Online ISSN: 2515-8260

Keywords : Perinatal asphyxia

Analysis of clinical and biochemical parameters to differentiate between antepartum and intrapartum asphyxia

Dr Sharika Anand Verma, Dr V. S. Raju, Dr. Swati P Mishra, Dr. Nazreen M Bilagi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1187-1193

Background: Perinatal asphyxia is a clinical or biochemical evidence of lack of oxygen or excess of carbon dioxide in the body, due to failure of efficient respiration at birth with resultant hypoxia and acidemia. It is also of medicolegal importance to know the exact cause of fetal distress whether it is antepartum or intrapartum. This study was undertaken to evaluate the use of cord blood serum erythropoietin (S. Epo) and blood gas analysis as a predictor to differentiate between antepartum and intrapartum asphyxia.
Material and Methods: A prospective cross- sectional study on 60 neonates born at term in the labor room of a tertiary hospital setting. Through clinical history and examination, cord blood serum erythropoietin and arterial blood gas analysis was performed in each case. Mild to moderate hypoxic-ischaemic encephalopathy (HIE) cases were treated with 500U/kg of recombinant human erythropoietin every alternate day for two weeks, with the first dose administered by 48 hours of life.
Results: Out of the 60 neonates, 68.3% required treatment with rHuEPO, Only those affordable of the treatment, (26.7%) were given rHuEPO. Amongst the 41 neonates with elevated S.Epo, 53.7% weighed<2.5 kg (mean weight- 2.52 kg). Low APGAR Score at 1 min (in 71.7% neonates) and 5 min (in 93.3% neonates) were strongly associated with increased levels of erythropoietin (p≤0.00). Cord blood pH showed acidosis in majority (71.7%) of the cases, while 28.3% had normal cord blood pH.
Conclusion: High levels of S.Epo is associated with antepartum asphyxia while normal S.Epo level with low pH is associated with an intrapartum cause of asphyxia


Dr Keerthan N1, DrAshwin A M , DrS R Ravish, DrSupritha J C .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5311-5321

Background: Perinatal asphyxia is a major cause of neurologic morbidity and mortality. The
purpose of this study was to investigate variations in nucleated red blood cell
count per 100 white blood cells in cord blood of term newborns with
perinatal asphyxia and its relationship to both the severity and short term prognosis of
Methods:A cross-sectional comparative study was undertaken between June 2016 and May 2017 in the Neonatal Intensive Care Unit of CSI holsworth memorial hospital and Cheluvamba Hospital, Mysuru. A total of 120  newborns completed the study, out of which  60 asphyxiated term newborns  (case group)  and 60 normal term neonates (control group) Immediately after birth, umbilical cord blood was  collected and a thin blood smear slide was prepared which was  stained with Leishman stain for NRBC count. The NRBC count of the case group and the control group were compared. The results were analyzed statistically.
Results:The mean (± SD) NRBC count in normal term newborns born of normal vaginal delivery was 5.3 ± 3.25 NRBC/100WBC (range 0-16). The mean NRBC count in asphyxiated  babies was 23.65±12.9 NRBC/100WBC, ranging from 8 to 63. Hence, the NRBC  count was significantly higher in the asphyxiated group compared to normal babies  (p-value < 0.001).The NRBC count cut-off  of  >10/100WBC has sensitivity of 96.7% , specificity of 95%,positive predictive value of 95% and negative predicting value of 96.6% in predicting asphyxia defined as Apgar at 1 minute ≤ 6.
Conclusions:Nucleated red blood cell  cord blood collected is a simple marker for assessment of severity and early outcomes in perinatal asphyxia. Early NRBC count in cord blood is a simple & cost effective strong marker for  birth asphyxia.

Renal Doppler Sonography for Assessment of Renal Injury in the Asphyxiated Newborn Infant

Ahmed Hassan Hussein, Osama Abdullah Dawoud, Farida Mohammed Al Fawal, Ahmed Mohammed AlaaEldien

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4112-4125

Background:Asphyxia is an important cause of acute kidney injury (AKI) and transient kidney
impairment, there is a high incidence of AKI among the asphyxiated infants (50 – 72%). The
normal renal ultrasound appearance in a neonate typically shows higher cortical echogenicity than
in older child. Normally the parenchymal echogenicity is equal to or greater than that of liver and
spleen. Doppler examination of the renal artery includes complete evaluation of the kidneys. Left
and right decubitus patient positions are preferred for the kidney examination (left decubitus for
the right kidney and vice versa). Both kidneys are examined carefully with respect to size,
echogenicity and smoothness of outline, together with assessment of the corticomedullary
differentiation.There are two approaches are used in Doppler examination, anterior abdominal
approach and flank approach.