Aim To examine pro‐ and anti‐inflammatory cytokines in children with cerebral palsy (CP) at baseline and in response to endotoxin (lipopolysaccharide), and correlate outcomes compared with age‐matched comparisons, to evaluate their ability to mount an immune response. Method Serum cytokines were assessed in 12 children (eight males, four females; mean age 10y 1mo [SD 1y 8mo], 6–16y) with CP against 12 age‐matched comparisons (eight males, four females; mean age 9y 1mo [SD 1y 1mo]). Pro‐ and anti‐inflammatory cytokines (interleukin‐1β, interleukin‐2, interleukin‐6, interleukin‐8, interleukin‐10, interleukin‐18, tumour necrosis factor [TNF]‐α, TNF‐β, interferon‐γ, granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], vascular endothelial growth factor [VEGF], erythropoietin, and interleukin‐1 receptor antagonist) were measured at baseline and in response to in vitro simulation with lipopolysaccharide by multiplex enzyme‐linked immunosorbent assay. Results Significantly higher erythropoietin was found at baseline in children with CP compared with the comparison group. There was a strong response to lipopolysaccharide for interleukin‐8, VEGF, TNF‐α, and GM‐CSF in both children with CP and the comparison group; however, there was significant lipopolysaccharide hyporesponsiveness in children with CP compared with the comparison group for interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6. Interpretation Altered cytokine responses in children with CP compared with the comparison group demonstrate an altered inflammatory state that may contribute to ongoing sequelae and could be a target for therapy. What this paper adds Altered inflammatory responses persist in children with cerebral palsy (CP). Erythropoietin is elevated in children with CP compared with the comparison group. Children with CP have reduced interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6 inflammatory responses to lipopolysaccharide.
Introduction: Neonatal encephalopathy (NE) is associated with coagulation abnormalities. We aimed to investigate the serial alterations in coagulation profiles in term infants with NE and correlate with their clinical outcomes. This was a prospective cohort study in a tertiary referral, university-affiliated maternity hospital. Neonates exposed to perinatal asphyxia were recruited (n = 82) and 39 received therapeutic hypothermia. Infants had serial coagulation tests including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen in the first week of life. The main outcome measures included MRI brain and EEG seizures. Our results show that mortality was predicted on day 1 by decreased Fibrinogen (AUC = 0.95, p = 0.009) and by PT on day 2 with a cutoff of 22 s. An abnormal MRI was predicted by Fibrinogen on day 3 with a cut-off value of 2 g/L. For prediction of grade II/III NE, PT on day 2 of life was strongest with a cut-off value of 14 s. Only elevated APTT levels on day 1 of life were predictive of seizures (AUC = 0.65, p = 0.04).Conclusion: Coagulation parameters are strong predictors of outcomes such as abnormal NE grade, seizures, and mortality.
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