Browsing by Subject "Asphyxia"
Now showing items 1-7 of 7
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(Helsingin yliopisto, 2018)Perinatal asphyxia is a main cause of neonatal deaths worldwide. Asphyxia can lead to hypoxic ischemic encephalopathy, which may cause severe neurological impairment to infants. The consequences of hypoxic ischemic encephalopathy can have a significant impact on the life of affected children and their families. Neonates with hypoxic ischemic encephalopathy can be treated with therapeutic hypothermia. Therapeutic hypothermia is to be initiated within 6 hours after birth. Biomarkers of asphyxia used at present are cord blood pH and Apgar score. The severity of hypoxic ischemic encephalopathy is evaluated with the help of clinical assessment, magnetic resonance imaging and amplitude integrated electroencephalography. Currently there is a need for new biomarkers of asphyxia in order to identify adequate candidates for treatment, for the estimation of prognosis and planning of follow up. The purpose of this review is to present and evaluate studies concerning biomarkers of perinatal asphyxia. Biomarkers discussed are erythropoietin, activin a, S-100, nucleated red blood cells, lactate, lactate dehydrogenase, neuron specific enolase, cytokines, free radicals, glial fibrillar acidic protein, copeptin, metabolomics, magnetic resonance techniques (magnetic resonance imaging and magnetic resonance spectroscopy) and neurophysiology (electroencephalography, amplitude integrated electroencephalography and near-infrared spectroscopy. Based on this review, copeptin and glial fibrillary acidic protein may be potential biomarkers. Metabolomics show a new promising field. Further research is, however, required to find new biomarkers that can be validated into clinical use. (226 words)
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(2018)Objective: To evaluate the reliability of recording cortical somatosensory evoked potentials (SEPs) in asphyxiated newborns using the 4-electrode setup applied in routine long-term amplitude-integrated EEG (aEEG) brain monitoring and to assess the number of averages needed for reliably detecting the cortical responses. Methods: We evaluated median nerve SEPs in 50 asphyxiated full-term newborns. The SEP interpretation (present or absent) from the original recordings with 21-electrodes and approximately 600 trials served as the reference. This was compared to SEP classification (absent, present, or unreliable) based on a reduced (300 or 150) number of averages, and to classification based on only four electrodes (F3, P3, F4, P4). Results: Compared to the original classification, cortical SEPs were uniformly interpreted as present or absent in all 50 newborns with the 4-electrode setup and 600 averages. Reducing number of averages to 300 still resulted in correct SEP interpretation in 49/50 newborns with 21-electrode setup, and 46/50 newborns with 4-electrode setup. Conclusions: Evaluation of early cortical neonatal SEPs is reliable from the 4-electrode setup commonly used in aEEG monitoring. SEP is discernible in most newborns with 300 averages. Significance: Adding SEP into routine aEEG monitoring offers an additional tool for early neonatal neurophysiological evaluation. © 2018 International Federation of Clinical Neurophysiology
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(2017)Objective: To evaluate the added value of somatosensory (SEPs) and visual evoked potentials (VEPs) recorded simultaneously with routine EEG in early outcome prediction of newborns with hypoxicischemic encephalopathy under modern intensive care. Methods: We simultaneously recorded multichannel EEG, median nerve SEPs, and flash VEPs during the first few postnatal days in 50 term newborns with hypoxic-ischemic encephalopathy. EEG background was scored into five grades and the worst two grades were considered to indicate poor cerebral recovery. Evoked potentials were classified as absent or present. Clinical outcome was determined from the medical records at a median age of 21 months. Unfavorable outcome included cerebral palsy, severe mental retardation, severe epilepsy, or death. Results: The accuracy of outcome prediction was 98% with SEPs compared to 90% with EEG. EEG alone always predicted unfavorable outcome when it was inactive (n = 9), and favorable outcome when it was normal or only mildly abnormal (n = 17). However, newborns with moderate or severe EEG background abnormality could have either favorable or unfavorable outcome, which was correctly predicted by SEP in all but one newborn (accuracy in this subgroup 96%). Absent VEPs were always associated with an inactive EEG, and an unfavorable outcome. However, presence of VEPs did not guarantee a favorable outcome. Conclusions: SEPs accurately predict clinical outcomes in newborns with hypoxic-ischemic encephalopathy and improve the EEG-based prediction particularly in those newborns with severely or moderately abnormal EEG findings. Significance: SEPs should be added to routine EEG recordings for early bedside assessment of newborns with hypoxic-ischemic encephalopathy. (C) 2017 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
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(2016)Ääriolosuhteissa saunavammoja voi aiheutua kontaktin ja kuuman ilman lisäksi myös vesihöyryn syrjäyttäessä hapen. Saunomisen MM-kisoissa vuonna 2010 oletettavasti nimenomaan hapenpuute esti vaarallisten merkkien havaitsemisen ja saunojat jäivät saunaan kriittisiksi viimeisiksi minuuteiksi.
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(Helsingfors universitet, 2015)Kardiotokografia (KTG) on vakiintunut menetelmä synnytyksen aikana sikiön voinnin arvioinnissa. Patologisen rekisteröinnin vuoksi synnytyksen aikana mahdollisesti tehdyistä toimenpiteistä (mikroverinäytteen otto, synnytyksen nopeuttaminen tai sektio) osa voi olla turhia koska aina KTG löydös ei korreloi vastasyntyneen vointiin. Tutkimuksen potilaat ovat vuonna 2011 Kätilöopiston sairaalan synnytysosastolle sisäänkirjattuja. Sähköisestä potilastietojärjestelmästä on katsottu äitien ja syntyneiden lasten tietoja. Näiden pohjalta on katsottu eroaako ensisynnyttäjä uudelleen synnyttäjästä ja eroaako Kätilöopiston synnyttäjä koko Suomen keskimääräisestä synnyttäjästä. Synnyttäjille tehdyt KTG rekisteröinnit on tulkittu sokkoutetusti kahden erikoislääkärin ja statistikon toimesta. Tutkimuksen perusteella aiempi synnyttäneisyys vähentää seuraavassa synnytyksessä kivunlievityksen ja sektion tarvetta. Seuraava synnytys on myös yleensä spontaani ja nopeampi. Koko maahan verratessa Kätilöopistolla tehdään vähemmän sektioita ja käytetään enemmän kivunlievitystä. Laajemman tutkimuksen, jonka osa tämä työ on, tavoitteena on selvittää saltatorisen eli korostuneen sykkeen vaihtelun merkitystä vastasyntyneen voinnille. Toimenpiteitä voitaisiin jatkossa mahdollisesti ohjata paremmin niitä tarvitseville ja täten KTG:n tulkinta ja vastasyntyneen vointi voisivat parantua.
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(2021)Background: Somatosensory evoked potentials (SEPs) offer an additional bedside tool for outcome prediction after perinatal asphyxia. Aims: To assess the reliability of SEPs recorded with bifrontoparietal amplitude-integrated electroencephalography (aEEG) brain monitoring setup for outcome prediction in asphyxiated newborns undergoing therapeutic hypothermia. Study design: Retrospective observational single-center study. Subjects: 27 consecutive asphyxiated fullor near-term newborns (25 under hypothermia) that underwent median nerve aEEG-SEPs as part of their clinical evaluation at the neonatal intensive care unit of Helsinki University Hospital. Outcome measures: aEEG-SEP classification (present, absent or unreliable) was compared to classification of SEPs recorded with a full EEG montage (EEG-SEP), and outcome determined from medical records at approximately 12-months-age. Unfavorable outcome included death, cerebral palsy, or severe epilepsy. Results: The aEEG-SEP and EEG-SEP classifications were concordant in 21 of the 22 newborns with both recordings available. All five newborns with bilaterally absent aEEG-SEPs had absent EEG-SEPs and the four with outcome information available had an unfavorable outcome (one was lost to follow-up). Of the newborns with aEEG-SEPs present, all with follow-up exams available had bilaterally present EEG-SEPs and a favorable outcome (one was lost to follow-up). One newborn with unilaterally absent aEEG-SEP at 25 h of age had bilaterally present EEG-SEPs on the next day, and a favorable outcome. Conclusions: aEEG-SEPs recorded during therapeutic hypothermia on the first postnatal days are reliable for assessing brain injury severity. Adding SEP into routine aEEG brain monitoring offers an additional tool for very early outcome prediction after birth asphyxia.
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(2017)Vaimo toi tupakoivan keski-ikäisen miehen sairaalan päivystykseen äkillisesti alkaneen kovan hengenahdistuksen takia. Hengitystaajuus oli tulovaiheessa 40/min ja veren happisaturaatio 80 %. Mies oli ollut aiemmin terve.
