Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers ?

Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of...

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Veröffentlicht in:Pediatrics (Evanston) 1996-04, Vol.97 (4), p.456-462
Hauptverfasser: PERLMAN, J. M, RISSER, R
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description Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconium-stained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n=36), FHRT abnormalities and MSAF (n=20), MSAF only (n=23), abruptio placentae (n=6), intubation in the DR (n=44), intubation in the neonatal intensive care unit (n=22), chest compressions (n=2), 5-minute Apgar scores of 5 or less (n=21), umbilical cord arterial pH of 7.00 or less (n=21), and base deficits of -14 mEq/L or more negative (n=19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds rations (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%. A combination of
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M ; RISSER, R</creator><creatorcontrib>PERLMAN, J. M ; RISSER, R</creatorcontrib><description>Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconium-stained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n=36), FHRT abnormalities and MSAF (n=20), MSAF only (n=23), abruptio placentae (n=6), intubation in the DR (n=44), intubation in the neonatal intensive care unit (n=22), chest compressions (n=2), 5-minute Apgar scores of 5 or less (n=21), umbilical cord arterial pH of 7.00 or less (n=21), and base deficits of -14 mEq/L or more negative (n=19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds rations (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%. A combination of high-risk postnatal markers, specifically, a low 5-minute Apgar score and intubation in the DR in association with severe fetal acidemia, facilitates the identification within the first hour of life of term infants at highest risk for developing seizures secondary to perinatal asphyxia.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.97.4.456</identifier><identifier>PMID: 8632928</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: American Academy of Pediatrics</publisher><subject>Abruptio Placentae - complications ; Acid-Base Imbalance - complications ; Adrenergic Agonists - therapeutic use ; Amniotic Fluid - chemistry ; Apgar Score ; Asphyxia neonatorum ; Asphyxia Neonatorum - complications ; Babies ; Biological and medical sciences ; Brain damage ; Brain Ischemia - complications ; Cardiopulmonary Resuscitation ; Cerebral palsy ; Cerebral Palsy - etiology ; Complications and side effects ; Epinephrine - therapeutic use ; Female ; Fetal Blood ; Forecasting ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Heart Rate, Fetal ; Humans ; Hydrogen-Ion Concentration ; Hypoxia, Brain - complications ; Infant, Newborn ; Infants (Newborn) ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Meconium - chemistry ; Medical examination ; Medical research ; Medical sciences ; Neonatal screening ; Nervous system (semeiology, syndromes) ; Neurology ; Pediatrics ; Positive-Pressure Respiration ; Pregnancy ; Prospective Studies ; Risk Factors ; Seizures (Medicine) ; Seizures - diagnosis ; Seizures - etiology</subject><ispartof>Pediatrics (Evanston), 1996-04, Vol.97 (4), p.456-462</ispartof><rights>1996 INIST-CNRS</rights><rights>COPYRIGHT 1996 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Apr 1996</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-c9b7425c056e737ac6fc27782872c44629327e91689e58739e740397de592b3d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=3050482$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8632928$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PERLMAN, J. M</creatorcontrib><creatorcontrib>RISSER, R</creatorcontrib><title>Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers ?</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconium-stained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n=36), FHRT abnormalities and MSAF (n=20), MSAF only (n=23), abruptio placentae (n=6), intubation in the DR (n=44), intubation in the neonatal intensive care unit (n=22), chest compressions (n=2), 5-minute Apgar scores of 5 or less (n=21), umbilical cord arterial pH of 7.00 or less (n=21), and base deficits of -14 mEq/L or more negative (n=19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds rations (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%. A combination of high-risk postnatal markers, specifically, a low 5-minute Apgar score and intubation in the DR in association with severe fetal acidemia, facilitates the identification within the first hour of life of term infants at highest risk for developing seizures secondary to perinatal asphyxia.</description><subject>Abruptio Placentae - complications</subject><subject>Acid-Base Imbalance - complications</subject><subject>Adrenergic Agonists - therapeutic use</subject><subject>Amniotic Fluid - chemistry</subject><subject>Apgar Score</subject><subject>Asphyxia neonatorum</subject><subject>Asphyxia Neonatorum - complications</subject><subject>Babies</subject><subject>Biological and medical sciences</subject><subject>Brain damage</subject><subject>Brain Ischemia - complications</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - etiology</subject><subject>Complications and side effects</subject><subject>Epinephrine - therapeutic use</subject><subject>Female</subject><subject>Fetal Blood</subject><subject>Forecasting</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Heart Rate, Fetal</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Hypoxia, Brain - complications</subject><subject>Infant, Newborn</subject><subject>Infants (Newborn)</subject><subject>Intensive Care, Neonatal</subject><subject>Intubation, Intratracheal</subject><subject>Meconium - chemistry</subject><subject>Medical examination</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Neonatal screening</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Pediatrics</subject><subject>Positive-Pressure Respiration</subject><subject>Pregnancy</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Seizures (Medicine)</subject><subject>Seizures - diagnosis</subject><subject>Seizures - etiology</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0s1rFDEUAPAgSl2rR49CEA8eOmsmH5PkJGXRKiz0oueQybyZzXY2MyYZ6PrXm9qlUFhyCMn75SV5PITe12RdC06_zNCltZZrvuaieYFWNdGq4lSKl2hFCKsrToh4jd6ktCeEcCHpBbpQDaOaqhXab2zANs274723GTrsQ29DTthmHH26w_0UcYAp2GxHnMD_XSIk3AKOdvbdeMS-g5B978vZ9ojdEmNZ450fdtX_BAcb7yAm_PUtetXbMcG703yJfn__9mvzo9re3vzcXG8rx5XOldOt5FQ4IhqQTFrX9I5KqaiS1HHeUM2oBF03SoNQkmmQnDAtOxCatqxjl-jjY945Tn8WSNnspyWGcqWhVLFaNbUq6OoRDXYEUz495WjdAAGiHacAvS_b17WitKFMFl6d4WV0cPDunP_8zBeS4T4PdknJqJvtM3p1jrppHGEAU0qzuT33EhenlCL0Zo6-1PhoamIeGsI8NITR0nBTGqL4D6dqLO0Buid96oAS_3SK2-Ts2EcbnE9PjBFBuKLsHwgFuy8</recordid><startdate>19960401</startdate><enddate>19960401</enddate><creator>PERLMAN, J. M</creator><creator>RISSER, R</creator><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope></search><sort><creationdate>19960401</creationdate><title>Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers ?</title><author>PERLMAN, J. M ; RISSER, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-c9b7425c056e737ac6fc27782872c44629327e91689e58739e740397de592b3d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Abruptio Placentae - complications</topic><topic>Acid-Base Imbalance - complications</topic><topic>Adrenergic Agonists - therapeutic use</topic><topic>Amniotic Fluid - chemistry</topic><topic>Apgar Score</topic><topic>Asphyxia neonatorum</topic><topic>Asphyxia Neonatorum - complications</topic><topic>Babies</topic><topic>Biological and medical sciences</topic><topic>Brain damage</topic><topic>Brain Ischemia - complications</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - etiology</topic><topic>Complications and side effects</topic><topic>Epinephrine - therapeutic use</topic><topic>Female</topic><topic>Fetal Blood</topic><topic>Forecasting</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Heart Rate, Fetal</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Hypoxia, Brain - complications</topic><topic>Infant, Newborn</topic><topic>Infants (Newborn)</topic><topic>Intensive Care, Neonatal</topic><topic>Intubation, Intratracheal</topic><topic>Meconium - chemistry</topic><topic>Medical examination</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Neonatal screening</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Pediatrics</topic><topic>Positive-Pressure Respiration</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Seizures (Medicine)</topic><topic>Seizures - diagnosis</topic><topic>Seizures - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PERLMAN, J. M</creatorcontrib><creatorcontrib>RISSER, R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing &amp; Allied Health Premium</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PERLMAN, J. M</au><au>RISSER, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers ?</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>1996-04-01</date><risdate>1996</risdate><volume>97</volume><issue>4</issue><spage>456</spage><epage>462</epage><pages>456-462</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Markers currently used to identify infants at highest risk for perinatal hypoxic-ischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconium-stained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n=36), FHRT abnormalities and MSAF (n=20), MSAF only (n=23), abruptio placentae (n=6), intubation in the DR (n=44), intubation in the neonatal intensive care unit (n=22), chest compressions (n=2), 5-minute Apgar scores of 5 or less (n=21), umbilical cord arterial pH of 7.00 or less (n=21), and base deficits of -14 mEq/L or more negative (n=19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds rations (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%. A combination of high-risk postnatal markers, specifically, a low 5-minute Apgar score and intubation in the DR in association with severe fetal acidemia, facilitates the identification within the first hour of life of term infants at highest risk for developing seizures secondary to perinatal asphyxia.</abstract><cop>Elk Grove Village, IL</cop><pub>American Academy of Pediatrics</pub><pmid>8632928</pmid><doi>10.1542/peds.97.4.456</doi><tpages>7</tpages></addata></record>
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subjects Abruptio Placentae - complications
Acid-Base Imbalance - complications
Adrenergic Agonists - therapeutic use
Amniotic Fluid - chemistry
Apgar Score
Asphyxia neonatorum
Asphyxia Neonatorum - complications
Babies
Biological and medical sciences
Brain damage
Brain Ischemia - complications
Cardiopulmonary Resuscitation
Cerebral palsy
Cerebral Palsy - etiology
Complications and side effects
Epinephrine - therapeutic use
Female
Fetal Blood
Forecasting
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Heart Rate, Fetal
Humans
Hydrogen-Ion Concentration
Hypoxia, Brain - complications
Infant, Newborn
Infants (Newborn)
Intensive Care, Neonatal
Intubation, Intratracheal
Meconium - chemistry
Medical examination
Medical research
Medical sciences
Neonatal screening
Nervous system (semeiology, syndromes)
Neurology
Pediatrics
Positive-Pressure Respiration
Pregnancy
Prospective Studies
Risk Factors
Seizures (Medicine)
Seizures - diagnosis
Seizures - etiology
title Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers ?
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