OBJECTIVESevere asphyxia during peripartum may lead to some sequela of the nervous system. Currently the neurologic outcome of asphyxiated neonates is assessed by using imaging techniques such as cranial ultrasound, CT and MRI except for evaluating perinatal abnormal factors and routine physical examinations of nervous system. These assessment approaches are based on the changes of anatomic structures of neonates. Electroencephalography (EEG) can show early abnormal cerebral functions. This study examined the EEG background activity and investigated the parameters associated with the prognostic assessment in full-term neonates with asphyxia.

METHODSA standard EEG was recorded in 49 asphyxiated full-term neonates aged from 24 hrs to 8 days. Of the 49 neonates, 14 had concurrent mild, 5 had moderate and 9 had severe hypoxic-ischemic encephalopathy (HIE). Thirty-one aged-matched full-term neonates without asphyxia severed as the control group. Forty-three of 49 asphyxiated neonates were followed-up for neurological development for 6-12 months. Important parameters associated with neurological prognosis were evaluated by the principle of data statistics.

RESULTSThe mean interburst intervals was prolonged, the amplitude of brain electrical activity during all the states were lower, and the incidence of brief burst and sleep-wake cycle disturbance was higher in the asphyxiated group when compared with the control group (P < 0.05). In the follow-up, 4 infants had poor fine motor function and 7 showed retarded psychomotor development in the asphyxiated group. Gestational age, birth weightamplitude of brain electrical activity, severity of HIE, occurrence of sleep-wake cycle disturbance and imaging abnormality were shown as important parameters for predicting neurological outcomes in asphyxiated neonates. The infants who EEG showed isoelectric tracings or isoelectric tracings accompanied with much abnormal discharge had very poor prognosis.

CONCLUSIONSEEG background pattern is valuable in predicting neurological outcomes for term neonates with asphyxia. EEG in combination with clinic data such as gestational age, birth weight, imaging examination, and severity of HIE may provide an accurate evaluation of neurological outcome.

Asphyxia Neonatorum ; mortality ; physiopathology ; Electroencephalography ; methods ; Humans ; Infant, Newborn ; Prognosis

OBJECTIVE: To explore the role of diaphgram fatigue in the death from hanging with bound upper limbs of rabbits. METHODS: Rabbits were hanged with upper limbs bound, then the data of EMGdi were gathered RESULTS: By analyzing power spectral of EMGdi in experiment, we compare the ratio change of H/L between pre-experiment and post-experiment. There is a significance decrease of the ratio of H/L, so it indicates that diaphgram fatigue does exist. CONCLUSION Diaphgram fatigue plays an important role in the death from hanging with limbs of rabbits bound.
Animals ; Asphyxia/physiopathology* ; Cause of Death ; Diaphragm/physiopathology* ; Electromyography ; Female ; Forensic Medicine ; Male ; Muscle Fatigue ; Rabbits

OBJECTIVETo investigate the renal function in newborns with birth asphyxia or intrauterine distress in the first week of life.

METHODSSixty full-term newborns born between June 2002 and February 2003 were assigned into three groups: Control group (healthy newborns), Intrauterine distress group (Apgar score > 7), and Birth asphyxia group without intrauterine distress (12 mild asphyxia and 8 severe asphyxia) (n=20 each). Urinary levels of alpha1-microglobulin (alpha1-MG), beta2-microglobulin (beta2-MG) and albumin (Alb) were detected by radioimmunoassay at 0-2, 3-4 and 6-7 days after birth.

RESULTSThe urinary levels of alpha1-MG, beta2-MG and Alb in the Asphyxia group were significantly higher than those in the Control group at all time points (P < 0.05), peaking at 3-4 days after birth. Statistically significant differences were found between the severely and mildly asphyxiated newborns for the urinary levels of alpha1-MG, beta2-MG and Alb at all time points (P < 0.05). There were no significant differences in the urinary levels of alpha1-MG, beta2-MG and Alb between the Intrauterine distress and the Control groups at each time point.

CONCLUSIONSBirth asphyxia may lead to renal glomerular and tubular impairments and it is speculated that the most serious impairment occurs at the 3rd and 4th days of life. The severity of renal impairments is associated with the degree of asphyxia. The renal function of the newborn appears to be normal following intrauterine distress.

Albuminuria ; urine ; Alpha-Globulins ; urine ; Asphyxia Neonatorum ; physiopathology ; Fetal Distress ; physiopathology ; Humans ; Infant, Newborn ; Kidney ; physiopathology ; beta 2-Microglobulin ; urine

OBJECTIVETo study the value of a new technique, maximum length sequences brainstem auditory evoked potential (MLS BAEP), in the assessment of the severity of brain damage following asphyxia in term neonates.

METHODSOne hundred and three neonates with perinatal asphyxia and 26 normal term neonates were eligible for the study. Conventional and MLS BAEP examinations were performed within three days after birth. Of the 103 neonates with asphyxia, 17 did not suffer from HIE, 37 had mild HIE, 31 had moderate HIE, and 18 had severe HIE. The latencies and amplitudes of waves I, III and V, and the inter-peak intervals of I-III, III-V, and I-V were analyzed.

RESULTSThe latencies of wave V and the inter-peak intervals of I-III, III-V and I-V prolonged gradually with the more severe HIE in both the MLS and the conventional BAEP (P<0.05 or 0.01). The differences among groups were more significant with the increasing repetition rate of click in the MLS BAEP. Compared with the normal controls, conventional BAEP did not show prolonged intervals of I-III and III-V in the mild HIE subgroup, and a prolonged inter-peak interval of III-V in the moderate HIE subgroup, while the MLS BAEP showed significantly prolonged inter-peak intervals of I-III and III-V in the three HIE subgroups and the differences were more and more significant as an increase in the repetition rate of click from 91 to 910 times/seconds.

CONCLUSIONSMLS BAEP is more sensitive and valuable than the conventional one in detecting hypoxic-ischemic brain damage following asphyxia by increasing the repetition rate of click. MLS BAEP provides a new measurement in quantity to assess the severity of HIE in neonates with perinatal asphyxia.

Asphyxia Neonatorum ; physiopathology ; Evoked Potentials, Auditory, Brain Stem ; Female ; Humans ; Hypoxia, Brain ; diagnosis ; Infant, Newborn ; Male

OBJECTIVETo explore the value of electroencephalogram (EEG) in early diagnosis of brain injury in neonates with asphyxia.

METHODSEEG examination was performed in 49 neonates with asphyxia (mild: n=9; severe: n=40) within 6 hrs of their births. Of the 49 asphyxiated neonates, 33 had concurrent HIE, including 20 cases of mild, 9 cases of moderate and 4 cases of severe HIE.

RESULTSTwenty-one (63.6%) out of the 33 patients with HIE showed abnormal EEG, but only one (6.3%) in the asphyxia group without HIE. All of 13 patients with moderate-severe HIE showed abnormal EEG. The degree of EEG abnormality in neonates with HIE was consistent with the clinical grading of HIE. The neonates whose EEG showed electrical silence and burst suppression and the abnormalities were kept unrecoverable for more than 2 weeks had very poor prognosis.

CONCLUSIONSEEG can reflect brain injury caused by neonatal asphyxia and the severity of brain injury. It may be useful for early diagnosis of brain injury following asphyxia in neonates.

Asphyxia Neonatorum ; complications ; physiopathology ; Early Diagnosis ; Electroencephalography ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; Infant, Newborn ; Male

OJBECTIVETo investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia.

METHODSA total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age.

RESULTSThe results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%.

CONCLUSIONSCramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.

Asphyxia Neonatorum ; physiopathology ; Child Development ; Humans ; Infant ; Infant, Newborn ; Movement ; Predictive Value of Tests ; Qualitative Research

Airway Obstruction ; complications ; etiology ; physiopathology ; Asphyxia ; etiology ; physiopathology ; Fibroma ; complications ; pathology ; Humans ; Infant, Newborn ; Oropharyngeal Neoplasms ; complications ; pathology ; Rare Diseases

Under hypoxia condition, microRNA （miRNA） can interact with transcription factors for regulating the cell metabolism, angiogenesis, erythropoiesis, cellular proliferation, differentiation and apoptosis. The biological processes above may play an important role in mechanical asphyxia death. This article reviews the regulating function of miRNA under hypoxia condition and the influence of hypoxia to biosynthesis of miRNA, which may provide some new ideas to the research of miRNA on determining the cause of mechanical asphyxia death in the field of forensic medicine.
Accidents ; Airway Obstruction/physiopathology* ; Apoptosis ; Asphyxia/pathology* ; Cause of Death ; Death ; Forensic Medicine ; Humans ; Hypoxia/physiopathology* ; MicroRNAs/metabolism* ; Oxygen

PURPOSESuicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases.

METHODSAll patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test.

RESULTSGlasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome.

CONCLUSIONGCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.

Adult ; Aged ; Asphyxia ; complications ; physiopathology ; Emergency Service, Hospital ; Female ; Glasgow Coma Scale ; Humans ; Male ; Middle Aged ; Suicide

OBJECTIVETo study the effects of hypothermia on cardiac function in neonates after birth asphyxia.

METHODSFifty term newborns with Apgar score < 5 at 5 minutes were randomly divided into no cooling group (normothermia group, NG; rectal temperature = 36.5 degrees C +/- 0.5 degrees C, n = 27) and cooling group (hypothermia group, HG; rectal temperature = 34.5 degrees C +/- 0.3 degrees C, nasopharyngeal temperature = 34.0 degrees C +/- 0.5 degrees C, n = 23). The selective head cooling was applied to maintain nasopharyngeal temperature at 34 degrees C for 72 h in hypothermia group. Systolic and diastolic function was detected at the end of treatment by echocardiogram.

RESULTS(1) The heart rate was obviously decreased during the hypothermia treatment, and there was a significant difference between HG and NG [(103 +/- 15) bpm vs. (126 +/- 14) bpm, P < 0.05]. No cardiac arrhythmia and hypotension were found in all neonates. (2) There were no significant differences on the ejection fraction, stroke volume and cardiac output of left ventricle between the two groups (P > 0.05). No significant difference was found in the numbers of left and right ventricular diastolic dysfunction, pulmonary hypertension between the two groups (P > 0.05). (3) The level of cardiac troponin T (cTnT) in plasma was (0.47 +/- 0.15) ng/ml in HG, and (0.35 +/- 0.21) ng/ml in NG, and there was no significant difference between the two groups (P > 0.05).

CONCLUSIONNo significant cardiac dysfunction complication caused by the hypothermia treatment was found in term neonates after birth asphyxia.

Asphyxia Neonatorum ; physiopathology ; prevention & control ; Electrocardiography ; Heart ; physiopathology ; Heart Function Tests ; Humans ; Hypothermia, Induced ; methods ; Infant, Newborn ; Monitoring, Physiologic ; Troponin ; blood