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Pediatrics and Neonatology Mar 2024Although neonatal disseminated intravascular coagulation (DIC) is associated with high mortality and severe complications, few studies have reported its clinical course....
BACKGROUND
Although neonatal disseminated intravascular coagulation (DIC) is associated with high mortality and severe complications, few studies have reported its clinical course. We aimed to describe the characteristics, treatments, and outcomes of neonatal DIC by using a national inpatient database.
METHODS
Using the Japanese Diagnosis Procedure Combination database, we identified 5533 patients with neonatal DIC who were admitted to neonatal intensive care units between July 2010 and March 2020. We categorized the patients into those with asphyxia (n = 2911) and those without asphyxia (n = 2622). We investigated the patient characteristics, treatments, and outcomes. We further categorized neonates with asphyxia according to its severity.
RESULTS
The gestational age of neonates with asphyxia was significantly lower than that of neonates without asphyxia (P < 0.001). Antithrombin was most commonly used for DIC (40%). Neonates with asphyxia were more likely to receive antithrombin (43% vs. 38%; P < 0.001), recombinant human soluble thrombomodulin (28% vs. 20%; P < 0.001), and fresh frozen plasma transfusion (68% vs. 51%; P < 0.001) than those without asphyxia. Neonates with asphyxia had higher in-hospital mortality (17% vs. 10%; P < 0.001), severe bleeding (11% vs. 6.8%; P < 0.001), and hospitalization costs than those without asphyxia. Additionally, neonates with severe asphyxia were more likely to receive several DIC therapies (such as recombinant human soluble thrombomodulin [30% vs. 24%]) and had higher in-hospital mortality (19% vs. 11%) and hospitalization costs than those with mild asphyxia.
CONCLUSIONS
In this large retrospective study of neonatal DIC, patients with asphyxia received several treatments and demonstrated unfavorable outcomes when compared to those without asphyxia.
Topics: Infant, Newborn; Humans; Thrombomodulin; Japan; Retrospective Studies; Asphyxia; Disseminated Intravascular Coagulation; Blood Component Transfusion; Plasma; Antithrombins; Asphyxia Neonatorum; Infant, Newborn, Diseases
PubMed: 37659900
DOI: 10.1016/j.pedneo.2023.07.003 -
Neurotoxicity Research Feb 2018Perinatal asphyxia (PA) is a relevant cause of death at the time of labour, and when survival is stabilised, associated with short- and long-term developmental... (Review)
Review
Perinatal asphyxia (PA) is a relevant cause of death at the time of labour, and when survival is stabilised, associated with short- and long-term developmental disabilities, requiring inordinate care by health systems and families. Its prevalence is high (1 to 10/1000 live births) worldwide. At present, there are few therapeutic options, apart from hypothermia, that regrettably provides only limited protection if applied shortly after the insult.PA implies a primary and a secondary insult. The primary insult relates to the lack of oxygen, and the secondary one to the oxidative stress triggered by re-oxygenation, formation of reactive oxygen (ROS) and reactive nitrogen (RNS) species, and overactivation of glutamate receptors and mitochondrial deficiencies. PA induces overactivation of a number of sentinel proteins, including hypoxia-induced factor-1α (HIF-1α) and the genome-protecting poly(ADP-ribose) polymerase-1 (PARP-1). Upon activation, PARP-1 consumes high amounts of ATP at a time when this metabolite is scarce, worsening in turn the energy crisis elicited by asphyxia. The energy crisis also impairs ATP-dependent transport, including glutamate re-uptake by astroglia. Nicotinamide, a PARP-1 inhibitor, protects against the metabolic cascade elicited by the primary stage, avoiding NAD exhaustion and the energetic crisis. Upon re-oxygenation, however, oxidative stress leads to nuclear translocation of the NF-κB subunit p65, overexpression of the pro-inflammatory cytokines IL-1β and TNF-α, and glutamate-excitotoxicity, due to impairment of glial-glutamate transport, extracellular glutamate overflow, and overactivation of NMDA receptors, mainly of the extrasynaptic type. This leads to calcium influx, mitochondrial impairment, and inactivation of antioxidant enzymes, increasing further the activity of pro-oxidant enzymes, thereby making the surviving neonate vulnerable to recurrent metabolic insults whenever oxidative stress is involved. Here, we discuss evidence showing that (i) inhibition of PARP-1 overactivation by nicotinamide and (ii) inhibition of extrasynaptic NMDA receptor overactivation by memantine can prevent the short- and long-term consequences of PA. These hypotheses have been evaluated in a rat preclinical model of PA, aiming to identify the metabolic cascades responsible for the long-term consequences induced by the insult, also assessing postnatal vulnerability to recurrent oxidative insults. Thus, we present and discuss evidence demonstrating that PA induces long-term changes in metabolic pathways related to energy and oxidative stress, priming vulnerability of cells with both the neuronal and the glial phenotype. The effects induced by PA are region dependent, the substantia nigra being particularly prone to cell death. The issue of short- and long-term consequences of PA provides a framework for addressing a fundamental issue referred to plasticity of the CNS, since the perinatal insult triggers a domino-like sequence of events making the developing individual vulnerable to recurrent adverse conditions, decreasing his/her coping repertoire because of a relevant insult occurring at birth.
Topics: Animals; Antioxidants; Asphyxia; Humans; Neuroprotective Agents; Niacinamide; Oxidative Stress; Receptors, Glutamate
PubMed: 28844085
DOI: 10.1007/s12640-017-9795-9 -
Canadian Journal of Comparative... Oct 1975The effects of asphyxia and potassium on the electrocardiogram (ECG), lead II, were recorded from dogs and cats anesthetized with sodium pentobarbital and halothane....
The effects of asphyxia and potassium on the electrocardiogram (ECG), lead II, were recorded from dogs and cats anesthetized with sodium pentobarbital and halothane. Electrocardiographic recordings were made during control periods, during asphyxia (occluded endotracheal tube), during infusion of an isotonic KCl solution and during infusion of an isotonic NaCl solution. Arterial and venous blood gas partial pressures (PaCO2, PvCO2, PaO2 and and PvO2), plasma Na+ and K+ concentrations, heart rate and mean arterial blood pressure were measured during control periods, asphyxia and during the periods of infusion. The vagi were severed to assess the effect of vagal tone on the ECG changes. The characteristic ECG changes during asphyxia and the electrolyte imbalances resulting from infusion of isotonic KCl and NaCl were determined during sodium pentobarbital and halothane anesthesia in both dogs and cats. The combination of halothane and high PCO2 caused cardiac arrhythmias. Spontaneous recovery from ventricular fibrillation, as a result of hyperkalemia, was recorded from cats. Disappearance of the P waves, which is characteristic of hyperkalemia, was infrequent in this study and the U waves associated with hypokalemia were not found. Severing the vagi did not alter the ECG changes characteristic of asphyxia, hyperkalemia and hypokalemia. It was found that asphyxia and infusion of fluids high or low in potassium can produce ECG changes in both dogs and cats that can be correlated with blood gas partial pressure changes or plasma potassium concentrations.
Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Animals; Arrhythmias, Cardiac; Asphyxia; Blood Pressure; Cat Diseases; Cats; Dog Diseases; Dogs; Electrocardiography; Halothane; Oxygen; Pentobarbital; Potassium; Sodium; Vagus Nerve
PubMed: 1175078
DOI: No ID Found -
Scientific Reports May 2021The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are...
The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. Histological examination is currently considered the gold standard for CA post-mortem diagnosis. Here we present the comparative results of histopathology versus those previously obtained by H nuclear magnetic resonance (NMR) metabolomics in a swine model, originally designed for clinical purposes, exposed to two different CA causes, namely ventricular fibrillation and asphyxia. While heart and brain microscopical analysis could identify the damage induced by CA without providing any additional information on the CA cause, metabolomics allowed the identification of clearly different profiles between the two groups and showed major differences between asphyxiated animals with good and poor outcomes. Minute-by-minute plasma sampling allowed to associate these modifications to the pre-arrest asphyxial phase showing a clear correlation to the cellular effect of mechanical asphyxia reproduced in the experiment. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA.
Topics: Animals; Asphyxia; Disease Models, Animal; Female; Histological Techniques; Humans; Metabolomics; Proton Magnetic Resonance Spectroscopy; Swine
PubMed: 33980966
DOI: 10.1038/s41598-021-89570-0 -
Fa Yi Xue Za Zhi Feb 2023Lung is the largest organ of the respiratory system. During hypoxia, pulmonary cells undergo rapid damage changes and activate the self-rescue pathways, thus leading to... (Review)
Review
Lung is the largest organ of the respiratory system. During hypoxia, pulmonary cells undergo rapid damage changes and activate the self-rescue pathways, thus leading to complex biomacromolecule modification. Death from mechanical asphyxia refers to death due to acute respiratory disorder caused by mechanical violence. Because of the absence of characteristic signs in corpse, the accurate identification of mechanical asphyxia has always been the difficulty in forensic pathology. This paper reviews the biomacromolecule changes under the pulmonary hypoxia condition and discusses the possibility of application of these changes to accurate identification of death from mechanical asphyxia, aiming to provide new ideas for related research.
Topics: Humans; Asphyxia; Cause of Death; Hypoxia; Lung; Forensic Pathology
PubMed: 37038857
DOI: 10.12116/j.issn.1004-5619.2022.421005 -
Ethiopian Journal of Health Sciences May 2022Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal...
BACKGROUND
Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns.
METHODS
This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05.
RESULTS
Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia.
CONCLUSION
In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.
Topics: Asphyxia; Asphyxia Neonatorum; Birth Weight; Case-Control Studies; Ethiopia; Female; Hospitals, Special; Humans; Infant; Infant, Newborn; Perinatal Death; Pregnancy; Referral and Consultation; Risk Factors
PubMed: 35813672
DOI: 10.4314/ejhs.v32i3.6 -
The Journal of Physiology Aug 19801. The effects of hypoxia and asphyxia on cerebral blood flow and oxidative metabolism have been investigated in the calf and lamb under sodium pentobarbitone...
1. The effects of hypoxia and asphyxia on cerebral blood flow and oxidative metabolism have been investigated in the calf and lamb under sodium pentobarbitone anaesthesia. 2. Cerebral blood flow was determined using a hydrogen clearance technique, and cerebral metabolism quantified by the simultaneous measurement of arteriocerebral venous concentration differences for oxygen, glucose and lactate. Continuous measurements were made of arterial and cerebral venous PO2 in vivo. 3. Both cerebral blood flow and oxygen consumption were less in animals anaesthetized with sodium pentobarbitone than in conscious animals. 4. In the calf, recovery from transient episodes of severe hypoxia and asphyxia was associated with a rapid recovery and overshoot of cerebral venous PO2. Evidence was obtained that rapid changes in blood pressure during severe asphyxia were associated with pressure-passive cerebral blood flow. Prolonged hypoxia (Pa,O2:21 +/- 2 mmHg) with normocapnia was associated with an increase in cerebral blood flow, fall in cerebral oxygen consumption, and no change in the glucose-oxygen index. 5. In the lamb, prolonged asphyxia (Pa,O2:30 +/- 1 mmHg; Pa,CO2:56 +/- 2 mmHg) was associated with an increase in cerebral blood flow. Cerebral glucose uptake did not change, but cerebral oxygen consumption was markedly depressed, and the glucose-oxygen index increased. 6. In the lamb during normoxia, there was a linear correlation between cerebral blood flow and arterial PCO2 in the range 10-95 mmHg (r = 0.92; P < 0.001), with a slope of 1.74 ml. 100g-1 min-1 . mmHg Pa,CO2-1 . Hypoxia did not significantly increase the fall in cerebral vascular resistance associated with a rise in Pa,CO2 from 34 to 56 mmHg.
Topics: Animals; Animals, Newborn; Asphyxia; Brain; Carbon Dioxide; Cattle; Cerebrovascular Circulation; Glucose; Hypoxia, Brain; Lactates; Oxygen; Oxygen Consumption; Sheep
PubMed: 6777488
DOI: 10.1113/jphysiol.1980.sp013369 -
International Journal of Molecular... Sep 2023This review describes and discusses unusual axonal structural details and evidence for unmasking sulfhydryl groups (-SH) in axoplasmic membranes resulting from... (Review)
Review
This review describes and discusses unusual axonal structural details and evidence for unmasking sulfhydryl groups (-SH) in axoplasmic membranes resulting from electrical stimulation or asphyxia. Crayfish axons contain fenestrated septa (FS) that, in phase contrast, micrographs appear as repeated striations. In the electron microscope, each septum is made of two cross-sectioned membranes containing ~55 nm pores, each occupied by a microtubule. Thin filaments, which we believe are made of kinesin, bridge the microtubule to the edge of the pore. FS are believed to play a role in axoplasmic flow. The axons also display areas in which axon and sheath glial cell plasma membranes are sharply curved and project into the axoplasm. In freeze-fractures, the protoplasmic leaflet (P-face) of the projections appears as elongated indentations containing parallel chains of particles. The sheath glial cell plasma membrane also contains particles, but they are irregularly aggregated. The axons also display areas where axonal and glial plasma membranes fuse, creating intercellular pores. In axons fixed during electrical stimulation, the plasma membrane, the outer membrane of mitochondria, membranes of other cytoplasmic organelles, and gap junctions increase in electron opacity and thickness, resulting from unmasking of sulfhydryl groups (-SH). Similar changes occur in asphyxiated nerve cords.
Topics: Animals; Asphyxia; Axons; Gap Junctions; Cell Membrane; Electric Stimulation; Framycetin; Gastropoda
PubMed: 37686371
DOI: 10.3390/ijms241713565 -
BMC Neurology Aug 2015Neurolymphomatosis (NL) is an extremely rare disease and tracheal asphyxia due to NL has not been previously reported. (Review)
Review
BACKGROUND
Neurolymphomatosis (NL) is an extremely rare disease and tracheal asphyxia due to NL has not been previously reported.
CASE PRESENTATION
A 54-year-old Chinese woman with a history of diffuse large B-cell lymphoma in her first complete remission developed peripheral neuropathy and tracheal asphyxia. Neurolymphomatosis involving the right brachial plexus and the right vagus nerve was demonstrated by PET/CT, but not by MRI. She underwent urgent tracheotomy and impact chemotherapy using rituximab combined with high dose methotrexate and involved field radiotherapy. She achieved a second complete remission.
CONCLUSION
PET/CT plays valuable role in differentiating NL from other neuropathies in patients with lymphoma. Complete remission can be achieved in NL due to large B-cell lymphoma.
Topics: Antineoplastic Agents; Asphyxia; Brachial Plexus; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Methotrexate; Middle Aged; Multimodal Imaging; Peripheral Nervous System Diseases; Peripheral Nervous System Neoplasms; Positron-Emission Tomography; Radiotherapy; Rituximab; Tomography, X-Ray Computed; Tracheal Diseases; Tracheotomy; Vagus Nerve
PubMed: 26298453
DOI: 10.1186/s12883-015-0405-2 -
Annals of the Royal College of Surgeons... Sep 2018Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid...
Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid gel. Its main use is to reduce spillages. If ingested, this substance presents significant risk of asphyxiation. There have been 15 reported cases of Vernagel ingestion in 6 years and 1 death from asphyxiation. We present the case of an elderly patient who was admitted following a fall. He accidentally ingested a sachet of Vernagel during the early hours of the morning. An urgent rigid panendoscopy was performed and the material was evacuated using suction aspiration. Patients should be supervised when using Vernagel on the ward, to avoid ingestion. Ear, nose and throat doctors should be aware of Vernagel and its properties. Owing to the risk of airway obstruction, excellent coordination between the anaesthetist and surgeon is crucial, and prompt management is required.
Topics: Acrylic Resins; Aged; Asphyxia; Endoscopy; Foreign Bodies; Humans; Male; Risk Factors; Suction
PubMed: 29909673
DOI: 10.1308/rcsann.2018.0104