الفهرس 
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Abstract
HIE remains a major cause of perinatal and neonatal mortality, as well as of permanent neurodevelo-pmental disability.
Early detection is crucial for interventions aimed at preventing or reversing ongoing injury.
Neonatal encephalopathy is a heterogeneous syndrome characterized by symptoms of CNS dysfunction in infants born at/ or near term (> 36 wk gestation). An infant with neonatal encephalopathy may exhibit abnormal loss of consciousness, seizures, tone and reflex abnormalities, apnea and feeding difficulties.
HIE is defined as brain hypoxia and ischemia due to systemic hypoxemia and reduced cerebral perfusion characterized by clinical and laboratory evidence of acute or subacute brain injury, most often the underlying cause remains unknown.
Brain-type natriuretic peptide (B N P) is a natriuretic, diuretic, and vasodilator compound first discovered in the hypothalamus but mainly synthesized in the myocardium.
Arial natriuretic peptide (ANB) is synthesized primarily in the cardiac atria, while BNP in both the cardiac atria and the ventricles.
It was reported that high concentrations of plasma BNP have been associated with the development of cerebral ischemia and neurological deficits, moreover, it was suggested that BNP release is associated with the intensity of brain tissue ischemia, reflecting increased biosynthesis and secretion from ischemic brain tissue, especially from hypothalamus.
The present study aimed at assessment of NT-pro BNP (N-terminal pro-brain natriuretic peptide) serum level at birth in full-term newborns with HIE, following up its level 2 weeks after birth, and studying its possible diagnostic and prognostic values in such neonates. It had been conducted on 45 full-term neonates inside the NICUs of Ain Shams University Gynecology & Obstetrics hospital, in the period from December 2008 to October 2009.
The study included 2 groups:
The patient group:
Included 30 neonates, 17 males and 13 females, with a gestational age ranging from 38-41 wks. They all had met the designation criteria for HIE. The previous 30 neonates had been re-studied 2 weeks after birth.
The control group:
Included 15 healthy neonates, 8 males and 7 females of comparable gestational age, sex, and mode of delivery.
Neonates with IUGR, prematurity, low birth weight, and apparent congenital anomalies were excluded from the study.
All neonates included in the study were subjected to full perinatal history, complete clinical assessment and laboratory workups (blood samples were taken from the neonates for ABG, CBC, KFTs, and LFTs, assessments). NT-pro BNP. Serum levels were assayed in the studied groups at birth and 2 weeks after birth.
In the present study there was statistically no significant difference regarding gestational age, sex, modes of delivery, and presentations between patients and controls.
In addition, there was a highly significant decrease in pH serum values in patients with HIE compared to healthy controls at birth. Moreover, pH values significantly decreased with increased Sarnat stages at birth. On the other hand, there was a highly significant increase in ALT, AST, creatinine, and BUN, levels among patients compared to controls at birth.
Furthermore, there was a highly significant increase in NT-pro BNP serum levels in cases with HIE compared to healthy controls at birth. Moreover, NT-pro BNP serum levels significantly decreased in the follow up patients group at 2 weeks.
Also, there was statistically non significant difference regarding serum NT-pro BNP levels in relation to sex and gestational age among patients and controls. While, there was a highly significant +ve correlations between NT-pro BNP serum levels and ALT, AST, BUN, creatinine, among patients at birth. In addition, there was a highly significant –ve correlations between NT-pro BNP serum levels and Apgar scores, pH values within case group at birth.
The present study demonstrated that serum NT-pro BNP at a cut-off value of 190 pg/mL, was 80% sensitive and 60 % specific marker for prediction of hypoxic-ischemic brain insult at day 1. The cut-off value at day 15 of life was 43.5 pg/mL with 100% specificity and sensitivity.