Interleukins in diagnosis of perinatal asphyxia: A systematic review

Background: Biochemical markers including interleukins (ILs) has been proposed for early diagnosis of asphyxia. Objective: This study has aimed to systematically review the significance of IL measurements in the diagnosis of perinatal asphyxia. Materials and Methods: PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases before 2017 were searched for the following keywords: asphyxia, neonatal, interleukin, and diagnosis. A total of 13 out of 300 searched papers were finally selected for evaluation. Interleukins under study were IL6 and interleukin 1β (IL-1β). Interleukins had been measured in 10 studies by serum samples, 2 studies by samples of Cerebro Spinal Fluid (CSF), and 1 study by sample of umbilical cord blood. The inclusion criteria were: studies on neonates, with adequate information from the test results and studies using markers other than ILs to detect asphyxia; however, studies with only abstracts available were excluded. Results: Research on the issue suggests that IL6 > 41 Pg/dl has the sensitivity of 84.88% and the specificity of 85.43%, whereas IL-1β > 4.7 Pg/dl has the sensitivity of 78% and specificity of 83% in the diagnosis of neonatal asphyxia. Among diagnostic ILs for neonatal asphyxia, combination of IL6 and IL-1β had the highest sensitivity, that is, 92.9%. Conclusion: IL6 and IL-1β of serum samples were used in the early diagnosis of perinatal asphyxia and are useful predictors for the outcomes of perinatal asphyxia and its intensity. In addition, simultaneous evaluation of IL-1β and IL6 can improve the sensitivity of the early diagnosis of perinatal asphyxia

Serum Hsp70 antigen: Early diagnosis marker in perinatal asphyxia

BACKGROUND: Perinatal asphyxia is an important cause of mortality and permanent neurological and developmental deficit. Early and accurate diagnosis would help to establish the likely prognosis and may also help in determining the most appropriate treatment. Studies in experimental animal models suggest that a protein called Hsp70 may be a good and potentially useful marker of cellular stress that may be clinically useful in determining the presence of neonatal asphyxia. OBJECTIVES: Regarding the importance of early and accurate diagnosis of asphyxia, we conducted this study, which is the first investigation of the comparison of the serum Hsp70 antigen level between asphyxiated and healthy infants. PATIENTS AND METHODS: In this observational study, the serum concentrations of Hsp70 antigen were compared between neonates suffering from perinatal asphyxia (n = 50) and normal neonates (n = 51). The inclusion criteria for the cases were neonates who had reached term and had at least two clinical criteria of asphyxia. Exclusion criteria were babies with gestational age < 37 weeks, infants with congenital abnormalities or positive blood culture. Exclusion criteria in this group were the requirement to hospital stay during first week of the life or babies whose mothers had difficulties during pregnancy or delivery. Term neonates without major anomalies who had asphyxia during delivery were enrolled in the first six hours after delivery, and control group consisted of healthy term neonates without problems and normal delivery process in the first week of life. The cord blood was taken during labor to measure Hsp70 antigen level by using an in-house ELISA (The enzyme-linked immunosorbent assay). RESULTS: The median values of serum anti Hsp70 titers were significantly higher in asphyxiated neonates compared with non-asphyxiated neonates (0.36 [0.04 - 1.14] vs 0.24 [0.01 - 0.63]). At cutoff point = 0.3125 ng/mL, sensitivity was 58% and specificity 76% based on ROC curve. CONCLUSIONS: A significant difference between the serum concentrations of Hsp70 of the control and patient group was observed in this study. It is inferred serum concentrations of Hsp70 antigen may be a useful marker for the early diagnosis of that prenatal hypoxia

Interleukin-6 as A Prognostic Biomarker in Perinatal Asphyxia

Abstract Objective Early diagnosis is considered as a priority for prevention and treatment of asphyxia-related complications. The main aim of the present study was to evaluate the prognostic value of interleukin-6 (IL-6) and hypoxic ischemic encephalopathy grade in prediction mortality and developmental status of neonates affected by prenatal asphyxia. Materials &amp; Method The cohort study was conducted on 38 term asphyxiated infants at Ghaem hospital, Mashhad, Iran, during 2013-2017. The HIE grade and serum IL-6 levels were determined at the time of birth. The developmental status was determined using the Denver II test at the end of two-year follow-up. Results &nbsp;HIE grade 3 resulted in 83% mortality rate and developmental delay in all the survivors. The average IL-6 level was 2.7 ng/ml in the control group (not affected HIE) which increased up to 29, 175 and 136 ng/ml in those with HIE grades 1, 2 and 3, respectively. Roc curve analysis revealed the cut-off levels 24 pg/ml to predict the developmental delay with sensitivity and specificity of 96 and 92%, respectively. Conclusion &nbsp;The IL-6 level and HIE grade are the potential prognostic biomarkers for determination of mortality and morbidity rate in the asphyxiated neonate

Incidence of Thrombocytopenia in Idiopathic Hyperbilirubinemic Newborns

Background: Hyperbilirubinemia is the most common reason for admission during the neonatal period and may develop serious complications. Thrombocytopenia is defined as platelet count &lt;150,000/mm3 and has not been conclusively reported as a complication of hyperbilirubinemia in any of the standard paediatric textbooks. The aim of this study was to find the incidence of thrombocytopenia in neonates with idiopathic jaundice and the relationship between hyperbilirubinaemia and platelet count.Methods: This was a descriptive-analytic study accomplished on 878 newborns. After a detailed history, clinical examination and baseline investigations,185 babies with idiopathic hyperbilirubinemia were tested for platelet counts and then categorized in two groups namely group A (n=65) and group B (n=120) showing the presence and absence of thrombocytopenia, respectively. Newborns data were recorded and Statistical analysis was carried out, using SPSS 11.5.Results: The incidence of thrombocytopenia was seen in 65 (12%) newborns admitted due to jaundice. The mean serum bilirubin in group A and B was defined as 19.7 (± 6) and 20.4 (± 5), respectively (P = 0.362).There was no significant difference in Laboratory variables likeTSH, T4, coombs test, reticulocite count, serum sodium and hematocrit values between two groups.Conclusion: This study determines higher rate of thrombocytopenia among idiopathic hyperbilirubinemic neonates (36%) and helps the practitioner to be aware of this association and avoid unnecessary investigations.We did not find a significant correlation between serum bilirubin values and thrombocytopenia

Comparison of new Biomarkers in the Diagnosis of Perinatal Asphyxia

&nbsp; Objectives Precise and early diagnosis of neonatal asphyxia may improve its outcomes. New studies aim to identify diagnostic biomarkers in neonates at risk for brain damage. The current study was designed to evaluate the diagnostic value of new biomarkers neonatal asphyxia. Materials &amp; Methods This prospective study was conducted with an available sampling of infants upper 35 weeks of gestational age, including neonates with asphyxia (case group) and healthy controls, 2014-2022, in Ghaem Hospital, Mashhad, Iran. Data collection was performed utilizing a researcher-made questionnaire, including maternal and neonatalcharacteristics, as well as clinical and laboratory evaluation. Serum umbilical cord levels of interleukin-6 (IL6), interleukin-1-beta (IL- 1β), pro-oxidant-antioxidant balance (PAB), and heat shock protein-70 (HSP70), as well as nucleated red blood cells count (NRBC), were determined. Data were analyzed by t-test, Chi-square, receiver operating characteristic (ROC), and regression models. Results Variables interleukin-6(IL6) (P&lt;0.0001), IL1β (P&lt;0.0001), PAB (P&lt;0.0001), NRBC/100WBC (P&lt;0.0001) and HSP70 (P&lt;0.0001) in the two groups, the difference was statistically significant. In the diagnosis of asphyxia, the most sensitive marker (89%) was IL1β more than 2.39 pg/ml and HSP 70 upper than 0.23 ng/ml while IL6 higher than 9pg/ml determined as the most specific marker (85%). For the diagnosis of asphyxia, combination of HSP + PAB and IL6 + lL1b + PAB + NRBC/100WBC possesses the prediction power of 93.2% and 87.3% respectively. Conclusion According to data analysis, the combination of new biochemical markers (NRBC count, IL6, IL1β, PAB, HSP 70) could be a reliable marker for the diagnosis of infants with asphyxia. The composition of the HSP + PAB indicators is more valid predictions 93.2% compared to the other combined indicators for the diagnosis of asphyxiated neonates. PAB values correlate with the severity of asphyxia. &nbsp

Developing Basic Educational Standards for Evaluation and Accreditation of Master of Sciences Course in Neonatal Intensive Care Nursing: A Report of a Delphi Study

Background & Objective: Despite the importance of local educational standards for the correct implementation and evaluation of higher education programs, studies show such standards do not exist for the master’s degree in neonatal intensive care nursing. Therefore, the purpose of the present study was to develop basic educational standards for program evaluation and accreditation of the master of sciences course in neonatal intensive care nursing. Methods: This study was a descriptive survey conducted using the Delphi survey method in 2014. A total of 20 experts, including infants and medical education specialists, administrators of the department of education, faculty members of the department of pediatrics, nursing administrators of neonatal intensive care units, and students and graduates of the neonatal intensive care nursing course were selected through purposive sampling. First, items related to basic educational standards were extracted through an extensive review of databases. Subsequently, 3 sessions in 2 rounds were held with the experts and basic educational standards for the evaluation of the master of sciences course in neonatal intensive care nursing were developed on the basis of consensus. Results: This study led to the proposal of 20 items as basic educational standards for the evaluation of the master of sciences course in neonatal intensive care nursing. In the first round, 25 items, of the total 41 items, were agreed upon by experts. Statistical results showed the content validity index in clear expression, importance, and availability in the second round was 0.94, 0.92, 0.87, respectively. Conclusion: Considering that the checklist of basic educational standards was developed by experts, it is hoped it will gain high acceptability and be an efficient model for the evaluation of the master’s program in neonatal intensive care nursing. ------------------------------------------------------------------------

Comparison of infants with jaundice due to maternal diabetes and infants with unknown jaundice

Background: Jaundice is the common cause of hospitalization of infants in the first month after birth. Therefore, detection of risk factors associated with jaundice can effect on its process and complications. This study aimed to determine the prevalence and characteristics of diabetic mother's infants and comparing with infants with unknown jaundice. Methods: In this cross-sectional study, among 2,800 infants with jaundice in Ghaem hospital in Mashhad during the 2007 to 2014, features of 59 infants of diabetic mother's (case group) and 78 infants with unknown jaundice (control group) were analyzed. After confirming of jaundice (Bilirubin &ge; 17 mg/dl) in newborns based on examination of pediatrician and laboratory results, a researcher made questionnaire containing maternal demographic data, (maternal age, parity, maternal problems during pregnancy, route of delivery). Also neonatal characteristics including age, sex, birth weight, current weight, duration of hospitalization, current age, age of recovery and laboratory data (Bilirubin, direct bilirubin, hematocrit, platelet, sodium, potassium, blood urea nitrogen, Cr, TSH, T4) were assessed. After data collection and recording information in SPSS software, version 19.5 (IBM SPSS, Armonk, NY, USA), by using tables, charts and statistical indices, the study was evaluated. Data were analyzed using statistical tests such as Mann-Whitney, Chi-square tests after normality control. Comparison of the two groups in normal distribution with t-test and for non-standard data with Mann-Whitney test. Also for definitive variables Chi-square test was used. P-value less than 0.50 was the significant level minimum. Results: In this study, the prevalence of jaundice due to maternal diabetes was 2.10 percent. Birth weight (P=0.02), current age (P=0.003), parity (P=0.000), maternal age (P=0.000), age of recovery (P=0.04), cesarean section (P=0.001), prematurity (P=0.000), maternal problems during pregnancy (P=0.000), abnormal physical examinations (P=0.001) in diabetic mother's infants and Bilirubin (P=0.000), length of hospitalization (P=0.003), in infants with unknown jaundice were higher. Conclusion: The infant of diabetic mother are at increased risk of maternal and neonatal complications. Neonatal complications consist of high birth weight, preterm labor, more jaundice and late recovery, abnormal physical examinations. Also, maternal complications during pregnancy and cesarean section were high

Evaluation of the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission

Background: Jaundice is the most common cause of neonatal admission within the first month after birth. Therefore, by identifying the causes of jaundice based on the infant’s age at disease onset and age at hospital admission and providing the required training, jaundice can be managed and its associated complications can be prevented. This study was performed to evaluate the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission. Methods: In this cross-sectional study, out of 3,130 infants with jaundice, referring to Ghaem Hospital, Mashhad, Iran, from 2003 to 2015, 2,658 newborns were selected. Causes of jaundice are determined based on hematocrit, direct and indirect bilirubin, Coombs test, reticulocyte count, blood group and Rh of mother and neonate, thyroid tests, glucose-6-phosphate dehydrogenase (G6PD) enzyme testing, urinalysis, urine culture, and If necessary, Na, blood urea nitrogen, creatinine and other tests depending on the doctor's supervision. After confirming jaundice in infants, based on the physician’s diagnosis and laboratory results, a researcher-made questionnaire including the infant’s characteristics, was completed. Results: Based on our study, 27.9% of infants had identified as causes of jaundice. Known causes of jaundice were blood group incompatibility (40%), infection (19%), G6PD enzyme deficiency (12%), endocrine disorders (8%), neonatal hypernatremic dehydration (7%), polycythemia (6%), congenital heart disease (CHD) (4%), occult bleeding (3%) and Crigler-Najjar syndrome (2%). The most common time of hospital admission of jaundice was 4-6 days after birth due to blood incompatibilities, occult bleeding, endocrine disorders, hypernatremic dehydration, CHD, polycythemia and G6PD enzyme deficiency. Moreover, the most common time of admission due to infection was after the first week of birth. Conclusion: The most common age of onset of jaundice was first three days of birth for blood incompatibility, although they were admitted two days later. Therefore, neonatal admission at appropriate time at onset of jaundice and receiving prompt treatments can reduce the probable complications (e.g., kernicterus)

Comparison between infants receiving traditional supplements (camel thorn, flix weed, and sugar water) and exclusively breast fed infants

Objectives: Although breast milk is considered the best nutritional option for neonates, use of traditional supplements such as sugar water, camel thorn, and flix weed in the first week of life of infants is quite common in Iran and many other countries. The aim of this study was to evaluate whether consuming such supplements has any impact on infant’s breastfeeding behavior. Materials and Methods: Four hundred fifty four term infants who were referred to the neonatal clinic of Ghaem hospital were enrolled and divided into two groups. Control (exclusively breastfed infants, N=243) and case (breast milk feeding plus traditional remedies such as sugar water, camel thorn, and flix weed, N=211). Spss 19.5 was used for statistical analysis. T-test and Man-Whitney tests were used. A p-value of Results: The two groups were similar in their baseline data. Regarding duration of breastfeeding and breastfeeding frequency, use of these supplements resulted in a reduction in both breastfeeding frequency and duration (

Assessment of Maternal Risk Factors Associated with Mortality in Preterm Infants

Background & Aims: Detection of maternal risk factors associated with neonatal mortality helps to identify high-risk infants and prevent neonatal death. It can also contribute to the design more effective prenatal care. This study was performed aiming to evaluate the maternal risk factors associated with mortality in preterm infants in Mashhad Ghaem Hospital, Iran, during 2009-2014. Methods: This cross-sectional study was performed on 335 dead infants (23 to 40 weeks of gestation). The infants were divided into two groups, according to the history of maternal risk factors: 185 cases (55.20%) with a previous history of normal pregnancy and 150 infants (44.80%) with a history of maternal risk factors. The researcher-made questionnaire containing maternal information, neonatal characteristics, and maternal risk factors was completed. The causes of infants' death were confirmed by the hospital mortality technical committee. Data were analyzed using t and chi-square test via SPSS19.5 software. P-value less than 0.05 was considered statistically significant. Results: There was a statistically significant difference between the two groups in terms of age, weight, height, head circumference, length of hospital stay, being a twin, gestational age, maternal age, and mode of delivery (P < 0.05 for all). There was history of maternal risk factors in 45% of cases. The most common maternal disease was preeclampsia (14%). Asphyxia in infants with previous history of maternal risk factors, and congenital anomalies in infants with normal pregnancy, were the most common causes of death. Conclusion: As the results indicated, maternal risk factors including preeclampsia, diabetes and placental abruption were involved in neonatal mortality. Maternal risk factors were identified in about half of the infants, who had died within the first week after the birth. Therefore, when these factors are identified during pregnancy, caring of infants during the first week after delivery is recommended. Keywords: Congenital abnormalities, Infant death, Pregnancy complications, Diabetes mellitus, Preeclampsi