Role of Carbon Monoxide and Nitric Oxide in Newborn Infants With Postasphyxial Hypoxic-Ischemic Encephalopathy

Shi, Yuan; Pan, Feng; Li, Huaqiang; Pan, Jie; Qin, Shiwen; Shen, Chengcheng

doi:10.1542/peds.106.6.1447

Cited by 26 publications

(8 citation statements)

References 34 publications

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“…This finding is consistent with previous studies that reported increased NO levels after perinatal asphyxia, in a way that correlated with the severity of brain damage in infants with HIE. 29,30 In our study, NO concentrations decreased significantly within 2 weeks in infants with HIE who received human recombinant erythropoietin. This is the first study to report the impact of human recombinant erythropoietin on NO concentrations in infants with HIE.…”

Section: Discussionsupporting

confidence: 51%

Human Recombinant Erythropoietin in Asphyxia Neonatorum: Pilot Trial

Elmahdy¹,

El-Mashad²,

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:Neuronal apoptosis that follows hypoxia-ischemia is triggered by upregulation of NO synthase, with excessive accumulation of NO and release of excitatory amino acids such as glutamate. Animal studies demonstrated the ability of erythropoietin to attenuate these mechanisms. WHAT THIS STUDY ADDS:The administration of erythropoietin to infants with asphyxia with mild/moderate HIE was associated with favorable decreases in endogenous NO production, decreases in seizure activity, and improved neurodevelopmental outcomes to 6 months of age. abstract OBJECTIVE: The goal was to examine biochemical, neurophysiologic, anatomic, and clinical changes associated with erythropoietin administration to neonates with hypoxic-ischemic encephalopathy (HIE). METHODS:We conducted a prospective case-control study with 45 neonates in 3 groups, a normal healthy group (N ϭ 15), a HIEerythropoietin group (N ϭ 15; infants with mild/moderate HIE who received human recombinant erythropoietin, 2500 IU/kg, subcutaneously, daily for 5 days), and a HIE-control group (N ϭ 15; did not receive erythropoietin). Serum concentrations of nitric oxide (NO) were measured at enrollment for the normal healthy neonates and at enrollment and after 2 weeks for the 2 HIE groups. The 2 HIE groups underwent electroencephalography at enrollment and at 2 to 3 weeks. Brain MRI was performed at 3 weeks. Neurologic evaluations and Denver Developmental Screening Test II assessments were performed at 6 months. RESULTS:Compared with normal healthy neonates, the 2 HIE groups had greater blood NO concentrations (P Ͻ .001). At enrollment, the 2 HIE groups did not differ in clinical severity, seizure incidence, NO concentrations, or electroencephalographic findings. At 2 weeks of age, electroencephalographic backgrounds improved significantly (P ϭ .01) and NO concentrations decreased (P Ͻ .001) in the HIEerythropoietin group, compared with the HIE-control group; MRI findings did not differ between groups. At 6 months of age, infants in the HIE-erythropoietin group had fewer neurologic (P ϭ .03) and developmental (P ϭ .03) abnormalities. CONCLUSION:This study demonstrates the feasibility of early administration of human recombinant erythropoietin to term neonates with HIE, to protect against encephalopathy.

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Section: Discussionsupporting

confidence: 51%

Human Recombinant Erythropoietin in Asphyxia Neonatorum: Pilot Trial

Elmahdy¹,

El-Mashad²,

et al. 2010

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“…Shi et al [ 17 ] observed that plasma CO levels at birth were increased in infants with severe neonatal hypoxic ischemic encephalopathy. If the lower Apgar scores of the moderate-to-severe BPD group were due to neonatal asphyxia, reperfusion-induced oxidative stress following asphyxia may have caused lung injury and compensatory induction of HO-1, resulting in the deterioration of subsequent BPD and the elevation of CO-Hb levels in the moderate-to-severe BPD group during the early postnatal period, respectively [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Carboxyhemoglobin Formation in Preterm Infants Is Related to the Subsequent Development of Bronchopulmonary Dysplasia

et al. 2015

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Objective. To evaluate the usefulness of carboxyhemoglobin (CO-Hb) levels as a biomarker to predict the development and severity of bronchopulmonary dysplasia (BPD). Methods. Twenty-five infants born at <33 wk of gestational age or with a birth weight of <1,500 g were enrolled. CO-Hb levels were measured between postnatal days 5 and 8, 12 and 15, 19 and 22, and 26 and 29. Urinary levels of 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation protein products, and Nε-(hexanoyl) lysine were measured between postnatal days 5 and 8 and 26 and 29. Receiver operating characteristic (ROC) analysis was used to compare the biomarkers' predictive values. Results. Compared with infants in the no-or-mild BPD group, infants with moderate-to-severe BPD exhibited higher CO-Hb levels during the early postnatal period and higher 8-OHdG levels between postnatal days 5 and 8. Using ROC analysis to predict the development of moderate-to-severe BPD, the area under the curve (AUC) for CO-Hb levels between postnatal days 5 and 8 was higher than AUCs for the urinary markers. Conclusions. CO-Hb levels during the early postnatal period may serve as a practical marker for evaluating oxidative stress and the severity of subsequently developing BPD.

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“…Similarly, Shi et al . showed significantly increased plasma NO levels in newborn infants with postaphyxial hypoxic‐ischemic encephalopathy 28 . Nitric oxide is proposed to be partially responsible for hypoxic‐ischemic brain damage 29 .…”

Section: Discussionmentioning

confidence: 99%

“…27 Similarly, Shi et al showed significantly increased plasma NO levels in newborn infants with postaphyxial hypoxic-ischemic encephalopathy. 28 Nitric oxide is proposed to be partially responsible for hypoxic-ischemic brain damage. 29 When hypoxia-ischemia was induced in 7-day-old rats the activation of microglia/macrophages, CD4 + lymphocytes and astroglia persisted up to at least 42 days of postnatal age, implicating a chronic inflammatory reaction.…”

Section: Infants With Hypoxic-ischemic Encephalopathymentioning

confidence: 99%