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Volume 3, No. 1, Jan., 2002
Lipid Peroxidation In Hypoxic-Ischemic Encephalopathy
Nayera I. Attia*, Gamal S. Ali*, and Mohamed N. Mahmoud**
Institute of Postgraduate Childhood Studies (Medical Department)*, and Physiology Department, Faculty of Medicine**,Ain Shams University
AbstractIt is now becoming increasingly clear that oxygen free radicals (OFR) contribute to brain damage in hypoxic-ischemic and reperfusion brain injury. This damage is related to their ability to attack the fatty acid moiety of cellular membranes causing lipid peroxidation. This study was aming to detect the release of OFR in neonates with hypoxic-ischemic encephalopathy (HIE), to correlate between the extent of lipid peroxidation and the degree of brain damage and to demonstrate the correlation between OFR and biophysical profile, Apgar score and blood gases. This study included 80 neonates who were subdivided into two groups; patient group: comprised 40 neonates who suffered different grades of HIE (20 terms and 20 preterms) and control group: comprised 40 neonates who were apparantly healthy (20 terms, 20 preterms). Fetal assessment was done using biophysical profile. Neonatal assessment was performed using 1,5 and 10 minutes Apgar score and blood gases. The level of lipid peroxidation products was assessed by measuring malondialdehyde (MDA) at birth, at 24 hr and 48 hr after birth. Sarnat and Sarnat classification was used to determine the degree of hypoxic-ischemic encephalopathy.
The results of this study revealed that both term and preterm patient groups demonstrated a significant decrease in the biophysical profile values at one minute as well as at five and ten minutes Apgar score associated with significantly decreased PH, PO2 and HCO3 values and a significant increase in the PCO2 value, when compared to their controls, such changes were more prominent in the preterm patient group. MDA showed a highly significant increase in the hypoxic groups at birth, 24 and 48 hours after birth which was more encountered in preterm group. MDA level was significantly increased with worsening stage of hypoxic-ischemic encephalopathy. Negative significant correlation between MDA level and 1, 5, 10 minute Apgar score and PH was detected as well as a positive significant correlation between MDA and PCO2. Biophysical profile correlated negatively with MDA level in preterm patients at the three successive occasions.
In conclusion, oxygen free radicals were released in cases of HIE, their deleterious effect extends from birth to 48 hours after birth and the extent of their release is related to the severity of hypoxic insult. So, measuring lipid peroxidation products (MDA) could be considered as a sensitive indicator for the occurrence and severity of hypoxic-ischemic brain insult.
SCREENING FOR DEFICIENT ERYTHROPOIESIS IN PREGNANCY AND IT’S INFLUENCE ON FETAL IRON STATUS
Ahmed Nabil Eissa* , Ashraf Nabil Eissa**, Hesham Fakher ***Abstract
Aims: to determine effects of defective maternal erythropoiesis on fetal iron status.
Methods: iron, ferritin and hemoglobin concentration were measured in 250 cord/ maternal blood pairs.
145 were iron depleted and 105 were with normal iron stores.
Results: maternal iron depletion was associated with decreased cord ferritin. (195 versus 175 ug/l ) and hemoglobin (135 versus 156 gm/l).
Conclusion: maternal iron depletion is associated with reduced fetal iron stores but no change in free iron availability.Value of Lactate Dehydrogenase (LDH), Aspartate Aminotransferase (AST), and Total Creatine Kinase (TCK) in Predicting Sequel of Perinatal Asphyxia
Sahar M. Hassanein, Mohammed F. Moustafa, Hanna M Afify*, Maha M. S. Abdel Latif**, Lobna M. El-Houshy
Departments of Pediatrics and Clinical Pathology*, Ain Shams University. Department of Biochemistry**, National Research Center, Cairo, EgyptAbstract
Background: Hypoxic ischemic encephalopathy (HIE) of the neonate is an important cause of neonatal mortality and neurologic disabilities. Identification of infants at risk of HIE soon after birth is important if neuroprotective therapy is to be given.
Objective: To determine the diagnostic and prognostic values of serum lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and total creatine kinase (TCK), in infants with HIE.
Design/ Methods: A prospective controlled study was conducted on 68 infants; 38 infants with HIE and 30 controls. Inclusion criteria were: gestation age >30 wks and postnatal age <4 hours. Infants with congenital anomalies, liver, neuromuscular diseases, hemolytic disease, and inborn errors of metabolism were excluded. Perinatal asphyxia was defined in accordance to the AAP criteria 1992. HIE was diagnosed and classified according to Sarnat & Sarnat, 1976. Serum LDH, TCK, AST & cranial U/S were assessed early on enrollment <4 hours (A), and late at 72-96 hours of life (B). Clinical neurologic examination was done up to 6 months of life. Results were expressed in (mean + SD) U/l.
Results: Out of the 38 HIE infants, 11 had stage I, 15 had stage II, 5 had stage III and 7 had intraventrivular hemorhage (IVH) combined with HIE (HIE/IVH).Serum LDH(925.7+421.5), AST (51.7+19) & TCK (347.3+162.5)in asphyxiated nwonates were all significantly elevated compared to the control group (243.9+89.6U/L, 24.8+8U/L & 183.7+ 103.5 U/L, respectively), P<0.05. In asphyxiated neonates, all 3 enzyme levels remained elevated up to 96 hours (p>0.05 no difference compared to initial levels). All enzymes were negativelly correlated to each of : apgar scores (at 1 & 5 min), and cord blood values (pH and base deficit) (p<0.01). Also, each of the early samples of the enzymes correlated positively with its late sample, LHD (A) correlated positively with TCK (A) & (B) . LDH was significantly higher in infants with HIE/IVH (1227+413) compared to infants with HIE alone (748+334.6), p<0.01. TCK was significantly higher in severe HIE ;stage I (245+116), stage II (323+128) and stage III (553+205), p<0.001. Preterm with HIE (n=9) did not differ in enzyme levels at (A) & (B) except for TCK (B) was higher (955+501), compared to full term neonates with HIE (n=22) (663.3+192), p<0.05. All enzymes were elevated in the non-surviving asphyxiated infants (n=14) (LDH: 1001.7+393, AST: 57.1+20.9 & TCK: 390.7+185.8) compared to those who survived (n=24) (LDH: 876+440, AST: 48+17 & TCK: 319+142 ), P<0.05.
In asphyxiated neonates elevated enzymes early <4 hours have sensitivity of (93.3%) for LDH, (80%) for AST, and (90%) for TCK; specificity of (25%) for LDH, (50%) for AST, and (12.5%) for TCK positive predictive value of (82.4%) for LDH, (85%) for AST, and (79.4%) for TCK ; and negative predictive value of (50%) for LDH, (40%) for AST, and (25%) for TCK, for the presence of cerebral lesion in asphyxiated neonates.Conclusion: Serum LDH, AST & TCK are elevated in asphyxiated neonates. They are diagnostic for the occurrence of perinatal asphyxia. TCK is diagnostic for HIE, and LDH for IVH. Persistently elevated AST and/or TCK predict poor outcome, and mortality is expected to be high. The 3 enzymes when combined together might be helpful in predicting mortality as well as severity of the disease. Sensitivity of these enzymes for detecting brain lesion, is high however, they are not specific.
CIRCULATING NEUTROPHIL CONCENTRATION: IS IT A PREDICTOR OF RESPIRATORY DISTRESS SYNDROME IN PREMATURE NEONATES ?
Abdel Razek M.H. El Shiekh, Ahmed G.K. El Akhrs , Ahmed H. A. Sherif, *Nagwa. M. Shawky And Amany A. Ahmed
(Pediatric and *clinical pathology departments Faculty of Medicine, Zagazig University)ABSTRACT
To evaluate the relationship between neutrophil concentration in systemic
circulation of premature infants and respiratory distress syndrome (RDS), 150
low birth weight premature neonates were subjected to this work. They were classified according to the occurrence of respiratory distress into 2 groups; group I included 72 neonates who developed respiratory distress and group II included 54 neonates who did not develop respiratory distress . The remaining 24 preterm neonates were ruled out because they developed septicemia . All neonates were subjected to :Full clinical history taken, gestational age assessment , thorough clinical examination, complete blood count with differential count of blood collected from cord blood, and from neonates at 2 hours, 12 hours and one week after delivery, blood culture and chest X-ray. Echocardiography was done when indicated. Tracheal aspirates were taken from those neonates who required mechanical ventilation and stained with eosin and haematoxylin .
We have found that , there was a highly significant lower neutrophil concentration in distressed than in non distressed group at 2 hours (Mean 109/L + SD 1.95 + 1.3 versus 3.5 + 1.2 respectively P<0.001) and at 12 hours (Mean 109/L+ SD 2.83 +1.9 versus 3.66 +1.2 respectively P<0.001),while there was non significant difference in neutrophil concentration between distressed and non distressed groups at one week after birth (Mean 109/L + SD 4.0 + 3.2 versus 4.48+ 2.5 respectively P> 0.05) . Neutrophil concentration showed significant decrease at 2 hours after birth compared to cord blood in distressed group (1.95+ 1.3 x 109/L versus 3.1+ 1.7 x 109/L respectively P < 0.001 ) ,while there was no significant difference in non distressed group . Also, this work showed that within the distressed group the occurrence of neutropenia was associated with increase need of mechanical ventilation and increase rate of mortality .
We conclude that premature neonates with early neutropenia within the 1st 2 hours of life are more liable to develop severe RDS (provided that there are no other obvious known causes of neutropenia). We recommend further studies to support our results hoping that early neutropenia (which is measured by simple and inexpensive test) may be not only a predictor of RDS but also a prognostic marker.CALPROTECTIN: IS IT A NOVEL DIAGNOSTIC MARKER OF NEONATAL SEPTICEMIA ?
Abdel Razek M. El-Shiekh (MD); Mohgah M. Zeiwer* (MD);
Ali F. Zanaty* (MD); Amany M. El-Gohary* (MD) and Maggie M. Fawzy*
Pediatrics and Clinical Pathology* Departments, Faculty of Medicine, Zagazig UniversityABSTRACT
Diagnosis of neonatal septicemia still one of the most difficult diagnosis in
clinical medicine. Therefore, a novel and more sensitive marker is requested.
Searching for this marker, we wondered whether leucocyte calprotectin would be the candidate.
For this purpose, fifty full term neonates were subjected to this study. They were divided into 2 groups, the patients group which included 30 neonates with septicemia and the control group which included 20 healthy neonates. All neonates were subjected to full clinical history taking, thorough clinical examination, complete blood count, blood culture, C-reactive protein, phagocytosis assessment, degenerative index (DI) and leucocyte calprotectin assessment.
We have found that, phagocytic index (PI) in patients group was significantly lower than that of control group (mean + SD 1.57 + 0.98 versus 2.3 + 0.79 respectively, P<0.05). Also phagocytic percent (P%) in patients group was significantly lower than that of control group (mean + SD 25.2 + 8.3 versus 79.5 + 6.39) respectively, P<0.0001). On the other hand, DI in patients group was significantly higher than that of control group (43.1 + 23.7 versus 0.0 + 0.0 respectively, P<0.0001). Regarding immature / total neutrophil quotient (ITQ), the patients group had significantly higher level than the control group (mean + SD 0.21 + 0.04 versus 0.07 + 0.01 respectively, P<0.001). As regard leucocyte calprotectin total intensity score (CTIS), it was significantly higher in patients group compared to that of control group (181 + 15.05 versus 4.6 + 4.5 respectively, P<0.00001). In this study, 5 out of the 30 patients died, their calprotectin levels were higher than others.
In conclusion, this study shows that leucocyte calprotectin can be used as a novel diagnostic marker of neonatal septicemia, however, widely scaled studies are recommended to support our finding of using calprotectin not only as an early diagnostic but also as a prognostic novel marker in neonatal septicemia.
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