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Psychiatria Polska 2016Autism spectrum disorders (ASD) are caused by disruptions in early stages of central nervous system development and are usually diagnosed in first years of life. Despite... (Review)
Review
Autism spectrum disorders (ASD) are caused by disruptions in early stages of central nervous system development and are usually diagnosed in first years of life. Despite common features such as impairment of socio-communicative development and stereotypical behaviours, ASD are characterised by heterogeneous course and clinical picture. The most important aetiological factors comprise genetic and environmental influences acting at prenatal, perinatal and neonatal period. The role of rare variants with large effect i.e. copy number variants in genes regulating synapse formation and intrasynaptic connections is emphasised. Common variants with small effect may also be involved, i.e. polymorphisms in genes encoding prosocial peptides system - oxytocin and vasopressin. The environmental factors may include harmful effects acting during pregnancy and labour, however their specificity until now is not confirmed, and in some of them a primary genetic origin cannot be excluded. In several instances, especially with comorbid disorders - intellectual disability, epilepsy and dysmorphias - a detailed molecular diagnostics is warranted, which currently may elucidate the genetic background of disorder in about 20% of cases.
Topics: Asphyxia Neonatorum; Autism Spectrum Disorder; Child Development Disorders, Pervasive; Comorbidity; Female; Humans; Male; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Exposure Delayed Effects
PubMed: 27556113
DOI: 10.12740/PP/43234 -
Developmental Neuroscience 2017Therapeutic hypothermia provides incomplete neuroprotection for neonatal hypoxic-ischemic encephalopathy (HIE). We examined whether hemodynamic goals that support... (Observational Study)
Observational Study
BACKGROUND
Therapeutic hypothermia provides incomplete neuroprotection for neonatal hypoxic-ischemic encephalopathy (HIE). We examined whether hemodynamic goals that support autoregulation are associated with decreased brain injury and whether these relationships are affected by birth asphyxia or vary by anatomic region.
METHODS
Neonates cooled for HIE received near-infrared spectroscopy autoregulation monitoring to identify the mean arterial blood pressure with optimized autoregulatory function (MAPOPT). Blood pressure deviation from MAPOPT was correlated with brain injury on MRI after adjusting for the effects of arterial carbon dioxide, vasopressors, seizures, and birth asphyxia severity.
RESULTS
Blood pressure deviation from MAPOPT related to neurologic injury in several regions independent of birth asphyxia severity. Greater duration and deviation of blood pressure below MAPOPT were associated with greater injury in the paracentral gyri and white matter. Blood pressure within MAPOPT related to lesser injury in the white matter, putamen and globus pallidus, and brain stem. Finally, blood pressures that exceeded MAPOPT were associated with reduced injury in the paracentral gyri.
CONCLUSIONS
Blood pressure deviation from optimal autoregulatory vasoreactivity was associated with MRI markers of brain injury that, in many regions, were independent of the initial birth asphyxia. Targeting hemodynamic ranges to optimize autoregulation has potential as an adjunctive therapy to hypothermia for HIE.
Topics: Asphyxia Neonatorum; Female; Hemodynamics; Homeostasis; Humans; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Infant, Newborn; Male; Monitoring, Physiologic; Spectroscopy, Near-Infrared
PubMed: 27978510
DOI: 10.1159/000452833 -
Anales de Pediatria Apr 2024
Topics: Humans; Infant, Newborn; Asphyxia Neonatorum; Neuroprotection; Health Resources
PubMed: 38604933
DOI: 10.1016/j.anpede.2024.02.013 -
The Veterinary Clinics of North... Apr 1994The abysmal survival rates for the first barking foals described more than 60 years ago were probably due to the cumulative effects of asphyxia on multiple organ... (Review)
Review
The abysmal survival rates for the first barking foals described more than 60 years ago were probably due to the cumulative effects of asphyxia on multiple organ systems. Successful treatment of asphyxiated foals requires recognition of periparturient conditions associated with the syndrome and appreciation of the spectrum of clinicopathologic complications that can ensue.
Topics: Animals; Animals, Newborn; Asphyxia Neonatorum; Horse Diseases; Horses; Humans; Infant, Newborn; Prognosis
PubMed: 8039031
DOI: 10.1016/s0749-0739(17)30374-7 -
BMC Pediatrics Sep 2022Birth asphyxia leads to profound systemic and neurological sequela to decrease blood flow or oxygen to the fetus followed by lethal progressive or irreversible life-long...
BACKGROUND
Birth asphyxia leads to profound systemic and neurological sequela to decrease blood flow or oxygen to the fetus followed by lethal progressive or irreversible life-long pathologies. In low resource setting countries, birth asphyxia remains a critical condition. This study aimed to develop and validate prognostic risk scores to forecast birth asphyxia using maternal and neonatal characteristics in south Gondar zone hospitals.
METHODS
Prospective cohorts of 404 pregnant women were included in the model in south Gondar Zone Hospitals, Northwest Ethiopia. To recognize potential prognostic determinants for birth asphyxia, multivariable logistic regression was applied. The model discrimination probability was checked using the receiver operating characteristic curve (AUROC) and the model calibration plot was assessed using the 'givitiR' R-package. To check the clinical importance of the model, a cost-benefit analysis was done through a decision curve and the model was internally validated using bootstrapping. Lastly, a risk score prediction measurement was established for simple application.
RESULTS
Of 404, 108 (26.73%) (95% CI: 22.6-31.3) newborns were exposed to birth asphyxia during the follow-up time. Premature rupture of membrane, meconium aspiration syndrome, malpresentation, prolonged labor, Preterm, and tight nuchal was the significant prognostic predictors of birth asphyxia. The AUROC curve for birth asphyxia was 88.6% (95% CI: 84.6-92.2%), which indicated that the tool identified the newborns at risk for birth asphyxia very well. The AUROC of the simplified risk score algorithm, was 87.9 (95% CI, 84.0- 91.7%) and the risk score value of 2 was selected as the optimal cut-off value, with a sensitivity of 78.87%, a specificity of 83.26%, a positive predictive value of 63.23%, and a negative predictive value of 91.52%.
CONCLUSIONS
We established birth asphyxia prediction tools by applying non-sophisticated maternal and neonatal characteristics for resource scares countries. The driven score has very good discriminative ability and prediction performance. This risk score tool would allow reducing neonatal morbidity and mortality related to birth asphyxia. Consequently, it will improve the overall neonatal health / under-five child health in low-income countries.
Topics: Asphyxia; Asphyxia Neonatorum; Child; Ethiopia; Female; Fetus; Hospitals; Humans; Infant, Newborn; Meconium Aspiration Syndrome; Pregnancy; Prognosis; Prospective Studies; Risk Factors
PubMed: 36088319
DOI: 10.1186/s12887-022-03582-x -
Acta Ophthalmologica Sep 2017This study aims to determine risk factors for retinal haemorrhage (RH) in high-risk infants.
PURPOSE
This study aims to determine risk factors for retinal haemorrhage (RH) in high-risk infants.
METHODS
A total of 3123 cases with high-risk pregnancy and/or neonatal asphyxia 72 hr after delivery were enrolled into this study. Fundus examinations were performed on newborns utilizing a wide-angle imaging system (RetCam III). Retinal haemorrhage (RH) was classified into three grades. Maternal, obstetric and neonatal parameters from high-risk infants with RH were compared with parameters from infants without RH.
RESULTS
Retinal haemorrhage (RH) was found in 550 (18%) of 3123 high-risk infants. Retinal haemorrhage (RH) was classified as grade I (39%), grade II (24%) and grade III (37%). Monocular RH occurred in 37% of cases, while the remaining cases were binocular. Moreover, six cases had vitreous haemorrhage. The following parameters correlated (p < 0.05) with RH in this study: delivery mode (χ = 469), gestational age (χ = 35), birth weight (χ = 18), asphyxia (χ = 73), scalp hematoma (χ = 55), maternal age (χ = 8.9), precipitate labour (χ = 120) and delivery times (χ = 6.1). Logistic regression analysis indicated that delivery mode and asphyxia were risk factors for RH in high-risk infants, with odds ratios of 0.827 and 2.5, respectively. Gender, intracranial haemorrhage and foetal distress were not correlated with RH in high-risk infants.
CONCLUSION
The incidence of RH in high-risk infants was 18%, and delivery mode, and neonatal asphyxia were major risk factors for RH in high-risk infants.
Topics: Asphyxia Neonatorum; Birth Weight; China; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Male; Retinal Hemorrhage; Retrospective Studies; Risk Factors
PubMed: 28671322
DOI: 10.1111/aos.13515 -
Clinics in Perinatology Jun 1993Nuclear magnetic resonance imaging and spectroscopy have added significant new information about the newborn brain during and following asphyxia. NMR imaging has... (Review)
Review
Nuclear magnetic resonance imaging and spectroscopy have added significant new information about the newborn brain during and following asphyxia. NMR imaging has permitted sequential in vivo analysis of CNS maturation in the perinatal period that is superior in anatomic resolution, and especially in the characterization of myelination, to either cranial ultrasound or radiographic computed tomography. As a result, the accurate detection and recognition of the brain lesions associated with hypoxic-ischemic encephalopathy is now possible, including PVL, cerebral infarction, intraparenchymal and intraventricular hemorrhage, and delayed myelination. This has improved our understanding of the associated potential risk for abnormal neuro-developmental outcome with specific lesions. NMR spectroscopy has provided a metabolic window into the biochemical events during and following asphyxia. 31P MRS captures the phosphorous metabolites as levels rise and fall and shift in relation to each other to maintain cellular energy homeostasis in the face of oxygen depletion. Meanwhile, proton NMR spectroscopy promises to sustain the metabolic purview beyond the immediate cellular response to asphyxia to the chronic adaptation phase. Appropriately applied, this noninvasive technology may yet enable us to identify brain injury that is reversible in sufficient time to intervene and to diagnose accurately what is irreversible for timely prognostication. Furthermore, the integration of clinical imaging and spectroscopy capabilities is both feasible and desirable; information provided by each being mutually complementary. Imaging could improve spectroscopy interpretation by identifying the observed tissue, whereas MRS should clarify diagnosis of anatomic lesions detected by MRI. Advances in spatial resolution and speed of data acquisition may soon make integrated MRI/MRS a clinical reality.
Topics: Age Factors; Asphyxia Neonatorum; Brain; Brain Chemistry; Brain Diseases; Cholesterol; Disease Models, Animal; Homeostasis; Humans; Infant, Newborn; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Myelin Sheath; Organ Size; Prognosis; Risk Factors; Sensitivity and Specificity
PubMed: 8358955
DOI: No ID Found -
BMC Pregnancy and Childbirth Oct 2020More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of... (Observational Study)
Observational Study
BACKGROUND
More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies.
METHODS
Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI.
RESULTS
The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI.
CONCLUSIONS
The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.
Topics: Adolescent; Adult; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Cross-Sectional Studies; Ethiopia; Female; Fetal Membranes, Premature Rupture; Hospitals, General; Humans; Infant, Newborn; Labor Presentation; Live Birth; Male; Meconium; Perinatal Death; Photoperiod; Pregnancy; Prevalence; Risk Factors; Time Factors; Vacuum Extraction, Obstetrical; Young Adult
PubMed: 33115413
DOI: 10.1186/s12884-020-03348-2 -
Frontiers in Public Health 2023Perinatal asphyxia is one of the most frequent causes of neonatal mortality, affecting approximately four million newborns worldwide each year and causing the death of...
INTRODUCTION
Perinatal asphyxia is one of the most frequent causes of neonatal mortality, affecting approximately four million newborns worldwide each year and causing the death of one million individuals. One of the main reasons for these high incidences is the lack of consensual methods of early diagnosis for this pathology. Estimating risk-appropriate health care for mother and baby is essential for increasing the quality of the health care system. Thus, it is necessary to investigate models that improve the prediction of perinatal asphyxia. Access to the cardiotocographic signals (CTGs) in conjunction with various clinical parameters can be crucial for the development of a successful model.
OBJECTIVES
This exploratory work aims to develop predictive models of perinatal asphyxia based on clinical parameters and fetal heart rate (fHR) indices.
METHODS
Single gestations data from a retrospective unicentric study from Centro Hospitalar e Universitário do Porto de São João (CHUSJ) between 2010 and 2018 was probed. The CTGs were acquired and analyzed by Omniview-SisPorto, estimating several fHR features. The clinical variables were obtained from the electronic clinical records stored by ObsCare. Entropy and compression characterized the complexity of the fHR time series. These variables' contribution to the prediction of asphyxia perinatal was probed by binary logistic regression (BLR) and Naive-Bayes (NB) models.
RESULTS
The data consisted of 517 cases, with 15 pathological cases. The asphyxia prediction models showed promising results, with an area under the receiver operator characteristic curve (AUC) >70%. In NB approaches, the best models combined clinical and SisPorto features. The best model was the univariate BLR with the variable compression ratio scale 2 (CR2) and an AUC of 94.93% [94.55; 95.31%].
CONCLUSION
Both BLR and Bayesian models have advantages and disadvantages. The model with the best performance predicting perinatal asphyxia was the univariate BLR with the CR2 variable, demonstrating the importance of non-linear indices in perinatal asphyxia detection. Future studies should explore decision support systems to detect sepsis, including clinical and CTGs features (linear and non-linear).
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Asphyxia; Retrospective Studies; Bayes Theorem; Asphyxia Neonatorum; Fetus
PubMed: 37033082
DOI: 10.3389/fpubh.2023.1099263 -
Zhongguo Dang Dai Er Ke Za Zhi =... Jul 2023To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of...
[Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study].
OBJECTIVES
To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.
METHODS
A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.
RESULTS
Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.
CONCLUSIONS
The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.
Topics: Infant, Newborn; Humans; Male; Pregnancy; Female; Nomograms; Retrospective Studies; Cesarean Section; Risk Factors; Asphyxia Neonatorum
PubMed: 37529951
DOI: 10.7499/j.issn.1008-8830.2301047