1
|
Reyes MP, Song I, Bhatt A. Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Mental Health and Suicide (1999-2021). Child Adolesc Ment Health 2024; 29:136-144. [PMID: 38525866 DOI: 10.1111/camh.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Limited studies have focused on recent trends in Asian American and Pacific Islander (AAPI) youth suicide. This study aimed to evaluate epidemiological trends in AAPI youth suicide and reports of depressive symptoms among Asian and Pacific Islander youth in the USA. METHODS This cross-sectional study analyzed mortality data from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and reports of depressive symptoms from the Youth Risk Behaviour Surveillance System (YRBSS). Data from 1999 to 2021 were analyzed for suicide rates and methods used among AAPI youth aged 5-24 years. YRBSS data from 1991 to 2021 were analyzed for depressive symptoms reported by Asian American (AA) 9th-12th graders. RESULTS From 1999 to 2021, 4747 AAPI youth died by suicide in the USA. Rates of suicide doubled from 3.6 to 7.1 per 100,000 during 1999-2021, with an increasing trend observed from 2014 onwards. The most common methods of suicide deaths in this population were suffocation, firearms and poisoning. Rates of suicide were higher among AA males than females, although more AA females reported depressive symptoms, including suicidal planning and attempts. CONCLUSION This study shows a concerning increase in suicide rates among AAPI youth over 1999-2021. Suffocation, firearms and poisoning were the most common methods used. While more AAPI males died by suicide, AA females reported higher rates of depressive symptoms. These findings highlight the urgent need for targeted prevention strategies and clinical interventions for this vulnerable population. The study also emphasizes the importance of addressing mental health stigma to improve reporting and support for Asian American, Native Hawaiian and Pacific Islander (AANHPI) youth.
Collapse
Affiliation(s)
- Miles P Reyes
- University of California Riverside, Riverside, CA, USA
| | - Ivy Song
- University of California Davis, Davis, CA, USA
| | | |
Collapse
|
2
|
Tsadik M, Legesse AY, Teka H, Abraha HE, Fisseha G, Ebrahim MM, Berhe B, Hadush MY, Gebrekurstos G, Ayele B, Tsegay H, Gebremeskel T, Gebremariam T, Hagos T, Gebreegziabher A, Muoze K, Mulugeta A, Gebregziabher M, Godefay H. Neonatal mortality during the war in Tigray: a cross-sectional community-based study. Lancet Glob Health 2024; 12:e868-e874. [PMID: 38614634 DOI: 10.1016/s2214-109x(24)00057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. METHODS A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. FINDINGS 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. INTERPRETATION Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. FUNDING UNICEF and United Nations Fund for Population Activities. TRANSLATION For the Tigrigna translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Mache Tsadik
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | - Awol Yemane Legesse
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Hospital Quality, Ayder Comprehensive Specialized Hospital, Mekelle University, Tigray, Ethiopia; Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Girmatsion Fisseha
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Bereket Berhe
- School of Medicine, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Martha Yemane Hadush
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Brhane Ayele
- Tigray Health Research Institute, Tigray, Ethiopia
| | - Haile Tsegay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| | - Tesfit Gebremeskel
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Abraha Gebreegziabher
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Kibrom Muoze
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Afewerk Mulugeta
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hagos Godefay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| |
Collapse
|
3
|
Mao Y, Lin X, Wu Y, Lu J, Shen J, Zhong S, Jin X, Ma J. Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study. Mol Autism 2024; 15:17. [PMID: 38600595 PMCID: PMC11007945 DOI: 10.1186/s13229-024-00596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that can significantly impact an individual's ability to socially integrate and adapt. It's crucial to identify key factors associated with ASD. Recent studies link both birth asphyxia (BA) and febrile seizures (FS) separately to higher ASD prevalence. However, investigations into the interplay of BA and FS and its relationship with ASD are yet to be conducted. The present study mainly focuses on exploring the interactive effect between BA and FS in the context of ASD. METHODS Utilizing a multi-stage stratified cluster sampling, we initially recruited 84,934 Shanghai children aged 3-12 years old from June 2014 to June 2015, ultimately including 74,251 post-exclusion criteria. A logistic regression model was conducted to estimate the interaction effect after controlling for pertinent covariates. The attributable proportion (AP), the relative excess risk due to interaction (RERI), the synergy index (SI), and multiplicative-scale interaction were computed to determine the interaction effect. RESULTS Among a total of 74,251 children, 192 (0.26%) were diagnosed with ASD. The adjusted odds ratio for ASD in children with BA alone was 3.82 (95% confidence interval [CI] 2.42-6.02), for FS alone 3.06 (95%CI 1.48-6.31), and for comorbid BA and FS 21.18 (95%CI 9.10-49.30), versus children without BA or FS. The additive interaction between BA and FS showed statistical significance (P < 0.001), whereas the multiplicative interaction was statistically insignificant (P > 0.05). LIMITATIONS This study can only demonstrate the relationship between the interaction of BA and FS with ASD but cannot prove causation. Animal brain experimentation is necessary to unravel its neural mechanisms. A larger sample size, ongoing monitoring, and detailed FS classification are needed for confirming BA-FS interaction in ASD. CONCLUSION In this extensive cross-sectional study, both BA and FS were significantly linked to ASD. The coexistence of these factors was associated with an additive increase in ASD prevalence, surpassing the cumulative risk of each individual factor.
Collapse
Affiliation(s)
- Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xindi Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yuhan Wu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayi Lu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xingming Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| |
Collapse
|
4
|
Bekele GG, Roga EY, Gonfa DN, Geda GM. Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia. BMJ Paediatr Open 2024; 8:e002403. [PMID: 38580447 PMCID: PMC11002380 DOI: 10.1136/bmjpo-2023-002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/20/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Birth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and predictors of mortality among newborns admitted with birth asphyxia are crucial to addressing this problem. As a result, the purpose of this study was to assess the incidence and predictors of mortality among neonates admitted with birth asphyxia to the neonatal intensive care units (NICUs) of West Shewa Zone Public Hospitals in Central Ethiopia. METHODS An institution-based retrospective cohort study was conducted among 760 asphyxiated neonates admitted to the NICUs of West Shewa Zone Public Hospitals between 30 March 2021 and 30 April 2023. The data were collected using CSEntry and analysed bu using Stata V.17. Bivariate and multivariate Cox proportional hazard regression analyses were carried out, and significant predictors were found using a 95% CI and a p<0.05. RESULTS A total of 760 asphyxiated neonates were followed for a total of 6880 neonatal days. At the end of follow-up, 263 (34.6%) of the neonates died (95% CI 31.3% to 38.1%), which resulted in a mortality incidence of 10.6/100 person-days of observation. Chewing khat (adjusted HR, AHR 2.21; 95% CI 1.13 to 4.31), home delivery (AHR 1.45, 95% CI 1.1 to 1.9), lack of antenatal care follow-up (AHR 1.44, 95% CI 1.08 to 1.89), hypothermia (AHR 1.56, 95% CI 1.12 to 2.17), hypoglycaemia (AHR 2.23, 95% CI 1.91 to 2.25) and obstructed labour (AHR 1.4, 95% CI 1.02 to 1.91) were found to be the significant predictors of neonatal mortality among asphyxiated neonates at a p≤0.05. CONCLUSION AND RECOMMENDATION The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Therefore, in order to significantly reduce the risks of birth asphyxia and subsequent newborn death, all interested stakeholders should take these predictors into consideration.
Collapse
|
5
|
Taye K, Kebede Y, Tsegaw D, Ketema W. Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia. BMC Pediatr 2024; 24:237. [PMID: 38570750 PMCID: PMC10988874 DOI: 10.1186/s12887-024-04689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it's contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS A hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05. RESULTS The magnitude of neonatal death was 14.2% (95% CI: 0.099-0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die. CONCLUSION The prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.
Collapse
Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- CEO at Makira Pediatrics and Child Health Specialty clinic, Hawassa, Sidama, Ethiopia
| | - Yenew Kebede
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tsegaw
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia.
| |
Collapse
|
6
|
Musa Obadia P, Pyana Kitenge J, Carsi Kuhangana T, Verpaele S, Ndala Nyongonyi A, Kayembe Kitenge T, Katoto PDM, Banza Lubaba Nkulu C, Nemery B. Hypoxaemia and risk of asphyxia during underground work in artisanal cobalt mines. Occup Med (Lond) 2024; 74:178-185. [PMID: 38332656 DOI: 10.1093/occmed/kqae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND More than half the cobalt needed for vehicle electrification originates from the southern part of the Democratic Republic of the Congo (DRC), with a substantial part being extracted by artisanal miners. AIMS To investigate oxygen saturation during underground work among cobalt artisanal miners. METHODS In a field survey, we measured oxygen saturation (SpO2) and heart rate by pulse oximetry in 86 miners from two underground mines and 24 miners from a surface mine at four different time points: before descent into the mine (T1), at 50 minutes in the mine (T2), upon leaving the shaft (T3), and 10 minutes after having left the mine (T4). RESULTS Miners working underground (-36 to -112 meters) were somewhat older (34.8 ± 6.7 years) than those working in the surface mine (32.0 ± 6.5 years), and they worked more hours daily (12.6 ± 1.2 hours) than controls (9.0 ± 0.0 hours). All participants had SpO2 >95% at T1 and T4. At T2, SpO2 dropped below 93% and 80% in 35% and 10% underground miners, respectively; SpO2 was still <93% at T3 in 13%. SpO2 remained stable among surface miners. Later, we showed that underground ambient oxygen levels decreased well below 21% in several pits. CONCLUSIONS Pulse oximetry revealed relevant hypoxaemia during underground work in a substantial proportion of artisanal miners. Such hypoxaemia without evidence of underlying cardiovascular disease is indicative of low ambient oxygen, due to insufficient mine ventilation. This may cause deaths from asphyxia. The hazards of low ambient oxygen in artisanal mines must be prevented by appropriate technical measures ensuring the supply of sufficient fresh air.
Collapse
Affiliation(s)
- P Musa Obadia
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - J Pyana Kitenge
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Département de Santé Publique, Faculté de Médecine, Unité de Santé au travail et Santé environnementale, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - T Carsi Kuhangana
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Ecole de Santé Publique, Université de Kolwezi, Kolwezi, Democratic Republic of Congo
| | - S Verpaele
- Belgian Center for Occupational Hygiene (BeCOH), 9052 Zwijnaarde, Belgium
| | - A Ndala Nyongonyi
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - T Kayembe Kitenge
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of Congo
| | - P D M Katoto
- Centre for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Expertise Centre on Mining Governance (CEGEMI), Bukavu, Democratic Republic of Congo
- Cochrane South Africa, Medical Council of South Africa, Cape Town 7505, South Africa
| | - C Banza Lubaba Nkulu
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - B Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| |
Collapse
|
7
|
Tangviriyapaiboon D, Thaineua V, Sirithongthaworn S, Kanshana S, Damrongtamwattana S, Prasitwattanaseree S, Srikummoon P, Thongsak N, Thumronglaohapun S, Traisathit P. Factors Associated with Suspected Developmental Delay in Thai Children Born with Low Birth Weight or Asphyxia. Matern Child Health J 2024; 28:631-640. [PMID: 37938440 DOI: 10.1007/s10995-023-03814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES The aim of the study was to identify factors associated with a risk of suspected developmental delay (SDD) in high-risk children in Thailand. METHODS We used data on children enrolled for developmental delay (DD) screening across Thailand collected by the Rajanagarindra Institute of Child Development, Department of Mental Health, Ministry of Public Health, Thailand. Children who were under 5 years of age with a birth weight of fewer than 2500 g and/or birth asphyxia in Thailand with high risk of DD were assessed using the Developmental Assessment for Intervention Manual (DAIM) between August 2013 and November 2019 (N = 14,314). RESULTS The high-risk children who had a gestational age at birth of < 37 weeks (adjusted odds ratio = 1.54; 95% confidence interval = 1.39-1.70) and/or had a birth weight < 2500 g (1.22; 1.02-1.45), or had mothers who were not government officers (1.46; 1.11-1.93), had a low education level (1.36; 1.19-1.55), had a poor nutritional status (1.34; 1.09-1.65), and/or who were living in a high-altitude area (1.59; 1.32-1.91) were at a higher risk of SDD. CONCLUSIONS FOR PRACTICE Children with a low birth weight and/or asphyxia during birth had a high risk of DD. SDD monitoring of children by community health workers and/or by developing outreach strategies, especially in underserved regions, should be considered. In addition, developing policies and guidelines, and intervention for high-risk children ought to be conducted to reduce the subsequent problems caused by the late detection of DD.
Collapse
Affiliation(s)
- Duangkamol Tangviriyapaiboon
- Rajanagarindra Institute of Child Development, Chiang Mai, Thailand
- Department of Mental Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Vallop Thaineua
- Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Siripon Kanshana
- Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Natthapat Thongsak
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | | | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
8
|
Tarvonen M, Markkanen J, Tuppurainen V, Jernman R, Stefanovic V, Andersson S. Intrapartum cardiotocography with simultaneous maternal heart rate registration improves neonatal outcome. Am J Obstet Gynecol 2024; 230:379.e1-379.e12. [PMID: 38272284 DOI: 10.1016/j.ajog.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Intrapartum cardiotocographic monitoring of fetal heart rate by abdominal external ultrasound transducer without simultaneous maternal heart rate recording has been associated with increased risk of early neonatal death and other asphyxia-related neonatal outcomes. It is unclear, however, whether this increase in risk is independently associated with fetal surveillance method or is attributable to other factors. OBJECTIVE This study aimed to compare different fetal surveillance methods and their association with adverse short- and long-term fetal and neonatal outcomes in a large retrospective cohort of spontaneous term deliveries. STUDY DESIGN Fetal heart rate and maternal heart rate patterns were recorded by cardiotocography during labor in spontaneous term singleton cephalic vaginal deliveries in the Hospital District of Helsinki and Uusimaa, Finland between October 1, 2005, and September 30, 2023. According to the method of cardiotocography monitoring at birth, the cohort was divided into the following 3 groups: women with ultrasound transducer, women with both ultrasound transducer and maternal heart rate transducer, and women with internal fetal scalp electrode. Umbilical artery pH and base excess values, low 1- and 5-minute Apgar scores, need for intubation and resuscitation, neonatal intensive care unit admission for asphyxia, neonatal encephalopathy, and early neonatal death were used as outcome variables. RESULTS Among the 213,798 deliveries that met the inclusion criteria, the monitoring type was external ultrasound transducer in 81,559 (38.1%), both external ultrasound transducer and maternal heart rate recording in 62,268 (29.1%), and fetal scalp electrode in 69,971 (32.7%) cases, respectively. The rates of both neonatal encephalopathy (odds ratio, 1.48; 95% confidence interval, 1.08-2.02) and severe acidemia (umbilical artery pH <7.00 and/or umbilical artery base excess ≤-12.0 mmol/L) (odds ratio, 2.03; 95% confidence interval, 1.65-2.50) were higher in fetuses of women with ultrasound transducer alone compared with those of women with concurrent external fetal and maternal heart rate recording. Monitoring with ultrasound transducer alone was also associated with increased risk of neonatal intubation for resuscitation (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A greater risk of severe neonatal acidemia was observed both in the ultrasound transducer (odds ratio, 2.78; 95% confidence interval, 2.23-3.48) and concurrent ultrasound transducer and maternal heart rate recording (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) groups compared with those monitored with fetal scalp electrodes. No difference in risk of neonatal encephalopathy was found between newborns monitored with concurrent ultrasound transducer and maternal heart rate recording and those monitored with fetal scalp electrodes. CONCLUSION The use of external ultrasound transducer monitoring of fetal heart rate without simultaneous maternal heart rate recording is associated with higher rates of neonatal encephalopathy and severe neonatal acidemia. We suggest that either external fetal heart rate monitoring with concurrent maternal heart rate recording or internal fetal scalp electrode be used routinely as a fetal surveillance tool in term deliveries.
Collapse
Affiliation(s)
- Mikko Tarvonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Janne Markkanen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Intensive and Intermediate Care Unit, Helsinki University Hospital, Helsinki, Finland
| | - Ville Tuppurainen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Helsinki University Hospital Area Administration, Helsinki, Finland
| | - Riina Jernman
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
9
|
Leković A, Vukićević A, Nikolić S. Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas. Forensic Sci Int 2024; 357:111973. [PMID: 38479057 DOI: 10.1016/j.forsciint.2024.111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression - fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical ('posterior) and atypical ('anterior' and 'lateral') hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models' parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron - Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical ('anterior' and 'lateral') hangings, compared to typical ('posterior') hangings.
Collapse
Affiliation(s)
- Aleksa Leković
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, Belgrade, Serbia
| | - Arso Vukićević
- Faculty of Engineering, University of Kragujevac, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, Belgrade, Serbia.
| |
Collapse
|
10
|
Lee KKY, Chattopadhyaya B, do Nascimento ASF, Moquin L, Rosa-Neto P, Amilhon B, Di Cristo G. Neonatal hypoxia impairs serotonin release and cognitive functions in adult mice. Neurobiol Dis 2024; 193:106465. [PMID: 38460800 DOI: 10.1016/j.nbd.2024.106465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024] Open
Abstract
Children who experienced moderate perinatal asphyxia (MPA) are at risk of developing long lasting subtle cognitive and behavioral deficits, including learning disabilities and emotional problems. The prefrontal cortex (PFC) regulates cognitive flexibility and emotional behavior. Neurons that release serotonin (5-HT) project to the PFC, and compounds modulating 5-HT activity influence emotion and cognition. Whether 5-HT dysregulations contribute to MPA-induced cognitive problems is unknown. We established a MPA mouse model, which displays recognition and spatial memory impairments and dysfunctional cognitive flexibility. We found that 5-HT expression levels, quantified by immunohistochemistry, and 5-HT release, quantified by in vivo microdialysis in awake mice, are reduced in PFC of adult MPA mice. MPA mice also show impaired body temperature regulation following injection of the 5-HT1A receptor agonist 8-OH-DPAT, suggesting the presence of deficits in 5-HT auto-receptor function on raphe neurons. Finally, chronic treatment of adult MPA mice with fluoxetine, an inhibitor of 5-HT reuptake transporter, or the 5-HT1A receptor agonist tandospirone rescues cognitive flexibility and memory impairments. All together, these data demonstrate that the development of 5-HT system function is vulnerable to moderate perinatal asphyxia. 5-HT hypofunction might in turn contribute to long-term cognitive impairment in adulthood, indicating a potential target for pharmacological therapies.
Collapse
Affiliation(s)
- Karen Ka Yan Lee
- Neurosciences Department, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Azrieli Research Center, Montréal, Canada
| | | | | | - Luc Moquin
- Department of Psychiatry, McGill University, Douglas Hospital Research Center, Canada
| | - Pedro Rosa-Neto
- Department of Psychiatry, McGill University, Douglas Hospital Research Center, Canada
| | - Bénédicte Amilhon
- Neurosciences Department, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Azrieli Research Center, Montréal, Canada.
| | - Graziella Di Cristo
- Neurosciences Department, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Azrieli Research Center, Montréal, Canada.
| |
Collapse
|
11
|
Mönkkönen A, Rajala K, Backman H, Keski-Nisula L. Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery. J Obstet Gynaecol Res 2024; 50:557-565. [PMID: 38168051 DOI: 10.1111/jog.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
AIM To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. METHODS The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. RESULTS The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91-10.97) and duration of ruptured fetal membranes (ORs 1.36-2.46), higher gestational age at birth (ORs 1.41-1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. CONCLUSIONS Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries.
Collapse
Affiliation(s)
- Arttu Mönkkönen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Kontiolahti Health Center, Siun Sote, Kontiolahti, Finland
| | - Katri Rajala
- Department of Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
| | - Heli Backman
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Wellbeing services county of North Savo, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Wellbeing services county of North Savo, Kuopio, Finland
| |
Collapse
|
12
|
Zhu H, Cai J, Liu H, Zhao Z, Chen Y, Wang P, Chen T, He D, Chen X, Xu J, Ji L. Trajectories tracking of maternal and neonatal health in eastern China from 2010 to 2021: A multicentre cross-sectional study. J Glob Health 2024; 14:04069. [PMID: 38515427 PMCID: PMC10958191 DOI: 10.7189/jogh.14.04069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background China's fertility policy has dramatically changed in the past decade with the successive promulgation of the partial two-child policy, universal two-child policy and three-child policy. The trajectories of maternal and neonatal health accompanied the changes in fertility policy are unknown. Methods We obtained data of 280 203 deliveries with six common pregnancy complications and thirteen perinatal outcomes between 2010 and 2021 in eastern China. The average annual percent change (AAPC) was calculated to evaluated the temporal trajectories of obstetric characteristics and adverse outcomes during this period. Then, the autoregressive integrated moving average (ARIMA) models were constructed to project future trend of obstetric characteristics and outcomes until 2027. Results The proportion of advanced maternal age (AMA), assisted reproduction technology (ART) treatment, gestational diabetes mellitus (GDM), anaemia, thrombocytopenia, thyroid dysfunction, oligohydramnios, placental abruption, small for gestational age (SGA) infants, and congenital malformation significantly increased from 2010 to 2021. However, the placenta previa, large for gestational age (LGA) infants and stillbirth significantly decreased during the same period. The AMA and ART treatment were identified as independent risk factors for the uptrends of pregnancy complications and adverse perinatal outcomes. The overall caesarean section rate remained above 40%. Importantly, among multiparas, a previous caesarean section was found to be associated with a significantly reduced risk of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), placenta previa, placental abruption, perinatal asphyxia, LGA infants, stillbirths, and preterm births. In addition, the ARIMA time series models predicted increasing trends in the ART treatment, GDM, anaemia, thrombocytopenia, postpartum haemorrhage, congenital malformation, and caesarean section until 2027. Conversely, a decreasing trend was predicted for HDP, PROM, and placental abruption premature, LGA infants, SGA infants, perinatal asphyxia, and stillbirth. Conclusions Maternal and neonatal adverse outcomes became more prevalent from 2010 to 2021 in China. Maternal age and ART treatment were independent risk factors for adverse obstetric outcomes. The findings offered comprehensive trajectories for monitoring pregnancy complications and perinatal outcomes in China, and provided robust intervention targets in obstetric safety. The development of early prediction models and the implementation of prevention efforts for adverse obstetric events are necessary to enhance obstetric safety.
Collapse
Affiliation(s)
- Hui Zhu
- Department of Internal Medicine, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Jie Cai
- Center for Reproductive Medicine, Ningbo Women and Children’s Hospital, Ningbo city, Zhejiang province, China
| | - Hongyi Liu
- School of Public Health, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Zhijia Zhao
- School of Public Health, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Yanming Chen
- Department of Medical Records and Statistics, Beilun People's Hospital, Ningbo city, Zhejiang province, China
| | - Penghao Wang
- School of Public Health, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Tao Chen
- School of Public Health, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Da He
- Department of Obstetrics and Gynecology, Yinzhou District Maternal and Child Health Care Institute, Ningbo city, Zhejiang province, China
| | - Xiang Chen
- Department of Obstetrics and Gynecology, Yinzhou District Maternal and Child Health Care Institute, Ningbo city, Zhejiang province, China
| | - Jin Xu
- School of Public Health, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| | - Lindan Ji
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China
| |
Collapse
|
13
|
Paudel PK, Bhandari P, Kc N, Devkota B. Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit. J Nepal Health Res Counc 2024; 21:373-379. [PMID: 38615206 DOI: 10.33314/jnhrc.v21i3.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal. METHODS This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma. RESULTS A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes. CONCLUSIONS Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome.
Collapse
Affiliation(s)
| | | | - Nawaraj Kc
- Department of Pediatrics, Province Hospital, Karnali
| | - Bibek Devkota
- Department of Anesthesia, Province Hospital, Karnali
| |
Collapse
|
14
|
Hu Y, Han L, Zhang H, Li W, Wu T, Ma J, Zhang D, Ma K, Xiao B, Yu Y, Xu H, Tian L, Liao X, Chen L. The down-regulation of STC2 mRNA may serve as a biomarker for death from mechanical asphyxia. Leg Med (Tokyo) 2024; 67:102382. [PMID: 38159418 DOI: 10.1016/j.legalmed.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Death from mechanical asphyxia (DMA) is a common cause of death in forensic pathology. However, due to the lack of biomarkers, the authentication of DMA now relies on a series of non-specific signs, which may cause troubles in the judicial trials, especially when the criminal scene is not fully elucidated. To search for the potential biomarkers for DMA, brain samples of DMA and craniocerebral injury groups were screened by microarray. The obtained mRNAs were validated by animal and human samples. Primary cell culture was conducted to explore the biochemical changes under hypoxia. 415 differentially expressed mRNAs between two groups were discovered. Ten mRNAs were examined in both human and animal samples died of different causes of death. Stanniocalcin-2 (STC2) showed significant down-regulation in DMA samples compared to other groups, regardless of PMI, age, or temperature. Cellular experiments indicated that ROS level peaked after 15-min-hypoxic culture, when the expression level of STC2 was significant down-regulated simultaneously. The ER-stress-related proteins also showed potential connection with STC2. In general, it is indicated that the down-regulation of STC2 may serve as a biomarker for DMA.
Collapse
Affiliation(s)
- Yikai Hu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Liujun Han
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Heng Zhang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China; Department of Pathology, Anhui Medical University, Hefei 230032, China
| | - Wencan Li
- Institute of Criminal Scientific Technology, Shanghai Municipal Public Security Bureau Pudong Branch, Shanghai 200125, China
| | - Tianpu Wu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Jianlong Ma
- Institute of Criminal Science and Technology, Investigation Department of Shenzhen Municipal Public Security Bureau, Key Laboratory of Forensic Pathology, Ministry of Public Security, Shenzhen 518040, China
| | - Dongchuan Zhang
- Forensic Lab, Criminal Science and Technology Institute, Shanghai Municipal Public Security Bureau, Shanghai 200082, China
| | - Kaijun Ma
- Forensic Lab, Criminal Science and Technology Institute, Shanghai Municipal Public Security Bureau, Shanghai 200082, China
| | - Bi Xiao
- Forensic Lab, Criminal Science and Technology Institute, Shanghai Municipal Public Security Bureau, Shanghai 200082, China
| | - Yangeng Yu
- Institute of Forensic Science, Guangdong Provincial Public Security Department, Key Laboratory of Forensic Pathology, Ministry of Public Security, Guangzhou 510050, China
| | - Hongmei Xu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Lu Tian
- Institute of Criminal Scientific Technology, Shanghai Municipal Public Security Bureau Pudong Branch, Shanghai 200125, China.
| | - Xinbiao Liao
- Institute of Forensic Science, Guangdong Provincial Public Security Department, Key Laboratory of Forensic Pathology, Ministry of Public Security, Guangzhou 510050, China.
| | - Long Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.
| |
Collapse
|
15
|
Hisamura W, Takasu S, Iwadate K. Usefulness of Heart-Type Fatty Acid-Binding Protein Measurement in Postmortem Urine Specimens. Am J Forensic Med Pathol 2024; 45:26-32. [PMID: 37994478 DOI: 10.1097/paf.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
ABSTRACT Heart-type fatty acid-binding protein (HFABP) is a 15-kDa substance reported to pass through the renal tubules and be renally excreted. Therefore, it is possible that its concentration in the urine collected postmortem may reflect antemortem blood levels. We measured the postmortem urine concentration of HFABP in 94 forensic autopsy cases and compared it between acute myocardial infarction (AMI), sepsis, heat stroke cases, and asphyxia cases as control cases to examine its diagnostic validity. Kidney tissue collected at autopsy was immunostained with antibodies against HFABP to evaluate the correlation with the urinary measurements. Urinary HFABP was significantly higher in AMI, sepsis, and heat stroke cases than in asphyxia cases. Quantitative immunostaining results showed no significant differences between any 2 groups. The usefulness of kidney immunostaining for HFABP in elucidating the cause of death was low. Two reasons may explain the lack of significant differences in kidney immunostaining: nonspecific leakage of tubular epithelial HFABP into the tubules because of postmortem changes and oliguria due to dehydration caused by heat stroke. In conclusion, the measurement of urinary HFABP may be useful in elucidating the cause of death; however, the kidney HFABP immunostaining was not significantly different from AMI.
Collapse
Affiliation(s)
- Waka Hisamura
- From the Department of Forensic Medicine, Jikei University School of Medicine: Tokyo Jikeikai Ika Daigaku, Tokyo, Japan
| | | | | |
Collapse
|
16
|
Fellman V. Biomarkers needed to discriminate early onset sepsis from asphyxia in newborn infants. Acta Paediatr 2024; 113:382-383. [PMID: 38196318 DOI: 10.1111/apa.17094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Vineta Fellman
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Children's Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
17
|
Abstract
ABSTRACT A study was undertaken at Forensic Science SA, Adelaide, South Australia, of all cases of homicide (January 2003-December 2022) where the victims' bodies had been concealed. Three hundred twenty-six homicides were identified, which included 27 cases where bodies had been deliberately hidden (8%) (age range, 2-82 years; ave, 34.9 years; M:F = 1.5:1). Deaths were due to blunt force trauma (n = 11), sharp force trauma (n = 4), asphyxia (n = 4), gunshot wound (n = 2), and a combination of drowning and asphyxia (n = 1). In 5 cases, the cause of death was not determinable. The methods of concealment (which were sometimes overlapping) included the following: dumping at a hidden/isolated location (n = 8), burial (n = 7), dismembering (n = 3), incinerating (n = 3), hiding in a wheeled garbage bin (n = 2), disposing in garbage resulting in the remains being located at waste disposal facilities (n = 2), hiding in a shed (n = 1), under a concrete floor (n = 1), in a suitcase (n = 1), in a river (n = 1), in a mine shaft (n = 1), and in a septic tank (n = 1). Although it has been asserted that concealed homicides are rarely encountered in forensic practice, the current study has demonstrated that the bodies in at least 8% of victims of homicide in South Australia have undergone some form of concealment.
Collapse
Affiliation(s)
- Roger W Byard
- From the Forensic Science SA and the School of Biomedicine, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
18
|
Handing G, Straneo M, Agossou C, Wanduru P, Kandeya B, Abeid MS, Annerstedt KS, Hanson C. Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda. Acta Obstet Gynecol Scand 2024; 103:590-601. [PMID: 38183308 PMCID: PMC10867390 DOI: 10.1111/aogs.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. MATERIAL AND METHODS This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. CLINICAL TRIAL Pan African Clinical Trial Registry 202006793783148. RESULTS Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). CONCLUSIONS There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.
Collapse
Affiliation(s)
- Greta Handing
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Manuela Straneo
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Christian Agossou
- Department of StatisticsCenter for Research in Human Reproduction and DemographyCotonouBenin
| | - Phillip Wanduru
- School of Public HealthMakerere University College of Health SciencesMulago KampalaUganda
| | - Bianca Kandeya
- Center for Reproductive HealthKamuzu University of Health SciencesChichiriMalawi
| | - Muzdalifat S. Abeid
- Department of Obstetrics and GynecologyAga Khan UniversityDar es SalaamTanzania
| | | | - Claudia Hanson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonEngland
| |
Collapse
|
19
|
Behera C, Chauhan M, Bijarnia M. Infant death resulting from sharing a cot with a 10-year-old boy. Med Leg J 2024; 92:54-56. [PMID: 32700631 DOI: 10.1177/0025817220930550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An infant may die from unintentional suffocation if their exhausted, or inebriated or sedated mothers fall asleep while breast feeding or just sharing a bed and roll over on to them. The mother wakes up to find the baby dead in the morning. Diagnosis is complex due to minuscule autopsy findings and denial by parents about overlaying although it was accidental. Unusually, in this case, the baby was "over layed" by a young male child from the same family. The female baby was found listless next morning by her mother and died after three months of treatment. Death circumstances, non-sudden outcome, and unusual circumstances of overlaying the baby.
Collapse
Affiliation(s)
- C Behera
- Government Medical College and Hospital, Chandigarh, India
| | - M Chauhan
- Government Medical College and Hospital, Chandigarh, India
| | - M Bijarnia
- Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
20
|
Farag MM, Khedr AAEHAER, Attia MH, Ghazal HAER. Role of Near-Infrared Spectroscopy in Monitoring the Clinical Course of Asphyxiated Neonates Treated with Hypothermia. Am J Perinatol 2024; 41:429-438. [PMID: 34965589 DOI: 10.1055/s-0041-1740513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. STUDY DESIGN Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. RESULTS Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. CONCLUSION NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. KEY POINTS · Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.. · Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.. · Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia..
Collapse
Affiliation(s)
| | | | - MennattAllah Hassan Attia
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | |
Collapse
|
21
|
Slaoui A, Cordier C, Lefevre-Morane E, Tessier V, Goffinet F, Le Ray C, Bourgeois-Moine A, Sibiude J, Laurent AC, Azria E. Impact of an e-learning training for interpreting intrapartum fetal heart rate monitoring to avoid perinatal asphyxia: A before-after multicenter observational study. J Gynecol Obstet Hum Reprod 2024; 53:102736. [PMID: 38278214 DOI: 10.1016/j.jogoh.2024.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Perinatal asphyxia, a condition that results from compromised placental or pulmonary gas exchange during the birth process, is rare but can lead to serious neonatal and long-term consequences. The visual analysis of cardiotocography (CTG) is designed to avoid perinatal asphyxia, but its interpretation can be difficult. Our aim was to test the impact of an e-learning training program for interpreting CTG on the rate of avoidable perinatal asphyxia at term. METHOD We conducted a retrospective multicenter before-after study comparing two periods, before and after the implementation of e-learning training program from July 1, 2016 to December 31, 2016, in CTG interpretation for midwives and obstetricians in five maternity hospitals in the Paris area, France. The training involved theoretical aspects such as fetal physiology and heart rhythm abnormalities, followed by practical exercises using real case studies to enhance skills in interpreting CTG. We included all term births that occurred between the "before" period (July 1 to December 31, 2014) and the "after period (January 1 to June 30, 2017). We excluded multiple pregnancies, antenatal detection of congenital abnormalities, breech births and all scheduled caesarean sections. Perinatal asphyxia cases were analyzed by a pair of experts consisting of midwives and obstetricians, and avoidability of perinatal asphyxia was estimated. The main criterion was the prevalence of avoidable perinatal asphyxia. RESULTS The e-learning program was performed by 83 % of the obstetrician-gynecologists and 65 % of the midwives working in the delivery rooms of the five centers. The prevalence of perinatal asphyxia was 0.45 % (29/7902 births) before the training and 0.54 % (35/7722) after. The rate of perinatal asphyxia rated as avoidable was 0.30 % of live births before the training and 0.28 % after (p = 0.870). The main causes of perinatal asphyxia deemed avoidable were delay in reactions to severe CTG anomalies and errors in the analysis and interpretation of the CTG. These causes did not differ between the two periods. CONCLUSION One session of e-learning training to analyze CTG was not associated with a reduction in avoidable perinatal asphyxia. Other types of e-learning, repeated and implemented over a longer period should be evaluated.
Collapse
Affiliation(s)
- Aziz Slaoui
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Paris 75014, France
| | - Cécile Cordier
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Paris 75014, France
| | - Emilie Lefevre-Morane
- Midwifery school of Baudelocque, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris FR-75006, France; Maternité Port-Royal, AP-HP, APHP Centre, Université Paris Cité, FHU PREMA, Paris 75014, France
| | - Véronique Tessier
- Maternité Port-Royal, AP-HP, APHP Centre, Université Paris Cité, FHU PREMA, Paris 75014, France
| | - François Goffinet
- Maternité Port-Royal, AP-HP, APHP Centre, Université Paris Cité, FHU PREMA, Paris 75014, France; CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France
| | - Camille Le Ray
- Maternité Port-Royal, AP-HP, APHP Centre, Université Paris Cité, FHU PREMA, Paris 75014, France; CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France
| | - Agnès Bourgeois-Moine
- Department of Obstetrics and Gynecology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, FHU PREMA, Paris, France
| | - Jeanne Sibiude
- Department of Obstetrics and Gynecology, AP-HP, Louis Mourier Hospital, FHU PREMA, Colombes, France; IAME UMR 1137, INSERM, Université de Paris, Paris, France
| | | | - Elie Azria
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Paris 75014, France; CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France.
| |
Collapse
|
22
|
Tambuzzi S, Crudele G, Maggioni L, Collini F, Tunesi S, Decarli A, Russo AG, Cattaneo C. Are autopsies on minors a taboo?: The experience of Milan in a 19-year retrospective study. Int J Legal Med 2024; 138:639-649. [PMID: 37934209 PMCID: PMC10861724 DOI: 10.1007/s00414-023-03114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
Forensic autopsy is an important tool for the proper management of non-natural deaths in minors. However, it seems that autopsy in minors is a practice which may not be performed routinely. In this framework, we conducted a study analyzing autopsies of minors (under 18 years of age in Italy) performed at the Institute of Forensic Medicine in Milan in the period 2001-2019. For the period 2015-2019, we extrapolated all deaths due to non-natural causes in minors to investigate how many and which of these deaths were not subjected to forensic autopsy. Of the total, 344 minors (235 males and 109 females) underwent autopsies, with an overall downward trend of about 80% since 2004. Most autopsies occurred between the ages of 0 and 1 year, and the fewest between the ages of 5 and 9 years. The place of death was home in most cases, and accidental death was most common, followed by natural death, suicide, and homicide, with prevalence varying by age group. Blunt force trauma predominated among accidental death in all age groups, followed by asphyxia. Similar findings were observed for suicides, although there was a more differentiated pattern for suicides between the ages of 15 and 17 years. Among homicides, blunt force trauma, asphyxia, and gunshot wounds were fairly evenly distributed across all age groups. Between 2015 and 2019, a total of 86 minors died of a non-natural cause, and a forensic autopsy was performed in only 33 cases (38%). Our data shows that fewer and fewer autopsies are being performed over the last years, which indicates a dangerous lack of forensic investigation of children and adolescent deaths, with enormous implications for prevention of child abuse.
Collapse
Affiliation(s)
- Stefano Tambuzzi
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy.
| | - Graziano Crudele
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
| | - Lidia Maggioni
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
| | - Federica Collini
- Department of Health Sciences, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Sara Tunesi
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Adriano Decarli
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | | | - Cristina Cattaneo
- Department of Biomedical Sciences for Health, Institute of Forensic Medicine, University of Milan, Luigi Mangiagalli Street, 37, 20133, Milan, Italy
| |
Collapse
|
23
|
Zhao S, Jiang H, Miao Y, Liu W, Li Y, Liu H, Wang A, Cui X, Zhang Y. Factors influencing necrotizing enterocolitis in premature infants in China: a systematic review and meta-analysis. BMC Pediatr 2024; 24:148. [PMID: 38418993 PMCID: PMC10903018 DOI: 10.1186/s12887-024-04607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a multifactorial gastrointestinal disease with high morbidity and mortality among premature infants. However, studies with large samples on the factors of NEC in China have not been reported. This meta-analysis aims to systematically review the literature to explore the influencing factors of necrotizing enterocolitis in premature infants in China and provide a reference for the prevention of NEC. METHODS PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang and VIP databases were systematically searched from inception to February 2023. We used Stata14.0 software to perform the systematic review and meta-analysis. We used fixed or random effects models with combined odds ratios (ORs) and 95% confidence intervals (CIs), and quality was evaluated using the Newcastle‒Ottawa Scale (NOS). RESULTS The total sample was 8616 cases, including 2456 cases in the intervention group and 6160 cases in the control group. It was found that 16 risk factors and 3 protective factors were related to necrotizing enterocolitis in premature infants. Septicemia (OR = 3.91), blood transfusion (OR = 2.41), neonatal asphyxia (OR = 2.46), pneumonia (OR = 6.17), infection (OR = 5.99), congenital heart disease (OR = 4.80), intrahepatic cholestasis of pregnancy (ICP) (OR = 2.71), mechanical ventilation (OR = 1.44), gestational diabetes mellitus (GDM) (OR = 3.08), respiratory distress syndrome (RDS) (OR = 3.28), hypoalbuminemia (OR = 2.80), patent ductus arteriosus (PDA) (OR = 3.10), respiratory failure (OR = 7.51), severe anemia (OR = 2.86), history of antibiotic use (OR = 2.12), and meconium-stained amniotic fluid (MSAF) (OR = 3.14) were risk factors for NEC in preterm infants in China. Breastfeeding (OR = 0.31), oral probiotics (OR = 0.36), and prenatal use of glucocorticoids (OR = 0.38) were protective factors for NEC in preterm infants. CONCLUSIONS Septicemia, blood transfusion, neonatal asphyxia, pneumonia, infection, congenital heart disease, ICP, GDM, RDS, hypoproteinemia, PDA, respiratory failure, severe anemia, history of antibiotic use and MSAF will increase the risk of NEC in premature infants, whereas breastfeeding, oral probiotics and prenatal use of glucocorticoids reduce the risk. Due to the quantity and quality of the included literature, the above findings need to be further validated by more high-quality studies.
Collapse
Affiliation(s)
- Shuliang Zhao
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
- Nursing Department Affiliated Hospital of Shandong Second Medical University, Weifang, 261031, China
| | - Huimin Jiang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, 100071, China
| | - Wenwen Liu
- Xiangya School of Nursing, Central South University, Changsha, 410000, China
| | - Yanan Li
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Hui Liu
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Aihua Wang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China.
| | - Xinghui Cui
- Nursing Department Affiliated Hospital of Shandong Second Medical University, Weifang, 261031, China.
| | - Yuanyuan Zhang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| |
Collapse
|
24
|
Gizachew S, Wogie G, Getnet M, Lonsako AA. Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023. BMC Pediatr 2024; 24:142. [PMID: 38413908 PMCID: PMC10898049 DOI: 10.1186/s12887-024-04627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/07/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia. METHOD A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables. RESULTS The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia. CONCLUSIONS In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.
Collapse
Affiliation(s)
- Shewazerf Gizachew
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hossaina, Ethiopia
| | - Girma Wogie
- School of Nursing and Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mekasha Getnet
- School of Nursing and Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Arega Abebe Lonsako
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia.
| |
Collapse
|
25
|
Yadav DP, Kumar V, Gupta MK. Birth Asphyxia among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2024; 62:68-71. [PMID: 38409988 PMCID: PMC10924504 DOI: 10.31729/jnma.8429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Birth asphyxia causes significant morbidity and mortality among neonates, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to find the prevalence of birth asphyxia among neonates admitted to the neonatal intensive care unit of a tertiary care hospital. Methods This descriptive cross-sectional study was conducted among neonates at a tertiary care hospital between 15 January 2022 to 14 January 2023 after obtaining ethical approval from the Institutional Review Committee. Neonates with gestational age ≥35 weeks were included and those with major congenital anomalies were excluded. A convenience sampling method was used. A point estimate was calculated at a 95% Confidence Interval. Results Among 902 neonates, 120 (13.30%) (11.08-15.52, 95% Confidence Interval) had birth asphyxia. A total of 108 (90%) were outborn, and 84 (70%) were males. HIE stage-I, II and III were seen in 47 (39.17%), 64 (53.33%) and 9 (7.50%) of the asphyxiated neonates respectively. Poor suck 92 (76.67%), seizures 73 (60.83%) and lethargy 70 (58.33%) were common abnormal neurological findings. Death occurred in 15 (12.50%) neonates in the hospital. Conclusions The prevalence of birth asphyxia was found to be similar to other studies done in similar settings. The high burden underscores an urgent need to implement better perinatal care and delivery room management practices. Keywords hypoxic-ischemic encephalopathy; neonates; prevalence.
Collapse
Affiliation(s)
- Dhirendra Prasad Yadav
- Department of Pediatrics, National Medical College Teaching Hospital, Birgunj, Parsa, Nepal
| | - Vivek Kumar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Manoj Kumar Gupta
- Department of Pediatrics, National Medical College Teaching Hospital, Birgunj, Parsa, Nepal
| |
Collapse
|
26
|
Garstang JJ, Menka M. Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events? BMJ Paediatr Open 2024; 8:e002419. [PMID: 38316470 PMCID: PMC10860092 DOI: 10.1136/bmjpo-2023-002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death determined at multiprofessional case conference. Detailed evidence on sleep arrangements is available for most cases potentially leading to more being identified as due to accidental suffocation. SUDI remaining unexplained following investigation are classified as SIDS (sudden infant death syndrome) or unspecified deaths.Our objective was to determine whether detailed SUDI investigation has led to an increase in deaths classified as accidental suffocation or strangulation in bed (ASSB)? METHODS We obtained official mortality data for England and Wales for infants dying aged 0-364 days for International Statistical Classification of Diseases and Related Health Problems, 10th revision codes R95 (SIDS), R96, R98, R99 (unspecified causes of mortality) and W75 (ASSB) for the years 2000-2019.We calculated the mortality rate for ASSB, SIDS and unspecified causes based on total live births each year. RESULTS Unexplained SUDI decreased from 353 in 2000 to 175 in 2019, with the mortality rate falling from 0.58 to 0.29 per 1000 live births. The total postneonatal mortality rate fell during this time from 1.9 to 0.9 per 1000 live births suggesting this is a genuine fall. SIDS accounted for 70% of unexplained SUDI in 2000 falling to 49% in 2020 with a corresponding increase in R99 unspecified deaths.Few deaths were recorded as ASSB (W75), ranging between 4 in 2010 and 24 in 2001. The rate for ASSB ranged from 0.6 to 4.0 per 100000 live births. CONCLUSIONS There is a shift away from SIDS (R95) towards unspecified causes of death (R96, R98, R99). Improved investigation of deaths has not led to increased numbers of death identified as due to ASSB. There needs to be clear guidelines on accurate classification of deaths from ASSB to facilitate learning from deaths and inform prevention efforts.
Collapse
Affiliation(s)
- Joanna Jane Garstang
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK
| | - Marivjena Menka
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
27
|
Parekh V, Brkic A, McMinn J, Williams D, Van Diemen J. Non-fatal strangulation versus general assault in a clinical forensic medicine cohort: Characteristics of patient, perpetrator and presentation. J Forensic Leg Med 2024; 102:102651. [PMID: 38364447 DOI: 10.1016/j.jflm.2024.102651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Interpersonal violence impacts communities, victims, perpetrators, families, and children. This audit of 315 cases of non-sexual assault compares characteristics of general assault to those of non-fatal strangulation (NFS). METHOD Clinical review of all cases referred to Clinical Forensics Australian Capital Territory (CFACT) by ACT Policing between 2018 and 2022, following allegations of non-sexual assault. Descriptions of the model of care, victim characteristics, alleged perpetrators, and presentations in NFS versus general assault, from forensic medical examination. RESULTS Patients: Of 315 cases, 170 were victims of NFS, females (153/170, 90%), males 16/170 (9%), and one person with another preferred term. General assault cases comprised 145/315 (46%) presentations, 69/145 (47.6%) patients being female, 76/145 (52.4%) male. A majority of individuals who experienced NFS 113/170 (66%) presented within 12 h of the events, 41% of victims thought they might die during the NFS. Perpetrators: Most NFS perpetrators were male (161/170: 95%), NFS was mostly perpetrated by a partner 104/170 (62%), ex-partner 35/170 (21%), or family member 17/170 (10%). Repeated assaults by the same perpetrator was common 109/170 (64%). Children were present in 48/170 (28%) cases of NFS. DISCUSSION NFS is gendered violence overwhelmingly affecting women, many experience NFS repeatedly. Later presentation may affect clinical signs, symptoms, and evidence collection. Forensic medicine management of NFS provides an opportunity to effect change, especially in those who thought they may die during the attack. Intervention to prevent trauma in children may be enabled by reporting their presence during an assault. Twenty-four-hour service provision enables both clinical and forensic assessment following NFS. CONCLUSIONS NFS is gendered, mostly affecting women, occurs in a family violence context, perpetrated by current and/or ex-partners, and often occurs with children present. Clinical forensic medicine doctors can provide care and support, provide referrals, and collect forensic medical evidence to support legal process.
Collapse
Affiliation(s)
- Vanita Parekh
- Clinical Forensic Medical Services, Canberra Health Services, Yamba Drive Garran, Australian Capital Territory, Australia; School of Medicine and Psychology, Australian National University, Canberra Hospital Campus, Australian Capital Territory, Australia.
| | - Anna Brkic
- Clinical Forensic Medical Services, Canberra Health Services, Yamba Drive Garran, Australian Capital Territory, Australia.
| | - Janine McMinn
- Clinical Forensic Medical Services, Canberra Health Services, Yamba Drive Garran, Australian Capital Territory, Australia.
| | - David Williams
- Family Violence & Vulnerable Persons, ACT Policing, Australian Capital Territory, Australia.
| | - Jane Van Diemen
- Clinical Forensic Medical Services, Canberra Health Services, Yamba Drive Garran, Australian Capital Territory, Australia; School of Medicine and Psychology, Australian National University, Canberra Hospital Campus, Australian Capital Territory, Australia
| |
Collapse
|
28
|
Camatti J, Galliani I, Cirnelli A, Cecchi R. Drug-facilitated sexual assault followed by femicidal chloroform poisoning and suffocation: A case-report of criminal responsibility. Leg Med (Tokyo) 2024; 66:102356. [PMID: 37980883 DOI: 10.1016/j.legalmed.2023.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Criminal responsibility evaluation represents one of the most controversial and debated issues in forensic psychiatry. Although clear procedures have been recommended, little research exists on decision-making process by forensic psychiatrists. We present a case assessing the criminal responsibility of a murderer who committed femicide as a result of chloroform poisoning and suffocation after a drug-facilitated sexual assault. MATERIALS AND METHODS A.S., a 30-year-old female, was found dead in the home of S.P., a 50-year-old male. S.P. recounted killing A.S. by forced inhalation of chloroform, when the woman had experienced sensory clouding following unintentional ingestion of Zolpidem, a hypnotic agent. A multidisciplinary approach was taken to resolve the case. Autopsy, histological, genetic, and toxicological examinations were performed by a forensic pathologist, while a digital forensic examiner analysed electronic devices. A pool of three forensic psychiatrists and two psychologists was asked to assess the mental state of S.P. at the time of the crime. RESULTS AND CONCLUSIONS The cause of death of A.S. was identified as a lethal chloroform intoxication in altered consciousness caused by Zolpidem, while homicidal suffocation was also described. Mobile forensics demonstrated that S.P. had videotaped the crime scene, clearly revealing that A.S. had been sexually assaulted by S.P. before dying. Criminal responsibility of S.P. was evaluated through various psychological tests and seven interviews with the accused, each lasting an average of 180 min. Specialists concluded that S.P. could not be exempted from being responsible for the homicide.
Collapse
Affiliation(s)
| | | | - Antonello Cirnelli
- Medical Office Located in Via G.B. Vico 12 in Portogruaro, Venice, Italy.
| | | |
Collapse
|
29
|
Dervišević E, Katica M, Mašić E, Čamdžić N, Ajanović Z, Dervišević L, Salihbegović A, Sarajlić N. Bone and Tooth: Substrates for determining Drowning: A new diagnostic procedure in forensic medicine Practice? Leg Med (Tokyo) 2024; 66:102366. [PMID: 38039660 DOI: 10.1016/j.legalmed.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Diatom tests are rarely used during autopsy to confirm drowning as the cause of death (COD) because of limitations of the current literature involving these techniques. Instead, experts rely on physical examination by the pathologist. Due to interpretive concerns regarding Diatom tests, they are often insufficient in establishing a diagnosis, but offer the potential to be an extremely useful diagnostic tool with further understanding. The aim of study is to optimize "Diatom Tests" for use in forensic medicine in Bosnia and Herzegovina. METHODS A randomized prospective experimental study was conducted, using albino Wistar rat models (Rattus norvegicus), at the Veterinary Facility, University of Sarajevo. Thirty-two adult albino rats, were used and distributed into groups as follows: Group A (6 deceased rats with COD other than drowning, but due to mechanical asphyxia, which were then submerged for 1 h after death); Group B (6 deceased rats with COD other than drowning, but due to mechanical asphyxia, which were then submerged for 72 h after death); Group C (6 rats that were immediately autopsied after drowning, with COD determined as drowning); Group D (6 rats that underwent a 48-hour postmortem period after drowning); Group E (COD: drowning, post-mortem 72hrs after death, remained submerged in water until PM). Live algological material was collected for the research of the systematics of algae from the Bosna river, Sarajevo, and transported to the University of Sarajevo (Department of Biology, Faculty of Science). Periphyllon, epiphyllon and epipelon were used to collect phytobenthos. The material was fixed with 4% formalin solution. Laboratory processing of diatoms was performed using the methods described by Hustedt (16). In the process of obtaining pure diatom valves, part of the material is digested with potassium permanganate (KMnO4), sulfuric acid (H2SO4), and oxalic acid (C2H2O4). In the next step, the cleaned diatom valves were mounted in Canadian balsam. A light microscope under 1000x magnification (Best Scope 2020) was used to evaluate and analyze the species. The identification of diatoms was performed using the reference of Cantonati et al (17). The nomenclature of diatom species was performed according to Guiry & Guiry's worldwide electronic internet database. RESULTS No diatoms were found in Groups A and B. However, Navicula sp. and Sellaphora sp. cf., were discovered during bone analysis of Group C where rats were immediately autopsied after drowning. Hantzschia amphioxus taxon was present in Group D, which underwent a 48-hour postmortem period after drowning and before samples were taken. In Groups C and D, where drowning was the COD, Diatoma vulgaris i Pinnularia major, Achnanthidium minutissimum i Melosira varians were present in the tooth samples. CONCLUSION Optimization of the "Diatom Test" method could potentially lead to its future use as a routine method within experimental settings. This experimental study is a starting point that guides forenscic medicine pracitioners towards the optimization of tests and sampling in cases of unexplained etiology, where preserved soft tissue structures is not available. In these cases, teeth and bones serve as accessible materials for diagnosing COD, alongside standardized nonspecific findings in the absence of organs for micro- and macroanalysis.
Collapse
Affiliation(s)
- Emina Dervišević
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
| | - Muhamed Katica
- Veterinary Clinical Pathology, Veterinary Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ermin Mašić
- Department of Biology, Faculty of Science, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nina Čamdžić
- Department of Pathology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zurifa Ajanović
- Department of Human Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lejla Dervišević
- Department of Human Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Adis Salihbegović
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermin Sarajlić
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
30
|
Kebede BF, Biyazin Tesfa T, Yetwale Hiwot A, Mulu KK, Adugnaw E, Mihretu E, Sewmehone E, Genie YD. Time to death and predictors of mortality among asphyxiated neonates in southwest Ethiopia, 2022: prospective cohort study. BMJ Open 2024; 14:e077943. [PMID: 38238169 PMCID: PMC10806697 DOI: 10.1136/bmjopen-2023-077943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE This study aimed to determine the time to death and predictors of mortality among asphyxiated neonates admitted to public hospitals in the southwest region of Ethiopia. DESIGN An institution-based prospective cohort study was conducted. SETTING Public hospitals in southwest Ethiopia. PARTICIPANTS A total of 144 asphyxiated neonates, who were admitted to the neonatal intensive care unit, and their mothers participated from March 2022 to 30 September 2022. Data were entered into EpiData V.4.4.2.1 and exported to STATA V.16 for analysis. The Cox proportional hazards model using bivariate (p<0.25) and multivariate (p<0.05) analyses was used to identify the predictors of mortality. The median survival time was estimated using Kaplan-Meier survival estimates. PRIMARY OUTCOME Time to death from asphyxia and its predictors in neonates. RESULTS The mortality incidence rate of asphyxiated neonates was 9.1 deaths per 1000 person-days of observation (95% CI: 7.11 to 11.52) with a median survival time of 8 days, and 45.83% (95% CI: 37.81% to 54.08%) of asphyxiated neonates died. Being male (adjusted HR (AHR) 0.32 (95% CI: 0.14 to 0.76)), neonatal sepsis (AHR 0.321 (95% CI: 0.13 to 0.77)), not receiving kangaroo mother care (AHR 0.16 (95% CI: 0. 07 to 0.39)) and vaginal delivery (AHR 0.39 (95% CI: 0.16 to 0.95)) were independent predictors of mortality of asphyxiated neonates. CONCLUSIONS In this study, asphyxiated neonates had a higher incidence of mortality with a median survival time of only 8 days. Being male, vaginal delivery, not receiving kangaroo mother care and comorbidities such as neonatal sepsis were independent predictors of mortality among asphyxiated neonates. Therefore, healthcare providers and other stakeholders should provide timely initiation of advanced diagnosis and appropriate therapeutic interventions for neonates with asphyxia to reduce neonatal mortality.
Collapse
Affiliation(s)
| | | | | | | | - Emebet Adugnaw
- Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Esmelalem Mihretu
- Pediatrics and Child Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | |
Collapse
|
31
|
Wortinger LA, Stavrum AK, Shadrin AA, Szabo A, Rukke SH, Nerland S, Smelror RE, Jørgensen KN, Barth C, Andreou D, Weibell MA, Djurovic S, Andreassen OA, Thoresen M, Ursini G, Agartz I, Le Hellard S. Divergent epigenetic responses to perinatal asphyxia in severe mental disorders. Transl Psychiatry 2024; 14:16. [PMID: 38191519 PMCID: PMC10774425 DOI: 10.1038/s41398-023-02709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Epigenetic modifications influenced by environmental exposures are molecular sources of phenotypic heterogeneity found in schizophrenia and bipolar disorder and may contribute to shared etiopathogenetic mechanisms of these two disorders. Newborns who experienced perinatal asphyxia have suffered reduced oxygen delivery to the brain around the time of birth, which increases the risk of later psychiatric diagnosis. This study aimed to investigate DNA methylation in blood cells for associations with a history of perinatal asphyxia, a neurologically harmful condition occurring within the biological environment of birth. We utilized prospective data from the Medical Birth Registry of Norway to identify incidents of perinatal asphyxia in 643 individuals with schizophrenia or bipolar disorder and 676 healthy controls. We performed an epigenome wide association study to distinguish differentially methylated positions associated with perinatal asphyxia. We found an interaction between methylation and exposure to perinatal asphyxia on case-control status, wherein having a history of perinatal asphyxia was associated with an increase of methylation in healthy controls and a decrease of methylation in patients on 4 regions of DNA important for brain development and function. The differentially methylated regions were observed in genes involved in oligodendrocyte survival and axonal myelination and functional recovery (LINGO3); assembly, maturation and maintenance of the brain (BLCAP;NNAT and NANOS2) and axonal transport processes and neural plasticity (SLC2A14). These findings are consistent with the notion that an opposite epigenetic response to perinatal asphyxia, in patients compared with controls, may contribute to molecular mechanisms of risk for schizophrenia and bipolar disorder.
Collapse
Affiliation(s)
- Laura A Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Alexey A Shadrin
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Attila Szabo
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | | | - Stener Nerland
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Runar Elle Smelror
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dimitrios Andreou
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Melissa A Weibell
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Srdjan Djurovic
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Marianne Thoresen
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Gianluca Ursini
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
32
|
Berber Çiftci H, Topbaş S, Taştekin A. Effect of Nonnutritive Sucking on Oral Feeding in Neonates With Perinatal Asphyxia: A Randomized Controlled Trial. Am J Speech Lang Pathol 2024; 33:406-417. [PMID: 38039979 DOI: 10.1044/2023_ajslp-23-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
AIMS The effect of nonnutritive sucking (NNS) stimulation is unclear in infants with perinatal asphyxia. Thus, the aim of this study was to assess the effect of NNS stimulation on oral intake, discharge time, and early feeding skills in infants with perinatal asphyxia. DESIGN A randomized controlled study was conducted. METHOD Of the 94 infants, 47 were included in the experimental group and given NNS stimulation once a day before tube feeding by a speech-language therapist (SLT) in addition to hypothermia treatment. Infants' feeding performances on the days of first oral intake and discharge were evaluated with the Early Feeding Skills Scale (EFS). RESULTS The time from tube feeding to oral intake was significantly lower in the experimental group compared to the control group (p < .05). EFS scores at discharge were significantly higher in the experimental group than in the control group (p < .05). There was no significant difference between the experimental and control groups in terms of discharge and weight gain (p > .05). CONCLUSIONS The findings indicated that the NNS stimulation positively affected oral intake and early feeding skills in infants with perinatal asphyxia, as in preterms. However, NNS stimulation had no significant effect on discharge and weight gain in infants with asphyxia. This finding may be attributed to other factors. It is recommended to use NNS by an SLT in a neonatal intensive care unit within a multidisciplinary team to accelerate the transition to oral feeding and improve feeding skills in infants with perinatal asphyxia. Further studies on the effect of NNS stimulation in infants with perinatal asphyxia are needed to corroborate its effects on discharge time and weight gain.
Collapse
Affiliation(s)
- Hilal Berber Çiftci
- Department of Speech and Language Therapy, Graduate School of Health Sciences, Istanbul Medipol University, Turkey
- Department of Speech and Language Therapy, School of Health Sciences, Tarsus University, Mersin, Turkey
| | - Seyhun Topbaş
- Department of Speech and Language Therapy, Graduate School of Health Sciences, Istanbul Medipol University, Turkey
| | - Ayhan Taştekin
- Department of Neonatology, International School of Medicine, İstanbul Medipol University, Turkey
| |
Collapse
|
33
|
Giri A, Yadav SK, Shah VK. Acute Kidney Injury among Neonates with Perinatal Asphyxia in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2024; 62:13-16. [PMID: 38410009 PMCID: PMC10924489 DOI: 10.31729/jnma.8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 02/28/2024] Open
Abstract
Introduction Perinatal asphyxia is a very common cause of morbidity and mortality in both term and preterm neonates and ranks the second most important cause of neonatal death. The incidence and importance of acute kidney injury in the neonatal period are becoming increasingly apparent. Early diagnosis and timely management of acute kidney injury is very important in these newborns to avoid other long-term adverse events. This study aimed to find out the prevalence of acute kidney injury among neonates with perinatal asphyxia in a tertiary care centre. Methods A descriptive cross-sectional study was conducted at the neonatal intensive care unit and nursery in a tertiary care hospital of Eastern Nepal from 1 November 2021 to 31 October 2022 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 97 neonates, the prevalence of acute kidney injury was seen among 60 (61.86%) (50.25-69.75, 95% Confidence Interval) neonates. Out of which 42 (70%) were males and 18 (30%) were female. Conclusions The prevalence of acute kidney injury among neonates with perinatal asphyxia was found to be higher than other studies done in a similar setting. Keywords acute kidney injury; neonates; prevalence.
Collapse
Affiliation(s)
- Arun Giri
- Department of Paediatrics, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Sunil Kumar Yadav
- Department of Paediatrics, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Vijay Kumar Shah
- Department of Paediatrics, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| |
Collapse
|
34
|
Harruff RC, Johnston R, Lubin M, Perera ULMS. Analysis of female strangulation homicides in King County, Washington, from 1978 to 2022. J Forensic Sci 2024; 69:199-204. [PMID: 37753824 DOI: 10.1111/1556-4029.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
Asphyxia due to strangulation is an uncommon but important modality of homicide that tends to disproportionately involve female victims. The present study was designed to investigate the circumstances, motivations, and injuries associated with strangulation homicides of females and to measure trends in incidence over time. Electronic records of the King County Medical Examiner's Office in Seattle, Washington, were used to compile a data set of all homicides in King County from 1995 through 2022. A second data set of female homicides due to strangulation was constructed with additional records prior to 1995, supplemented with data abstracted from autopsy reports, and linked to the Washington Attorney General's Office Homicide Investigation Tracking System database. This comprehensive data set was used to analyze demographics, circumstances, motives, and injuries of female strangulation homicides from 1978 through 2016. The results found that, from 1995 through 2022, females accounted for 22.8% of 2394 homicides but 80.3% of strangulation homicides. The average annual rate of all strangulation homicides decreased until 2020. Mean ages of female decedents were 27.7 years in homicides associated with sexual assault, 36.8 years with domestic violence, and 63.9 years with robbery. Lethal assaults most often occurred in private homes, and perpetrators were usually well known to the victim. Injuries included petechiae in 83%; ligature marks in 20%; fingernail marks in 1.4%; hyoid fractures in 23%; and thyroid cartilage fractures in 31%. Fractures were more common in manual strangulation and in decedents of ages over 40 years.
Collapse
Affiliation(s)
| | - Robert Johnston
- King County Medical Examiner's Office, Seattle, Washington, USA
| | - Micheline Lubin
- King County Medical Examiner's Office, Seattle, Washington, USA
| | - U L M S Perera
- King County Medical Examiner's Office, Seattle, Washington, USA
| |
Collapse
|
35
|
Huang T, Duan M. G6PD gene detection in neonatal hyperbilirubinemia and analysis of related risk factors. Technol Health Care 2024; 32:565-572. [PMID: 37393443 DOI: 10.3233/thc-220472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Hyperbilirubinemia is a common disorder in neonates, with premature infants at higher risk of developing the disorder. OBJECTIVE Glucose-6-phosphate dehydrogenase (G6PD) gene detection was used to determine the incidence of G6PD deficiency and analyze the etiologies of G6PD deficiency in neonates with hyperbilirubinemia in the Zunyi region with the aim of providing scientific evidence for the clinical diagnosis and treatment. METHODS For the gene detection, 64 neonates with hyperbilirubinemia were selected as the observation group and 30 normal neonates were selected as the control group, and the risk factors for hyperbilirubinemia were investigated by using multivariate logistic regression analysis. RESULTS Among the neonates in the observation group, 59 cases had the G1388A mutation (92.19%) and 5 cases had the G1376T mutation (7.81%). No mutation was detected in the control group. In the observation group, the proportion of neonates who were born prematurely, with artificial feeding, with the age of starting feeding of more than 24 h, the time of first bowel movement of more than 24 h, premature rupture of membranes, infection, scalp hematoma, and perinatal asphyxia was higher than that in the control group, and the difference was statistically significant (p< 0.05). Multivariate logistic regression analysis showed that prematurity, infection, scalp hematoma, perinatal asphyxia, the age of starting feeding of more than 24 h, and the time of first bowel movement over 24 h were risk factors for the development of neonatal hyperbilirubinemia (p< 0.05). CONCLUSION The G1338A and G1376T mutations were important features of the genetics of neonatal hyperbilirubinemia, and genetic detection together with the prevention of prematurity, infection, scalp hematoma, perinatal asphyxia, the age of starting feeding, and the time of first bowel movement would help reduce the incidence of this disease.
Collapse
|
36
|
Ogba EI, Chukwudi NK, Izuka OM, Adizua UC. Prevalence of Perinatal Asphyxia Using Apgar Scores and Cord Blood pH and the Relationship between the Two Methods: A Study of FMC Umuahia. Niger J Clin Pract 2024; 27:117-123. [PMID: 38317044 DOI: 10.4103/njcp.njcp_563_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/23/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perinatal asphyxia contributes significantly to neonatal morbidity and mortality. It occurs worldwide, and the Apgar score is the most widely used method of diagnosis. Recently, umbilical cord arterial pH has been reported as the most objective way to assess fetal acidosis at birth as it predicts the adverse outcome of perinatal asphyxia. It is imperative to establish the concordance between these two diagnostic methods to reinforce the practicality of the Apgar score as the preferred diagnostic tool for perinatal asphyxia in developing nations, such as Nigeria. AIM To determine the prevalence of perinatal asphyxia by using the Apgar score and arterial cord blood pH and the relationships between these methods at the Federal Medical Center (FMC), Umuahia. MATERIALS AND METHODS This cross-sectional study enrolled 245-term newborns. Perinatal asphyxia was diagnosed using both Apgar scoring and arterial cord blood pH measurements. Data obtained were analyzed using SPSS version 20 and a P value < 0.05 was considered significant. RESULTS Perinatal asphyxia was reported in 33.1% and 31.4% by using the Apgar score and arterial cord blood pH, respectively. There was a moderate agreement between the two methods for diagnosing perinatal asphyxia (κ = 0.44), and no statistically significant difference was observed in the prevalence of perinatal asphyxia between these methods (McNemar's χ2 = 0.27, P = 0.699). Furthermore, a strong positive correlation was observed between the Apgar score at 1 and 5 minutes of life and arterial cord blood pH (rs = 0.87, P ≤ 0.001 and rs = 0.80, P ≤ 0.001 respectively). CONCLUSION The prevalence of perinatal asphyxia by the two methods was high, and there was no significant difference between both methods of assessing perinatal asphyxia. Thus, the diagnosis of perinatal asphyxia can effectively be made using either the Apgar score or arterial cord blood pH, affirming the practicality and reliability of the Apgar score in resource-limited healthcare settings.
Collapse
Affiliation(s)
- E I Ogba
- Department of Pediatrics, Federal Medical Center, Umuahia, Abila State, Nigeria
| | - N K Chukwudi
- Department of Pediatrics, Federal Medical Center, Umuahia, Abila State, Nigeria
| | - O M Izuka
- Department of Pediatrics, Federal Medical Center, Umuahia, Abila State, Nigeria
| | - U C Adizua
- Department of Chemical Pathology, Federal Medical Center, Umuahia, Abila State, Nigeria
| |
Collapse
|
37
|
Liu J, Ma Z, Shi X, Wu Y, Nan C, Song F, Zhang B. [Discussion on the relationship between the disposal time of hypobaric oxygen chamber and the establishment of rat cardiac arrest model at high altitude]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2024; 36:82-85. [PMID: 38404278 DOI: 10.3760/cma.j.cn121430-20221130-01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To establish the rat cardiac arrest model in high-altitude hypobaric hypoxia environment, and to explore the effect of the treatment time in the hypobaric oxygen chamber on the reproduction of high-altitude rat cardiac arrest model. METHODS SPF grade healthy male Sprague-Dawley (SD) rats were used as observation subjects. The experiment was conducted in two different altitude areas. The rats from the Plateau Branch of Institute of Cardiopulmonary and Cerebral Resuscitation of Sun Yat-sen University (Xining, Qinghai) were weighed and numbered, and they were placed in a hypobaric oxygen chamber (simulated altitude of 3 000 meters, speed of ascent and descent of 15 m/min, temperature of 20 centigrade, cabin pressure of 69.5 kPa, cabin oxygen pressure of 14.5 kPa). After 30 days of feeding, the rats were obtained according to random number table method, and the cardiac arrest model was established by asphyxia method as the 30-day hypobaric hypoxia group. After 60 days of feeding, rats were randomly selected again, and the cardiac arrest model was established as the 60-day hypobaric hypoxia group. Thirty rats were randomly selected from the Institute of Cardiopulmonary Cerebral Resuscitation at Sun Yat-sen University (Guangzhou, Guangdong) by the same method, and the cardiac arrest model was established as the plain control group. The differences in the body weight of rat modeling precursors and the induction time of asphyxia during the modeling process among different groups were compared. RESULTS Finally, cardiac arrest model was established in 16 rats in the 30-day hypobaric hypoxia group and in 22 rats in the 60-day hypobaric hypoxia group. There was no significant difference in the body weight of rats before modeling among the plain control group, 30-day hypobaric hypoxia group and 60-day hypobaric hypoxia group [g: 429.00 (389.25, 440.75), 440.00 (415.50, 486.25), 440.00 (400.00, 452.50), all P > 0.05]. The asphyxia induction time of rats in the 60-day hypobaric hypoxia group was significantly longer than that in the 30-day hypobaric hypoxia group (s: 294.59±75.39 vs. 234.31±93.86, P < 0.01), even about 1.4 times of the plain control group (s: 294.59±75.39 vs. 208.73±30.88, P < 0.01). There was no significant difference in the asphyxia induction time between the 30-day hypobaric hypoxia group and the plain control group (P > 0.05). CONCLUSIONS Rats treated in a hypobaric oxygen chamber for 60 days are more suitable for the preparation of high-altitude cardiac arrest model, and are also consistent with the oxygen reserve and hypoxia tolerance of high-altitude rats.
Collapse
Affiliation(s)
- Jie Liu
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| | - Zengwen Ma
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| | - Xiaoxu Shi
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| | - Yan Wu
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| | - Cuoji Nan
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| | - Fengqing Song
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Cardiopulmonary and Cerebral Resuscitation Institute, Sun Yat-sen University, Guangzhou 510006, Guangdong, China. Corresponding author: Zhang Bin,
| | - Bin Zhang
- Department of Emergency, People's Hospital Affiliated to Qinghai University (Qinghai Provincial People's Hospital), Plateau Branch, Institute of Cardiopulmonary and Cerebral Resuscitation, Sun Yat-sen University, Xining 810000, Qinghai, China
| |
Collapse
|
38
|
Amir AA, Amir BA, Alghannam AA, Abdeen TH, Alshneiber RM, Alhowaish AA, Menezes RG. Systematic review of laryngohyoid fractures in fatal falls: A potential mimicker of strangulation. J Forensic Leg Med 2024; 101:102612. [PMID: 38006652 DOI: 10.1016/j.jflm.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023]
Abstract
Fractures of the laryngohyoid complex are classically associated with deaths due to strangulation. Recent studies, however, indicate the possible presence of such fractures in fatal falls. The primary focus of this systematic review is to analyze the characteristics of laryngohyoid fractures in the context of falls to aid in a more accurate interpretation of autopsy findings. Search for relevant literature occurred on PubMed on the 26th of October 2022, and Embase and Web of Science on the 5th of November 2022. Inclusion criteria included being a primary study, published in English, involving fatal falls and injuries to the laryngohyoid complex, and presenting sufficient details about the relevant cases. Four case reports and six descriptive retrospective studies were included in the final analysis yielding a sum of 38 cases. The risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Potential limitations of this study include the inclusion of case reports and studies published in English only. The cumulative male-to-female ratio was 23:15 with a mean age of 48 years old. The fall height ranged from standing height to 60 m. Forty-three fractures to the laryngohyoid complex were identified with the thyroid cartilage most commonly affected, followed by fracture of the hyoid bone, and finally the cricoid cartilage. While cases of falls did indeed display hallmark laryngohyoid findings classically displayed in strangulation, they also featured unique presentations such as fractures of the clavicle and a reduced prevalence of conjunctival petechiae.
Collapse
Affiliation(s)
- Amaar A Amir
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Baraa A Amir
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asim A Alghannam
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tareq H Abdeen
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rayan M Alshneiber
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A Alhowaish
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| |
Collapse
|
39
|
Idota N, Takazakura R, Ikegaya H. Postmortem computed tomography imaging of negative pressure pulmonary edema induced by rice cakes: A case report. J Forensic Leg Med 2024; 101:102620. [PMID: 37988900 DOI: 10.1016/j.jflm.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
Airway obstruction by foreign bodies or laryngospasms often results in negative pressure pulmonary edema (NPPE). NPPE can develop despite the removal of airway obstruction. This is well-known among clinicians, particularly anesthesiologists, emergency physicians, pediatricians, and radiologists. Computed tomography (CT) features of NPPE include diffuse central ground-glass opacities and thickening of the bronchovascular bundles and bronchial walls. NPPE can also occur after strangulation or smothering with a plastic bag, and is sometimes fatal. Nevertheless, no reports of NPPE are available in forensic journals, and forensic practitioners may not be dedicating the necessary attention to this condition. Recently, the use of postmortem CT as an auxiliary imaging modality for autopsies has increased among forensic institutions in Japan. Understanding the mechanisms and CT findings of NPPE will be useful for forensic practitioners. Herein, we present a case wherein the postmortem CT image revealed NPPE resulting from the obstruction of the airway induced by rice cakes.
Collapse
Affiliation(s)
- Nozomi Idota
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ryutaro Takazakura
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| |
Collapse
|
40
|
Gebremichael MW, Tsadik M, Abebe HT, Gebreegzabiher A, Beyene S, Aregawi AB, Weldemariam S. Trends and causes of neonatal mortality from 2010 to 2017 at a Health and Demographic Surveillance site in Northern Ethiopia. Glob Health Action 2023; 16:2289710. [PMID: 38126362 PMCID: PMC10763885 DOI: 10.1080/16549716.2023.2289710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality. OBJECTIVES To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017. METHODS A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression. RESULTS The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia. CONCLUSIONS The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.
Collapse
Affiliation(s)
| | - Mache Tsadik
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | | | | | - Selam Beyene
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | - Abera Berhe Aregawi
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | - Solomon Weldemariam
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| |
Collapse
|
41
|
Marincowitz GJO, Marincowitz C. Neonatal death audits at Kgapane Hospital, Limpopo province. S Afr Fam Pract (2004) 2023; 65:e1-e5. [PMID: 38197690 PMCID: PMC10784183 DOI: 10.4102/safp.v65i1.5815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Neonatal deaths (NNDs) are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most NNDs are preventable. Therefore, this study reviewed perinatal clinical audit data at Kgapane Hospital over a 4-year period with a special focus on the factors associated with NNDs. METHODS File audits were performed for all NNDs occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with NNDs. RESULTS The NND rate for the study period was 12.6/1000 live births. In this study (n = 236), 90% of the deaths could be associated with four factors, namely prematurity (44%); intrapartum complications (19%) including asphyxia, meconium aspiration and breech deliveries; neonatal infections (16%) of which human immunodeficiency virus (HIV) positivity was the most prevalent; and foetal congenital abnormalities (11%). The modifiable factors included inadequate intrapartum foetal monitoring; delays in management interventions; instances where no attempts were made to refer patients for specialised care, or where no beds were available at the next level of care; patient-related factors; and inadequate adherence to management protocols, such as for the management of prematurity and HIV. CONCLUSION Understanding factors associated with NNDs can guide health worker training and improvement strategies to reduce this heart-breaking complication of pregnancy.Contribution: Family physicians working in rural hospitals are also responsible for newborn care. Understanding the factors associated with NNDs will guide them to focus training and develop improvement strategies to reduce these preventable deaths.
Collapse
Affiliation(s)
- Gert J O Marincowitz
- Department of Family Medicine, Faculty of Health Sciences, University of Limpopo, Mankweng.
| | | |
Collapse
|
42
|
Maiwald CA, Rovers C, Janvier A, Sturm H, Michaelis M, Marckmann G, Ehni HJ, Poets CF, Rüdiger M, Franz AR. Parental perspectives about information and deferred versus two-stage consent in studies of neonatal asphyxia. Arch Dis Child Fetal Neonatal Ed 2023; 109:106-111. [PMID: 37648417 PMCID: PMC10804040 DOI: 10.1136/archdischild-2023-325900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The ALBINO Trial (NCT03162653) investigates effects of very early postnatal allopurinol on neurocognitive outcome following perinatal asphyxia where prenatal informed consent (IC) is impossible. Ethically and legally, waiver of consent and/or deferred consent (DC) is acceptable in such an emergency. Short oral/two-step consent (SOC, brief information and oral consent followed by IC) has recently been investigated. METHODS Mixed-methods analysis of parental opinions on DC versus SOC in the context of neonatal asphyxia in a survey at two German centres. Prospective parents (ProP), parents of healthy newborns (PNeo) and parents of asphyxiated infants (PAx) born between 2006 and 2016 were invited. RESULTS 108 of 422 parents participated (ProP:43; PNeo:35; PAx:30). Most parents trusted physicians, wanted preinterventional information and agreed that in emergencies interventions should begin immediately. Intergroup and intragroup variability existed for questions about DC and SOC. In the ALBINO Trial situation, 55% preferred SOC, and 26% reported DC without information might adversely affect their trust. Only 3% reported to potentially take legal action after DC. PAx were significantly more likely to support DC. PAx more frequently expressed positive emotions and appreciation for neonatal research. In open-ended questions, parents gave many constructive recommendations. CONCLUSION In this survey, parents expressed diverse opinions on consent, but the majority preferred SOC over DC. Parents who had experienced emergency admission of their asphyxiated neonates were more trusting. Obtaining parental perspectives is essential when designing studies, while being cognisant that these groups of parents may not represent the opinion of all parents.
Collapse
Affiliation(s)
- Christian A Maiwald
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Charlotte Rovers
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montreal, Québec, Canada
- Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Heidrun Sturm
- Centre for Public Health and Health Services Research, Faculty of Medicine, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Martina Michaelis
- Centre for Public Health and Health Services Research, Faculty of Medicine, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University (LMU) Munich, Munich, Bayern, Germany
| | - Hans-Joerg Ehni
- Institute for Ethics and History of Medicine, Medical Faculty, University of Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Mario Rüdiger
- Clinic for Pediatrics, Department of Neonatology and Pediatric Intensive Care, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| |
Collapse
|
43
|
Regmi PR, Yadav AK, Koirala B, Yadav S, Amatya I. Late Presentation of Hypoxic Injury of Brain in an Infant. J Nepal Health Res Counc 2023; 21:349-352. [PMID: 38196234 DOI: 10.33314/jnhrc.v21i02.4451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
Perinatal asphyxia is one of the leading causes of hypoxic-ischemic encephalopathy. In a developing country like Nepal, home delivery is the leading cause of perinatal asphyxia. Neuroimaging remains the diagnostic modality of choice. We present a case report of a 10-month-old infant who presented to the pediatric Out-patient-department with complaints of being unable to hold his head and unable to sit without support. Detailed history, physical examination, and developmental assessment along with lab investigation flash visual evoked potentials and Magnetic Resonance Imaging of the brain was performed. Hypoxic ischemic injury has common five types of imaging patterns in neonates. There are a few imaging differentials to be considered while evaluating the case for hypoxic injury. Clinicians and radiologists must go hand in hand to narrow down the possibilities which can fasten the treatment thereby decreasing morbidity and mortality. Keywords: Hypoxic ischemic encephalopathy, Infant, Magnetic Resonance Imaging.
Collapse
Affiliation(s)
| | | | - Bibek Koirala
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Isha Amatya
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| |
Collapse
|
44
|
Wang Y, Wang X, Wang Z, Guo W. Clinical study of early intervention of brain-derived nerve growth factor on reducing the degree of brain injury in newborns with severe asphyxia. Panminerva Med 2023; 65:542-543. [PMID: 32759908 DOI: 10.23736/s0031-0808.20.04037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Zhenzhen Wang
- Department of Pediatric Three Areas, Liaocheng Dongchangfu District Maternal and Child Health Hospital, Liaocheng, China
| | - Wei Guo
- Department of Pediatric Second Ward, Binzhou Peoples Hospital, Binzhou, China -
| |
Collapse
|
45
|
Oliveira D, de Oliveira JM, Martins MDR, Barroso MR, Castro R, Cordeiro L, Pereira F. Maternal Profiles and Pregnancy Outcomes: A Descriptive Cross-Sectional Study from Angola. Matern Child Health J 2023; 27:2091-2098. [PMID: 37815656 DOI: 10.1007/s10995-023-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. METHODS We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. RESULTS Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). CONCLUSIONS There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango.
Collapse
Affiliation(s)
- Dinamene Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Rosalina Barroso
- Unidade de Cuidados Intensivos Neonatais, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Castro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lemuel Cordeiro
- Gabinete de Ensino, Pesquisa e Pós-graduação, Clínica Girassol, Luanda, Angola
| | - Filomena Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
46
|
Guo L, Han W, Su Y, Wang N, Chen X, Ma J, Liang J, Hao L, Ren C. Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies. J Matern Fetal Neonatal Med 2023; 36:2259049. [PMID: 37743349 DOI: 10.1080/14767058.2023.2259049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/09/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Early-onset neonatal sepsis (EONS) remains an important cause of neonatal mortality and has many risk factors, therefore, this study aimed to investigate the perinatal risk factors for EONS. METHODS We searched CNKI, Wan Fang, VIP, CBM, PubMed, Embase, and Web of Science to compile studies regarding the incidence of neonatal early-onset sepsis, published up to 1 May 2022. To evaluate the quality of the included studies, we used the Newcastle-Ottawa Scale, and the RevMan5.3 software was used for meta-analysis. RESULTS A total of 17 studies were included, with 1987 cases in the case group and 4814 cases in the control group. Meta-analysis showed that perinatal asphyxia or intrauterine distress (OR = 3.00, 95% CI: 2.18-4.13), amniotic fluid meconium contamination (OR = 4.51, 95% CI: 2.31-8.81), group B streptococcal (GBS) colonization in pregnant women (OR = 2.13, 95% CI: 1.48-3.05), chorioamnionitis (OR = 4.58, 95% CI: 2.61-8.05), premature rupture of membranes (OR = 2.63, 95% CI: 2.09-3.30), lower gestational age (OR = 1.31, 95% CI: 1.18-1.44), maternal urinary or reproductive tract infection (OR = 3.61, 95% CI: 2.14-6.11), perinatal fever (OR = 3.59, 95% CI: 2.25-5.71), very low birth weight (OR = 3.79, 95% CI: 2.14-6.73), and vaginal examination ≥3 times (OR = 7.95, 95% CI: 4.04-15.64) were the perinatal risk factors for EONS. CONCLUSION Perinatal asphyxia or intrauterine distress, meconium contamination in amniotic fluid, GBS colonization in pregnant women, chorioamnionitis, premature rupture of membranes, lower gestational age, maternal urinary tract or reproductive tract infection, perinatal fever, very low birth weight, and vaginal examinations ≥3 times may increase the risk of EONS.
Collapse
Affiliation(s)
- Liyan Guo
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Wenxiao Han
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Yan Su
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Na Wang
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Xinqing Chen
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Jinjin Ma
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Jiaojiao Liang
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Ling Hao
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| | - Changjun Ren
- Department of Pediatrics, Hebei Medical University First Affiliated Hospital, Shijiazhuang, P.R. China
| |
Collapse
|
47
|
Kazanasmaz H, Akan A, Yalçın Ö, Ölçücü MT, Onar S, Kazanasmaz Ö. Cerebral Tissue Oxygen Saturation Measurements in Perinatal Asphyxia Cases Treated with Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2023; 13:184-190. [PMID: 36920248 DOI: 10.1089/ther.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy (NIRS) technology has recently become the subject of several research studies. The aim of this study was to investigate the diagnostic value of CrSO2 measurements in perinatal asphyxia (PA) cases. The study included a patient group of 42 PA cases, who were to be applied with therapeutic hypothermia (TH), and a control group of 42 healthy term newborns. PA cases were determined as moderate or severe encephalopathy (Sarnat score stage II or III) in clinical evaluation. In both groups, left (CrSO2L) and right (CrSO2R) NIRS measurements were taken for 10 minutes on the scalp. The arithmetic mean value of measurements was calculated and compared. The mean measurements were CrSO2R 67.38 ± 9.39 and CrSO2L 66.73 ± 7.76 in the patient group, and CrSO2R 80.28 ± 8.04 and CrSO2L 79.14 ± 8.49 in the control group. The mean CrSO2R and CrSO2L measurements of the patient group were statistically significantly lower than those of the control group (p < 0.001). In the Pearson correlation analysis, a significant correlation was determined in the patient group between cord blood gas pH and CrSO2R (r: 0.539, p < 0.001) and CrSO2L (r: 0.54, p < 0.001). For a cutoff value of CrSO2L ≤ 72%, the positive predictive value was 80 and the negative predictive value was 84.6. For a cutoff value of CrSO2R ≤ 74%, the positive predictive value was 79.5 and the negative predictive value was 82.5. Low CrSO2 measurements obtained with the NIRS method in PA cases to be applied with TH together with cord blood gas parameters can be considered a helpful parameter in diagnosis.
Collapse
Affiliation(s)
- Halil Kazanasmaz
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Abdulsamed Akan
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ömer Yalçın
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | | | - Selehattin Onar
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Özlem Kazanasmaz
- Department of Pediatrics Sanliurfa, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| |
Collapse
|
48
|
Yilmaz A, Cebi MN, Yilmaz G, Karacaoglu G, Aydin SN, Perk Y, Vural M. Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn. J Matern Fetal Neonatal Med 2023; 36:2284115. [PMID: 37989542 DOI: 10.1080/14767058.2023.2284115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia. METHODS This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated. RESULTS No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother's working situation (p = .948), mother's education level (p = .828), father's education level (p = .507), and family's total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores. DISCUSSION In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.
Collapse
Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Memnune Nur Cebi
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gizem Yilmaz
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gursel Karacaoglu
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Sümeyye Nur Aydin
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| |
Collapse
|
49
|
Wortinger LA, Shadrin AA, Szabo A, Nerland S, Smelror RE, Jørgensen KN, Barth C, Andreou D, Thoresen M, Andreassen OA, Djurovic S, Ursini G, Agartz I. The impact of placental genomic risk for schizophrenia and birth asphyxia on brain development. Transl Psychiatry 2023; 13:343. [PMID: 37938559 PMCID: PMC10632427 DOI: 10.1038/s41398-023-02639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
The placenta plays a role in fetal brain development, and pregnancy and birth complications can be signs of placental dysfunction. Birth asphyxia is associated with smaller head size and higher risk of developing schizophrenia (SZ), but whether birth asphyxia and placental genomic risk factors associated with SZ are related and how they might impact brain development is unclear. 433 adult patients with SZ and 870 healthy controls were clinically evaluated and underwent brain magnetic resonance imaging. Pregnancy and birth information were obtained from the Medical Birth Registry of Norway. Polygenic risk scores (PRS) from the latest genome-wide association study in SZ were differentiated into placental PRS (PlacPRS) and non-placental PRS. If the interaction between PRSs and birth asphyxia on case-control status was significant, neonatal head circumference (nHC) and adult intracranial volume (ICV) were further evaluated with these variables using multiple regression. PlacPRS in individuals with a history of birth asphyxia was associated with a higher likelihood of being a patient with SZ (t = 2.10, p = 0.018). We found a significant interaction between PlacPRS and birth asphyxia on nHC in the whole sample (t = -2.43, p = 0.008), with higher placental PRS for SZ associated with lower nHC in those with birth asphyxia. This relationship was specific to males (t = -2.71, p = 0.005) and also found with their adult ICV (t = -1.97, p = 0.028). These findings suggest that placental pathophysiology and birth asphyxia may affect early and late trajectories of brain development, particularly in males with a higher vulnerability to SZ. This knowledge might lead to new strategies of treatment and prevention in SZ.
Collapse
Affiliation(s)
- Laura A Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Alexey A Shadrin
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Attila Szabo
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Stener Nerland
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Runar Elle Smelror
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dimitrios Andreou
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Marianne Thoresen
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gianluca Ursini
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
50
|
Zheng Z, Zhang L, Zhao C, Xiong H, Li J. Identification of differentially expressed proteins in heart of mouse death from smother based on label-free proteomics. Leg Med (Tokyo) 2023; 65:102302. [PMID: 37549592 DOI: 10.1016/j.legalmed.2023.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
Identification of mechanical asphyxia deaths without obvious injuries is a difficult problem for forensic medicine. This study aimed to identify molecular biological markers to predict death from mechanical asphyxia (smother). We established a smother model of mice by over the head with plastic bag tightly until the mice died and applied label-free proteomic technology to identify differentially expressed proteins (DEPs) in heart. A total of 3307 proteins were quantified, and a Fold Change (FC) > 1.2 (or <1/1.2) and Q value < 0.05 were considered as DEPs. Through comparative analysis, we identified 606 DEPs compared to the control group, comprising 219 upregulated and 387 downregulated proteins. Bioinformatics analysis (MCODE analysis) showed that the candidate proteins were mainly involved in regulation of ribosome function, myocardial contraction and calcium regulation, regulation of coagulation and regulation of mitochondrial oxidative respiration. Seven of these proteins were validated using parallel reaction monitoring (PRM), including fibrinogen alpha chain (FIBA), fibrinogen gamma chain (FIBG), Calsequestrin-2 (CASQ2), NADH dehydrogenase [ubiquinone] 1 alpha subcomplex subunit 11 (NDUAB), NADH dehydrogenase [ubiquinone] 1 alpha subcomplex subunit 3 (NDUA3), NADH dehydrogenase [ubiquinone] 1 alpha subcomplex subunit 13 (NDUAD) and Rab7 (RAB7A). CASQ2 and FIBG were further validated by immunohistochemistry. In conclusion, our results may provide some auxiliary indices for identifying the death from mechanical asphyxia.
Collapse
Affiliation(s)
- Zhe Zheng
- Department of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang, Henan 471023, China; Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
| | - Li Zhang
- Department of Basic Medicine, Chongqing College of Traditional Chinese Medicine, Chongqing 402760, China
| | - Congcong Zhao
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
| | - Hongli Xiong
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
| | - Jianbo Li
- Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China.
| |
Collapse
|