الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 186 |  |  |
| | | from | 186 | | |
Abstract
Hypoxic ischemic encephalopathy (HIE) is a brain injury due to inadequate blood flow to neonatal brain occurring as a result of hypoxic ischemic event during prenatal, intra partum or postnatal period. It is considered one of the most serious complications affecting full term neonates, so it requires immediate medical intervention. Vitamin D is a hormone affecting a wide range function in human body, traditionally vitamin D was known to be associated with calcium and bone metabolism, but recently it has been demonstrated to be a vital component in neuronal development and dysfunction through its effect on many neuro-trophic factors and its role in immune response. In addition to its effect on bone mineralization, vitamin D is a potent neuro-hormone. There are vitamin D receptors and several enzymes that enter vitamin D synthetic pathway found throughout neonatal brain, also it has effect on regulation of calcium and inflammatory cytokines during the inflammatory process. Many of clinical studies proved that vitamin D has antioxidant effect that play an important neuro protective role in the secondary energy failure phase of hypoxic ischemic encephalopathy to protect the brain from further damage and improving the outcome of neonatal hypoxic ischemic encephalopathy. Also, many of studies found that neonates with hypoxic ischemic encephalopathy tend to be vitamin D deficient, so administration of vitamin D during pre- or post-natal periods may alter the prevalence and the severity of neonatal hypoxic ischemic encephalopathy as they found that treatment with vitamin D result in reduction in size and severity of brain injury. The dose and level of vitamin D that would potentially be necessary to provide neuro protection is unknown. There is evidence that the usual for bone health are inadequate because higher levels of vitamin D are needed for inflammatory and immune functions than for calcium homeostasis and bone development. The American Academy of Pediatrics recommendations states that all healthy full-term neonates should be supplemented with 400 IU/day although other societies have recommended dose up to 1,000 IU/day in HIE neonates. Therefore, the aim of this work was to assess serum level of vitamin D in full term neonates with hypoxic ischemic encephalopathy in grades (I, II, III). This case control study was conducted on forty neonatal cases classified into two groups: group A (Case group): thirty patients diagnosed as hypoxic ischemic encephalopathy who were further classified into, ten cases of grade (I) HIE (groupA1), ten cases of grade (II) HIE (group A2) and ten cases of grade (III) HIE (group A3). group B (Control group): ten healthy full-term neonates. Summary of our results: • Head circumference was insignificantly different among the four groups. • Apgar score measurements at 1min were significantly lower in group A1, A2 and A3 than group B, lower in group A3 than group A1 and group A2 and in group A2 than group A1 (P value <0.001). • Apgar score measurements at 5min were significantly lower in group A1, A2 and A3 than group B, lower in group A3 than group A1 and group A2 (P value <0.001) but was insignificantly different between group A1 and group A2. • Occurrence of convulsions was significantly different among the four groups: higher with group A2 and A3 (P value<0.001). • Respiratory support was significantly different among the four groups: more with group A1, A2 and A3 (P value <0.001) • Haemoglobin, white blood cells and platelets were insignificantly different among the four groups. • Serum creatinine and blood urea were significantly different among the four groups (P value <0.001). • CRP was significantly different among the four groups (P value <0.001). • pH measurements at 12 and 72 h were significantly different among the four groups (P value <0.001) and PaCO2, PaO2 and HCO3 measurements at 12 and 72 h were insignificantly different among the four groups. • Total serum calcium and ionized calcium measurements at 12 h were significantly different among the four groups (P value = 0.013 and 0.022, respectively), and was insignificantly different at 72 h. • 25(Oh) vitamin D measurements at 12h and 72h post-natal were significantly different among the four groups (P value <0.001), lower in groups A1, A2 and A3 than group B (P value <0.05). lower in group A3 than group A1 and group A2 and in group A2 than group A1 (P value <0.05).