A retrospective study of a cohort of 54 term infants with perinatal asphyxia admitted to the neonatal intensive care unit at Hvidovre University Hospital i 1995 is described. The purpose of the study was to find clinical markers for prediction of outcome after perinatal asphyxia. Neither complications of pregnancy, gestational age, the sex of the infant, passage of meconium before delivery, abnormal fetal heart rate nor birth weight seemed to have any interrelationship with outcome. The Apgar score was more depressed, and the metabolic acidosis worse among the infants with poor outcome. The best predictor of outcome after intrapartum asphyxia was the severity of postasphyxial encephalopathy. No infant with mild or moderate postasphyxial encephalopathy died or developed any handicap. All with severe postasphyxial encephalopathy either died or developed minor handicaps.
We compared absolute values of regional tissue hemoglobin saturation (StO(2)), reproducibility, and dynamic range of four different instruments on the forearm of adults. The sensors were repositioned 10 times on each subject. Dynamic range was estimated by exercise with subsequent arterial occlusion. Mean StO(2) was 70.1% ± 6.7 with INVOS 5100, 69.4% ± 5.0 with NIRO 200 NX, 63.4% ± 4.5 with NIRO 300, and 60.8% ± 3.6 with OxyPrem. The corresponding reproducibility S(w) was 5.4% (CI 4.4-6.9), 4.4% (CI 3.5-5.2), 4.1% (CI 3.3-4.9), and 2.7% (CI 2.2-3.2), respectively. The dynamic ranges ΔStO(2) were 45.0%, 46.8%, 44.8%, and 27.8%, respectively. In conclusion, the three commercial NIRS instruments showed different absolute values, whereas reproducibility and dynamic range were quite similar.
Cognitive dysfunction is a well-known consequence of epilepsy in children. This review summarizes cognitive difficulties presenting in different types of childhood epilepsy. The possibility of screening and monitoring cognitive dysfunction is desirable to provide optimal support and treatment. The clinical test tool EpiTrack Junior is introduced. It was developed for screening and continuous monitoring of cognitive function in children with epilepsy.
Abstract Aim: The aim of the study was to compare the cerebral tissue oxygenation index (c‐TOI) measured by near infrared spectroscopy (NIRS) in infants with and without foetal vasculitis. Methods: Twenty‐four infants with placental signs of a foetal inflammatory response (FIR), foetal vasculitis, were compared with 39 controls. NIRS examination was done within the first 24 h. Results: Infants with FIR had a significant lower gestational age (26.8 ± 2.4 vs. 29.8 ± 2.4 weeks' gestation; p < 0.01), Hb (9.4 ± 1.2 vs. 10.9 ± 1.5 mM; p < 0.01) and blood P CO2 (5.5 ± 0.8 vs. 6.3 ± 1.1 kPa, p < 0.01) compared to controls. There was no significant difference in arterial blood pressure, inspiratory oxygen content, needs of mechanical ventilation or c‐TOI (73.6 ± 8.1% vs. 73.9 ± 8.1% (p = 0.9)). The effect of FIR on c‐TOI was −0.3% (95% CI −3.9 to 4.5%). This result was not affected by inclusion of potential confounders in the analysis. Eight infants subsequently developed intra/periventricular haemorrhage: four with minor lesions and four with severe lesions. There was a significant negative correlation between the severity of the intraventricular haemorrhage and the cerebral oxygenation (p = 0.002). Conclusion: Cerebral oxygenation was not affected in the first day of life in preterm infants born with foetal vasculitis, while cerebral oxygenation in infants that later developed intraventricular haemorrhage was impaired.
Abstract 3-hydroxyisobutyryl-CoA hydrolase deficiency (HIBCHD) is a rare metabolic disease. Early symptoms include poor feeding, seizures, hypotonia and impaired psychomotor development. Acute metabolic crisis can cause encephalopathy with high risk of neurological sequelae or death. Casuistic, we here report a nine-year old Danish girl with HIBCHD treated with intravenous high-dose methylprednisolone when presenting with encephalopathy during acute metabolic crisis. Presentation of acute encephalopathy with basal ganglia changes seen on MRI was regarded as acute disseminated encephalomyelitis (ADEM) leading to intravenous high-dose methylprednisolone treatment. The effect of methylprednisolone was profound, not only on the acute neurological symptoms, but also accelerated the development of the child. After re-evaluation of MR images, Whole Genome Sequencing (WGS) confirmed the diagnosis HIBCHD. The high-dose methylprednisolone treatment regime was repeated in a following severe metabolic crisis presenting with acute encephalopathy, dystonia and spasticity. The child survived and after rehabilitation neurological sequelae are present but considerably reduced. We consider if high-dose methylprednisolone should be recommended in children with acute metabolic crisis and encephalopathy due to HIBCHD. Since influenza A virus was the triggering cause to metabolic crisis with encephalopathy, vaccination should be considered in HIBCHD.
Inflammatory reactions and other events in early life may be part of the etiology of late-onset diseases, including cerebral palsy, autism, and type 1 diabetes. Most neonatal screening programs for congenital disorders are based on analysis of dried blood spot samples (DBSS), and stored residual DBSS constitute a valuable resource for research into the etiology of these diseases. The small amount of blood available, however, limits the number of analytes that can be determined by traditional immunoassay methodologies.We used new multiplexed sandwich immunoassays based on flowmetric Luminex xMAP technology to measure inflammatory markers and neutrophins in DBSS.The high-capacity 25-plex multianalyte method measured 23 inflammatory and trophic cytokines, triggering receptor expressed on myeloid cells-1 (TREM-1), and C-reactive protein in two 3.2-mm punches from DBSS. It also measured 26 cytokines and TREM-1 in serum. Standards Recovery in the 25-plex method were 90%-161% (mean, 105%). The low end of the working range for all 25 analytes covered concentrations found in DBSS from healthy newborns. Mean recovery of exogenous analytes added at physiologic concentrations in DBSS models was 174%, mean intra- and interassay CVs were 6.2% and 16%, respectively, and the mean correlation between added and measured analytes was r2 = 0.91. In DBSS routinely collected on days 5-7 from 8 newborns with documented inflammatory reactions at birth, the method detected significantly changed concentrations of inflammatory cytokines. Measurements on DBSS stored at -24 degrees C for >20 years showed that most cytokines are detectable in equal concentrations over time.The method can reliably measure 25 inflammatory markers and growth factors in DBSS. It has a large potential for high-capacity analysis of DBSS in epidemiologic case-control studies and, with further refinements, in neonatal screening.
Spatially resolved spectroscopy (SRS) allows the estimation of absolute tissue oxygen saturation, the ratio of oxygenated to total hemoglobin concentration, which may facilitate the comparison of results among patients. Eighty-two premature infants were included over two years. The cerebral tissue oxygenation index (c-TOI) was measured using NIRO 300 (Hamamatsu Photonics KK). c-TOI was measured at several positions in each infant. c-TOI varied over time, increasing in the first third and decreasing in the last third of the study period (p<10−6). Two probes were used in the study, and a highly significant difference was found between these (p<10−6). The mean difference was 8.5% (95%CI 5.4 to 11.6%). After correction for this difference, there was no variation over time. A conclusive explanation for the bias could not be identified. Since the study groups were well distributed, the bias had no influence on the results of our clinical study. We investigated an unexpected but highly significant probe-dependent bias in c-TOI with no conclusive explanation. Hence, comparisons of absolute TOI between groups of patients and among studies should be regarded with caution. A better strategy to detect potential instrumental problems will be useful in preventing biased c-TOI from occurring.
