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Метою проведеного дослідження було вивчення перебігу та результатів вагітності у пацієнток з високою легеневою гіпертензією. Наведені власні спостереження 14 вагітних жінок з високою легеневою гіпертензією, а також проведено аналіз експертних і літературних даних. Проаналізовано ефективність різних способів лікування і розродження цих жінок. З 14 пологів, що відбулися, шість були передчасними (42,9 %). У пацієнток, які спостерігалися нами, кесарів розтин було зроблено в 64,3 % випадків, пологи через природні родові шляхи відбулися в 35,7 % випадків. У стані асфіксії тяжкого ступеня народилося 21,4 % дітей, помірного — 35,7 %. Частота гіпотрофії плода при високій легеневій артеріальній гіпертензії склала 57,1 %. Не було жодного випадку материнської та перинатальної смертності.

There is restrained evidence that selective head cooling combined with erythropoietin may provide promising results in newborns with neonatal encephalopathyObjective: to estimate effectiveness and safety of combined therapy i.e. selective head cooling and erythropoietin in newborns with hypoxic-ischemic encephalopathy (HIE).Material and methods: 56 infants born in Zhitomir regional perinatal center with severe asphyxia during June 2008 to January 2016 were included into prospective study. We compared outcome of neonates (n=36) treated with selective head cooling (June 2008 – December 2013, group A) and newborns (n = 20) which received selective head cooling and erythropoietin treatment (1000 OD/kg, 6 days) (January 2014 - January 2016, group B). Informed consent of the parents for the treatment was obtained. 29 children of group A and 20 children of group B underwent neurologic examination and neurodevelopmental evaluation in the age of 12 – 18 months.Results: no complications were observed during treatment with selective head cooling combined with erythropoietin. We did not observe significant improvement of survival of newborns in group B: 100% vs 93,1%, RR = 1,1, [95% CІ 0,93 – 1,2], р = 0,33. The investigation revealed statistically significantly lower percent of death or severe neurologic disorders in group B in comparison with group A: 5,0% vs 31,0%, р = 0,03; RR = 1,37, [95% CІ 1,06 – 1,8], р = 0,02. There was higher percent of survived newborns with normal neurologic outcome in group B compared to group A (95,0% vs 68,9 %, р = 0,03; RR = 1,40 [95% CІ 1,06 – 1,8], р = 0,02, as well as higher percent of children without severe neurologic outcome (with borderline significance, 95,0% vs 74,1%, р = 0,11, RR = 1,28, [CІ]: 1,0 – 1,63, р = 0,046). The quota of children without severe neurodevelopmental delay was greater in group B: 95,0% vs 70,4%, р = 0,059, RR = 1,35, [95% CІ 1,04 – 1,76], р = 0,03.Conclusion: Addition of erythropoietin treatment to hypothermia via selective head cooling appeared to be safe and provided certain advantage in HIE treatment.

Objectives Adolescent pregnancies are high risk due to the increased probability of adverse outcomes; as adolescents are usually considered to be ill-equipped to deal with the burden of pregnancy. We sought to determine the prevalence of adolescent deliveries in a secondary-level care hospital in semi-urban Cameroon-Bamenda, the adverse neonatal outcomes and to assess if previous obstetric history could preclude adolescents from having adverse outcomes in their present pregnancy. Results The prevalence of adolescent deliveries was 8.7% (95% CI 7.01–10.73%). The neonates of adolescent mothers were more likely to have severe asphyxia (OR 4.0; 95% CI 1.2–12.9; p = 0.03) and low birth weight (OR 2.4; 95% CI 1.3–4.4; p

Objectives: This study aimed to illustrate the response time of pregnant women with fetal distress undergoing caesarean section at dr. Soetomo Hospital and Universitas Airlangga Hospital during 2015-2017.Materials and Methods: This was a non-experimental descriptive observational study using medical records at dr. Soetomo Hospital and Universitas Airlangga Hospital during 2015-2017. Samples of the study were enrolled using total sampling.Results: Data at dr. Soetomo Hospital revealed 103 patients: the age characteristics of >30 year were 48 patients (38%), underlying diseases with hypertension 68 cases (66%), use of general anesthesia with 65 cases (63%). Caesarean section response time >30 minutes was in 85 cases (83%), from which 58 babies (56.3%) had severe asphyxia. At Universitas Airlangga Hospital there were 5 patients, from whom those of 20-30 years were 4 (80%), and those with underlying diseases of hypertension were 3 patients (60%), and those using general anesthesia were 4 (80%). caesarean section response time of >30 minutes were in 3 cases (60%) where all 5 babies (100%) had moderate asphyxia. Age data processing with Chi-square test revealed p = 0.534 (p>0.05), indicating no significant relationship between age group with fetal outcome. Response time of the caesarean section showed p = 0.027 (p

Tracheal agenesis – failure of trachea development - is an extremely rare and severe congenital disorder involving the respiratory system and in most cases it is associated with other abnormalities. Three anatomic types of tracheal agenesis were described by Floyd. Antenatal diagnosis is difficult, especially if it is combined with a tracheo-oesophageal fistula. We report a postnatally diagnosed case of a female newborn with Type II tracheal agenesis. Polyhydramnios and right upper limb anomaly were diagnosed prenatally. Only typical postnatal clinical signs, such as severe asphyxia with strong respiratory efforts, no audible cry, failed endotracheal intubation and no palpable tracheal tissue on the neck aroused suspicion of tracheal agenesis. Despite the few published cases when antenatal diagnosis of tracheal agenesis and series of heroic postnatal surgical interventions resulted in few years’ survival, tracheal agenesis is still considered as a lethal condition. Possibilities of antenatal diagnosis, postnatal management and therapeutic options are discussed.

OBJETIVO: Determinar la morbilidad de recién nacidos por cesárea programada. DISEÑO: Estudio retrospectivo, descriptivo, comparativo, transversal y analítico. MATERIALES Y MÉTODOS: Se revisa 102 casos de recién nacidos de gestantes con partos por cesárea programada atendidos en el Servicio de Obstetricia del Hospital III Essalud "Félix Torrealva Gutiérrez" de la ciudad de Ica, en el período comprendido entre el 1 de enero de 2000 y el 31 de diciembre de 2003. Se les comparó con un número similar de nacidos de parto eutócico. RESULTADOS: En el período estudiado, se atendió 3780 partos, de los cuales 102 fueron por cesárea programada. La edad materna mayor correspondio en 36,3% al grupo etáreo de 35 a 40 años, 70 (70,6%) eran casadas, 51,9% empleadas, 46,1% primigestas. El Ápgar del recién nacido fue >=7 en 96,7% de neonatos, no hubo caso de asfixia severa; 58,8% fueron varones, 70,6% con peso adecuado. Se encontró 27,5% de casos de ictericia fisiológica, 17,7% con síndrome de dificultad respiratoria II y 7,8% con trastornos metabólicos, mientras en el grupo control fueron 6,9%, 4,9% y 3,9% respectivamente; en el grupo control, los traumatismos obstétricos fueron 6,9 y sólo 0,9% en el grupo de estudio. CONCLUSIONES: Existió relación entre morbilidad y la vía del parto; el riesgo de enfermedad fue mayor para los neonatos nacidos por cesárea programada.

Fibrovascular polyps (FVPs) are rare, benign tumors of the esophagus; they usually appear as an intraluminal mass within the esophagus, which can grow and reach enormous sizes if left untreated. They can cause a variety of symptoms, from mild dysphagia to life-threatening asphyxia. Diagnosis is challenging because FVPs can resemble any respiratory condition, which can lead to misdiagnosis and potentially dangerous therapies. We present a 47-year-old man who suffered from recurrent episodes of odynophagia. This time he suffered an incident of severe asphyxia and loss of consciousness. After complementary examinations, an FVP was detected and successfully treated.

OBJETIVO. Determinar la tasa actual de mortalidad perinatal durante el año 1995 y compararla en todos sus componentes con los hallazgos de hace 10 años. DISENO. Estudio retrospectivo descriptivo transversal. RESULTADOS. Se revisó 5249 historias clínicas, encontrándose 70 muertes perinatales, conformando un tasa de mortalidad perinatal de 13,3%, Se encuentra que ha incrementado el número de pretérminos de 4,32 (1985) a 6,76% (1995), así como el de peso muy bajo < 1500 g, de 0,99 (1985) a 1,11% (1995), sin haberse incrementado la tasa de mor-talidad perinatal. También ha variado la conformación de la patología. Actualmente la primera causa es la anomalía congénita en 26,4%, habiendo sido fuertemente des-plazada la asfixia severa que era la primera causa de muerte perinatal en 1985. Igualmente se identifica que la de las muertes es en pacientes sin control prenatal. CONCLUSIÓN. Es gracias al impacto de la lactancia materna exclusiva, el alojamiento conjunto, el método canguro para prematuros y la capacitación del personal en reanimación neonatal que se logra disminuir la tasa de mortalidad perinatal a lo largo de los últimos 10 años. Si se desea bajar aún más esta tasa de mortalidad perinatal, será necesario seguir insistiendo en el control prenatal, las tecnologías perinatales y el enfoque de riesgo.

Objective: Therapeutic hypothermia (HT) is the standard treatment for newborns after perinatal asphyxia. Preclinical studies report that HT is more effective when started early. Methods: Eighty cooled newborns were analyzed and grouped according to when cooling was started after birth: early (≤180 min) or late (>181 min). For survivors we analyzed whether starting cooling early was associated with a better psychomotor or mental developmental index (PDI or MDI, Bayley Scales of Infant Development II) than late cooling. Results: Forty-three newborns started cooling early and 37 started late. There was no significant difference in the severity markers of perinatal asphyxia between the groups; however, nonsurvivors (n = 15) suffered more severe asphyxia and had significantly lower centiles for weight (BWC; p = 0.009). Of the 65 infants that survived, 35 were cooled early and 30 were cooled late. There was no difference in time to start cooling between those who survived and those who did not. For survivors, median PDI (IQR) was significantly higher when cooled early [90 (77-99)] compared to being cooled later [78 (70-90); p = 0.033]. There was no increase in cardiovascular adverse effects in those cooled early. There was no significant difference in MDI between early and late cooling [93 (77-103) vs. 89 (76-106), p = 0.594]. Conclusion: Starting cooling before 3 h of age in surviving asphyxiated newborns is safe and significantly improves motor outcome. Cooling should be initiated as soon as possible after birth in eligible infants.

Introduction: Non-specific lung inflammatory events caused by severe asphyxia may be intensified by the way we resuscitate the newly born. Assessing lung injury is potentially important because if alternative resuscitation approaches induces similar inflammatory responses or less lung injury. then we may choose the resuscitation approach that is most gentle, and easiest to perform and learn. We investigated the levels of lung inflammatory markers by comparing different ventilation, chest compression and inhaled oxygen fraction strategies in resuscitation of newly born pigs at cardiac arrest. Materials and Methodology: Progressive asphyxia in newborn pigs was induced until asystole occurred. With current resuscitation guidelines as a reference group, pigs were randomized to receive initial ventilation before chest compressions for 30s, 60s or 90s, or to compression-to-ventilation ratios 3:1or 9:3, or to resuscitation using pure oxygen or air. We analysed inflammatory markers in bronchoalveolar lavage fluid (BAL), IL8 and TNFα, and lung tissue qPCR for genes matrix metalloproteinases (MMP)2, MMP9, TNFα and ICAM-1. Results: BAL-levels of TNFα and IL8 tended to be higher in the 30s group compared to 60s group (p = 0.028 and p = 0.023, respectively) as was gene expression in lung tissue of ICAM-1 and MMP2 (p=0.012 and p=0.043, respectively). MMP2 expression was slightly higher in the 30s group compared to 90s group (p = 0.020). No differences were found between pigs resuscitated with C:V ratio 9:3 and 3:1 or pure oxygen versus air. Conclusion: Compared to current guidelines, with respect to lung injury, resuscitation with longer initial ventilation should be considered. Longer series of chest compressions did not change the lung inflammatory response, neither did the use of air instead of pure oxygen in severely asphyxiated pigs resuscitated from asystole.

We report on an infant with severe asphyxia and persistent pulmonary hypertension as a newborn. The baby received prolonged intravenous calcium gluconate therapy for hypocalcemia. At 5 weeks of age, multiple firm, indurated areas (armor-like lesions) were palpable in the subcutaneous tissues of the trunk, arms, legs, and face, particularly in skin folds. Roentgenographic study showed generalized soft-tissue calcifications throughout the body, extremities, and face. Calcinosis cutis occurs through a variety of pathogenetic mechanisms. Case reports on calcinosis cutis in infants are uncommon, and the calcifications are mostly localized. In our patient, they are generalized.

Introduction Neonatal asphyxia is still the leading cause of high morbidity and mortality in developed countries, as well as in devel- oping countries including Indonesia. As a response to asphyxia, renal hypoxia occurs which is initially temporary, but if persisting, can cause permanent damage to the cortex and medulla. Objective The purpose of this study was to determine the nephrologic abnormalities in neonatal asphyxia at Cipto Mangunkusumo Hospital. Methods This was a cross sectional descriptive study conducted in the Division of Neonatology, Cipto Mangunkusumo Hospital from August until November 2002. Neonates with congenital malforma- tion were excluded. Results The study showed that the incidence of nephrologic ab- normalities in neonatal asphyxia based on Apgar scores at 1, 5, and 10 minutes were 65/100, 26/33, and 5/6, respectively. The risk of nephrologic abnormalities was not statistically different in se- vere asphyxia compared to moderate asphyxia. Severe asphyxia at 1 minute Apgar scores was correlated with the occurrence of oliguria. Conclusion In asphyxiated newborn, it is very important to inves- tigate the possibility of nephrologic abnormalities

We compared the current guidelines for neonatal resuscitation with alternative measures and aimed to find out whether this modulated brain inflammation.Progressive asphyxia was induced in 94 newborn pigs until asystole. With the reference being resuscitation guidelines, 30 s of initial positive-pressure ventilation before compression (C) and ventilation (V) (C:V; 3:1) in 21% oxygen, pigs were randomized to (i) ventilation for 30, 60, or 90 s before chest compressions; (ii) C:V ratios of 3:1, 9:3, or 15:2; or (iii) 21% or 100% oxygen. Concentrations of inflammatory markers in the cerebrospinal fluid (CSF) and gene expression in the hippocampus and frontal cortex were measured for different interventions.In CSF, S100 was higher with 90 s than with 30 or 60 s of initial positive-pressure ventilation, whereas concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were higher with 30 than with 60 s. Matrix metalloproteinase-2 (MMP-2) and intracellular adhesion molecule 1 (ICAM-1) were higher with 30 than with 60 s. No other comparison between ratios and oxygen concentrations used yielded significant results.With respect to signs of brain inflammation, newly born pigs at asystole should be ventilated for longer than 30 s before chest compressions start. C:V ratios of 9:3 and 15:2 as compared with 3:1, or air instead of pure oxygen, did not modulate inflammatory markers.

Can theophylline prevent the development of renal dysfunction in neonates with severe asphyxia?

In 1851, the German pathologist Barbedelan reported the autopsy findings of a 6-month-old infant who died from severe asphyxia ([1][1]). Evaluation of the cardiac anatomy revealed hypoplasia of the left ventricular cavity without communication to the aorta, severe hypoplasia of the ascending aorta

The Aim of this study To evaluate the effect of selective head cooling (introduced 3 months ago in the Neonatal Intensive Care Unit at the University Children’s Hospital in Skopje-Macedonia) on S100 B protein levels, previously measured only in normothermic infants after perinatal asphyxia and the preliminary neurodevelopment outcome at the age of 3 months. Methods All risk neonates with severe asphyxia admitted within 24h of injury were eligible for inclusion in the study. One serum blood sample was obtained from each patient the first day of admission, and 48h and 72h hours after admission. S100B levels were measured using ECLIA method (Electro-Chemil-Luminiscence Immuno Assay-Elecsys 2010-Roche Diagnostic). Results The avarage serum S100B levels for the control group (N=48) was 0.12 microgL (–1) (cut-off point). Serum S100B levels were grossly elevated in both HT and NT groups of infants with asphyxia. The differences were statistically significant as follows: a) between the first (24h) and second (day 4) time interval significant at p Conclusion Serum S100B levels were lower in the HT group after 72h, and strongly correlated with the neurodevelopment impairment. S100B levels are highly elevated following asphyxia. Serum S100B levels are lowering in the HT and strongly correlate with the early neurodevelopment outcome.

Sixteen newborn infants with severe asphyxia were prospectively studied for evidence of secondary myocardialdamage and, in that case, their clinical findings. Myocardial damage was diagnosed in three term newborn in-fants of adequate weight for gestacional age (18,7%) by means of serial electrocardiograms taken in the first 72hours of life. Two of them showed evidence of difusse subendocard'al ischemia and a third one showed electro-cardiographic signs suggesting necrosis of the left ventricular posteroinferior wall. Neither creatinephosphokinaseserum activity nor its muscle brain MB isoenzyme were useful in the identification of myocardial damage. All threeaffected neonates developed respiratory distress syndrome without signs of cardiac failure and one of them died.The histopathological study of this late one showed localized hemorrhage of the papillary muscles and inter-ventricular septum. These finding underscore the need of serial electrocardiographic recordings in newborns withsevere asphyxia, sincecardiac dysfunction may inadvertently occur under the appearence of respiratory distresssyndrome.(Key words: myocardium, ischemia,asphyxia neonatorum.)

The policy of surgical treatment in infants with open myelomeningocele is now controversial. Criticisms against the selective operation for myelomeningocele, proposed by Lorber and Stein, have been reported and the decision making process for treatment has become more complex in recent years. Generally, aggressive treatments for myelomeningocele are not recommended in neonatal infants associated with severe asphyxia, severe intracranial hemorrhage, fetal infections or irremediable systemic anomalies. But the decision to treat or not treat infants with myelomeningocele and remediable systemic anomalies other than the central nervous system is debatable. The authors treated aggressively two neonatal infants with myelomeningocele and associated congenital intrathoracic cysts. Both of these infants had thoraco-lumbar myelomeningocele and a congenital pulmonary cyst or neurenteric cyst. Myelomeningocele in both infants were repaired within 3 days after birth and the congenital intrathoracic cysts were also extirpated. Both were followed-up for 2 years after the surgery and showed subnormal development except for the total dysfunction of the lower extremities and bladder at the end of the follow-up period. The author concluded that the decision making in the treatment of infants wth myelomeningocele and accompanying systemic anomalies other than CNS is principally based on whether these systemic anomalies are remediable or not, and what the likely outcome in these infants is.

Hypothermia is being studied as a neuroprotective therapy after asphyxia. This report is about a term newborn with severe asphyxia who underwent systemic hypothermia (34.5 degrees C) for 72 h. He survived without apparent brain damage but developed sclerema on his back, in the area in contact with the cooling mattress. The sclerema resolved without scarring after three months.

Background: Perinatal asphyxia is responsible for multiple organ damage which is increased upon re-oxygenation by the generation of an excess of oxygen free radicals. Proximal tubular damage and the subsequent acute renal failure are common complications of severe asphyxia. Thus, limiting the amount of oxygen supplied upon resuscitation seems an adequate approach to reduce oxidative stress-derived renal damage. We hypothesized that room-air resuscitated infants would exhibit diminished renal damage as shown by specific clinical and biochemical markers.

INTRODUCTION AND OBJECTIVE In order to determine the effects of hyperbaric oxygenation, 14 Cuban children (8 boys and 6 girls) with affected lesions on the Central Nervous System (CNS), were prospectively studied between September 1994 and September 1995; the patients came from the external consultation of Neuropediatric of the Academic Pediatrics Hospital, Tuna Martyrs, Cuba. PATIENTS AND METHODS They were evaluated from the neuropediatric and neurophysiologic point of view and submitted to treatment with hyperbaric oxygenation (HBO). Five patients showed a injury to the CNS by severe asphyxia, seven by generalized infections of CNS, one patient with cerebral damage by craneoencephalic traumatism and other with vasoclusive cerebral crisis of siclemic. The average age of the children was of 4.8 +/- 3.4 years. The symptoms and signs were depending on the type on cerebral damage and its evolution. 100% of the children presented infantile cerebral paralysis (ICP) and epilepsy, most of the children were in treatment with antiepileptic drugs, buy they weren't balanced. RESULTS AND CONCLUSIONS Satisfactory response was observed in patients that were oxygenated within the first year of the lesion, with better and faster results.

Aim: To evaluate in a randomized controlled trial if high-dose phenobarbital (PB) improves outcome after severe asphyxia. Patients: Newborn infants with a 5-min Apgar score 0-3 or need for ventilatory assistance >30 min after birth were allocated to the treatment (PB+, n=21, mean gestational age 38.6; SEM 0.6 wk) or control group (PB+, n=17, 38.7; 0.6 wk). Intervention: PB 30 mg/kg was given iv before the age of 4h, a second dose 15 mg/kg iv 4h later to reach a serum level of 200-300 μmol/l, thereafter 5 mg/kg/d for 5 days. Follow-up results: Of the 21 PB+ infants, there were 4 neonatal deaths, 4 CP (1 late death), and of the 17 PB- infants, 3 deaths, 2 CP (NS). At 6 yrs of age, the mean IQ (WISC-r) was 108 (95%CI: 99-117) in PB+ are 111 (97-125, NS) in PB- testable infants. The groups performed similarly in the neuropsychological tests: copying design (VMI), attention and confrontation naming (NEPSY). Including all outcome criteria on a quality-of-life scale ranging fom 0 (dead) to 1 (perfect health), the mean score in PB+ infants (0.500; 95%CI:0.328-0.672) did not differ from PB- (0.559; 0.368-0.750) infants. Conclusion: PB does not prevent postasphyxial brain damage.

Seven full-term infants with severe encephalopathy following perinatal asphyxia were followed longitudinally to 2 years of age to determine health and developmental outcome and to investigate mother-infant interaction patterns over time. Infants received either ongoing or follow-up intervention that differed in terms of intensity and focus of intervention procedures. Developmental assessment scores at 12 and 24 months of age indicated that all infants except one demonstrated varying degrees of delayed development. Five infants were diagnosed with cerebral palsy at or before their 12-month follow-up clinic visit. One was diagnosed with and one remained without evidence of cerebral palsy at the 24-month visit. Mother-infant interactions differentiated among degree of infant disability at outcome where medical signs alone were unreliable predictors of later developmental outcome. Interactions between mothers and their infants upon discharge from the hospital differentiated babies with severe disability from those with moderate, minimal, or no disability. At 6 months, interaction patterns were different for all levels of disability, and these differences remained at 12 months.

Magnetic resonance (MR) imaging with a 0.6-T magnet was performed on 51 neonates, aged 29-42 weeks postconception. In 45 neonates, the ventricular/brain ratio (V/B) at the level of the frontal horns and midbody of the lateral ventricles ranged from 0.26 to 0.34. In six other infants a V/B of 0.36 or greater was associated with either cerebral atrophy or obstructive hydrocephalus. The width of the extracerebral space measured along specified points varied little in the neonatal period and ranged from 0 to 4 mm in 48 infants. Extracerebral space widths of 5-6 mm were seen in three other infants with severe asphyxia. Prominence of the subarachnoid space overlying the posterior parietal lobes is normal in neonates and should not be confused with cerebral atrophy. The authors conclude that V/B ratios of 0.26-0.34 and extracerebral space widths of 0-4 mm represent the normal range, and that neonates whose measurements exceed these values should be followed up.

Fifty-four infants born severely. asphyxiated with birth weights of more than 2500 g and gestational ages older than 37 weeks were studied with help of careful review of the case files. To establish a relationship between the time elapsed after birth to spontaneous regular active respiration and later outcome, the infants were divided into three groups: group A of 34 children, established spontaneous active respiration within 15 min; group B of 7 children recovered in 15–30 min, and group C of 13 children recovered 30 min after birth. The outcome in group C, in which the infants also had a history of prolonged intrapartum asphyxia, was uniformly bad. The absence or presence of an audible heart beat at birth was not a reliable clinical sign for a prognosis. The time that elapsed between the start of resuscitation and the first gasp had to be doubled to indicate the likely start of regular active respiration in one third of our babies. The results indicated that the combination of prolonged intrapartum asphyxia and a delay in onset of spontaneous regular respiration of more than 30 min following birth predicted a uniformly bad prognosis. Attempts at resuscitation after this interval did not appear to be warranted.

1. 1. Evipal soluble was administered rectally to 75 women in labor and the results were tabulated. The dosage corresponds to that of previous investigators. 2. 2. The analgesia and amnesia secured were extremely variable. The duration of analgesia was generally short, ranging from fifteen minutes to six hours, averaging about two and one-half hours. In some cases amnesia was complete and in others totally absent. Despite the fact that about 35 per cent of the patients received supplementary drugs, the total number of good results was low (46.6 per cent). 3. 3. Two grave maternal reactions were observed. Although both patients recovered, the reactions were very alarming. These two cases are described in detail. 4. 4. Three babies were moderately asphyxiated at birth when evipal was the only analgesic drug used during labor. Two babies in cases in which evipal alone was used during labor exhibited severe asphyxia. All the babies in this series were drowsy for about twenty-four hours following delivery.

1. 1. The method of closed chest cardiac resuscitation was used in 5 full-term newborn infants for periods ranging from 6 minutes to 2½ hours. In the case in which direct measurements were made, it was found to be effective in producing adequate blood pressures and improvement of the electrocardiographic patterns without inadvertent trauma to the bony structures or viscera. 2. 2. The one permanent survivor, at 16 months of age, is healthy, developing normally, and has no demonstrable neurological sequelae. The other infants had been exposed to either severe asphyxia in utero or prolonged delays in instituting the cardiac massage. 3. 3. The prime advantages of this technique to the newborn infant are the ease with which it can be instituted and the avoidance of a thoracotomy. 4. 4. The initial results with this method of cardiac resuscitation are encouraging and warrant further serious consideration and investigation.

Outcome of very low birthweight (VLBW) infants depends to a high degree on optimal cooperation between obstetricians and neonatologists. Until recently this necessity had not been recognized in many countries. Years ago there was very little chance of finding a position as a neonatologist because neonatology was almost unknown. This is still true in the Federal Republic of Germany. It was D.V.I. Fairweather (1981) who first in Europe emphasized the urgent need for close cooperation between the obstetrician and the neonatologist and stated that he enjoyed this successful “symbiosis.”

In severe asphyxia, expansion of the newborn lung must precede ventilation by intermittent positive pressure. Inadequate expansion may lead to hypoxia and excessive expansion to rupture of the lung. The only way in which a predetermined pressure can be achieved, and not exceeded in the alveoli, is by applying that pressure at the mouth and waiting until all flow ceases. Applying pressure in this way and increasing it according to a "staircase" pattern, with appropriate steps at suitable intervals, should ensure that the maximum pressure produced in the alveoli is no greater than the minimum necessary for resuscitation in each individual infant. On the basis of published work, ranges of optimum values for the increments and time intervals are suggested. Clinical judgement is still necessary to select from within these ranges, but this "pressure staircase" method should provide a systematic approach to the problem. A suitable apparatus is described.

The low APGAR baby delivered in a clinic presents the midwife with a formidable problem. The problem arises from the fact that clinics generally are poorly equipped for major resuscitation of the newborn. The problem is further compounded by the fact that the baby with a low APGAR score travels very badly. He becomes hypothermic easily, and is likely to die if moved in a cold ambulance without oxygen or adequate heating. Then too, midwives are generally poorly trained for the task o f resuscitating babies suffering from severe asphyxia neonatorum, because they received their training in hospitals with the basic assumption that a medical officer is always in the background ready to take over the management of such problems. Finally, acceptance by the community of clinic-based obstetric services is largely dependent upon the clinics' achieving a nil perinatal mortality rate. The delivery of a gasping newborn who dies in the midwife’s hands can do great damage to the reputation of the service.

Brain-type isoenzyme of creatine kinase was measured serially in 45 healthy and 22 severely asphyxiated term infants. The enzyme was measured in cord blood and in venous, capillary, or arterial blood at six to eight hours, 24 to 30 hours, and 72 to 80 hours after birth. In the healthy infants a brief rise of CK-BB occurred at six to eight hours; CK-BB activities were greater than 2.5 log-transformed standard deviations above the mean of the control values in ten of the asphyxiated infants and in none of the control infants. When normal CK-BB activity was used as a predictor of good neurologic outcome and elevated CK-BB as a predictor of subsequent neurologic abnormality, the outcome was predictable from the CK-BB activity in 17 of 22 cases (77%) and in 11 of the 12 survivors (92%). Eight of the 12 surviving infants had neonatal seizures and outcome was predictable from CK-BB activity in all cases. We conclude that serum CK-BB activity, especially when measured in cord blood and at six to 12 hours of life, correlates with neurologic outcome after severe asphyxia, and that measurement of CK-BB compares favorably with radionuclide and computerized tomographic scanning as a method of predicting neurologic outcome after asphyxia.

Recent advances in respiratory and cardiovascular support make it possible for many infants with severe asphyxia or intracranial hemorrhage to survive the neonatal period. It is the concern of all of us involved in the care of these infants that advanced skills in life support technology lead to the survival of children without neurological deficits. The goal of this review is to describe several new techniques to study the human nervous system and to indicate their potential role in the development of treatments to limit or reverse brain damage produced by asphyxia and hemorrhage.

Three children who had suffered prolonged hypotension or severe asphyxia and who subsequently developed cystic subcortical leucomalacia are reported. This condition fits into the spectrum of perinatal ischaemic brain disease but the diagnosis in life has not previously been reported. Aetiological factors and neurodevelopmental outcome, which was poor in all cases, are discussed.