Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and r...Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.展开更多
Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated ...Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score < 7 at the 5<sup>th</sup> minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.展开更多
Objective: To study the factors associated with oligohydramnios and its related neonatal morbidity and mortality. Materials and Methods: This was a 10-year retrospective nested case-control study conducted at a level ...Objective: To study the factors associated with oligohydramnios and its related neonatal morbidity and mortality. Materials and Methods: This was a 10-year retrospective nested case-control study conducted at a level 2 maternity ward. Given that the prevalence of oligohydramnios ranges between 0.5% and 8%, the sample size of the cases was calculated using the following formula: n = (z/∆)2 × p(1 − p). We selected 20 controls for each case. Data were exported to Excel and analyzed using the Statistical Package for Social Sciences (SPSS) and R Studio 4.1.3 software. The maximal deepest pocket of amniotic fluid or the amniotic fluid index was used to establish the diagnosis. Qualitative variables were described as proportions relative to the total. Data were compared using the chi-square test when normality conditions were met or non-parametric tests otherwise. The significance threshold was set at 0.05. Results: Out of a cohort of 56,775 deliveries, we collected 145 cases of oligohydramnios and 2953 controls. The prevalence of preeclampsia was seven times higher in cases of oligohydramnios (OR = 7.7 [5.12;11.7]). The prevalence of small-for-gestational-age (SGA) fetuses was four times higher in the case group (OR = 4.3 [3.04;6.21]). Oligohydramnios were associated with an increased risk of labor artificial induction and cesarean sections respectively 4.51 ([2.95;6.99]) and 3.41 ([3.03;3.78]). Perinatal asphyxia was nearly three times more frequent in children born in the context of oligohydramnios (OR = 2.7 [1.38;5.30]). Vaginal delivery and SGA were not associated with neonatal morbidity or mortality in cases of oligohydramnios. Conclusion: Oligohydramnios is associated with obstetric pathologies and increased neonatal morbidity and mortality. However, vaginal delivery and labor induction do not impact neonatal morbidity and mortality. The risk of perinatal asphyxia in oligohydramnios requires special monitoring in the delivery room. Further studies on the relationship between fetal heart patterns during and asphyxia in oligohydramnios will need to be conducted.展开更多
The present study was undertaken to figure out the source of urinary endothelin (ET) and the clinical significance of its possible variations. Urinary ET levels were measured by radioimmunoassay (RIA) in 17 healthy ne...The present study was undertaken to figure out the source of urinary endothelin (ET) and the clinical significance of its possible variations. Urinary ET levels were measured by radioimmunoassay (RIA) in 17 healthy newborns and 20 asphyxiated neonates on days 1, 3, 7 after birth. Plasma ET concentrations of healthy premature infants on day 7 and urinary ET levels in 10 healthy children were also observed at the same time. Results showed that: (1) Urinary ET levels and ET excretion rates were higher than plasma ET in preterm infants on days 7 after birth; (2) Both in preterm and full term infants, urinary ET concentrations fell from the 1st day to the 7th day after birth. ET excretion rates elevated markedly at the end of the 1st week, and they were significantly higher than that of children; (3) Urinary ET levels of asphyxiated group on days 1 and 3 were much higher than those of healthy neonates, and positively correlated with the severity of the illness and urinary NAG. We conclude that: (1) urinary ET mainly comes from the production in renal cells; (2) ET levels in healthy neonatal urine reflect the maturity of kidney: (3) measurement of urinary ET levels in asphyxiated neonates is helpful to judge the degree and to evaluate the prognosis of renal injury.展开更多
Introduction: Neonatal seizures are one of the most challenging situations for paediatricians. The objective of this work was to study the epidemiological and diagnostic aspects and short-term outcomes of neonatal sei...Introduction: Neonatal seizures are one of the most challenging situations for paediatricians. The objective of this work was to study the epidemiological and diagnostic aspects and short-term outcomes of neonatal seizures at Issaka Gazoby Maternity Hospital in Niamey. Patients and Methods: This was a prospective study from November 2020 to April 2021 in the neonatology department of Issaka Gazoby Maternity Hospital. All newborns aged 0 to 28 days hospitalized for seizures and/or having convulsions during hospitalization were included. Neonatal characteristics, diagnostic aspects, and their outcomes were studied. Data were analyzed using SPSS version 20 software. Results: Of the 3.068 newborns admitted, 69 cases of neonatal seizures were recorded (2.24%). The sex ratio was 1.22, and 94.2% of neonates were born at term. Generalized crises were found in 50.7%. The main etiologies were perinatal asphyxia (46.4%) and early-onset neonatal infection (40.6%). The death rate was 20.3%. Neonates died between one (1) and three (3) days of age in 42.9%. The main death causes were perinatal asphyxia (50%) and early-onset neonatal infection (21.4%). Conclusion: Neonatal seizures are uncommon frequent, with a semiology dominated by generalized seizures. Mortality is high. The reinforcement of preventive measures is necessary.展开更多
基金Supported by The Health Research Board CSA/2012/40a Science Foundation Ireland Research Centre Award(INFANT-12/RC/2272)
文摘Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.
文摘Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score < 7 at the 5<sup>th</sup> minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.
文摘Objective: To study the factors associated with oligohydramnios and its related neonatal morbidity and mortality. Materials and Methods: This was a 10-year retrospective nested case-control study conducted at a level 2 maternity ward. Given that the prevalence of oligohydramnios ranges between 0.5% and 8%, the sample size of the cases was calculated using the following formula: n = (z/∆)2 × p(1 − p). We selected 20 controls for each case. Data were exported to Excel and analyzed using the Statistical Package for Social Sciences (SPSS) and R Studio 4.1.3 software. The maximal deepest pocket of amniotic fluid or the amniotic fluid index was used to establish the diagnosis. Qualitative variables were described as proportions relative to the total. Data were compared using the chi-square test when normality conditions were met or non-parametric tests otherwise. The significance threshold was set at 0.05. Results: Out of a cohort of 56,775 deliveries, we collected 145 cases of oligohydramnios and 2953 controls. The prevalence of preeclampsia was seven times higher in cases of oligohydramnios (OR = 7.7 [5.12;11.7]). The prevalence of small-for-gestational-age (SGA) fetuses was four times higher in the case group (OR = 4.3 [3.04;6.21]). Oligohydramnios were associated with an increased risk of labor artificial induction and cesarean sections respectively 4.51 ([2.95;6.99]) and 3.41 ([3.03;3.78]). Perinatal asphyxia was nearly three times more frequent in children born in the context of oligohydramnios (OR = 2.7 [1.38;5.30]). Vaginal delivery and SGA were not associated with neonatal morbidity or mortality in cases of oligohydramnios. Conclusion: Oligohydramnios is associated with obstetric pathologies and increased neonatal morbidity and mortality. However, vaginal delivery and labor induction do not impact neonatal morbidity and mortality. The risk of perinatal asphyxia in oligohydramnios requires special monitoring in the delivery room. Further studies on the relationship between fetal heart patterns during and asphyxia in oligohydramnios will need to be conducted.
文摘The present study was undertaken to figure out the source of urinary endothelin (ET) and the clinical significance of its possible variations. Urinary ET levels were measured by radioimmunoassay (RIA) in 17 healthy newborns and 20 asphyxiated neonates on days 1, 3, 7 after birth. Plasma ET concentrations of healthy premature infants on day 7 and urinary ET levels in 10 healthy children were also observed at the same time. Results showed that: (1) Urinary ET levels and ET excretion rates were higher than plasma ET in preterm infants on days 7 after birth; (2) Both in preterm and full term infants, urinary ET concentrations fell from the 1st day to the 7th day after birth. ET excretion rates elevated markedly at the end of the 1st week, and they were significantly higher than that of children; (3) Urinary ET levels of asphyxiated group on days 1 and 3 were much higher than those of healthy neonates, and positively correlated with the severity of the illness and urinary NAG. We conclude that: (1) urinary ET mainly comes from the production in renal cells; (2) ET levels in healthy neonatal urine reflect the maturity of kidney: (3) measurement of urinary ET levels in asphyxiated neonates is helpful to judge the degree and to evaluate the prognosis of renal injury.
文摘Introduction: Neonatal seizures are one of the most challenging situations for paediatricians. The objective of this work was to study the epidemiological and diagnostic aspects and short-term outcomes of neonatal seizures at Issaka Gazoby Maternity Hospital in Niamey. Patients and Methods: This was a prospective study from November 2020 to April 2021 in the neonatology department of Issaka Gazoby Maternity Hospital. All newborns aged 0 to 28 days hospitalized for seizures and/or having convulsions during hospitalization were included. Neonatal characteristics, diagnostic aspects, and their outcomes were studied. Data were analyzed using SPSS version 20 software. Results: Of the 3.068 newborns admitted, 69 cases of neonatal seizures were recorded (2.24%). The sex ratio was 1.22, and 94.2% of neonates were born at term. Generalized crises were found in 50.7%. The main etiologies were perinatal asphyxia (46.4%) and early-onset neonatal infection (40.6%). The death rate was 20.3%. Neonates died between one (1) and three (3) days of age in 42.9%. The main death causes were perinatal asphyxia (50%) and early-onset neonatal infection (21.4%). Conclusion: Neonatal seizures are uncommon frequent, with a semiology dominated by generalized seizures. Mortality is high. The reinforcement of preventive measures is necessary.
