Objective: Free oxygen radicals and proinflammatory cytokines are important causes for brain injury in neonates with hypoxic ischemic encephalopathy (HIE). Our objectives were to test the hypothesis that a combination of antioxidants (ascorbic acid) and anti-inflammatory agents (ibuprofen) can ameliorate the brain injury in HIE and improve neurodevelopmental outcomes when given to term infants immediately after birth.Study Design: In a prospective, randomized, double-blinded controlled trial, 60 asphyxiated term infants were assigned to one of two groups, intervention and control. The intervention group (n ¼ 30) received intravenous ascorbic acid and oral ibuprofen for 3 days; and the control group (n ¼ 30) received similar volumes of a placebo. We measured a panel of cytokines at enrollment and administered the treatment drugs within 2 h after birth. Neurological evaluations and developmental screenings were performed for all survivors at 6 months of age.Result: The Intervention and Control groups did not differ in the severity of HIE at enrollment, the concentrations of IL-1b and IL-6, the incidence of mortality (37 vs 33%), the incidence of neurological abnormalities at hospital discharge (47 vs 55%) and the incidence of developmental delay at 6 months of age (32 vs 40%), respectively. None of the observed complications were related to intervention. Serum interleukin (IL)-1b and IL-6 concentrations correlated positively with the severity of HIE at birth (P<0.01), whereas only serum IL-6 correlated with neurodevelopmental outcome at 6 months (P<0.001).Conclusion: Early administration of ascorbic acid and ibuprofen did not affect outcomes in infants with perinatal asphyxia. This study does not explain whether our intervention was not effective in blocking free radicals and inflammatory cytokines, if the dosing and route of administration were inadequate, or if other mediators existed that could have a more powerful role in brain injury during hypoxia-ischemia.
AimThere are different guidelines to calculate red blood cell (RBC) replacement volume in neonates, ranging from 5 ml/kg up to 20 ml/kg RBC volume to be transfused. We aimed to investigate which method is more reliable in achieving the desired Haemoglobin (Hb) from a single blood transfusion in infants<32 weeks gestation admitted to the Neonatal Intensive Care Unit (NICU).MethodsPreterm infants<32 weeks gestations were enrolled if they were admitted to the Neonatal Intensive Care Unit, required a RBC transfusion and parental consent was obtained. Infants were excluded if there was evidence of active bleeding, intraventricular haemorrhage (IVH) grade ≥III or more at the time of transfusion,<24 hours post surgical intervention, ABO/Rh incompatibility or Disseminated Intravascular Coagulopathy. Each infant was then randomised to either the standard practice of calculating RBC volume (RBC volume=20 ml/kg) or to the intervention volume calculation (RBC volume=5×working weight × [Hb desired – Hb current]).ResultsSixty three infants were randomised, 55 infants had values for both the post-transfusion Hb and the target Hb. A chi-square test was used to determine if there was an association between the group to which the infant was randomised and whether they achieved the target Hb level. 21 (84.0%) of the 25 infants in the control group achieved the target Hb level, and 20 (66.7%) of the 30 infants in the intervention group achieved the target Hb level. Testing at a 5% significance level, there is no significant difference between the control and intervention groups in the proportion of infants who achieved the target Hb level (p=0.142, df=1).ConclusionThere was no significant difference between the 2 methods of RBC volume calculation in achieving the target Hb. The simpler calculation method of 20 ml/kg may be the optimum method as less chance of calculation error.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.