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.

Risk Factors for Perinatal Asphyxia in Newborns Delivered at Term

Perinatal asphyxia is defined as harm to the fetus or the newborn caused by hypoxia and/or ischemia of various organs with intensity to produce biochemical and/or functional changes. Understanding the risk factors for this clinical condition allows the identification of vulnerable groups, enabling an improvement in care planning in the perinatal period in neonatal intensive care units. In this sense, this research aimed to identify risk factors for perinatal asphyxia present in newborns term that showed record for this clinical condition. This was a cross-sectional, retrospective documentary, quantitative and descriptive, conducted from data from medical records of 55 infants admitted to a neonatal intensive care unit. As for maternal characteristics (78.0%) had between 16 and 35 years, only one child (53.0%) and (76.0%) had no prior history of miscarriage. As for pre-existing diseases or pregnancy (38.0%) developed by Hypertensive Pregnancy Specific disease (02.0%) were suffering from Hypertension and (02.0%) of Diabetes Mellitus. As for newborns, most infants had birth weight (43.6%) and correlation with gestational age (78.2%) compatible for good conditions of birth. Only (20.0%) of the infants had a difficult labor. It stood out although there was a slight predominance of severe asphyxia (50.9%) in the first minute and (45.5%) of the infants had record release intrauterine meconium. It was concluded that most mothers and newborns did not have risk factors for perinatal asphyxia, thus, this fact could be attributed to the structural conditions of service, especially in the care during labor, delivery and immediate assistance newborn.

Application Effect of Midwifery Nursing in the Prevention of Neonatal Asphyxia

Objective:To explore the role of midwifery care in the prevention of neonatal asphyxia.Method:The 100 cases of parturient received in our hospital from January 2018 to January 2021 were divided into two groups,respectively,the control group and the experimental group with 50 cases in each group.The control group received routine care,and the experimental group received midwifery care.The psychological status of the mothers and the occurrence of neonatal asphyxia were compared between the two groups.Results:Before nursing,there was no significant difference in the mental state of the two groups of parturient(P>0.05).After the nursing,the mental state of the parturient in the experimental group was significantly better than that of the control group(P<0.05);After different ways of nursing,the incidence of asphyxia in neonates in the control group was significantly higher than that in the experimental group(P<0.05),and the comparison between the groups was statistically significant.Conclusion:The timely delivery of midwifery care for parturient can improve the mental state of the parturient and help reduce the incidence of neonatal asphyxia.It is worthy of clinical attention and promotion.

窒息新生儿血浆神经肽Y水平变化与脑实质CT值的相互关系

目的:研究窒息新生儿血浆神经肽Y(NPY)的含量,探讨它与新生儿窒息及窒息后脑损伤的关系。方法:采用放射免疫分析法测定37例窒息新生儿及12例健康新生儿血浆NPY含量,同时行头颅CT检查,测定脑实质CT值。结果:窒息组血浆NPY含量明显高于对照组,重度窒息组NPY明显高于轻度窒息组,差异均有显著意义。窒息组CT值明显低于对照组,重度窒息组明显低于轻度窒息组,差异均有显著意义;轻、重度窒息组血浆NPY水平与脑实质CT值呈显著负相关(r分别为-0.768、-0.846,P<0.01),对照组血浆NPY水平与脑实质CT值相关分析,无统计学意义。结论:血浆NPY含量及CT值与窒息程度密切相关,窒息越重,血浆NPY含量越高,CT值越低。血浆NPY可作为观察新生儿窒息程度和窒息后脑损伤的指标。

PROGNOSTIC VALUE OF ELECTROENCEPHALO-GRAPHY BACKGROUND ACTIVITIES IN ASPHYXIATED NEONATES

Objective To identify the changes in the electroencephalography (EEG) background activities in asphyxiated neonates and to determine the prognostic value of these changes in neurological outcomes.Methods A total of 46 asphyxiated neonates and 31 healthy newborns were studied using standard EEG.Forty-three neonates from the asphyxiated group were followed up and had neurological examinations and developmental assessments at 3,6,9 and 12 months of age.The parameters that had prognostic significance were statistically analyzed,and the correlations of these parameters with neurological outcome were estimated.Results ①Significant EEG changes were found in asphyxiated neonates:a longer maximum duration of interburst interval,lower amplitudes during all states,and a higher incidence of brief burst and sleep-wake cycle disturbance.②There were significant correlations between hypoxic-ischemic encephalopathy (HIE) classification,debased amplitude,positive spikes and sharp waves,and abnormal sleep cycles.③Gestational age,birth weight,EEG amplitude,severity of HIE,occurrence of sleep-wake cycle disturbance,and imaging abnormality were found to be important markers for predicting the outcome of neonates with asphyxia.Conclusion The study suggested that changes in the EEG background activities correlated with the prognosis of neonates with asphyxia.EEG is an effective tool for predicting the neurologic outcome of asphyxiated newborns.

Normal Range of Head-to-body Delivery Interval by Two-step Delivery

Background： The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction （two-step） after head delivered in normal birth. Methods： From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed. Results： Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04± 61.02 s, （mean ＋ 2 standard deviation - 193.07 s, 95% confidence interval [15.65-229.15] s）. Fifty-one patients （51/92, 55.43%） were 〈60 s, 41 patients （41/92, 44.57%） were over 60 s. Shoulders delivered at the first contraction were 96.74% （89/92）, 3.26% （3/92） had delivered by the second contraction. Shoulders emerged from perineum were 71.73% （66/92）, 15.21% （14/92） transversely, and 13.04% （12/92） emerged from under pubic arch. Babies cried before the shoulder were 31.52% （29/92）, cried after birth 52.17% （48/92）, and 16.30% （15/92） did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion. Conclusions： The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby＇s breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.