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Background: During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O2); however, the most effective O2 concentration for infants unknown. Aim: We aimed to determine if 21% O2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100% O2 in infant piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure < 25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC + SI or CCaV with either 21% or 100% O2 or the sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Main results: Baseline parameters, duration, and degree of asphyxiation were not different. Median (interquartile range) time to ROSC was 107 (90–440) and 140 (105–200) s with CC + SI 21% and 100% O2, and 600 (50–600) and 600 (95–600) s with CCaV 21% and 100% O2 (p = 0.27). Overall, six (86%) and six (86%) piglets with CC + SI 21% and 100% O2, and three (43%) and three (43%) piglets achieved ROSC with CCaV 21% and 100% O2 (p = 0.13). Conclusions: In infant piglets resuscitated with CC + SI, time to ROSC reduced and survival improved compared to CCaV. The use of 21% O2 had similar time to ROSC, short-term survival, and hemodynamic recovery compared to 100% oxygen. Clinical studies comparing 21% with 100% O2 during infant CPR are warranted. [ABSTRACT FROM AUTHOR]

Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates. [ABSTRACT FROM AUTHOR]

In the first days after birth, a major focus of research is to identify infants with hypoxic-ischemic encephalopathy at higher risk of death or severe neurological impairment, despite therapeutic hypothermia (TH). This is especially crucial to consider redirection of care, according to neonatal outcome severity. We aimed to seek associations between some neonatal routine parameters, usually recorded in Neonatal Intensive Care Units, and the development of severe outcomes. All consecutive patients prospectively recruited for TH for perinatal asphyxia, born between February 2009 and July 2016, were eligible for this study. Severe outcome was defined as death or major neurological sequelae at one year of age. Among all eligible neonates, the final analysis included 83 patients. Severe outcome was significantly associated with pH and base excess measured in the first hour of life, mode of delivery, Apgar score, Sarnat and Sarnat score, electroencephalogram-confirmed neonatal epileptic seizures, and antiepileptic therapy. Studying univariate analysis by raw relative risk (RR) and 95% confidence intervals (CI), severe outcome was significantly associated with pH (p = 0.011), Apgar score (p = 0.003), Sarnat score (p < 0.001), and Caesarian section (p = 0.015). Conclusions. In addition to clinical examination, we suggest a clinical-electroencephalographic protocol useful to identify neonates at high neurological risk, available before rewarming from TH. [ABSTRACT FROM AUTHOR]

One of the most relevant public health issues among pediatric injuries concerns foreign body (FB) aspiration. The risk perception of choking hazards (CH) and risk perception, in general, are complex multifactorial problems that play a significant role in defining protective behavior. Risk prevention policies should take this aspect into account. A lack of scientific knowledge of FB injury risk perception may be evidenced in Brazil and other newly developed countries. This study aims to characterize the differences and peculiarities in risk perception of CH between Italian and Brazilian populations. The risk perception among adults in Italy and Brazil between September and October 2017 was investigated in a survey. A Multiple Correspondence Analysis was carried out to identify the latent components characterizing the risk perception in Italian and Brazilian population samples. The most relevant dimension characterizing risk perception is the “Professional–educational status and the related perception of Risk” (13% of factorial inertia). The Italians identify batteries and magnets as the most dangerous choking risks (20% of responses). On the other hand, Brazilian people, mainly manual laborers (22%) with secondary or primary education (94%), perceive coins as the most dangerous items (30% of responses, p < 0.001). Socio-economic issues characterize the subjective risk perception of Italian and Brazilian survey respondents. In this framework, data-driven prevention strategies could be helpful to tailor intervention strategies to the cultural context to which they are addressed. [ABSTRACT FROM AUTHOR]

Background: Worldwide neonatal mortality is mainly due to asphyxia at birth with significant higher contribution from developing countries. Objectives: To assess the biochemical changes in birth asphyxiated newborns before and after Vitamin C and Vitamin E administration. Methodology: Non-randomized pre and post intervention study was carried out with matched controls at neonatal ICU among birth asphyxiated term neonates delivered at rural tertiary health care centre. The study duration was completed within of six months in the year 2019. The study enrolled 50 cases and equal number of controls and interventions with Vitamin C and E was carried out in study group. All the clinical history, demographic information, examination findings and biochemical parameters values were noted into the case record proforma and analyzed for inferential statistics by using SPSS Version 20. Results: The total leukocyte count was significantly decreased in intervention group from 16593.32 to 13292.44 with apparent difference in controls. Mean platelet count was significantly increased from 1.4396 to 2.0236. The mean SGOT and SGPT levels were significantly decreased from 169.74 and 56.76 to 94.44 and 40.76 respectively. Serum levels of total proteins, albumins and levels were significantly hiked from 5.09 to 5.43, 2.98 to 3.59 and 2.23 and after 3.12 respectively. The serum LDH and creatinine levels were decreased from 1683.72 to 775.4 and 1.26 to 0.69 and difference was statically significant in study group respectively. Conclusion: The study concluded that after administration of Vitamin C and E, biochemical parameters showed protective changes in neonates with birth asphyxia. [ABSTRACT FROM AUTHOR]

Choking occurs more frequently in children and senior citizens than in other groups. Obstruction materials are varied, including food or foreign bodies such as toys and coins. The number of choking accidents has not decreased because its mechanism remains unclear; the manner in which such accidents occur cannot be observed. The purpose of this study is to visualize choking on toys by using a computer simulation, Swallow Vision®, after creating a new child model of swallowing. An organ model for the simulation was created from the CT of a 9-month-old boy and videofluorographic images during swallowing for a 9-month-old girl. The organ models were defined as hyperelastic and contained particles that moved by forced displacement. The toy models were spheres with diameters of 10 and 15 mm and different coefficients of friction and restitution. The applied calculation method was the Hamiltonian Moving Particle Simulation. The results demonstrated that the simulation could visualize how a toy model obstructed the upper airway in the pharynx and larynx. Moreover, the ball size and the coefficients of friction and restitution affected the site obstructed. As choking accidents were successfully visualized using the Swallow Vision®, The computer simulation is expected to advance research on understanding the choking mechanism. [ABSTRACT FROM AUTHOR]

The article presents a study which aimed to do diagnose the preventable causes early and develop strategies for the prevention of neonatal seizures. Topics discussed include birth asphyxia as the most common cause of seizures observed in the study, cases of metabolic abnormalities including hypoglycaemia and hypocalcaemia, and possible reason for the decreased mortality in the study.

Objectives: To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. Methods: We examined demographics and circumstances of 141 infant deaths during 2004–2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. Results: Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. Conclusions for Practice: Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies. METHODS: We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics. RESULTS: Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%). CONCLUSIONS: Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups. [ABSTRACT FROM AUTHOR]

Background: Asphyxia is the most common cause of brain damage in newborns. Substantial evidence indicates that leukocyte recruitment in the cerebral vasculature during asphyxia contributes to this damage. We tested the hypothesis that superoxide radical ( O 2 ⋅ _ ) promotes an acute post-asphyxial inflammatory response and blood-brain barrier (BBB) breakdown. We investigated the effects of removing O 2 ⋅ _ by superoxide dismutase (SOD) or C3, the cell-permeable SOD mimetic, in protecting against asphyxia-related leukocyte recruitment. We also tested the hypothesis that xanthine oxidase activity is one source of this radical. Methods: Anesthetized piglets were tracheostomized, ventilated, and equipped with closed cranial windows for the assessment of post-asphyxial rhodamine 6G-labeled leukocyte-endothelial adherence and microvascular permeability to sodium fluorescein in cortical venules. Asphyxia was induced by discontinuing ventilation. SOD and C3 were administered by cortical superfusion. The xanthine oxidase inhibitor oxypurinol was administered intravenously. Results: Leukocyte-venular adherence significantly increased during the initial 2 h of post-asphyxial reperfusion. BBB permeability was also elevated relative to non-asphyxial controls. Inhibition of O 2 ⋅ _ production by oxypurinol, or elimination of O 2 ⋅ _ by SOD or C3, significantly reduced rhodamine 6G-labeled leukocyte-endothelial adherence and improved BBB integrity, as measured by sodium fluorescein leak from cerebral microvessels. Conclusion: Using three different strategies to either prevent formation or enhance elimination of O 2 ⋅ _ during the post-asphyxial period, we saw both reduced leukocyte adherence and preserved BBB function with treatment. These findings suggest that agents which lower O 2 ⋅ _ in brain may be attractive new therapeutic interventions for the protection of the neonatal brain following asphyxia. [ABSTRACT FROM AUTHOR]

Background: Sudden Unexpected Postnatal Collapse (SUPC) is characterized by apnea, bradycardia, cyanosis, and cardiorespiratory collapse in healthy term newborns soon after birth, often during initial skin-to-skin contact, or with the first breastfeeding attempt. The etiology is not well understood, but accidental suffocation of the infant as a result of poor positioning, together with maternal fatigue and/or distraction, appear to play key roles. The aim of this quality improvement project was to educate clinicians and parents, in order to prevent SUPC cases. Methods: A task force spearheaded an educational program; using the words "pink and positioned" to teach staff how to educate parents about the proper distraction-free positioning of their infant. Intervention: Staff education consisted of poster presentations and lectures. A video depicting a simulated SUPC case and two other videos showing an obstetrician and post-partum nurse counseling a new mother about SUPC-prevention were created, circulated internally, and added to an online educational module. Practice changes included more frequent post-natal assessment of the newborn and documentation of 'Pink and Positioned' into our EMR. Results: After taking the module, nurses and PCTs (n=254) are more knowledgeable and report feeling more comfortable teaching parents about SUPC prevention. Conclusions: We anticipate that, as a result of this comprehensive educational program and practice changes, SUPC cases will be prevented. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to evaluate the value of neutrophil gelatinase-associated lipocalin (NGAL) for becoming a good endogenous marker of renal function in asphyxial preterm babies. Materials and Methods: This is a two-center retrospective study. Between October 2016 and October 2017, 71 asphyxial preterm infants were included in asphyxia group. Seventy babies were randomly included in control group. Samples were tested at 24, 48, and 96 h after birth. Quantitative data were compared by independent sample t-test or repeated measures ANOVA. For qualitative data, Pearson's Chi-squared test was performed. Draw ROC and compare the area under the curve (AUC), 95% confidence interval for AUC, specificity (Spe), sensitivity (Sen), and Youden index (Sen+Spe-1) at 24-h, 48-h, and 96-h time points. Results: (1) There are no significant differences concerning on baseline data. However, blood gas, Apgar score, and resuscitation showed a significant difference (P < 0.05). (2) In 24-h samples, only uNGAL and estimated glomerular filtration rate (eGFR) showed differences between the two groups (P < 0.05). In 48-h samples, significant differences could be found in uKIM-1, uNGAL, blood urea nitrogen, and eGFR (P < 0.05). In 96-h samples, almost all indicators have significant differences except urine output and eGFR (P < 0.05). (3) All biomarkers showed statistical difference in the three time points (P < 0.05), but only uNGAL showed a downward trend after the increase of expression. (4) uNGAL has better Sen and Spe than other indicators (24-h AUC 0.870, Youden index 0.606; 48-h AUC 0.879, Youden index 0.692; and 96-h AUC 0.806, Youden index 0.606). Conclusion: uNGAL has a better distinguishability in asphyxial neonates compared with other indicators. Certainly, a larger sample, prospective study is still needed. [ABSTRACT FROM AUTHOR]

Background: Birth asphyxia, defined as 5-minute Apgar score <7 in apneic newborns, is a major cause of newborn mortality. Heart rate (HR) response to ventilation is considered an important indicator of effective resuscitation.Objectives: To describe the relationship between initial HR in apneic newborns, HR responses to ventilation and 24-h survival or death.Methods: In a Tanzanian hospital, data on all newborns ≥34 weeks gestational age resuscitated between June 2013-January 2017 were recorded using self-inflating bags containing sensors measuring ventilation parameters and expired CO2, dry-electrode electrocardiography sensors, and trained observers.Results: 757 newborns of gestational age 38 ± 2 weeks and birthweight 3131 ± 594 g were included; 706 survived and 51 died. Fetal HR abnormalities (abnormal, undetectable or not assessed) increased the risk of death almost 2-fold (RR = 1.77; CI: 1.07, 2.96, p = 0.027). For every beat/min increase in first detected HR after birth the risk of death was reduced by 2% (RR = 0.98; CI: 0.97, 0.99, p < 0.001). A decrease in HR to <100 beats/minute when ventilation was paused increased the risk of death almost 2-fold (RR = 1.76; CI: 0.96, 3.20, p = 0.066). An initial rapid increase in HR to >100 beats/min in response to treatment reduced the risk of dying by 75% (RR = 0.25; CI: 0.14, 0.44, p < 0.001). A 1% increase in expired CO2 was associated with 28% reduced risk of death (RR = 0.72; CI: 0.62,0.85, p < 0.001).Conclusions: The risk of death in apneic newborns can be predicted by the fetal HR (absent or abnormal), initial newborn HR (bradycardia), and the HR response to ventilation. These findings stress the importance of reliable fetal HR monitoring during labor and providing effective ventilation following birth to enhance survival. [ABSTRACT FROM AUTHOR]

Background. Neonatal sepsis is an important cause of morbidity and mortality among neonates in developing countries accounting for 30-50% of total deaths each year. Childhood mortality is often used as broad indicator of the social development or a specific indicator of health conditions of a country. Objectives. The objective of this study is to assess the prevalence of neonatal sepsis and associated factors among neonates admitted in neonatal intensive care unit at two hospitals in Shashemene town, Ethiopia. Method. An institution based cross-sectional study with retrospective document review method was conducted in NICUs of two governmental hospitals in Shashemene town. Sample size was calculated by using single population proportion sample formula and the final sample size was 244. The study subject was selected by using systematic random sampling method, and adopted data collection tool was used. Then the collected data was coded and entered in to SPSS for windows version 20.0 for cleaning, editing, and analysis. Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable. Result. The overall prevalence of neonatal sepsis in this study was 77.9%. From this 65% and 35% of neonates developed early onset neonatal sepsis and late onset neonatal sepsis, respectively. This study found out that age of neonates, birth asphyxia, and use of oxygen via mask were significantly associated with neonatal sepsis. Conclusion and Recommendation. The most risk factors of neonatal sepsis were identified as age of neonates, birth asphyxia, and use of oxygen via mask strongly associated with prevalence of NS. Based on this results we recommend the concerned body to focus on the prevention of risk factors rather than treating the disease after it occurs. [ABSTRACT FROM AUTHOR]

Abstract: As one of the leading causes of traumatic deaths in newborns, infants, and young children, there is no anatomic or microscopic feature that is pathognomonic for asphyxial deaths. Instead, pathologists rely on investigation information, including confessions and/or witness statements, and potential evidence at the scene. Twenty cases of homicidal newborn, infant, and young children asphyxial deaths were reviewed, which included death and police investigation reports and autopsy reports, as well as histology slides of lung sections. This series of homicidal asphyxial deaths highlight that, in a vast majority of such cases, the final cause and manner of death rulings are dependent on confession by the perpetrator. Furthermore, this series highlights the possible role of histology to help forensic pathologists better certify asphyxial deaths. Finally, this series emphasizes important investigation points and considerations at autopsy during the investigation of asphyxial deaths in newborns, infants, and young children. [ABSTRACT FROM AUTHOR]

The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT’s is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional’s opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties. [ABSTRACT FROM AUTHOR]

Objective: To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia.Design: Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice.Setting: Tanzanian low-resource referral hospital, Mnazi Mmoja Hospital.Population: Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2015 until 31 January 2016) [corrected].Methods: Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi-randomly selected subgroups (n = 283 and n = 264, respectively).Main Outcome Measures: Stillbirths and neonates with 5-minute Apgar score ≤5.Results: Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53-0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41-0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60-240) to 74 minutes (IQR 30-130) (Mann-Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37-0.81) and timely use improved.Conclusion: Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. TWEETABLE ABSTRACT: #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low-resource hospital PLAIN LANGUAGE SUMMARY: PartoMa guidelines help birth attendants in Tanzania to save lives Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived. At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth. At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied. The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8-page pocket booklet providing locally achievable and simple decision support for care during birth. Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high. Use of the PartoMa guidelines is associated with: A decrease by one-third in stillbirths (59 to 39 per 1000 total births) A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births) The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th-12th month of use. Such a 'before-after' study cannot exclude the possibility of other causes of better survival at birth. However, the improved survival is consistent with improved care during birth, which is in line with the PartoMa guidelines. [ABSTRACT FROM AUTHOR]

The incidence of SIDS decreased during the previous 25 years significantly. This is mainly due to epidemiological research identifying important risk factors such as prone sleeping position and subsequent campaigns to reduce this risk factor. Originally, the prone sleeping position for babies had been strongly recommended in the sixties and seventies despite previous publications pointed to the associated risk. Worldwide, many infants died of SIDS whose deaths could have been avoided. Today, the recommendation that infants should sleep in supine position has been scientifically verified. In supine sleeping position, pathophysiological mechanisms can be avoided which may lead to hypoxia and death in prone position. Such mechanisms could be occlusion of airways (in particularly associated with face-down position), elevated diaphragm, positional cerebral hypoxia caused by constriction of arteries, rebreathing CO2, and overheating. Irrespective of the specific pathomechanism leading to death in individual cases, it has been established that the prone position is the most important risk factor for SIDS and therefore should be incorporated in the definition of the term SIDS. [ABSTRACT FROM AUTHOR]

Objective: To determine morbidity and mortality of neonates with low APGAR score in a resource constrained health care set up. Study Design: Prospective descriptive study. Place and Duration of Study: The study was carried out in combined military hospital Attock, from Jan 2013 to Jan 2015. Material and Methods: All term neonates with 37 completed weeks of gestation and APGAR score less than 7 were included in the study. APGAR score was calculated by an attending pediatrician, gynecologist or trained female nurse at 0 and 5 minutes. In Neonatal Intensive Care Unit [NICU] the babies were daily examined by pediatrician. Outcome was documented in term of morbidity i.e. fits and mortality i.e. death of babies. Results: Total number of neonates included in the study were 85 of which 55 (65%) were males and 30 (35%) were females. Of the total neonates 65 (76%) were discharged in satisfactory conditions and 20 (24%) expired during stay in the hospital. The mean APGAR score of newborns was 4.98 ± 0.98 at 5 minutes. During stay in hospital 46 (54%) were diagnosed to have hypoxic ischemic encephalopathy 2 (HIE2), those diagnosed with HIE3 were 5 (6%) and the rest 14 (16%) with HIE1. Conclusion: Low APGAR score is an important cause of admission to NICU. Low APGAR score was found associated with increased risk of fits in neonates and one of the most important cause of mortality in our set up. [ABSTRACT FROM AUTHOR]

Background: Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1-59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India.Methods: Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1·3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001-13 with annual UN estimates of national births and deaths (partitioned across India's states and rural or urban areas) for 2000-15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1-59-month-old children.Findings: The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1-59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11·9 per 1000 livebirths in 2000 to 4·0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9·0 per 1000 livebirths in 2000 to 2·2 per 1000 livebirths in 2015. At 1-59 months, the mortality rate from pneumonia fell by 63% from 11·2 per 1000 livebirths in 2000 to 4·2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9·4 per 1000 livebirths in 2000 to 3·2 per 1000 livebirths in 2015 (with narrowing girl-boy gaps). The neonatal tetanus mortality rate fell from 1·6 per 1000 livebirths in 2000 to less than 0·1 per 1000 livebirths in 2015 and the 1-59-month measles mortality rate fell from 3·3 per 1000 livebirths in 2000 to 0·3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12·3 per 1000 livebirths in 2000 to 14·3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3·3% for neonates and 5·4% for children aged 1-59 months. Annual declines from 2005 to 2015 (3·4% decline for neonatal mortality and 5·9% decline in 1-59-month mortality) were faster than were annual declines from 2000 to 2005 (3·2% decline for neonatal mortality and 4·5% decline in 1-59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000-05 declines.Interpretation: To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1-59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwards. Continued progress in reduction of child mortality due to pneumonia, diarrhoea, malaria, and measles at 1-59 months is feasible. Additional attention to low birthweight is required.Funding: National Institutes of Health, Disease Control Priorities Network, Maternal and Child Epidemiology Estimation Group, and University of Toronto. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to estimate the incidence of acute kidney injury (AKI) in birth asphyxia and to find out the predictors of AKI in birth asphyxia in a tertiary care hospital. Materials and Methods: This is a cross-sectional study conducted in the neonatal intensive care unit of a tertiary care center in Northern India during November 2014– October 2015. Inborn babies admitted here with severe birth asphyxia were included in the study. The neonates were evaluated for the evidence of AKI and were grouped into two groups: Group I (all neonates with severe birth asphyxia as per the WHO definition and having evidence of AKI) and Group II (all neonates with severe birth asphyxia as per the WHO definition and without having evidence of AKI). Those with congenital renal anomalies were excluded from the study. The two groups were then compared. AKI network definition was used to define AKI. Results: The incidence of AKI in the present study was 44.21%. There was no significant difference in incidence between term and preterm neonates, and among various stages of hypoxic-ischemic encephalopathy. The majority (95%) had nonoliguric renal failure. Most (92.8%) of the cases recovered before discharge and the rest recovered at 1 month follow-up. Prolonged labor was found to be significantly associated with AKI. Patients with shock had more advanced stages of AKI compared to those without shock. Conclusion: From this study, it can be inferred that it is difficult to predict AKI based on clinical features such as oliguria or Apgar score, and it is better to screen all the birth asphyxia cases for AKI so that they can be detected early and managed accordingly. In addition, a single normal value of blood urea/serum creatinine cannot exclude AKI, and serial monitoring is important. Shock should be detected early and treated aggressively as shock was associated with advanced stages of AKI. [ABSTRACT FROM AUTHOR]

Insulin-like growth factors play a key role for neuronal growth, differentiation, the survival of neurons and synaptic formation. The action of IGF-1 is most pronounced in the developing brain. In this paper we will try to give an answer to the following questions: Why are studies in children important? What clinical studies in neonatal asphyxia, infantile spasms, progressive encephalopathy-hypsarrhythmia-optical atrophy (PEHO) syndrome, infantile ceroid lipofuscinosis (INCL), autistic spectrum disorders (ASD) and subacute sclerosing encephalopathy (SSPE) have been carried out? What are IGF-based therapeutic strategies? What are the therapeutic approaches? We conclude that there are now great hopes for the therapeutic use of IGF-1 for some neurological disorders (particularly ASD). [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by 1 H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome. Methods At the age of 6.0 ± 1.8 days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30 months the Bayley Scale of Infant Development-III was performed. Results Infants that died had lower gray matter NAA levels than infants that survived ( P = 0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome ( r = − 0.45). In the white matter, choline correlated negatively with fine motor skills ( r = − 0.40), and creatine positively with gross motor skills ( r = 0.58, P = 0.02). There was no relationship between lactate levels and outcome. Conclusion MRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate. [ABSTRACT FROM AUTHOR]

Aim: The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.Methods: Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used.Results: Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.Conclusion: Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training. [ABSTRACT FROM AUTHOR]

Objectives: After birth asphyxia, a variety of hemodynamic disorders may be noted in the neonatal intensive care unit; these require appropriate recognition and management. The present study was designed to demonstrate the prevalence of heart complications amongst asphyxiated newborns. Methods: Through a cohort study, 29 asphyxiated term neonates were followed since birth until amelioration of pulmonary hypertension and compared with 31 well born neonates. Both groups were evaluated for their heart anatomy and hemodynamic with meticulous assessment through echocardiography. This study was conducted in Besat Medical Center since August 2010 until February 2012. Results: Hemodynamic and anatomic disorders including myocardial dysfunction, pulmonary hypertension and patent arterial duct (PDA) were strongly associated with birth asphyxia (P< 0.05). Conclusion: Birth asphyxia was associated with systolic and diastolic dysfunction and pulmonary hypertension which demands precise evaluation, early recognition and appropriate management. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical effect of ganglioside (GM) and fructose-1, 6-diphosphate (FDP) on neonatal heart and brain injuries after asphyxia. Methods: Ninety-one neonates with asphyxia neonatal heart and brain injuries were randomly divided into an observation group and a control group. Both groups were given symptomatic treatment as soon as possible. On this basis, the observation group was given 200 mL of 5% glucose injection and 20 mg of GM and 250 mg/kg.d FDP by intravenous infusion. The above two drugs were given once a day for 14 days. The control group was given 20 mL of 5% glucose injection, 2 mL of cerebrolysin and 250 mg/kg.d FDP by intravenous infusion, once a day for 14 days. Both groups were administered on the first day after admission, and the course of treatment was 14 days. The treatment outcomes of the two groups were compared by detecting the levels of glycogen phosphorylase isoenzyme BB (GPBB), cTn-I and CK-MB, MRI results and Neonatal Behavioral Neurological Assessment (NBNA) scores before and after treatment. Results: The levels of GPBB, cTn-I and CK-MB in the observation group were significantly higher than those of normal neonates. After treatment, the levels of cTn-I and CK-MB in the observation group were closer to those of normal neonates compared with the control group, with significant differences (P<0.05). There was a significant difference in the brain MRI examination between the two groups (P<0.05). The NBNA scores of the two groups were significantly different before and after treatment (P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). Conclusion: Neonatal heart and brain injuries after asphyxia can be well treated by combining GM with FDP. [ABSTRACT FROM AUTHOR]

Background and aims. Language is a shared system of communication, it exchanges knowledge, feelings, thoughts and beliefs; it involves sounds, signs, gestures, and/or spoken or written words that convey meanings within a group or community. Perinatal events like asphyxia, convulsions, sepsis, infections, jaundice are known to alter language development. The study aim was to evaluate if there is a relation between the level of language development in infants with psychomotor retardation and the different risk factors, especially the pre-/perinatal ones. Methods. We performed an observational retrospective study in a group of children first time presented to neurology department for language disorders and psychomotor retardation. Results. In our group of 30 children, language disturbances have been identified mainly around the age of 12 months. We found no relation between language development and perinatal asphyxia, meconium aspiration, APGAR score or neonatal icterus. We found clinical significance between language retardation and pseudobulbar syndrome, dyspraxia and mental retardation. Conclusions. There is a tight connection between the level of language development and pseudobulbar syndrome. It is an aspect that should be taken more carefully and diagnosed as soon as possible and the therapy started. Motor development in an infant and prematurity could alter language development. Further studies should be done to confirm or rule out a correlation between language development and motor retardation and prematurity. [ABSTRACT FROM AUTHOR]

Background: Hypoxic-ischemic encephalopathy (HIE), a serious complication of perinatal asphyxia, is commonly associated with an unfavorable outcome. In-depth research is important not only for the interpretation of the underlying biological alternations but may also provide the basis for the development of novel diagnostic and therapeutic tools. The application of metabolomics in perinatal asphyxia/HIE is a relatively new approach. Methods: We performed a narrative, non-systematic review in the literature of metabolomic studies involving newborn animals and humans exposed to hypoxia-ischemia or developing perinatal asphyxia/HIE. Results: Fifteen animal studies, nine studies in human neonates, and two review articles were evaluated. Changes in the metabolomic profile of newborn animals exposed to hypoxia-ischemia and of asphyxiated neonates with HIE are presented in relation to the underlying pathophysiology. The clinical relevance of these findings is further discussed in a comprehensible to the bedside clinician manner. Conclusions: Metabolomics may provide an explanation for the various metabolic alternations occurring in perinatal asphyxia/HIE, elucidate the biological background of the applied therapeutic interventions and promote the development of novel diagnostic-prognostic biomarkers of the disease. [ABSTRACT FROM AUTHOR]

Aim Although birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder ( ADHD). We examined whether birth asphyxia measured by the pH of the blood in the umbilical artery cord was associated with childhood ADHD. Method A population-based cohort of 295 687 children born in Finland between 1991 and 2002 was followed until December 31, 2007. ADHD was identified by the International Classification of Diseases, 10th edition, as a diagnosis of hyperkinetic disorder. We examined the risk of ADHD with varying pH values using Cox regression, taking time trends into consideration. Results When compared to the reference group, a pH value below 7.10 was significantly associated with an increased risk of ADHD. The strongest risks were observed among children with a pH value <7.15 and a gestational age of <32 weeks. The pH value did not contribute much to the risk among children with an Apgar score of 0-3. Conclusion Birth asphyxia, defined by low pH value, may predict an increased risk of ADHD in childhood. The association between the pH value and ADHD was homogenous when stratified by gestational age and the Apgar score. [ABSTRACT FROM AUTHOR]

Background: Hypoxic Ischemic Encephalopathy (HIE) remains a problem of great concern worldwide especially in developing countries. The occurrence of a neurological syndrome can be an indicator of insult to the brain. We aimed to determine the prevalence, HIE proportions, neurological signs and early outcomes of newborns that developed birth asphyxia at KCMC Tanzania.Methods: A prospective study was conducted at KCMC from November 2014 to April 2015 among newborns with birth asphyxia. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE and were later followed daily for 7 days or until discharge.Results: Of the 1752 deliveries during the study period, 11.5% (n = 201) had birth asphyxia. Of the 201 newborns, 187 had HIE. Of these 187 with HIE; 39.0% had moderate HIE and 10.2% had severe HIE according to the Sarnat and Sarnat classification. Neurological signs that were observed during the study period were; weak/absent reflexes (46.0%), hypotonia (43.3%) and lethargy (42.2%). Mortality was 9.1% among the 187 newborns with HIE. Mortality was higher among newborns with severe HIE 84.2% (16/19) compared to those with moderate HIE 1.4% (1/73). On the 7th day after delivery, 17.1% (32/187) of the newborns did not show any change from the initial score at delivery.Conclusion: Prevalence of birth asphyxia is high in our setting and most of the newborns (49%) end up with moderate/severe HIE. Good obstetric care and immediate resuscitation of newborns are vital in reducing the occurrence of HIE and improving the general outcome of newborns. [ABSTRACT FROM AUTHOR]

Symmetrical thalamic calcification or bilateral symmetrical thalamic gliosis presents at delivery with hypertonia, fixed flexion contractures and prominent bulbar signs, without preceding perinatal asphyxia. At post-mortem, there is evidence of bilateral symmetrical selective thalamic neuronal encrustation and gliosis. To date, 27 cases are published with no underlying diagnosis identified. Two affected children from singleton pregnancies were reported and therefore, a genetic cause proposed. No previous reports have performed genetic testing to confirm or reject this hypothesis. We report three additional cases of this rare condition, expanding the clinical and pathological phenotype. We performed trio whole exome sequencing, the first in this cohort of patients, and did not identify a pathogenic variant. As postulated in the original report, the likely underlying mechanism is antenatal hypoxia in the third trimester. [ABSTRACT FROM AUTHOR]

Hypoxic-ischemic encephalopathy remains a common cause of brain damage in neonates. Preterm infants have additional complications, as prematurity by itself increases the risk of encephalopathy. Currently, therapy for this subset of asphyxiated infants is limited to supportive care. There is an urgent need for therapies in preterm infants – and for representative animal models for preclinical drug development. In 1991, a novel rodent model of global asphyxia in the preterm infant was developed in Sweden. This method was based on the induction of asphyxia during the birth processes itself by submerging pups, still in the uterine horns, in a water bath followed by C-section. This insult occurs at a time-point when the rodent brain maturity resembles the brain of a 22–32 week old human fetus. This model has developed over the past 25 years as an established model of perinatal global asphyxia in the early preterm brain. Here we summarize the knowledge gained on the short- and long-term neuropathological and behavioral effects of asphyxia on the immature central nervous system. [ABSTRACT FROM AUTHOR]

Purpose: We investigated prospectively cord blood TNF-α and IL-6 levels as diagnostic indicators of brain damage in neonates with non-asphyxia fetal distress.Methods: Eighty neonates delivered by cesarean section from January 2013 to December 2014 were enrolled. Magnetic resonance imaging was conducted to determine brain damage. Neonates were assigned to a healthy control group (n = 30) or, with fetal distress, apportioned to groups with or without brain damage (n = 20 and 30, respectively). After delivery, the umbilical arterial blood of all neonates was harvested. Serum tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) levels were evaluated to investigate a correlation between cord blood TNF-α and IL-6 levels and brain damage caused by non-asphyxia fetal distress.Results: The TNF-α and IL-6 levels in the cord blood of brain-damaged neonates with fetal distress (75.63 ± 7.68 and 217.95 ± 25.15 pg/mL, respectively) were significantly higher than that of neonates with fetal distress without brain damage (43.67 ± 5.54, 119.08 ± 12.30 pg/mL) or the healthy neonates (42.35 ± 6.63, 128.46 ± 16.15 pg/mL); the latter two groups were comparable for both TNF-α and IL-6. The receiver operating characteristic curve showed that when TNF-α (IL-6) reached 53.23 pg/mL (156.23 pg/mL), the specificity and sensitivity for diagnosis of brain damage was 80.3% (82.5%) and 90.1% (81.5%), respectively.Conclusion: Monitoring TNF-α and IL-6 levels in umbilical cord blood may assist early diagnosis of brain damage in neonates with non-asphyxia fetal distress. [ABSTRACT FROM AUTHOR]

Background: Birth asphyxia is the failure to initiate and sustain breathing at birth as a result of hypoxia and ischemia, assessed on Apgar score of 0-3 at 5 minutes or later, acid base status by fetal scalp pH. Objective: To determine the frequency of maternal factors responsible for birth asphyxia. Material and Methods: This cross sectional descriptive study has been conducted at department of perinatology, National Institute of Child Health, Jinnah Postgraduate Medical Center, Karachi. From 28th January 2015 to 27th July 2015. A total of 196 mothers of asphyxiated newborn babies of either gender were enrolled. A detailed clinical history with possible factors leading to asphyxia along their biodata including age, parity and education were taken on predesigned proforma. Results: The mean maternal age was 32.53±7.23 years with mean parity was 2.68±1.29 and gravidity was 3.30±1.48. The mean no. of antenatal visits was 7.32±1.11. Multiple pregnancies were observed in 11.2% mothers, vaginal bleeding was observed in 56.1% mothers, meconium stained liquor in 71.9% mothers, prolong rupture of membrane >18 hours was found in 86.7% mothers, presentation other than cephalic was positive in 26.0% mothers, anemia was positive in 41.8%, edema in 10.7%, and hypertension in 14.3% mothers. Conclusion: The maternal risk factor for the birth asphyxia observed more frequent were improper antenatal visits, maternal age, prolonged rupture of membrane, meconium stained liquor, anemia, vaginal bleeding, and caesarian section. [ABSTRACT FROM AUTHOR]

We studied youth injury fatality rates in America, the Northeast region of the US, and in the state of Connecticut for the years 1990 and 2013 to evaluate the incidence of injury. All areas of injury showed a decrease in mortality rates with the exception of deaths by suffocation and poisoning. The age group most affectedby suffocation is infants younger than one year. Adolescents between the ages of 15 and 19 years appear to be at increased risk for poisoning deaths. Injury surveillance provides important guidance for the implementation of community based programs to prevent injury. [ABSTRACT FROM AUTHOR]

An apparent life-threatening event (ALTE) is defined as the combination of clinical presentations such as apnea, marked change in skin and muscle tone, gagging, or choking. It is a frightening event, and it predominantly occurs during infancy at a mean age of 1–3 months. The causes of ALTE are categorized into problems that are: gastrointestinal (50%), neurological (30%), respiratory (20%), cardiovascular (5%), metabolic and endocrine (2%–5%), or others such as child abuse. Up to 50% of ALTEs are idiopathic, where the cause cannot be diagnosed. Infants with an ALTE are often asymptomatic at hospital and there is no standard workup protocol for ALTE. Therefore, a detailed initial history and physical examination are important to determine the extent of the medical evaluation and treatment. Regardless of the cause of an ALTE, all infants with an ALTE should require hospitalization and continuous cardiorespiratory monitoring and evaluation for at least 24 hours. The natural course of ALTEs has seemed benign, and the outcome is generally associated with the affected infants’ underlying disease. In conclusion, systemic diagnostic evaluation and adequate treatment increases the survival and quality of life for most affected infants. [ABSTRACT FROM AUTHOR]

Birth asphyxia or hypoxia arises from impaired placental gas exchange during labor and remains one of the leading causes of neonatal morbidity and mortality worldwide. It is a condition that can strike in pregnancies that have been uneventful until these final moments, and leads to fundamental loss of cellular energy reserves in the newborn. The cascade of metabolic changes that occurs in the brain at birth as a result of hypoxia can lead to significant damage that evolves over several hours and days, the severity of which can be ameliorated with therapeutic cerebral hypothermia. However, this treatment is only applied to a subset of newborns that meet strict inclusion criteria and is usually administered only in facilities with a high level of medical surveillance. Hence, a number of neuropharmacological interventions have been suggested as adjunct therapies to improve the efficacy of hypothermia, which alone improves survival of the post-hypoxic infant but does not altogether prevent adverse neurological outcomes. In this review we discuss the prospect of using creatine as a dietary supplement during pregnancy and nutritional intervention that can significantly decrease the risk of brain damage in the event of severe oxygen deprivation at birth. Because brain damage can also arise secondarily to compromise of other fetal organs (e.g., heart, diaphragm, kidney), and that compromise of mitochondrial function under hypoxic conditions may be a common mechanism leading to damage of these tissues, we present data suggesting that dietary creatine supplementation during pregnancy may be an effective prophylaxis that can protect the fetus from the multi-organ consequences of severe hypoxia at birth. [ABSTRACT FROM AUTHOR]

Hypoxic-ischemic encephalopathy (HIE) is one of the leading pediatric neurological conditions causing long-term disabilities and socio-economical burdens. Nearly 20-50 % of asphyxiated newborns with HIE die within the newborn period and another third will develop severe health consequences and permanent handicaps. HIE is the result of severe systemic oxygen deprivation and reduced cerebral blood flow, commonly occurring in full-term infants. Hypoxic-ischemic changes trigger several molecular and cellular processes leading to cell death and inflammation. Generated reactive oxygen species attack surrounding cellular components resulting in functional deficits and mitochondrial dysfunction. The aim of the present paper is to review present knowledge about the pathophysiology of perinatal hypoxic-ischemic encephalopathy, especially with respect to novel treatment strategies and biomarkers that might enhance early detection of this disorder and thus improve the general outcome of patients. [ABSTRACT FROM AUTHOR]

Sleeping accidents are a particular risk for infants and young children as they lack an understanding of potentially dangerous situations and are unable to self-extricate. These situations may result in deaths from asphyxia. While safety campaigns have focused on the faulty design of cots that are available for sale, modification of cots at home represents another potential problem area. A 17-month-old girl was found dead with her head wedged between the top side rail of her cot and a broomstick, which had been attached in an attempt to raise the height of the cot side. Death was due to neck compression from head entrapment. This case demonstrates that infant and toddler safe sleeping programmes should alert carers to the potential dangers of structurally altering cots or beds. Home modifications may create dangerous gaps that could result in entrapment with lethal neck compression; such alterations should be carefully assessed and documented by forensic death scene investigators. [ABSTRACT FROM PUBLISHER]

Background: Improved quantitative assessment of cerebral hemodynamics in newborns might enable us to optimize cerebral perfusion. Our objective was to develop an approach to assess cerebral hemodynamics across multiple time scales during the first 72 hours of life in newborns during hypothermia therapy.Methods: Spontaneous oscillations in mean arterial pressure and regional cerebral tissue oxygen saturation were analyzed using a moving window correlation method with time scales ranging from 0.15 to 8 hours in this pilot methodology study. Abnormal neurodevelopmental outcome was defined by Bayley III scores and/or cerebral palsy by age 24 months using receiver operating curve.Results: Multiple-time-scale correlations between the mean arterial pressure and regional cerebral tissue oxygen saturation oscillations were tested in 10 asphyxiated newborns undergoing hypothermia therapy. Large noninduced fluctuations in the blood pressure were observed during cooling in all five infants with abnormal outcomes. Notably, these infants had two distinct patterns of correlation: a positive in-phase correlation at the short time scales (15 minutes) and/or a negative antiphase correlations observed at long time scales (4 hours.). Both the in-phase (area under the curve 0.6, [95% confidence interval 0.2-0.95]) and antiphase correlations (area under the curve 0.75, [95% confidence interval 0.4-0.95]) appeared to be related to an abnormal outcome.Conclusions: Our observations suggest that the time scale is an important factor that needs to be standardized in the assessment of neonatal cerebral hemodynamics. [ABSTRACT FROM AUTHOR]

Background: End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). Methods: Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed. Results: There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets. Conclusion: Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions. [ABSTRACT FROM AUTHOR]

Objective: Only a few studies on improving the early diagnosis of severe neonatal infections have focused on the role of serum RANTES concentration (sRC). The aim of the study was to establish sRC in neonates with early-onset infections, according to their gestational age, sex, birth asphyxia, mode of delivery and value of some biochemical and hematological parameters. Material/Methods: The analysis comprised 129 neonates, including 89 infected (52 preterm, 37 full-term; 43 with sepsis, 39 with congenital pneumonia, 7 with severe urinary tract infection) and 40 healthy (control group, 25 full-term, 15 preterm). The sRC in peripheral vein blood was measured by the ELISA method using Quantikine Set (R & D systems, USA). Results: The sRC in infected neonates ranged from 10.83 to 122.55 μg/ml, in full-term neonates from 18.28 to 122.55 μg/ml, and in preterm from 10.83 to 118.24 μg/ml. The mean sRCs in full-term septic neonates (73.95±25.99 μg/ml) and with organ infections (58.43±29.24 μg/ml) were significantly higher than healthy ones (28.25±14.06 μg/ml). The mean sRCs in septic preterm neonates (59.17±28.29 μg/ml) and those with organ infections (50.86±28.16) were significantly higher than in healthy preterm neonates (25.61±8.29 μg/ml). Positive correlations between sRC and CRP value (r=0.3014, p=0.004) and between sRC and band cell count (r=0.2489, p=0.019) were found in all infected neonates. Conclusion: The significant increase of serum RANTES concentration in early-onset infections in neonates, regardless of their gestational age, sex and birth asphyxia, not only proves the presence of an active immunological process but also may be a useful biomarker for diagnosis of severe neonatal infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: Every year, millions of babies are born and a large proportion of them are being admitted to hospital for various indications. This study was conducted to identify the general characteristics, disease spectrum and common causes of Neonatal morbidity and mortality at Gondar University Hospital, Neonatal Unit. METHODS: Institution based prospective cross-sectional study was conducted at Gondar University Hospital (GUH), Neonatal Unit, from January 1st to March 31st, 2014. The study included 325 newborns who were admitted to the unit during the study period. The neonates were followed up using structured checklist and neonatal parameters like Neonatal sex, place of delivery, address, length of stay, gestational age, diagnosis and discharge conditions were transcribed into an electronic database for all observations. The primary outcome measures were death and cause of death. RESULTS: A total of 325 neonates were admitted during the study period. Of these, 75.1%, 23.1%, 1.2% and 0.6% were discharged improved, died, discharged with same condition and disappeared, respectively. Ten variables were found to have significant statistical associations with neonatal mortality after adjusting for demographic covariates: Prematurity (p < 0.001), Meningitis (p <0.001), Hemorrhagic Diseases (P <0.001), Hyaline Membrane Disease (P<0.001), Neonatal Sepsis (p <0.05), Meningitis (<0.05), Perinatal Asphyxia (p <0.05), Neonatal Seizure (p <0.05), Home delivery (p <0.05) and Meconium Aspiration (p <0.05). CONCLUSION: Our study showed that the common causes of neonatal mortality are almost similar with the previous evidences (problems of prematurity, Asphyxia and Sepsis). [ABSTRACT FROM AUTHOR]

Unlabelled: Soft infant carriers such as slings have become extremely popular in the west and are usually considered safe. We report 19 cases of sudden unexpected death in infancy (SUDI) linked to infant carrier. Most patients were healthy full-term babies less than 3 months of age, and suffocation was the most frequent cause of death.Conclusion: Infant carriers represent an underestimated cause of death by suffocation in neonates.What Is Known: • Sudden unexpected deaths in infancy linked to infant carrier have been only sparsely reported.What Is New: • We report a series of 19 cases strongly suggesting age of less than 3 months as a risk factor and suffocation as the mechanism of death. [ABSTRACT FROM AUTHOR]

Introduction Foreign bodies aspiration can lead to significant morbidity, few have examined in detail the deaths resulting from foreign bodies aspiration. Methods We conducted a review of children who presented to the pediatric intensive care unit of a university hospital due to fatal foreign bodies aspiration during the period of 2010–2017. Result Of the 28 patients, 17 (61%) patients were male and 11 (39%) were female. The range of age was 1–63 months, with mean of 15.2 months. The common foreign bodies included milk, nuts and fruits. Majority of them had round shapes. All the patients died due to asphyxia or serious complications after foreign bodies aspiration. Conclusions Prevention and early recognition remains a critical factor to reduce the mortality of foreign bodies aspiration. [ABSTRACT FROM AUTHOR]

The prone (face down) sleeping position is known to be associated with a significantly increased risk of sudden and unexpected death in infancy (sudden infant death syndrome or SIDS), however, the reasons for this are unclear. Suggested mechanisms have involved suffocation from occlusion of the external airways by soft bedding/pillows or from flattening of the nose with backward displacement of the tongue, rebreathing of carbon dioxide, blunting of arousal responses with decreased cardiac responses to auditory stimulation, diaphragmatic splinting or fatigue, lowering of vasomotor tone with tachycardia, nasopharyngeal bacterial overgrowth, overheating, alteration of sleep patterns, compromise of cerebral blood flow and upper airway obstruction from distortion of nasal cartilages. Recent studies have, however, shown a significant reduction in substance P in the inferior portion of the olivo-cerebellar complex in SIDS infants which is crucial for the integration of motor and sensory information for the control of head and neck movement. This deficit may explain why some infants are not able to move their faces away from potentially dangerous sleeping environments. [ABSTRACT FROM AUTHOR]

Peroxisomal diseases are rare (1:50,000), genetically determined disorders (autosomal recessive), systemic, multiorgan illnesses with prominent involvement of the nervous system, caused either by the failure to form or to maintain the peroxisome, or by a defect in the function of a single or multiple peroxisomal enzymes. Peroxisomes contain approximately 50 enzymes which are responsible for many metabolic reactions, and play an important role in the oxidation of saturated very-long-chain fatty acids (VLCFA). The authors present the case of a Romanian boy, who died at the age of 1.6 of one of the peroxisomal diseases-Zellweger syndrome. Newborn infants with Zellweger syndrome have a typical dysmorphic facies, neonatal seizures, profound hypotonia, and eye abnormalities. Major abnormalities are present in the liver (fibrotic), kidney (cortical cysts), and brain (lipid-laden macrophages and histiocytes in cortical and periventricular areas, demyelination, centrosylvian polymicrogyria and pachygyria)-cerebro-hepato-renal syndrome (CHRS) (Zellweger). Infants with Zellweger syndrome rarely live more than a few months, but in this case the survival was longer, and the cause of death was not directly the peroxisomal disease but a violent cause of death-mechanical asphyxia with tracheo-bronchial food aspiration. The authors present the results of investigations carried out during the child's life, but also data collected at the autopsy and hystopathological postnecroptic investigations. By presenting this case, the authors wish to bring to your attention a rare pathology in forensic practice by the paradox of finding a common violent cause of death, asphyxia with food aspiration, in a rare metabolic-genetic disease, which is usually fatal by itself. [ABSTRACT FROM AUTHOR]

Phenobarbital is an anticonvulsive drug widely used in newborns with hypoxic-ischemic encephalopathy. The objective of our study was to describe possible effect of frequently co-administered medications (dopamine, dobutamine, norepinephrine, furosemide, phenytoin, and analgesics) on the phenobarbital pharmacokinetics in full term newborns with hypoxic-ischemic encephalopathy. Phenobarbital pharmacokinetic parameters (standardized intravenous loading dose was 10-20 mg/kg, maintenance dose 2-6 mg/kg/day) were computed using non-compartmental analysis. Co-medication was evaluated throughout the whole treatment period up to 5 days. Volume of distribution, clearance, and half-life median values (95 % CI) for phenobarbital in the whole study population (n=37) were 0.48 (0.41-0.56) l/kg, 0.0034 (0.0028-0.0040) l/h/kg, and 93.7 (88.1-99.2) h, respectively. Phenobarbital pharmacokinetic parameters were not significantly affected by vasoactive drugs (dopamine, dobutamine, and norepinephrine), furosemide, phenytoin, or analgesics. Furthermore, no dose-dependent alteration of phenobarbital pharmacokinetic parameters was noted for vasoactive medication at doses equivalent to cumulative vasoactive-inotropic score (area under the curve in a plot of vasoactive-inotropic score against time) 143.2-8473.6, furosemide at cumulative doses of 0.2-42.9 mg/kg, or phenytoin at cumulative doses of 10.3-46.2 mg/kg. Phenobarbital pharmacokinetics was not affected by investigated co-administered drugs used in newborns with hypoxic-ischemic encephalopathy in real clinical settings. [ABSTRACT FROM AUTHOR]

Background Accidental suffocation during sleep, leading to death, has been described as due to overlay or wedging of infants, particularly in a bed-sharing situation. Bed sharing is a risk factor for sudden infant death syndrome but the mechanism of death is not clearly defined. Accidental suffocation may be one such mechanism. Objective To describe accidental suffocation deaths during sleep in New Zealand between 2002 and 2009. Design The New Zealand mortality database, which holds data collected by the Child Youth Mortality Review Committee and the Perinatal and Maternal Mortality Review Committee, was searched for potential deaths by accidental suffocation in infants less than 1 year of age. Deaths underwent a detailed analysis by demographic data and qualitative report. Results There were 48 deaths due to accidental suffocation between 2002 and 2009 in New Zealand, equating to a rate of 0.10 deaths per 1000 live births. The most common age at death was 1 month or under (n=11, 23%). Deaths were due to overlay (n=30, 63%) or wedging (n=18, 37%) and two-thirds (n=34, 71%) were in a bed-sharing situation. A quarter of deaths (n=12, 25%) occurred in makeshift bedding arrangements, some of which were away from home. Conclusions Accidental suffocation in bed was responsible for 48 preventable deaths. Prevention of these accidental deaths needs to focus on supporting changes in family behaviour with safety messages that are consistent, persistent and disseminated widely. [ABSTRACT FROM AUTHOR]