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International Journal of Legal Medicine May 2020Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and...
PURPOSE
Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.
METHODS
All cases of asphyxia in children and adolescents (0-21 years of age) among the Hamburg Legal Medical Department's autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.
RESULTS
Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15-21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.
CONCLUSION
Asphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.
Topics: Adolescent; Age Distribution; Asphyxia; Autopsy; Cause of Death; Child; Child, Preschool; Female; Germany; Humans; Infant; Male; Retrospective Studies; Sex Distribution; Young Adult
PubMed: 31955241
DOI: 10.1007/s00414-020-02248-6 -
American Journal of Physiology. Heart... Nov 2023Growth-restricted neonates have worse outcomes after perinatal asphyxia, with more severe metabolic acidosis than appropriately grown neonates. The cardiovascular...
Growth-restricted neonates have worse outcomes after perinatal asphyxia, with more severe metabolic acidosis than appropriately grown neonates. The cardiovascular physiology associated with fetal growth restriction (FGR) may alter their response to asphyxia. However, research on asphyxia in FGR is limited. Here we compared cardiovascular hemodynamics in preterm FGR and control lambs during mild perinatal asphyxia. We induced FGR in one twin at 89 days gestation (term 148 days), while the other served as a control. At 126 days gestation, lambs were instrumented to allow arterial blood pressure and regional blood flow recording, and then mild perinatal asphyxia was induced by umbilical cord clamping, and resuscitation followed neonatal guidelines. FGR lambs maintained carotid blood flow (CBF) for 7 min, while control lambs rapidly decreased CBF ( < 0.05). Fewer growth-restricted lambs needed chest compressions for return of spontaneous circulation (ROSC) (17 vs. 83%, = 0.02). The extent of blood pressure overshoot after ROSC was similar, but it took longer for MAP to return to baseline in FGR lambs (18.83 ± 0.00 vs. 47.67 ± 0.00 min, = 0.003). Growth-restricted lambs had higher CBF after ROSC ( < 0.05) and displayed CBF overshoot, unlike control lambs ( < 0.03). In conclusion, preterm growth-restricted lambs show resilience during perinatal asphyxia based on prolonged CBF maintenance and reduced need for chest compressions during resuscitation. However, CBF overshoot after ROSC may increase the risk of cerebrovascular injury in FGR. Preterm growth-restricted lambs maintain carotid blood flow for longer than control lambs during asphyxia and have a lower requirement for chest compressions than control lambs during resuscitation. Preterm growth-restricted, but not control, lambs displayed an overshoot in carotid blood flow following return of spontaneous circulation.
Topics: Pregnancy; Female; Animals; Sheep; Asphyxia; Animals, Newborn; Sheep, Domestic; Asphyxia Neonatorum; Hemodynamics
PubMed: 37656131
DOI: 10.1152/ajpheart.00485.2023 -
BMJ (Clinical Research Ed.) Sep 1992
Topics: Asphyxia; Humans; Sexual Behavior; Suicide
PubMed: 1393140
DOI: 10.1136/bmj.305.6855.716 -
Archives of Disease in Childhood Feb 1969
Topics: Asphyxia; Cartilage Diseases; Female; Humans; Infant; Infant, Newborn; Male; Ribs; Thoracic Diseases
PubMed: 5765978
DOI: 10.1136/adc.44.233.11 -
BMJ Open Mar 2023Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or... (Review)
Review
OBJECTIVES
Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent.
METHOD
Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution.
RESULTS
Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction.
CONCLUSION
Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.
Topics: Humans; Asphyxia; Crime Victims; Forensic Medicine; Violence; Law Enforcement
PubMed: 36972965
DOI: 10.1136/bmjopen-2023-072077 -
Journal of Forensic and Legal Medicine Nov 2023A young woman was buried in a sitting position in sandy soil in a shallow grave. PMCT showed filling of the upper airways with radio-opaque material consistent with...
A young woman was buried in a sitting position in sandy soil in a shallow grave. PMCT showed filling of the upper airways with radio-opaque material consistent with soil, with autopsy dissection confirming the presence of soil in the mouth, pharynx, upper oesophagus, larynx, trachea and main bronchi. Death was due to upper airway occlusion by soil. Live burial as a type of homicide is extremely rare. Issues that need to be clarified include whether the victim was alive at the time of burial, the level of consciousness/awareness of the process, whether restraints or drugs were used and the speed with which death occurred. Possible mechanisms of death include smothering, choking and positional/compression asphyxia.
Topics: Female; Humans; Forensic Medicine; Larynx; Autopsy; Homicide; Mouth; Asphyxia; Soil; Burial
PubMed: 37950991
DOI: 10.1016/j.jflm.2023.102617 -
PloS One 2022Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates...
INTRODUCTION
Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6-10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors.
METHODS
A retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019.
RESULT
The review of 311 neonates' medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1-12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3-8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9-9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33-4.7) fetal distress (AOR = 3,95%CI:1.3-7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1-19.3) were the associated factors.
CONCLUSION
Substantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority.
Topics: Asphyxia; Asphyxia Neonatorum; Cross-Sectional Studies; Ethiopia; Female; Hospitals, Public; Humans; Infant, Newborn; Male; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Premature Birth; Prevalence; Retrospective Studies; Term Birth
PubMed: 35025979
DOI: 10.1371/journal.pone.0262619 -
BMC Pediatrics Jul 2022The leading cause of neonatal death worldwide is birth asphyxia. Yearly, in the first month of life, 2.5 million children died around the world. Birth asphyxia is a...
BACKGROUND
The leading cause of neonatal death worldwide is birth asphyxia. Yearly, in the first month of life, 2.5 million children died around the world. Birth asphyxia is a major problem, particularly in developing nations like Ethiopia. The goal of this study was to determine the magnitude of birth asphyxia and the factors that contributed to it among neonates delivered at the Aykel Primary Hospital in north-central Ethiopia.
METHODS
From August 1 to August 31, 2021, a hospital-based cross-sectional study was conducted on 144 live births. An Apgar score less than 7 in the fifth minute of birth authorized the diagnosis of birth asphyxia. Variable contention (P < 0.250) for multivariable analysis was determined after data examination and cleaning. Then, to identify important factors of birth asphyxia, a multivariable logistic regression model with a p-value of 0.05 was developed. Finally, a significant relationship between a dependent variable and independent factors was defined as a p-value less than 0.05 with a 95% confidence interval.
RESULTS
The majority of the mothers, 71.53%, received at least one Antenatal care visit, and more than half of the newborns were male (62.50%). The percentage of neonates that had asphyxia at delivery was 11.11% (95% CI: 6.3 -16.9%). Male newborns were 5.02 times more probable than female newborns to asphyxiate [AOR: 5.02, 95% CI (1.11-22.61)]. Mothers who have not had at least one Antenatal Care visit were 3.72 times more likely to have an asphyxiated newborn than those who have at least one Antenatal Care visit [AOR: 3.72, 95%CI (1.11-12.42)]. Similarly, mothers who had an adverse pregnancy outcome were 7.03 times more likely to have an asphyxiated newborn than mothers who had no such history [AOR: 7.03, 95% CI (2.17-22.70)].
CONCLUSION
Birth asphyxia in newborn has come to a standstill as a major public health issue. The sexual identity of the newborn, Antenatal Care visits, and a history of poor pregnancy outcomes were all found to be significant risk factors for birth asphyxia. These findings have great importance for various stakeholders who are responsible for reducing birth asphyxia; in addition, policymakers should establish and revise guidelines associated to newborn activities and workshops.
Topics: Asphyxia; Asphyxia Neonatorum; Child; Cross-Sectional Studies; Ethiopia; Female; Humans; Infant, Newborn; Live Birth; Male; Pregnancy
PubMed: 35850676
DOI: 10.1186/s12887-022-03500-1 -
African Health Sciences Sep 2023Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it...
BACKGROUND
Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it was the first cause of neonatal deaths followed by prematurity and sepsis. The study aims to assess prevalence of Birth asphyxia and associated factors.
METHODS
Institution-based cross-sectional study was conducted among neonates admitted to Neonatal intensive care unit of Hawassa University Specialized comprehensive hospital from December 1 to December 30, 2020. Systematic random sampling technique was employed to select samples. Logistic regression analysis using Statistical Package for Social sciences version 24was employed.
RESULTS
The prevalence of neonatal asphyxia in this study was17.9%. Prolonged labor [AOR (Adjusted odds ration) = 2.909; (95% CI (Confidence Interval): 1.184 - 7.151)], presence of meconium [AOR= 2.137; 95% CI 1.028 - 4.683)], premature rapture of membrane [AOR = 2.459; 95% CI: 1.021 - 6.076)] and complication during labor [AOR= 3.351; 95% CI: 2.142-5.871))], were factors associated with neonatal asphyxia.
CONCLUSION AND RECOMMENDATIONS
Nearly two in every ten newborns faced perinatal asphyxia in the study area. Early identification of high-risk women, intervening on delay in referral, and early and vigorous management of abnormal labor and complicated labor is essential to halt the problem.
Topics: Pregnancy; Child; Infant, Newborn; Humans; Female; Ethiopia; Perinatal Death; Tertiary Care Centers; Cross-Sectional Studies; Asphyxia; Infant, Premature; Asphyxia Neonatorum
PubMed: 38357164
DOI: 10.4314/ahs.v23i3.17 -
Seminars in Fetal & Neonatal Medicine Oct 2021Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or... (Review)
Review
Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.
Topics: Asphyxia; Asphyxia Neonatorum; Brain Diseases; Developing Countries; Female; Humans; Hypothermia, Induced; Infant, Newborn; Pregnancy
PubMed: 34330679
DOI: 10.1016/j.siny.2021.101271