Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy

Shah, PS; Riphagen, Shelley; Beyene, Joseph; Perlman, Max

doi:10.1136/adc.2002.023093

Cited by 276 publications

(165 citation statements)

References 21 publications

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“…In the study by Shah P et al the renal system was involved in 70%, the respiratory system in 86% and the cardiovascular system in 62% 5 . In the study by Martin-Ancel A, et al the renal system was involved in 42%, the respiratory system in 26%, the cardiovascular system in 29% and the gastrointestinal system in 29% 6 .…”

Section: Discussionmentioning

confidence: 99%

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Organ dysfunction other than central nervous system in perinatal asphyxia

Singh

Shrikhande

Vohra

et al. 2018

Sri Lanka J Child Health

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Introduction: Significant asphyxial insult to the fetus is likely to compromise a number of different organ systems of which the brain, kidneys and myocardium are particularly vulnerable, though bowel, endocrine and pulmonary complications may also occur. However much emphasis is given to central nervous system (CNS) dysfunction while other organs take a backseat. Objectives:To evaluate the frequency of organ dysfunction other than CNS in perinatal asphyxia and to correlate the organ dysfunction with immediate mortality.Method: A prospective observational study was done in all asphyxiated newborns, delivered at Pravara Institute of Medical Sciences, Loni, from September 2013 to August 2015. Neonates born before 37 weeks of gestation, or born outside the hospital or with congenital anomalies or with early onset sepsis were excluded from the study. Prior approval was obtained from the institutional ethics committee. A detailed history was taken and examination performed on admission to the neonatal intensive care unit (NICU). The clinical course was followed up to 14 days of birth. Data obtained was recorded. Data analysis was done by descriptive statistics as mean, SD, median, range and percentage. Comparison was done by applying Chi-square test. Significance was assessed at 5% (p<0.05).Results: During the study period 152 asphyxiated babies, fulfilling the preformed inclusion criteria were admitted in the NICU. The common modes of delivery were normal vaginal (55.2%) and caesarean section (38%). Meconium stained amniotic fluid (35.5%) was the most common perinatal risk factor followed by prolonged second stage of labour (23.7%). The renal system was involved in 64% cases, respiratory system in 45%, _________________________________________ Commons Attribution CC-BY License cardiovascular system in 32%, gastrointestinal system in 16%, hepatic system in 05% and the haematological system in 03%. There was an overall mortality rate of 37.5%. Conclusions:In the present study common organs of involvement other than the CNS were renal (64%), respiratory (45%), cardiovascular (32%) and gastrointestinal (16%). The overall mortality rate was 37.5%. Deaths were higher when 3 or more organs were involved.DOI: http://dx.doi.org/10.4038/sljch.v47i2.8480

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Section: Discussionmentioning

confidence: 99%

“…Infants with grade 1 or 2 ECG changes of were considered to have mild, and those with grades 3 or 4 changes, severe myocardial ischaemia respectively. The grading was done as per criteria defined by Jedeikin et al 5 . Creatinine kinase-MB isoenzyme levels were estimated at 8 hours and 24 hours of life in all neonates.…”

Section: Methodsmentioning

confidence: 99%

Organ dysfunction other than central nervous system in perinatal asphyxia

Singh

Shrikhande

Vohra

et al. 2018

Sri Lanka J Child Health

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“…There is a stepwise increase in the rate of adverse outcomes as the number of additional organs involved increase in newborns with NHIE (2). Lungs are often affected: depending on the definition criteria, 25 to 86% of HIE infants develop signs of respiratory dysfunction (1,2). Extracerebral impact of perinatal asphyxia has been uniformly attributed to the redistribution of blood flow and/or the effects of global hypoxia-ischemia (2,3).…”

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Hypoxic–ischemic brain damage induces distant inflammatory lung injury in newborn piglets

et al. 2015

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Postasphyxial Hypoxic-Ischemic Encephalopathy in Neonates

Shah¹,

Beyene²,

To³

et al. 2006

Arch Pediatr Adolesc Med

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Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia.Design: Retrospective cohort study. Setting: Regional outborn neonatal intensive care unit.Participants: Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375).Main Exposures: Clinical and laboratory predictors available at age 4 hours. Main Outcome Measures:A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome, which was defined as death or severe disability (severe cerebral palsy, severe developmental delay, sensorineural deafness, or cortical blindness singly or in com bination). A simple prediction rule was derived from 3 variables.Results: Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions, age at onset of respiration, and base deficit), severe adverse outcome rates were 46% (95% confidence interval, 33%-58%) with none of the 3 predictors, 64% (95% confidence interval, 54%-73%) with any 1 predictor, 76% (95% confidence interval, 66%-85%) with any 2 predictors, and 93% (95% confidence interval, 81%-99%) with all of the 3 predictors present. The internal validations revealed a robust model.Conclusions: This predictive model for neonatal hypoxicischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.

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Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy

Cited by 276 publications

References 21 publications

Organ dysfunction other than central nervous system in perinatal asphyxia

Organ dysfunction other than central nervous system in perinatal asphyxia

Hypoxic–ischemic brain damage induces distant inflammatory lung injury in newborn piglets

Postasphyxial Hypoxic-Ischemic Encephalopathy in Neonates

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