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PloS One 2021Hypoxic perinatal brain injury is caused by lack of oxygen to baby's brain and can lead to death or permanent brain damage. However, the effectiveness of therapeutic...
Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: A systematic review and meta-analysis of randomized control trials.
BACKGROUND
Hypoxic perinatal brain injury is caused by lack of oxygen to baby's brain and can lead to death or permanent brain damage. However, the effectiveness of therapeutic hypothermia in birth asphyxiated infants with encephalopathy is uncertain. This systematic review and meta-analysis was aimed to estimate the pooled relative risk of mortality among birth asphyxiated neonates with hypoxic-ischemic encephalopathy in a global context.
METHODS
We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search randomized control trials from electronic databases (PubMed, Cochrane library, Google Scholar, MEDLINE, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and meta register of Current Controlled Trials (mCRT)). The authors extracted the author's name, year of publication, country, method of cooling, the severity of encephalopathy, the sample size in the hypothermic, and non-hypothermic groups, and the number of deaths in the intervention and control groups. A weighted inverse variance fixed-effects model was used to estimate the pooled relative risk of mortality. The subgroup analysis was done by economic classification of countries, methods of cooling, and cooling devices. Publication bias was assessed with a funnel plot and Eggers test. A sensitivity analysis was also done.
RESULTS
A total of 28 randomized control trials with a total sample of 35, 92 (1832 hypothermic 1760 non-hypothermic) patients with hypoxic-ischemic encephalopathy were used for the analysis. The pooled relative risk of mortality after implementation of therapeutic hypothermia was found to be 0.74 (95%CI; 0.67, 0.80; I2 = 0.0%; p<0.996). The subgroup analysis revealed that the pooled relative risk of mortality in low, low middle, upper-middle and high income countries was 0.32 (95%CI; -0.95, 1.60; I2 = 0.0%; p<0.813), 0.5 (95%CI; 0.14, 0.86; I2 = 0.0%; p<0.998), 0.62 (95%CI; 0.41-0.83; I2 = 0.0%; p<0.634) and 0.76 (95%CI; 0.69-0.83; I2 = 0.0%; p<0.975) respectively. The relative risk of mortality was the same in selective head cooling and whole-body cooling method which was 0.74. Regarding the cooling device, the pooled relative risk of mortality is the same between the cooling cap and cooling blanket (0.74). However, it is slightly lower (0.73) in a cold gel pack.
CONCLUSIONS
Therapeutic hypothermia reduces the risk of death in neonates with moderate to severe hypoxic-ischemic encephalopathy. Both selective head cooling and whole-body cooling method are effective in reducing the mortality of infants with this condition. Moreover, low income countries benefit the most from the therapy. Therefore, health professionals should consider offering therapeutic hypothermia as part of routine clinical care to newborns with hypoxic-ischemic encephalopathy especially in low-income countries.
Topics: Animals; Asphyxia Neonatorum; Humans; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Randomized Controlled Trials as Topic
PubMed: 33630892
DOI: 10.1371/journal.pone.0247229 -
Journal of Neuroscience Research Dec 2022Neonatal encephalopathy (NE) that purportedly arises from hypoxia-ischemia is labeled hypoxic-ischemic encephalopathy (HIE). Perinatal asphyxia is a clinical syndrome... (Review)
Review
A systematic review of noninflammatory cerebrospinal fluid biomarkers for clinical outcome in neonates with perinatal hypoxic brain injury that could be biologically significant.
Neonatal encephalopathy (NE) that purportedly arises from hypoxia-ischemia is labeled hypoxic-ischemic encephalopathy (HIE). Perinatal asphyxia is a clinical syndrome involving acidosis, a low Apgar score and the need for resuscitation in the delivery room; asphyxia alerts one to the possibility of NE. In the present systematic review, we focused on the noninflammatory biomarkers in cerebrospinal fluid (CSF) that are involved in the development of possible brain injury in asphyxia or HIE. A literature search in PubMed and EMBASE for case-control studies was conducted and 17 studies were found suitable by a priori criteria. Statistical analysis used the Mantel-Haenszel model for dichotomous data. The pooled mean difference and 95% confidence intervals (CIs) were determined. We identified the best biomarkers, based on the estimation approach in evaluating the biological significance, out of hundreds in three categories: cell adhesion and proliferation, oxidants and antioxidants, and cell damage. The following subtotal-population comparisons were made: perinatal asphyxia versus no asphyxia, asphyxia with HIE versus asphyxia without HIE, asphyxia with HIE versus no asphyxia, and term versus preterm HIE newborn with asphyxia. Biological significance of the biomarkers was determined by using a modification of the estimation approach, by ranking the biomarkers according to the difference in the bounds of the CIs. The most promising CSF biomarkers for prognostication especially for the severest HIE include creatine kinase, xanthine oxidase, vascular endothelial growth factor, neuron-specific enolase, superoxide dismutase, and malondialdehyde. Future studies are recommended using such a combined test to prognosticate the most severely affected patients.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Asphyxia Neonatorum; Biomarkers; Creatine Kinase; Hypoxia; Hypoxia-Ischemia, Brain; Malondialdehyde; Oxidants; Phosphopyruvate Hydratase; Superoxide Dismutase; Vascular Endothelial Growth Factor A; Xanthine Oxidase
PubMed: 33543500
DOI: 10.1002/jnr.24801 -
European Journal of Pediatrics May 2021Heart rate variability (HRV) is currently considered the most valuable non-invasive test to investigate the autonomic nervous system function, based on the fact that... (Review)
Review
Heart rate variability (HRV) is currently considered the most valuable non-invasive test to investigate the autonomic nervous system function, based on the fact that fast fluctuations might specifically reflect changes of sympathetic and vagal activity. An association between abnormal values of HRV and brain impairment has been reported in the perinatal period, although data are still fragmentary. Considering such association, HRV has been suggested as a possible marker of brain damage also in case of hypoxic-ischemic encephalopathy following perinatal asphyxia. The aim of the present manuscript was to review systematically the current knowledge about the use of HRV as marker of cerebral injury in neonates suffering from hypoxic-ischemic encephalopathy. Findings reported in this paper were based on qualitative analysis of the reviewed data. Conclusion: A growing body of research supports the use of HRV as non-invasive, bedside tool for the monitoring of hypoxic-ischemic encephalopathy. The currently available data about the role of HRV as prognostic tool in case of hypoxic ischemic encephalopathy are promising but require further validation by future studies. What is Known: • Heart rate variability (HRV) is a non-invasive monitoring technique to assess the autonomic nervous system activity. • A correlation between abnormal HRV and cerebral injury has been reported in the perinatal period, and HRV has been suggested as possible marker of brain damage in case of hypoxic-ischemic encephalopathy. What is New: • HRV might provide precocious information about the entity of brain injury in asphyxiated neonates and be of help to design early, specific, and personalized treatments according to severity. • Further investigations are required to confirm these preliminary data.
Topics: Asphyxia Neonatorum; Brain; Brain Injuries; Female; Heart Rate; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Pregnancy
PubMed: 33245400
DOI: 10.1007/s00431-020-03882-3 -
BMC Complementary Medicine and Therapies Oct 2020Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy complication whose range has been calculated to be between 0.01 and 15.6% all around the world. We wanted to...
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy complication whose range has been calculated to be between 0.01 and 15.6% all around the world. We wanted to systematically evaluate the effect and safety of oral herbal medicine on treatment for ICP.
METHODS
Details of the methods could be found in the registered protocol on PROSPERO (CRD42018096013). Trials assessing the effectiveness of herbal medicine for ICP were searched from seven electronic databases from inception to 28th February 2020. RevMan 5.3 software was used to perform all statistical analysis. Meta-analysis, additional analysis, Trial Sequential Analysis (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were conducted if data permitted.
RESULTS
Totally 43 randomized controlled trials with 3556 patients were included. Meta-analysis showed potential good adjunctive effect of herbal medicine on decreasing the pruritus scores (MD -0.58, 95% CI - 0.79 to - 0.36), the serum TBA scores (MD - 3.99 μmol/L, 95% CI - 4.24 to - 3.74) on the basis with Ursodesoxycholic acid. Compared to the medicine alone, significantly lower incidence of fetal distress (RR 0.41, 95% CI 0.32 to 0.51), asphyxia neonatorum (RR 0.35, 95%CI 0.25 to 0.49), cesarean section (RR 0.73, 95% CI 0.63 to 0.85), postpartum hemorrhage (RR 0.45, 95% CI 0.28 to 0.72) were observed in the combination group. But the comparison between herbal medicine and medicine showed inconsistent results among trials. Insufficient information could be used to evaluate the safety of herbal medicine for ICP.
CONCLUSION
This review found the current evidence may support the effectiveness of combination of herbal medicine and conventional medicine for decreasing the maternal pruritus scores, the serum TBA, and the number of fetal distress, or asphyxia neonatorum events related to this condition (which was supported by TSA results). Since there were obvious statistical and clinical heterogeneity among trials, and the methodological quality of the included studies was poor, the level of the evidence could only be defined as "very low" according to the GRADE criteria. Further high quality studies are still needed to testify the effectiveness and safety of herbal medicine for ICP.
Topics: Cholestasis, Intrahepatic; Drugs, Chinese Herbal; Female; Humans; Phytotherapy; Pregnancy; Pregnancy Complications; Pruritus; Randomized Controlled Trials as Topic
PubMed: 33028282
DOI: 10.1186/s12906-020-03097-x -
European Review For Medical and... Jul 2020To evaluate the clinical manifestations and outcomes of neonates born to women who had Coronavirus Disease 2019 (COVID-19) during pregnancy.
OBJECTIVE
To evaluate the clinical manifestations and outcomes of neonates born to women who had Coronavirus Disease 2019 (COVID-19) during pregnancy.
MATERIALS AND METHODS
A systematic literature search was conducted on PubMed and Embase till April 15, 2020, by combining the terms (COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2, Novel Coronavirus, 2019-nCov, Wuhan pneumonia) and (pregnancy, pregnant women, mother, fetus, neonate, newborn, infant).
RESULTS
We included 16 case series and 12 case reports describing a total of 223 pregnant women and 201 infants. Four newborns born to mothers affected by COVID-19 were reported to have laboratory-confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection within 48 hours after birth. However, Reverse Transcription-Polymerase Chain Reaction tests of the breast milk, placenta, amniotic fluids, and cord blood and maternal vaginal secretions were all negative for SARS-CoV-2 in the reported cases. Fetal death was reported in two cases, and 48 of 185 newborns (25.9%) were born prematurely. Infants born small for gestational age and low birth weight (< 2,500 g) accounted for 8.3% and 15.6% of reported cases, respectively. Birth asphyxia and respiratory distress syndrome were observed in 1.8% and 6.4% of neonates, respectively. There was one neonatal death due to intractable gastric bleeding among the SARS-CoV-2-negative infants.
CONCLUSIONS
Current evidence suggests that COVID-19 during pregnancy rarely affects fetal and neonatal mortality, but can be associated with adverse neonatal morbidities. Vertical transmission has not been observed in the majority of the reported cases. The infants born to mothers with COVID-19 are carefully monitored for accompanying complication, and quarantine of infected mothers is warranted.
Topics: Asphyxia Neonatorum; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Infant, Low Birth Weight; Infant, Newborn; Infectious Disease Transmission, Vertical; Mothers; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome, Newborn; SARS-CoV-2; Stillbirth
PubMed: 32744708
DOI: 10.26355/eurrev_202007_22285 -
BMC Pediatrics Mar 2020Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still significantly increasing in Ethiopia. Perinatal asphyxia is the leading cause of neonatal morbidity and mortality worldwide. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of perinatal asphyxia in Ethiopia.
METHODS
Online databases (PubMed, HINARI, EMBASE, Google Scholar and African Journals), other gray and online repository accessed studies were searched using different search engines. Newcastle-Ottawa Quality Assessment Scale (NOS) was used for critical appraisal of studies. The analysis was done using STATA 11 software. The Cochran Q test and I test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to detect publication bias of the studies. The pooled prevalence of perinatal asphyxia and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.
RESULT
Nine studies were included in this review, with a total of 12,249 live births in Ethiopia. The overall pooled prevalence of perinatal asphyxia in Ethiopia was 24.06% (95 95%CI: 18.11-30.01). Associated factors of perinatal asphyxia included prolonged labor (OR = 2.79, 95% CI: 1.98, 3.93), low birth weight (OR = 6.52, 95% CI: 4.40, 9.65), meconium-stained amniotic fluid (OR = 5.91, 95% CI: 3.95, 8.83) and instrumental delivery (OR = 4.04, 95% CI: 2.48, 6.60) were the determinant factors of perinatal asphyxia in Ethiopia.
CONCLUSIONS
The overall pooled prevalence of perinatal asphyxia was remarkably high. Duration of labor, meconium-stained amniotic fluid, instrumental deliveries, and birth weight were the associated factors of perinatal asphyxia in Ethiopia. Therefore, efforts should be made to improve the quality of intrapartum care service to prevent prolonged labor and fetal complications and to identify and make a strict follow up of mothers with meconium-stained amniotic fluid. This finding is important to early recognition and management of its contributing factors, might modify hypoxic-ischemic encephalopathy and may improve the implementation of the standard guideline effectively and consistently.
Topics: Asphyxia Neonatorum; Cross-Sectional Studies; Ethiopia; Female; Humans; Infant, Newborn; Pregnancy; Prenatal Care
PubMed: 32209083
DOI: 10.1186/s12887-020-02039-3 -
Acta Paediatrica (Oslo, Norway : 1992) May 2019This paper examines the change in neonatal resuscitation practices after the implementation of the Helping Babies Breathe (HBB) programme. (Meta-Analysis)
Meta-Analysis
AIM
This paper examines the change in neonatal resuscitation practices after the implementation of the Helping Babies Breathe (HBB) programme.
METHODS
A systematic review was carried out on studies reporting the impact of HBB programmes among the literature found in Medline, POPLINE, LILACS, African Index Medicus, Cochrane, Web of Science and Index Medicus for the Eastern Mediterranean Region database. We selected clinical trials with randomised control, quasi-experimental and cross-sectional designs. We used a data extraction tool to extract information on intervention and outcome reporting. We carried out a meta-analysis of the extracted data on the neonatal resuscitation practices following HBB programme using Review Manager.
RESULTS
Four studies that reported on neonatal resuscitation practices before and after the implementation of the HBB programme were identified. The pooled results showed no changes in the use of stimulation (RR-0.54; 95% CI, 0.21-1.42), suctioning (RR-0.48; 95% CI, 0.18-1.27) and bag-and-mask ventilation (RR-0.93; 95% CI, 0.47-1.83) after HBB training. The proportion of babies receiving bag-and-mask ventilation within the Golden Minute of birth increased by more than 2.5 times (RR-2.67; 95% CI, 2.17-3.28).
CONCLUSION
The bag-and-mask ventilation within Golden minute has improved following the HBB programme. Implementation of HBB training improves timely initiation of bag-and-mask ventilation within one minute of birth.
Topics: Asphyxia Neonatorum; Humans; Infant, Newborn; Practice Patterns, Physicians'; Resuscitation
PubMed: 30582888
DOI: 10.1111/apa.14706 -
Neonatology 2019Heart rate variability analysis offers real-time quantification of autonomic disturbance after perinatal asphyxia, and may therefore aid in disease stratification and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Heart rate variability analysis offers real-time quantification of autonomic disturbance after perinatal asphyxia, and may therefore aid in disease stratification and prognostication after neonatal encephalopathy (NE).
OBJECTIVE
To systematically review the existing literature on the accuracy of early heart rate variability (HRV) to predict brain injury and adverse neurodevelopmental outcomes after NE.
DESIGN/METHODS
We systematically searched the literature published between May 1947 and May 2018. We included all prospective and retrospective studies reporting HRV metrics, within the first 7 days of life in babies with NE, and its association with adverse outcomes (defined as evidence of brain injury on magnetic resonance imaging and/or abnormal neurodevelopment at ≥1 year of age). We extracted raw data wherever possible to calculate the prognostic indices with confidence intervals.
RESULTS
We retrieved 379 citations, 5 of which met the criteria. One further study was excluded as it analysed an already-included cohort. The 4 studies provided data on 205 babies, 80 (39%) of whom had adverse outcomes. Prognostic accuracy was reported for 12 different HRV metrics and the area under the curve (AUC) varied between 0.79 and 0.94. The best performing metric reported in the included studies was the relative power of high-frequency band, with an AUC of 0.94.
CONCLUSIONS
HRV metrics are a promising bedside tool for early prediction of brain injury and neurodevelopmental outcome in babies with NE. Due to the small number of studies available, their heterogeneity and methodological limitations, further research is needed to refine this tool so that it can be used in clinical practice.
Topics: Asphyxia Neonatorum; Heart Rate; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Point-of-Care Testing; Prognosis
PubMed: 30300885
DOI: 10.1159/000493002 -
The Cochrane Database of Systematic... Jun 2018Cerebral palsy is an umbrella term that encompasses disorders of movement and posture attributed to non-progressive disturbances occurring in the developing foetal or...
BACKGROUND
Cerebral palsy is an umbrella term that encompasses disorders of movement and posture attributed to non-progressive disturbances occurring in the developing foetal or infant brain. As there are diverse risk factors and aetiologies, no one strategy will prevent cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for prevention.
OBJECTIVES
PrimaryTo summarise the evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions for preventing cerebral palsy (reducing cerebral palsy risk).SecondaryTo summarise the evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions that may increase cerebral palsy risk.
METHODS
We searched the Cochrane Database of Systematic Reviews (27 November 2016) for reviews of neonatal interventions reporting on cerebral palsy. Two review authors assessed reviews for inclusion, extracted data, and assessed review quality (using AMSTAR and ROBIS) and quality of the evidence (using the GRADE approach). Reviews were organised by topic; findings were summarised in text and were tabulated. Interventions were categorised as effective (high-quality evidence of effectiveness); possibly effective (moderate-quality evidence of effectiveness); ineffective (high-quality evidence of harm); probably ineffective (moderate-quality evidence of harm or lack of effectiveness); and no conclusions possible (low- to very low-quality evidence).
MAIN RESULTS
Forty-three Cochrane Reviews were included. A further 102 reviews pre-specified the outcome cerebral palsy, but none of the included randomised controlled trials (RCTs) reported this outcome. Included reviews were generally of high quality and had low risk of bias, as determined by AMSTAR and ROBIS. These reviews involved 454 RCTs; data for cerebral palsy were available from 96 (21%) RCTs involving 15,885 children. Review authors considered interventions for neonates with perinatal asphyxia or with evidence of neonatal encephalopathy (3); interventions for neonates born preterm and/or at low or very low birthweight (33); and interventions for other specific groups of 'at risk' neonates (7). Quality of evidence (GRADE) ranged from very low to high.Interventions for neonates with perinatal asphyxia or with evidence of neonatal encephalopathyEffective interventions: high-quality evidence of effectivenessResearchers found a reduction in cerebral palsy following therapeutic hypothermia versus standard care for newborns with hypoxic ischaemic encephalopathy (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.54 to 0.82; seven trials; 881 children).No conclusions possible: very low-quality evidenceOne review observed no clear differences in cerebral palsy following therapeutic hypothermia versus standard care.Interventions for neonates born preterm and/or at low or very low birthweightPossibly effective interventions: moderate-quality evidence of effectivenessResearchers found a reduction in cerebral palsy with prophylactic methylxanthines (caffeine) versus placebo for endotracheal extubation in preterm infants (RR 0.54, 95% CI 0.32 to 0.92; one trial; 644 children).Probably ineffective interventions: moderate-quality evidence of harmResearchers reported an increase in cerebral palsy (RR 1.45, 95% CI 1.06 to 1.98; 12 trials; 1452 children) and cerebral palsy in assessed survivors (RR 1.50, 95% CI 1.13 to 2.00; 12 trials; 959 children) following early (at less than eight days of age) postnatal corticosteroids versus placebo or no treatment for preventing chronic lung disease in preterm infants.Probably ineffective interventions: moderate-quality evidence of lack of effectivenessTrial results showed no clear differences in cerebral palsy following ethamsylate versus placebo for prevention of morbidity and mortality in preterm or very low birthweight infants (RR 1.13, 95% CI 0.64 to 2.00; three trials, 532 children); volume expansion versus no treatment (RR 0.76, 95% CI 0.48 to 1.20; one trial; 604 children); gelatin versus fresh frozen plasma (RR 0.94, 95% CI 0.52 to 1.69; one trial, 399 children) for prevention of morbidity and mortality in very preterm infants; prophylactic indomethacin versus placebo for preventing mortality and morbidity in preterm infants (RR 1.04, 95% CI 0.77 to 1.40; four trials; 1372 children); synthetic surfactant versus placebo for respiratory distress syndrome in preterm infants (RR 0.76, 95% CI 0.55 to 1.05; five trials; 1557 children); or prophylactic phototherapy versus standard care (starting phototherapy when serum bilirubin reached a pre-specified level) for preventing jaundice in preterm or low birthweight infants (RR 0.96, 95% CI 0.50 to 1.85; two trials; 756 children).No conclusions possible: low- to very low-quality evidenceNo clear differences in cerebral palsy were observed with interventions assessed in 21 reviews.Interventions for other specific groups of 'at risk' neonatesNo conclusions possible: low- to very low-quality evidenceReview authors observed no clear differences in cerebral palsy with interventions assessed in five reviews.
AUTHORS' CONCLUSIONS
This overview summarises evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions on cerebral palsy, and can be used by researchers, funding bodies, policy makers, clinicians, and consumers to aid decision-making and evidence translation. To formally assess other benefits and/or harms of included interventions, including impact on risk factors for cerebral palsy, review of the included Reviews is recommended.Therapeutic hypothermia versus standard care for newborns with hypoxic ischaemic encephalopathy can prevent cerebral palsy, and prophylactic methylxanthines (caffeine) versus placebo for endotracheal extubation in preterm infants may reduce cerebral palsy risk. Early (at less than eight days of age) postnatal corticosteroids versus placebo or no treatment for preventing chronic lung disease in preterm infants may increase cerebral palsy risk.Cerebral palsy is rarely identified at birth, has diverse risk factors and aetiologies, and is diagnosed in approximately one in 500 children. To date, only a small proportion of Cochrane Systematic Reviews assessing neonatal interventions have been able to report on this outcome. There is an urgent need for long-term follow-up of RCTs of such interventions addressing risk factors for cerebral palsy (through strategies such as data linkage with registries) and for consideration of the use of relatively new interim assessments (including the General Movements Assessment). Such RCTs must be rigorous in their design and must aim for consistency in cerebral palsy outcome measurement and reporting to facilitate pooling of data and thus to maximise research efforts focused on prevention.
Topics: Asphyxia Neonatorum; Brain Diseases; Cerebral Palsy; Humans; Hypothermia, Induced; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Review Literature as Topic
PubMed: 29926474
DOI: 10.1002/14651858.CD012409.pub2 -
International Journal of Reproductive... May 2019Biochemical markers including interleukins (ILs) has been proposed for early diagnosis of asphyxia.
BACKGROUND
Biochemical markers including interleukins (ILs) has been proposed for early diagnosis of asphyxia.
OBJECTIVE
This study has aimed to systematically review the significance of IL measurements in the diagnosis of perinatal asphyxia.
MATERIALS AND METHODS
PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases before 2017 were searched for the following keywords: asphyxia, neonatal, interleukin, and diagnosis. A total of 13 out of 300 searched papers were finally selected for evaluation. Interleukins under study were IL6 and interleukin 1 (IL-1 ). Interleukins had been measured in 10 studies by serum samples, 2 studies by samples of Cerebro Spinal Fluid (CSF), and 1 study by sample of umbilical cord blood. The inclusion criteria were: studies on neonates, with adequate information from the test results and studies using markers other than ILs to detect asphyxia; however, studies with only abstracts available were excluded.
RESULTS
Research on the issue suggests that IL6 > 41 Pg/dl has the sensitivity of 84.88% and the specificity of 85.43%, whereas IL-1 > 4.7 Pg/dl has the sensitivity of 78% and specificity of 83% in the diagnosis of neonatal asphyxia. Among diagnostic ILs for neonatal asphyxia, combination of IL6 and IL-1 had the highest sensitivity, that is, 92.9%.
CONCLUSION
IL6 and IL-1 of serum samples were used in the early diagnosis of perinatal asphyxia and are useful predictors for the outcomes of perinatal asphyxia and its intensity. In addition, simultaneous evaluation of IL-1 and IL6 can improve the sensitivity of the early diagnosis of perinatal asphyxia.
PubMed: 31435616
DOI: 10.18502/ijrm.v17i5.4598