe perinatal asphyxia (p0,05). The study revealed a number of undesirable consequences associated with GTH. Transient effusion into the abdominal and thoracic cavities was diagnosed by ultrasound in 8 (11%) patients after hypothermia, while there were no such changes in children in the control group (p<0,05). X-ray of the chest in newborns who received GTH during the first 14 days revealed edematous-hemorrhagic changes in the lungs more often than in patients of the control group – 55 (76%) and 24 (55%), respectively (p<0,05). Conclusions: GTH effectively prevented the development of severe post-hypoxic changes in the brain. The negative effect of hypothermia on microcirculation was manifested by the development of effusion into the serous cavities and edematous-hemorrhagic syndrome.

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Therapeutic Hypothermia Modifies Perinatal Asphyxia-Induced Changes of the Corpus Callosum and Outcome in Neonates

PLoS ONE ◽

10.1371/journal.pone.0123230 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0123230 ◽

Cited By ~ 10

Author(s):

Thomas Alderliesten ◽

Linda S. de Vries ◽

Yara Khalil ◽

Ingrid C. van Haastert ◽

Manon J. N. L. Benders ◽

...

Keyword(s):

Corpus Callosum ◽

Therapeutic Hypothermia ◽

Perinatal Asphyxia ◽

Induced Changes

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Therapeutic Hypothermia After Perinatal Asphyxia in Infants With Severe, Ductal-Dependent Congenital Heart Disease*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001878 ◽

2019 ◽

Vol 20 (5) ◽

pp. 457-465 ◽

Cited By ~ 2

Author(s):

Vinzenz Boos ◽

Anna Tietze ◽

Felix Berger ◽

Christoph Bührer

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Therapeutic Hypothermia ◽

Congenital Heart ◽

Perinatal Asphyxia

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293 The Myocardial Performance during and after 72-Hours of Therapeutic Hypothermia for Perinatal Asphyxia in Term Neonates

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.0293 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A86-A86

Author(s):

E. Nestaas ◽

J. Skranes ◽

A. Stoylen ◽

D. Fugelseth

Keyword(s):

Therapeutic Hypothermia ◽

Perinatal Asphyxia ◽

Myocardial Performance ◽

Term Neonates

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Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia

Journal of Perinatology ◽

10.1038/jp.2016.110 ◽

2016 ◽

Vol 36 (11) ◽

pp. 977-984 ◽

Cited By ~ 5

Author(s):

C M C Frank ◽

P G J Nikkels ◽

J C Harteman ◽

I C van Haastert ◽

M J N L Benders ◽

...

Keyword(s):

Therapeutic Hypothermia ◽

Perinatal Asphyxia ◽

Placental Pathology

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Therapeutic Hypothermia in a Neonate with Perinatal Asphyxia and Transposition of the Great Arteries

Therapeutic Hypothermia and Temperature Management ◽

10.1089/ther.2011.0016 ◽

2011 ◽

Vol 1 (4) ◽

pp. 205-208 ◽

Cited By ~ 6

Author(s):

Sarah B. Mulkey ◽

Eudice E. Fontenot ◽

Michiaki Imamura ◽

Vivien L. Yap

Keyword(s):

Therapeutic Hypothermia ◽

Perinatal Asphyxia

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Neonatal Thrombocytopenia after Perinatal Asphyxia Treated with Hypothermia: A Retrospective Case Control Study

International Journal of Pediatrics ◽

10.1155/2014/760654 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

N. Boutaybi ◽

F. Razenberg ◽

V. E. H. J. Smits-Wintjens ◽

E. W. van Zwet ◽

M. Rijken ◽

...

Keyword(s):

Platelet Count ◽

Therapeutic Hypothermia ◽

Case Control Study ◽

Perinatal Asphyxia ◽

Case Control ◽

Control Group ◽

Retrospective Case ◽

Increased Risk ◽

Hypothermia Group ◽

Control Study

Our objective was to estimate the effect of therapeutic hypothermia on platelet count in neonates after perinatal asphyxia. We performed a retrospective case control study of all (near-) term neonates with perinatal asphyxia admitted between 2004 and 2012 to our neonatal intensive care unit. All neonates treated with therapeutic hypothermia were included in this study (hypothermia group) and compared with a historic control group of neonates with perinatal asphyxia treated before introduction of therapeutic hypothermia (2008). Primary outcome was thrombocytopenia during the first week after birth. Thrombocytopenia was found significantly more often in the hypothermia group than in the control group, 80% (43/54) versus 59% (27/46) (P=.02). The lowest mean platelet count in the hypothermia group and control group was97×109/Land125×109/L(P=.06), respectively, and was reached at a mean age of 4.1 days in the hypothermia group and 2.9 days in the control group (P<.001). The incidence of moderate/severe cerebral hemorrhage was 6% (3/47) in the hypothermia group versus 9% (3/35) in the control group (P=.64). In conclusion, neonates with perinatal asphyxia treated with therapeutic hypothermia are at increased risk of thrombocytopenia, without increased risk of cerebral hemorrhage.

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