Neonatal hypoxic-ischemic encephalopathy in apparently low risk pregnancies: Retrospective analysis of the last five years at the University of Bologna
ABSTRACT To provide recent figures on the occurrence of neonatal hypoxic-ischemic encephalopathy (NHIE) from a Teaching Hospital.
A retrospective case-control study was conducted in a tertiary level university hospital with more than 3000 deliveries annually. Twenty-four cases of NHIE that occurred in apparently low-risk pregnancies were analysed and compared to a group of controls for the most common labor variables. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.
Of 15,371 apparently low-risk deliveries, 24 cases of NHIE were observed (0.16%), with perinatal death or cerebral palsy occurring in nine of these cases (0.06%). The following intra-partum variables were significantly more common in cases than in controls: stained amniotic fluid (OR: 7.50; 95% CI:1.77-31.79), maternal fever (none in the control group), abnormal CTG (OR: 253.0; 95% CI: 26.70-2397), persistent occiput posterior (OR: 15.67; 95% CI: 2.25-104.53) and operative delivery (OR: 3.98; 95% CI: 1.39-11.33).
The incidence of NHIE is considerably low in a Tertiary care Centre.
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ABSTRACT: Cerebral palsy (CP) is a group of disorders of the development of movement and posture, causing activity limitations, that are attributed to nonprogressing disturbances that occurred in the developing fetal or infant brain. The motor abnormalies are often accompagnied by disturbances of sensation, perception, cognition, behavior and/or by a seizure disorder. The prevalence of CP has not decreased in developed countries over the past 30years, despite the widespread use of electronic fetal heart rate monitoring and a 5- to 6-fold increase in the cesarean delivery rate. In the term newborn, CP may be attributed to perinatal asphyxia in case of metabolic acidosis in the cord blood (pH12mmol/L), followed by a moderate or severe neonatal encephalopathy within 24hours and a further neurological impairement characterized by spastic quadriplegia and dyskinesia/dystonia. Dating the time of fetal asphyxia during delivery is possible when there are acute catastrophic complications during labor and unexpected acute or progressive fetal heart rate anomalies after a normal admission test, when there is a need for intensive neonatal resuscitation, a multi-organ failure within 72hours of birth and visualization of acute non focal cerebral abnormalities, mainly by early magnetic resonance imaging (MRI). MRI sequences show either a brain-damaged pattern of the central basal ganglia, thalami and posterior limbs of internal capsules with relative cortical sparing, in acute, near-total asphyxial insults manifested by a continuous bradycardia or a pattern of cortical injury in the watershed zones and relative sparing of the central grey matter, in prolonged partial asphyxia, manifested by late or atypical variable decelerations with progressive fetal tachycardia, loss of reactivity and absent fluctuation. Prolongation of either type of asphyxial insult results in more global brain damage. In order to differentiate a CP occurring after perinatal asphyxia from other neurological sequelae in relation with infection, hemorrhage, stroke, malformations, genetic or metabolic diseases, it is essential that a definitive information from the brain by MRI and an extensive histological examination of the placenta are at disposal.Gynécologie Obstétrique & Fertilité 04/2010; 38(4):261-277. DOI:10.1016/j.gyobfe.2010.02.009 · 0.52 Impact Factor
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ABSTRACT: To investigate the association between maternal self-reported infections, fever and smoking in the prenatal period and subsequent risk for congenital cerebral palsy (CP). We included the 81,066 mothers of singletons born between 1996 and 2003, who participated in the Danish National Birth Cohort. Children were followed through December 2008. Information on maternal infections, fever, smoking and other demographic and lifestyle factors during pregnancy were reported by mothers in computer-assisted telephone interviews in early and mid-gestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals. Self-reported vaginal infections were associated with an increased risk of CP and sCP (aHR: 1.52; 95% CI: 1.04-2.24 and aHR: 1.73; 95% CI: 1.16-2.60, respectively) and particularly untreated vaginal infections were associated with an increased risk of sCP (aHR: 1.95; 95% CI: 1.16-3.26). Fever was associated with the risk of CP (aHR: 1.53; 95% CI: 1.06-2.21). Smoking 10 or more cigarettes per day during pregnancy was also associated with sCP (aHR: 1.80; 95% CI: 1.10-2.94). There was a modest excess in risk for children exposed to both heavy smoking and vaginal infections. No other self-reported infections were significantly associated with CP. Self-reported vaginal infections, fever and smoking 10 or more cigarettes per day during pregnancy were associated with a higher risk of overall CP and/or sCP.American journal of obstetrics and gynecology 06/2013; 209(4). DOI:10.1016/j.ajog.2013.06.023 · 4.70 Impact Factor
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ABSTRACT: Thioperamide, a selective histamine H3 receptor antagonist, can increase histamine content in the brain, improve brain edema, and exert a neuroprotective effect. This study aimed to examine the mechanism of action of thioperamide during brain edema in a rat model of neonatal hypoxic-ischemic encephalopathy. Our results showed that thioperamide significantly decreased brain water content and malondialdehyde levels, while significantly increased histamine levels and superoxide dismutase activity in the hippocampus. This evidence demonstrates that thioperamide could prevent oxidative damage and attenuate brain edema following neonatal hypoxic-ischemic encephalolopathy. We further observed that changes in the above indexes occurred after combined treatment of thioperamide with the H1 receptor antagonist, pyrilamine, and the H2 receptor antagonist, tidine. Experimental findings indicated that pyrilamine reversed the effects of thioperamide; however, cimetidine had no significant influence on the effects of thioperamide. Our present findings suggest that thioperamide can increase brain histamine content and attenuate brain edema and oxidative damage by acting in combination with postsynaptic H1 receptors in a rat model of neonatal ic-ischemic encephalopathy.Neural Regeneration Research 07/2013; 8(19):1814-22. DOI:10.3969/j.issn.1673-5374.2013.19.009 · 0.22 Impact Factor