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  1 / 6047 MEDLINE  
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PMID:29341561
Autor:Dobrosavljevic A; Martic J; Rakic S; Pazin V; Jankovic-Raznatovic S; Sreckovic S; Dobrosavljevic B
Título:Massive fetomaternal hemorrhage as a cause of severe fetal anemia.
Fonte:Vojnosanit Pregl; 73(11):1068-71, 2016 Nov.
ISSN:0042-8450
País de publicação:Serbia
Idioma:eng
Resumo:Introduction: Fetomaternal hemorrhage (FMH) is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report: A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion: For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (AFP protein, human); 0 (Biomarkers); 0 (alpha-Fetoproteins); 9034-63-3 (Fetal Hemoglobin)


  2 / 6047 MEDLINE  
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PMID:28448965
Autor:Berger HR; Brekke E; Widerøe M; Morken TS
Endereço:Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Título:Neuroprotective Treatments after Perinatal Hypoxic-Ischemic Brain Injury Evaluated with Magnetic Resonance Spectroscopy.
Fonte:Dev Neurosci; 39(1-4):36-48, 2017.
ISSN:1421-9859
País de publicação:Switzerland
Idioma:eng
Resumo:Perinatal hypoxic-ischemic brain injury is a major health problem. Adjuvant treatments that improve the neuroprotective effect of the current treatment, therapeutic hypothermia, are urgently needed. The growing knowledge about the complex pathophysiology of hypoxia-ischemia (HI) has led to the discovery of several important targets for neuroprotection. Early interventions should focus on the preservation of energy metabolism, the reduction of glutamate excitotoxicity and oxidative stress, the maintenance of calcium homeostasis, and the prevention of apoptosis. Delayed interventions should promote injury repair. The multiple metabolic changes following HI as well as the metabolic effects of potential treatments can be observed noninvasively by magnetic resonance spectroscopy (MRS). This mini-review provides an overview of the neuroprotective pharmacological agents that have been evaluated with 1H/31P/13C MRS. A better understanding of how these agents influence cerebral metabolism and the use of relevant translational MRS biomarkers can guide future clinical trials.
Tipo de publicação: JOURNAL ARTICLE; REVIEW
Nome de substância:0 (Neuroprotective Agents)


  3 / 6047 MEDLINE  
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PMID:29246356
Autor:Weeke LC; Groenendaal F; Mudigonda K; Blennow M; Lequin MH; Meiners LC; van Haastert IC; Benders MJ; Hallberg B; de Vries LS
Endereço:Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands.
Título:A Novel Magnetic Resonance Imaging Score Predicts Neurodevelopmental Outcome After Perinatal Asphyxia and Therapeutic Hypothermia.
Fonte:J Pediatr; 192:33-40.e2, 2018 Jan.
ISSN:1097-6833
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. STUDY DESIGN: This retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85. RESULTS: In cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity. CONCLUSION: A novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently.
Tipo de publicação: JOURNAL ARTICLE


  4 / 6047 MEDLINE  
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PMID:28961316
Autor:Liu X; Jary S; Cowan F; Thoresen M
Endereço:Neonatal Neuroscience, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Título:Reduced infancy and childhood epilepsy following hypothermia-treated neonatal encephalopathy.
Fonte:Epilepsia; 58(11):1902-1911, 2017 Nov.
ISSN:1528-1167
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To investigate what proportion of a regional cohort of cooled infants with neonatal encephalopathy develop epilepsy (determined by the International League Against Epilepsy [ILAE] definition and the number of antiepileptic drugs [AEDs]) up to 8 years of age. METHODS: From 2006-2013, 151 infants with perinatal asphyxia underwent 72 h cooling. Clinical and amplitude-integrated electroencepalography (aEEG) with single-channel EEG-verified neonatal seizures were treated with AEDs. Brain magnetic resonance imaging (MRI) was assessed using a 0-11 severity score. Postneonatal seizures, epilepsy rates, and AED treatments were documented. One hundred thirty-four survivors were assessed at 18-24 months; adverse outcome was defined as death or Bayley III composite Cognition/Language or Motor scores <85 and/or severe cerebral palsy or severely reduced vision/hearing. Epilepsy rates in 103 children age 4-8 years were also documented. RESULTS: aEEG confirmed seizures occurred precooling in 77 (57%) 151 of neonates; 48% had seizures during and/or after cooling and received AEDs. Only one infant was discharged on AEDs. At 18-24 months, one third of infants had an adverse outcome including 11% mortality. At 2 years, 8 (6%) infants had an epilepsy diagnosis (ILAE definition), of whom 3 (2%) received AEDs. Of the 103 4- to 8-year-olds, 14 (13%) had developed epilepsy, with 7 (7%) receiving AEDs. Infants/children on AEDs had higher MRI scores than those not on AEDs (median [interquartile range] 9 [8-11] vs. 2 [0-4]) and poorer outcomes. Nine (64%) of 14 children with epilepsy had cerebral palsy compared to 13 (11%) of 120 without epilepsy, and 10 (71%) of 14 children with epilepsy had adverse outcomes versus 23 (19%) of 120 survivors without epilepsy. The number of different AEDs given to control neonatal seizures, aEEG severity precooling, and MRI scores predicted childhood epilepsy. SIGNIFICANCE: We report, in a regional cohort of infants cooled for perinatal asphyxia, 6% with epilepsy at 2 years (2% on AEDs) increasing to 13% (7% on AEDs) at early school age. These AED rates are much lower than those reported in the cooling trials, even with adjusting for our cohort's milder asphyxia. Long-term follow-up is needed to document final epilepsy rates.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anticonvulsants)


  5 / 6047 MEDLINE  
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PMID:28931055
Autor:Kelen D; Andorka C; Szabó M; Alafuzoff A; Kaila K; Summanen M
Endereço:First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Título:Serum copeptin and neuron specific enolase are markers of neonatal distress and long-term neurodevelopmental outcome.
Fonte:PLoS One; 12(9):e0184593, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:The objective of this study was to evaluate the early changes in serial serum levels of copeptin and neuron-specific enolase (NSE) in neonates diagnosed with birth asphyxia, and to determine whether these biomarkers measured in the first 168 hours after birth are predictive of long-term neurodevelopmental outcome. Copeptin and NSE levels were measured from serum samples collected 6, 12, 24, 48, 72, and 168 hours after birth from 75 term neonates diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia for 72 hours. In addition, serum copeptin levels after birth were measured from 10 HIE diagnosed neonates, who were randomized to the normothermic arm of the TOBY cohort. All neonates underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development-II at two years of age. Copeptin levels were highest at 6 hours after birth and steadily decreased, whereas the highest NSE levels were measured at 24 hours after birth. The biomarker levels correlated with blood-gas parameters (base excess, pH and lactate) at 6 and 12 hours after birth. Copeptin and NSE levels in the early postnatal period were significantly higher in neonates with poor outcome compared to those with favorable outcome at two years of age. Furthermore, in the TOBY cohort, copeptin levels were significantly lower in hypothermic compared to normothermic neonates. To conclude, copeptin and NSE measured in the early postnatal period are potential prognostic biomarkers of long-term neurodevelopmental outcome in term neonates diagnosed with HIE and treated with therapeutic hypothermia.
Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância:0 (Biomarkers); 0 (Glycopeptides); 0 (copeptins); EC 4.2.1.11 (Phosphopyruvate Hydratase)


  6 / 6047 MEDLINE  
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PMID:28570867
Autor:Nevalainen P; Marchi V; Metsäranta M; Lönnqvist T; Toiviainen-Salo S; Vanhatalo S; Lauronen L
Endereço:Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland. Electronic address: paivi.nevalainen@hus.fi.
Título:Evoked potentials recorded during routine EEG predict outcome after perinatal asphyxia.
Fonte:Clin Neurophysiol; 128(7):1337-1343, 2017 Jul.
ISSN:1872-8952
País de publicação:Netherlands
Idioma:eng
Resumo:OBJECTIVE: To evaluate the added value of somatosensory (SEPs) and visual evoked potentials (VEPs) recorded simultaneously with routine EEG in early outcome prediction of newborns with hypoxic-ischemic encephalopathy under modern intensive care. METHODS: We simultaneously recorded multichannel EEG, median nerve SEPs, and flash VEPs during the first few postnatal days in 50 term newborns with hypoxic-ischemic encephalopathy. EEG background was scored into five grades and the worst two grades were considered to indicate poor cerebral recovery. Evoked potentials were classified as absent or present. Clinical outcome was determined from the medical records at a median age of 21months. Unfavorable outcome included cerebral palsy, severe mental retardation, severe epilepsy, or death. RESULTS: The accuracy of outcome prediction was 98% with SEPs compared to 90% with EEG. EEG alone always predicted unfavorable outcome when it was inactive (n=9), and favorable outcome when it was normal or only mildly abnormal (n=17). However, newborns with moderate or severe EEG background abnormality could have either favorable or unfavorable outcome, which was correctly predicted by SEP in all but one newborn (accuracy in this subgroup 96%). Absent VEPs were always associated with an inactive EEG, and an unfavorable outcome. However, presence of VEPs did not guarantee a favorable outcome. CONCLUSIONS: SEPs accurately predict clinical outcomes in newborns with hypoxic-ischemic encephalopathy and improve the EEG-based prediction particularly in those newborns with severely or moderately abnormal EEG findings. SIGNIFICANCE: SEPs should be added to routine EEG recordings for early bedside assessment of newborns with hypoxic-ischemic encephalopathy.
Tipo de publicação: JOURNAL ARTICLE


  7 / 6047 MEDLINE  
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PMID:28494564
Autor:Pu QL; Zhou QY; Liu J; Li P; Huang HF; Jiang HQ
Endereço:Department of Ophthalmology, The Maternal and Child Health Hospital of Jiaxing, Jiaxing 314000, China.
Título:[Clinical observation and related factors analysis of neonatal asphyxia complicated with retinal hemorrhage].
Fonte:Zhonghua Yan Ke Za Zhi; 53(5):358-362, 2017 May 11.
ISSN:0412-4081
País de publicação:China
Idioma:chi
Resumo:To observe and analyze related factors of neonatal asphyxia complicated with retinal hemorrhage. It was a retrospective case series. Seven hundred and twenty-one cases with neonatal asphyxia after 72 hours of birth were enrolled in this study. Fundus examination was performed on these newborns using the third generation wide-angle digital retina imaging system (RetCamâ…¢), and the bleeding level was divided into level I, level â…¡ and level â…¢. The conditions of the newborn and the mother during pregnancy were correlatively analyzed. The other factors were also analyzed including delivery mode, birth weight, gestational age, gender, grade of neonatal asphyxia, scalp hematoma, intracranial hemorrhage, fetal intrauterine distress, mother's age and antenatal complications. Single factor χ(2) test and multivariate logistic regression analysis were used to screen and judge risk factors causing retinal hemorrhage related to neonatal asphyxia. In 721 cases of neonatal asphyxia, retinal hemorrhage was found in 204 newborns (28.29%). The hemorrhage was at level â…  in 77 cases (37.75%) , at level â…¡ in 38 cases (18.63%) and at level â…¢ in 89 cases (43.63%) . Four cases also had vitreous hemorrhage. Asphyxia was mild in 673 infants (93.34%) and severe in 48 infants (6.66%). The difference in the degree of retinal hemorrhage between the patients with mild and severe asphyxia was significant (χ(2)=22.336, 0.000). When asphyxia was aggravated, the degree of retinal hemorrhage increased. Relative factors analysis showed that delivery mode (χ(2)=158.643, 0.05), gestational age (χ(2)=24.522, 0.05), birth weight (χ(2)=11.916, 0.05) and grade of neonatal asphyxia (χ(2)=19.809, 0.05) had correlations with retinal hemorrhage. Logistic regression analysis indicated that grade of neonatal asphyxia and delivery mode were risk factors of retinal hemorrhage in neonatal asphyxia ( 0.304, 0.085). The incidence of retinal hemorrhage in neonatal asphyxia was 28.29%. The degree of neonatal asphyxia and delivery mode may play roles in the occurrence of retinal hemorrhage in newborns with asphyxia. With aggravation of asphyxia, the degree of retinal hemorrhage may increase. 358-362 .
Tipo de publicação: JOURNAL ARTICLE


  8 / 6047 MEDLINE  
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PMID:28441439
Autor:Vali P; Chandrasekharan P; Rawat M; Gugino S; Koenigsknecht C; Helman J; Mathew B; Berkelhamer S; Nair J; Wyckoff M; Lakshminrusimha S
Endereço:Pediatrics, UC Davis, Sacramento, California, United States of America.
Título:Hemodynamics and gas exchange during chest compressions in neonatal resuscitation.
Fonte:PLoS One; 12(4):e0176478, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluid-filled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC). METHODS: The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation. RESULTS: ROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 ±4 mmHg) did not differ from those that were not resuscitated (10 ±6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC. CONCLUSIONS: Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.
Tipo de publicação: JOURNAL ARTICLE


  9 / 6047 MEDLINE  
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PMID:28435017
Autor:Ivanisevic J; Kotur-Stevuljevic J; Stefanovic A; Miljkovic M; Jelic-Ivanovic Z; Pejovic B; Peco-Antic A
Endereço:Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia. Electronic address: jasminai@pharmacy.bg.ac.rs.
Título:Association of paraoxonase 1 and oxidative stress with acute kidney injury in premature asphyxiated neonates.
Fonte:Chem Biol Interact; 272:47-52, 2017 Jun 25.
ISSN:1872-7786
País de publicação:Ireland
Idioma:eng
Resumo:OBJECTIVES: Acute kidney injury (AKI) is defined as a decrease in glomerular filtration rate with an increase in serum creatinine (sCr). Perinatal asphyxia (PNA) may be etiological factor for AKI with oxidative stress also implicated. Paraoxonase 1 (PON1) activity has been reported to be decreased in renal disease. The aim of our study was to evaluate paraoxonase 1 (PON1) activity and oxidative stress during the first hours and first days of life and to determine if these parameters could discriminate neonates having AKI from those who do not. METHODS: Serum samples at different time points after birth were obtained from 64 preterm newborns with PNA (45 defined as having AKI, 19 as non-AKI). Clinical markers, sCr, total oxidant status (TOS), total antioxidant status (TAS) and PON1 activity were measured. RESULTS: The AKI group had more newborns with hypoxic ischemic encephalopathy, significantly higher serum creatinine (sCr) at 3 and 7d, total antioxidant status (TAS) at 7d; decreased PON1 at 4h, 6h and 7d than the non-AKI group. Within the AKI group, significant positive correlations were found between PON1 activity at 2h and TAS at 2h, PON1 activity at 4h and base deficit (BD); whereas negative correlations between PON1 activity at 2h and ΔsCr (at 24h and at 3d), PON1 activity at 7d and ΔsCr (at 24h and 3d). Oxidative stress status parameters indicated excellent discriminative potential at 4h, 6h and 7d. CONCLUSIONS: AKI neonates were characterised by a marked decrease in PON1 activity. PON1 activity may be an important factor for discrimination of newborns having AKI from those that do not.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Biomarkers); AYI8EX34EU (Creatinine); EC 3.1.8.1 (Aryldialkylphosphatase)


  10 / 6047 MEDLINE  
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PMID:28389438
Autor:Martinello K; Hart AR; Yap S; Mitra S; Robertson NJ
Endereço:Department of Neonatology, Institute for Women's Health, University College London, UK.
Título:Management and investigation of neonatal encephalopathy: 2017 update.
Fonte:Arch Dis Child Fetal Neonatal Ed; 102(4):F346-F358, 2017 Jul.
ISSN:1468-2052
País de publicação:England
Idioma:eng
Resumo:This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help determine the cause. Over the last 7 years, infants with moderate to severe HIE have benefited from the introduction of routine therapeutic hypothermia; the number needed to treat for an additional beneficial outcome is 7 (95% CI 5 to 10). More recent research has focused on optimal resuscitation practices for babies with cardiorespiratory depression, such as delayed cord clamping after establishment of ventilation and resuscitation in air. Around a quarter of infants with asystole at 10 min after birth who are subsequently cooled have normal outcomes, suggesting that individualised decision making on stopping resuscitation is needed, based on access to intensive treatment unit and early cooling. The full benefit of cooling appears to have been exploited in our current treatment protocols of 72 hours at 33.5°C; deeper and longer cooling showed adverse outcome. The challenge over the next 5-10 years will be to assess which adjunct therapies are safe and optimise hypothermic brain protection in phase I and phase II trials. Optimal care may require tailoring treatments according to gender, genetic risk, injury severity and inflammatory status.
Tipo de publicação: JOURNAL ARTICLE



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