Gastroesophageal manometry and 24-hour double pH monitoring in neonates with birth asphyxia

INTRODUCTIONBirth asphyxia may lead to disturbances of gastroenteric motility of newborn infants[1.2] . The change of gut pressure and reflux are the major manifestations of the motor disturbance [3-9] . To evaluate the effects of perinatal asphyxia on the gastroenteric motility, gastric and esophageal pressure and double pH were measured in a group of asphyxiated newborns. And. their pathophysiological and anatomical effects on gastroenteric function were discussed.

Application of Positron Emission Tomography in the Detection of Myocardial Metabolism in Pig Ventricular Fibrillation and Asphyxiation Cardiac Arrest Models after Resuscitation

Objective To study the application of positron emission tomography （PET） in detection of myocardia metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest （VFCA） group （n=16） and an asphyxiation cardiac arrest （ACA） group （n=16）. Cardiac arrest （CA） was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation （CPR） and defibrillation. At four hours and 24 h after spontaneous circulation was achieved, myocardial metabolism was assessed by PET. 18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value （SUVmax） was measured. Results Spontaneous circulation was 200% and 62.5% in VFCA group and ACA group, respectively. PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVrnax was higher in VFCA group than in ACA group （P〈0.01）. In VFCA group, SUVmax at 24 h after spontaneous circulation increased to the level of baseline. Conclusion ACA causes more severe cardiac metabol associated with less successful resuscitation. Myocardial sm injuries than VFCA. Myocardial dysfunction is stunning does occur with VFCA but not with ACA.

Short and long term prognosis in perinatal asphyxia: An update

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.

Clinical Implication of the Changes of cAMP, TXA_2 and PGI_2 in CSF of Asphyxiated Newborns

To evaluate the changes of 3', 5'-cyclic adenosine monophosphate (cAMP), thrombox-ane A2(TXA2) and prostacyclin (PGI2) in cerebrospinal fluid (CSF) in the asphyxiated newborn and explore their roles in hypoxic-ischamic brain damage (HIBD). Thirty-six full term newborns were divided into 3 groups, including 12 with moderate-severe hypoxic-ischaemic encephalopathy (HIE), 13 with mild HIE, 11 without HIE (control group). The levels of cAMP, TXB2(TXA2 metabolite) and 6-keto-PGF1α(PGI2 metabolite) in CSF and plasma were measured 36-72 h after birth by RIA, and the concentrations were expressed as nM/L (cAMP), ng/L(TXB2 and 6-keto-PGF1α). The infants were followed-up at 6 and 12 month of age and Mental Development Index (MDI) and Psychomotor Development Index (FDD were measured using Bayley Scales of Infant Development (BSID). The CSF cAMP level in moderate-severe HIE group was 8. 60±2. 40, significantly lower than that of the mild HIE group (14. 83±2. 84) and the control group (24. 43±2. 39)(for both P<0. 01). The levels of TXB2 and 6-keto-PGF1α in CFS in the moderate-severe HIE group (206. 06±29. 74, 168. 47± 23. 02, respectively) were significantly higher than in the mild HIE group (83. 37±28. 57, 131. 42± 16. 57, respectively, P<0. 01) and the control group (41. 77±21. 58, 86. 23±13. 05, respectively, P<0. 01). The level changes of cAMP,TXB2 and 6-keto-PGF1α in plasma in all groups were similar to those in CSF, but no significant difference was found between mild HIE group and the control group (P>0. 05). The follow-up results showed that MDI and PDI of the moderate-severe HIE group were the lowest (84. 79±13. 34, 83. 50±13. 28, respectively), followed by mild HIE group (102.19±7. 02, 99. 94±9. 08, respectively) , with the control group being the highest (116. 63± 12.08, 116. 69±10. 87, respectively). Univariate analysis showed some significant difference (the moderate-severe HIE group vs. the mild HIE group or the control group, P<0. 01; the mild HIE group vs. the control group P<0. 05). The results suggested that the concentration of cAMP, TXA2 and T/K ratio in CSF after neonatal asphyxia might be sensitive markers in evaluating the severity of brain damage in early stage and predicting the future outcome.

Effect of naloxone on level of plasma beta-endorphin in neonates with severe asphyxia

β-endorphin is the most actively endogenous substance of cerebral endorphin. When combined with opiate receptor specially, it manifests a strong morphine-like activity and can decrease sensitivity of central nervous system to carbon dioxide so as to inhibit breath. OBJECTIVE： To observe the changes of content of plasma β-endorphin in neonates with severe asphyxia after naloxone treatment in a large dosage. DESIGN： Randomized controlled observation. SETTINGS： Department of Pediatrics, Shenzhen Shajing People＇s Hospital; Center of Pediatrics, Guangzhou Zhujiang Hospital. PARTICIPANTS： A total of 97 neonates with severe asphyxia including 57 boys and 40 girls were selected from Neonatal Intensive Care Unit, Department of Pediatrics, Shenzhen Shajing People＇s Hospital from January 2004 to November 2005. Their gestational age was （38±3） weeks, body mass was （3.2±1.7） kg, and hospitalization duration was （2.8±2.3） hours. All neonates met the diagnostic criteria of with severe asphyxia and all their parents provided the confirmed consent. METHODS： All neonates were treated with inspired oxygen, sedation, stopping terror, decreasing cranial pressure, maintaining a well blood perfusion and normal level of blood glucose （about 5.0 retool/L）. After hospitalization, 0.1 mg/（kg·d） naloxone hydrochloride （Beijing Sihuan Pharmaceutical Technology Co., Ltd.; certification： HI0900021; bullet preparation; 0.4 mg/ampoule） was intravenously dribbled into neonates for 4 - 6 hours, 14 days in total. 2 mL blood was collected from radial artery in neonates at the beginning of hospitalization and at 3 days after naloxone treatment, put in aprotinin-pre-cool tube, mixed evenly, and centrifuged at hypothermia. Plasma was maintained in refrigerator at - 70 ℃. The kit was provided by Neurobiology Department of Shanghai Second Military Medical University of Chinese PLA. Concentration of plasma β-endorphin was measured by using radio-immunity assay.All data were expressed as Mean ± SD and results were compared with paired t test. MAIN OUTCOME MEASURE： Concentration of plasma β-endorphin. RESULTS： All 97 neonates were involved in the final analysis. Concentration of plasma β-endorphin in neonates with severe asphyxia was lower after treatment as compared with that before treatment, and there was significant difference （t = 10.31, P 〈 0.01 ）. CONCLUSION： Naloxone can decrease level of plasma β-endorphin in neonates with severe asphyxia.

Histopathology of renal asphyxia in newborn piglets: Individual susceptibility to tubular changes

AIM： To analyze the effects on the kidney of hypoxia-reoxygenation in an experimental model of normocapnic asphyxia.METHODS： To this end, 40 newborn Landrace/Large-White piglets aged 1-4 d were studied in this work. Hypoxia was induced by decreasing the inspired fiO2 to 0.06-0.08. Animals were resuscitated with different fO2 and subdivided into 4 groups： group 1, 2, 3 and 4 received 18%, 21%, 40% and 100% O2 respectively. Macroscopic examination was carried out to evidence possible pathological features. Tissue sample were obtained from both kidneys. Four or fve micron paraffn sections were stained with H-E and PAS stain and examined under an optical microscope.RESULTS： Pathological changes, mainly affecting tubular cells, were observed in the vast majority of kidneys of asphyxiated piglets. The most frequent tubular changes were： tubular casts （95%）, tubulardilatation （87.5%）, tubular vacuolization （70%）, tubular eosinophilia （52.5%）, sloughing （50%）, fragmentation of the brush border （50%）, oedema （32.5%）, apoptosis （15%） and glomerular changes （meningeal cell pro-liferation, capsular adhesion between the flocculus and Bowman’s capsule, glomerulosclerosis and fbrous or cellular crescents associated with collapse of the glomerular tuft）. Statistical analysis was carried out on changes observed when the animals were allocated in the 4 groups （χ2-test 0.05）. The statistical analysis showed no evidence of differences regarding kidney lesions among the animals groups.CONCLUSION： Our data show that renal pathology in newborn piglets is characterized by interindividual variability to hypoxia and is not associated with oxygenGerosa C et al . Individual susceptibility in renal asphyxiaconcentration.

Influences on the activities of tissue-type plasminogen activator of mouse brain in asphyxia

Objective To observe the changes of the activity of tissue -type plasminogen activa tor(TPA)after asphyxia.Methods As-phyxia was induced in mouse pups by performing a ‘delayed cesarean section’.The experiment was designed for a co ntrol group and 4asphyctic groups to detect the activity of TPA.Results TPAactivity of brain increased afte r asphyxia(P <0.01).Conclusion TPAincreased after asphyxia might be able to attack the b asement membrane of microvessels,t hen opened the blood -brain barrier a nd induced neuronal damage.

Effect of Asphyxia on Urinary Epidermal Growth FactorLevels in Newborns

Urinary epidermal growth factor (EGF) excretion in normal newborn as well as neonates with asphyxia was investigated by using radioimmunoassay,and serum creatinine (Scr) levels determined at the same time. The results showed that in severe asphyxia group the ratio of urinary EGF to urinarycreatinine (Cr) (EGF/Cr), an index reflecting EGF excretion, was decreased on the first day (P<0. 05) and reached the lowest level on the third day (P<0.01).However, EGF/Cr values were decreased only on the third day in neonates with mild asphyxia (P<0. 05). On the seventh day. EGF/Cr values of neonates with asphyxia rose to normal. There were a negative correlation between urinary EGF/ Cr and Scr. It is suggested that EGF may play a role in the repair of acute renal injury after asphyxia and the detection of urinary EGF concentration is useful in the judgment of seventy of renal injury and in the evaluation of the recovery of renal tubule after injury.

Associative Factors for Birth Asphyxia at Queen Elizabeth Central Hospital—Malawi

Background: Birth asphyxia is one of the major causes of neonatal deaths worldwide. Queen Elizabeth Central Hospital (QECH) neonatal ward records indicate that 36.5% of neonates admitted in the ward from April to September 2012 had birth asphyxia. This study was conducted to explore associative factors for birth asphyxia at QECH. Methodology: The study design was descriptive cross sectional that employed quantitative methods of data collection and analysis. Data sources were case notes of neonates and their mothers.? Sample size was 87 neonates with birth asphyxia and 87 neonates admitted with conditions other than birth asphyxia as controls. Data were collected from November to December 2013. Statistical Package for Social Science (SPSS) version16.0 was used to analyze data. Results: Findings revealed that there were no maternal associative factors for birth asphyxia, however, foetal distress, prolonged first and second stage of labour were significant associative factors for birth asphyxia. Conclusion: Associative factors for birth asphyxia at QECH are Foetal distress, prolonged first and second stage of labour. These factors can be prevented if quality care is provided to women in labour through close monitoring of foetal heart, appropriate use of the partograph, prompt decision making and early interventions.

Physiopathological Mechanism and Assessment of Fetal Asphyxia

Treatment and outcome of childbirth depend on the acidobasic balance of the fetal blood related to the oxygen and carbon dioxide level. Hypoxemia could lead to asphyxia that is why fetal monitoring and biochemical parameters assessment are mandatory. Although there are compensatory mechanisms that temporarily protect the fetus, there are also other factors that interfere with the oxygenation of the fetus and determine the development of the fetus and the newborn. Actually, the level of the oxygen, the carbon dioxide, the acidobasic balance and the pH are the cornerstones of the well-being of the fetus.

Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study

Background: During the past two decades there has been a sustained decline in child mortality;however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services. Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan. Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths with birth asphyxia diagnosed through verbal autopsy accreditation during 2005 and 2006 were taken as cases. Controls were the live births during the same period, matched on area of residence, gender and age. Result: The factors found to be associated with birth asphyxia mortality in Matiari District of Sindh Province, Pakistan are maternal education, history of stillbirths, pregnancy complications (including smelly or excessive vaginal discharge and anemia), intrapartum complications (including fever, prolong or difficult labour, breech delivery, cord around child’s neck, premature delivery, large baby size) and failure to establish spontaneous respiration after birth. Conclusion and Recommendation: There is an immediate need to develop strategies for early identification and management of factors associated with birth asphyxia by involving women, families, communities, community health workers, health professionals and policy makers. Community health workers should be trained for emergency obstetric care, basic newborn care including preliminary resuscitation measures to provide skilled birth attendance and encourage early recognition and referral.

The Differences of Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels between Asphyxiated and Non-Asphyxiated Neonates

Objective: To evaluate the differences of urinary NGAL levels between asphyxiated and non-as- phyxiated neonates. Methods: This was a cross-sectional observational analytic study, including 34 newborns in Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Sample collection was conducted from December 2014 to March 2015. Urine NGAL levels were evaluated using enzyme-linked immunosorbent assays (ELISA) technique. To determine the differences of urinary NGAL levels between asphyxiated and non-asphyxiated group we used Mann-Whitney U test, and to determine the differences of gestational age and birth weight between these two groups we used Fisher’s exact test. Results: Twenty males (60%) and 14 females (40%) neonates participated in the study. From 34 subjects, 17 neonates were diagnosed with asphyxia and 17 neonates without asphyxia. The results showed that urine NGAL levels had significantly increased in asphyxiated neonates. The median urine NGAL level in asphyxiated group is 95% CI: 506.7 (60.0 - 651.7) ng/mL, while the median urine NGAL level in non-asphyxiated group is 95% CI: 6.7 (0.1 - 53.0) ng/mL. Statistically, there were significant urine NGAL levels differences between asphyxiated and non-asphyxi- ated neonates (p < 0.001). There were no differences in gestational age and birth weight between asphyxiated and non-asphyxiated neonates (p > 0.05). Conclusions: Urinary NGAL levels in asphyxiated neonates were significantly higher than those in non-asphyxiated neonates. There were significant differences of urine NGAL levels between the groups.

Pilot Study: Magnesium Sulphate Administration and Early Resolution of Hypoxic Ischemic Encephalopathy in Severe Perinatal Asphyxia

Introduction: Perinatal asphyxia is one of the leading causes of perinatal death and a recognized cause of neuromotor disability among survivors. About 20% - 30% of asphyxiated newborns who develop hypoxic ischemic encephalopathy (HIE) die during the neonatal period, and one third to one half of survivors are left with cerebral palsy and mental retardation. Objective of the Study: Was to determine the effect of magnesium sulphate as neuroprotective drug in hypoxic ischemic encephalopathy resulting from severe perinatal asphyxia. Materials and Methods: A prospective administration of magnesium sulphate to 52 severely asphyxiated newborns with hypoxic ischemic encephalopathy was conducted over one year period from 1st August 2017 to 31st July 2018. Results: Most (96.2%) of patients were term baby (GA ≥ 37 weeks). Most (90.4%) were in-hospital born, vaginal delivery accounted for 55.8% and 44.2% assisted delivery respectively. About one half (55.8%) of the patients commenced MgSO4 therapy at <6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - <24 hours and >24 hours after birth respectively. Time of commencement of first enteral feeding (p = 0.018) and time to full enteral feeding (p = 0.015) showed significant correlation with the survival without neurological deficit. The earlier the commencement of MgSO4 therapy, the better the proportion with strong palmar grasp, sucking reflex, tone and early resolution of encephalopathy. Conclusion: All the study subjects treated with magnesium sulphate had impressive improvement;however there is a need to conduct randomized placebo-controlled trial treatment of severe perinatal asphyxia so as to determine its effects on early resolution of hypoxic ischemic encephalopathy/neuroprotective activity.

Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi

A study was conducted to determine midwives adherence to guidelines on management of birth asphyxia at Queen Elizabeth Central Hospital in Blantyre district, Malawi. The study design was descriptive cross sectional using quantitative data analysis method on 75 midwives that were working in the maternity unit of the hospital. A structured questionnaire was used to collect data on participant’s demographic characteristics and midwives’ comprehension of birth asphyxia and an observational check list was used to observe midwives’ adherence to WHO resuscitation guidelines. In addition midwives were observed on their adherence to the Integrated Maternal and Neonatal Health guidelines that were developed by the Malawi Ministry of Health. The findings indicate that the midwives had knowledge of birth asphyxia in general. However, there were gaps in their ability to identify warning signs of birth asphyxia through partograph use. In addition the midwives did not adhere to 9 out of the 21 steps of the resuscitation guideline. Generally there was substandard adherence to guidelines on identification of warning signs of birth asphyxia and neonatal resuscitation. On the other hand, the facility did not have adequate resuscitation equipment and supplies. The results are discussed in relation to the importance of adhering to resuscitation guidelines in the management of birth asphyxia for babies that do not breathe at birth. Training of the midwives on partograph use and resuscitation to improve neonatal outcomes is recommended. It is recommended further that the health facility should have adequate resuscitation equipment and supplies.

The Differences of Cord Blood Troponin I (TnI) Level between Normal and Asphyxiated Infants and Its Correlation with APGAR Score

Asphyxia could increase infant morbidity and mortality. Ante- and intrapartum cardiotocography (CTG) examination could lead to a false positive diagnosis of asphyxia (fetal distress). Troponin I (TnI) is an important factor to the pathogenesis of asphyxia. Cord blood TnI level is increased in infants with fetal cardiac dysfunction, causing pathological CTG and low APGAR score (<7). In the future, TnI is expected to reduce false positive diagnosis of asphyxia caused by CTG. This research was conducted to examine and analyze the differences of cord blood TnI level between normal and asphyxiated infants and to determine the correlation between TnI level and APGAR score. An observational analytical cross sectional study was conducted to a total of 36 patients with asphyxiated infants (18 patients) and normal infants (18 patients). Subjects were selected according to the inclusion and exclusion criteria. Cardiotocography, TnI level, and APGAR score were examined. Umbilical cord blood samples were taken from each subject for the measurement of TnIlevel using a highly sensitive indirect sandwich Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was performed by Mann-Whitney and Rank Spearman correlation coefficient test. Cord blood TnI level of asphyxia andnormal groups were 1615.77 ± 1199.98 pg/mL and 819.88 ± 145.82 pg/mLrespectively (p ≤ 0.05). Rank Spearman correlation coefficient between cord blood TnI level and 1’ and 5’ APGAR score was -0.523 (p = 0.026;p ≤ 0.05)and -0.502 respectively (p = 0.034;p ≤ 0.05). There was a statistically significant difference between cord blood TnI level of asphyxia and normal groups;cord blood TnI level of asphyxia group was higher than normal group. Furthermore, negative correlation was observed between cord blood TnI level and APGAR score.

Differences of Asphyxia in Infants of 35 and 36 Weeks Pregnant Women with or without Antenatal Corticosteroids

Objective: To identify differences of Asphyxia in infants of 35 - 36 weeks with or without antenatal corticosteroid. Methods: Case control study was done on 35 and 36 weeks of pregnancy mother with threatened preterm labor who received and did not receive corticosteroids. Results: From 106 patients with threatened preterm labour between 35 - 36 gestational age, 53 patients received corticosteroid, and 53 did not receive corticosteroid. Incidence of asphyxia decreased significantly from patients received corticosteroid (34%:58.5%, P = 0.011). Incidence of decreased in patients received corticosteroid compared with patients did not receive corticosteroid (3.8%: 15.1%), but the difference was not significant (P = 0.093). Based on the length of stay at the hospital, babies receiving corticosteroid before delivery have shorter duration of stay (<3 days) with 94.3%: 84.9% (P = 0.224). Conclusion: There is a significant correlation of newborn asphyxia from 35 - 36 gestational weeks with or without corticosteroid treatment (58.5%:34%, P = 0.011).

Risk factors of clinical birth asphyxia and subsequent newborn death following nuchal cord in a low-resource setting

Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.

Neurodevelopmental Outcome of Newborns Aged More than 34 Weeks Gestational Age Managed for Birth Asphyxia in Douala (Cameroon): A Single Hospital-Based Study

Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score < 7 at the 5th minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.

Risk Factors for Birth Asphyxia in Togo: A Case-Control Study

Background: Birth Asphyxia (BA) is one of the leading causes of neonatal death in developing countries. In Togo, 30.55% of neonatal deaths were related to BA and caused by several risk factors. The purpose of this piece of work is to analyse the antepartum, intrapartum, and foetal risk factors of BA. Methods: This is a case control study, conducted from 1st December 2019 to 28th February 2020 in obstetrics wards and at neonatal intensive care of paediatric ward at the Sylvanus Olympio university teaching hospital (CHU-SO) in Lomé, Togo. Neonates diagnosed with BA (Apgar score < 7 at 5th minute) were considered as “cases” (N = 200) while neonates born either with normal vaginal delivery or by cesarean section having no abnormality were considered as “control” (N = 200). Results: The prevalence rate of BA was 9.13%. Age (p = 0.0391), gravidity (p = 0.0040), type of facility for prenatal follow-up (p < 0.0001), use of Long-lasting impregnated mosquito nets (LLIN) (p < 0.0001), notion of maternal fever (p < 0.0001) and chronic pathology (p < 0.0001) were related to occurrence of BA. Significant antepartum risk factors observed were age < 25 years (OR = 1.15;CI 95% [0.66 - 1.98], p = 0.0391), primigravidity (OR = 1.82;95% CI [0.86 - 3.85], 0.0040), prenatal follow-up in a private one (OR = 1.62;CI95% [1.03 - 12.55], p < 0.0001), non-use of LLIN (OR = 2.50;CI 95% [1.61 - 3.88], p < 0.0001), maternal fever (OR = 3.73;CI 95% [2.33 - 5.97], p < 0.0001) and existence of maternal chronic pathology (OR = 36.0, 95% [4.94 - 262.60], p < 0.0001). Significant intrapartum risk factors were PRM (OR = 7.89;CI 95% [2.62 - 14.02], p < 0.0001), abnormal AF (OR = 5.40;CI 95% [2.57 - 11.38],], p < 0.0001), long labour (OR = 2.11;CI 95% [1.34 - 3.34],], p = 0.0004), use of oxytocin (OR = 2.14;CI 95% [1.38 - 3.32], p = 0.0003), and spontaneous vaginal (OR = 1.76;CI 95% [1.14 - 2.72,], p = 0.0008]). Significant Foetal risk factors were male gender (OR = 1.55;CI 95% [1.03 - 2.33], p = 0.0423), preterm babies (OR = 8.83;CI 95% [3.79 - 20.60], p < 0.0001) and baby birth weight < 2500 gr (OR = 2.96;CI 95% [1.82 - 4.79], p < 0.0001). The Sarnat score had shown anoxo-ischemic encephalopathy stage III (19.00%), corresponding to 87.80% of case fatality rate (p < 0.0001). Conclusion: Various risk factors lead to BA in Lomé. Early identification of high-risk cases with improved antenatal and perinatal care can decrease the high mortality of BA in Togo.

PHENOBARBITAL FOR THE PREVENTION OF INTRACRANIAL DAMAGE IN CHINESE NEONATES WITH SEVERE ASPHYXIA

Objective TO evaluate the effect of phenobarbital on preventing intracranial damage and seizurein Chinese neonates with severe asphyxia. Methods A control trial was carried out in 60 Chinese neonates withsevere asphyxia. 30 neonates received loading dose of phenobarbital on an average of 5.6h of age. Results Themean value ol phenobarbital serum level obtained at the 4th day after birth was 21.9μg/ml. No significantdifference was observed in the two groups in terms of birth weight, gestational age, Apgar scores, sex, etc. Theimaging diagnosis within 3d of age in all subjects showed normal brain in 14, brain edema in 9 andintraventricular hemorrhage (IVH) in 7 in the treated group with a 53.3% of total complication rate, and normalbrain in 5, brain edema in 15, IVH in 9 and subarachnoid hemorrhage (SAH) in 1 in the untreated group with a83.3% of total complication rate. The incidence of intracranial damage in the untreated group was significantlyhigher than that in the treated group (83.3% vs 53.3%, P<0.05). In the treated group, 4 neonates with seizuresymptom were effectively controlled soon, and none of the other 26 developed seizure. The period of seizure in thetreated group was significantly shorter than that in the untreated group (P<0.05). Other clinical symptoms werealso sooner improved and no side effects were observed among the neonates treated with phenobarbital. Con-clusion The incidence of postasphyxiated intracranial damage was obviously decreased, and seizure could beprophylactically intervened by phenobarbital. It is recommended that early application of preventive phenobarbitalin severely asphyxiated neonates is reasonable in reducing the incidence of intracranial lesions and subsequentselzures.