الفهرس 
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Abstract
Hypoxic ischemic encephalopathy (HIE) is one of the major causes
of perinatal mortality and morbidity. To date, there are no reliable
methods to detect which infants will develop brain damage after asphyxia
insult.
In the last year’s new diagnostic technologies were developed to
assess brain development and to identify early brain injury. Some of them
are very attractive methods but invasive, expensive, and time-consuming.
The availability of clinically useful serum markers of risk for perinatal
brain damage will easily permit the development of rational strategies for
prevention of cerebral insults in neonates and more accurate prognostic
counseling making use of the fact that HIE after perinatal asphyxia is a
condition in which serum concentrations of brain-specific biochemical
markers including primarily protein S100B may be elevated.
The aim was to study the level of serum S100B protein in fullterm
neonates with hypoxic ischemic encephalopathy in relation to its severity.
Our cross sectional study included 60 full term newborn infants.
Thirty of them with hypoxic ischemic encephalopathy as a HIE group ,
from Neonatal Intensive Care Unit (NICU), pediatric department,
Menoufia University Hospitals from May 2016 to April 2017 and Results
were compared with another thirty clinically healthy full term infants well
matched for age, weight and sex as control group. Their gestational age
ranged between 37 and 40 weeks, that fulfilled the following inclusion
criteria:
Gestational age ≥ 36weeks.
5 minutes Apgar ≤5 .
Umbilical arterial / first postnatal PH < 7.1.
Thorough history taking including full prenatal ,antenatal and
postnatal history taking
Clinical examination and staging of severity of hypoxic ischemic
encephalopathy according to Sarnat and Sarnat (1976).
And were subjected to the following investigations:
Acid base measurements.: Arterial blood gases for (PH, PaCO2,
PaO2).
Complete blood count (CBC).
Kidney function test including urea and creatinine levels.
Liver function test (SGPT).
Protein S–100B a cytosolic constituent of neuroglial cells was
measured in serum 1 and 7 days of life by ELIZA
The HIE group included a total number of 30 patients ,18 males (60
%) and 12 females (40 %), their gestational ages ranged between 37 and
40 weeks (38.33±1.12 wk.) Whereas, there were no significant difference
between cases as regards the gestational age and sex distribution, as P
value were 0.063 and 0.396 respectively. They were exposed to different
maternal risk factors, the most important was PROM 40%, drug intake 30
% and hemorrhage 16,67 %.
As regards the Mode of delivery where the highest percentage was
among those delivered vaginally by 70 % while C.S was 30 % where
the decision was taken due to the adverse intrauterine environment with
the breech presentation as a 1ry cause 16.67%, the abruptio placentae
and obstructed labour by 13.33% then uterine rupture, cord prolapse and
cord around neck by 3.33% also no significant difference in its
relationship with severity of HIE.
The commonest clinical presentation on admission was Convulsions
37.5% with significant difference as p value 0.025 followed by delayed
crying and cyanosis 22.5%, baby not doing well 22.5 % and apnea 15 %
with no significant differences in relation to severity of HIE as p values
were 0.06, 0.061 and 0.6 respectively.
The mean Apgar scores in HIE group were (2.46± 1.06, 3.57±1.17,
6.90±1.03 and 7.8±1.02 at 1, 5 ,10 and 15 minutes respectively,
differences were highly significant as regards Apgar scores at 1, 5 and
10 minutes, as p values were 0.001, 0.000 and 0.001 respectively while it
was insignificant as regard at 15 minutes as p value was 0.075.
About 60% had healthy clinical outcome, while 13.3 % died (one
neonate with moderate HIE died at 20 days after birth while three neonates with severe HIE died within 10 days after birth) and about
26.7% had brain insult, there was significant difference between brain
insulted outcome and severity of HIE as p value was 0.048%.
The mean PH values were ( 7.12±0.04 , 7.05±0.06 and 6.9±0.07)
in mild , moderate and severe HIE respectively compared to 7.35±0.02 in
control group . PH values were significantly lower in severe HIE than
mild & moderate as P1 = 0.000 and p 2 = 0.001 respectively. Mean BE
values were ( -12±1.5 mEq/l, -14.4±1.63 mEq/l and -18.5±4.79 mEq/l in
mild, moderate and severe HIE respectively compared to 1.79±0.56
mEq/l in control group, BE values were significantly higher in severe
HIE than mild & moderate as P1 = 0.000 and p 2 = 0.001 respectively.