As a rare obstetric disease, fetomaternal hemorrhage (FMH) often causes severe fetal anemia, edema and even death, easily to be confused with severe neonatal asphyxia. Currently, there are several ways to detect or predict FMH, however, most of them are flawed and time-consuming, as well as unsuitable for rapid diagnosis and timely intervention of FMH. To explore the values of umbilical artery blood gas analysis in the rapid diagnosis of FMH, providing basis for rapid guidance of newborn rescue. Five cases of neonates with FMH from the First Affiliated Hospital of Army Military Medical University (Chongqing Southwest Hospital) from January 2013 to January 2016 were selected as the study group. Another 9 cases of severe asphyxia neonates were chosen into the control group. The difference in Apgar score and umbilical artery blood gas analysis between the 2 groups at birth was compared, and the treatments and clinical outcomes of the 2 groups were analyzed. The PH value of umbilical artery blood gas analysis in the study group was higher than that of the control group, but the difference was not statistically significant (P > .05). In the study group, cases with pH value < 7.0 accounted for 0%, whereas the cases with pH < 7.0 accounted for 66.67% in the control group, and the difference between the 2 groups was statistically significant (P < .05). Compared with the control group, the arterial oxygen partial pressure (PO2), the absolute value of (PCO2), lactic acid (lac) and alkali were not significantly different from those of the control group (P > .05), while the total hemoglobin (tHb) and hematocrit (Hct) were significantly lower than the control group (P < .0001). In the study group, tHb in the umbilical cord blood of 2 newborns with FMH death was significantly lower than 40 g/L. FMH should be highly suspected when there is an expression of severe asphyxia in neonates, indicated by significantly lower tHb levels in umbilical cord blood. It is helpful to improve the neonatal outcome by FMH neonatal resuscitation as soon as possible.

BACKGROUND: Prolonged perinatal asphyxia (PA) may cause hypoxic-ischemic damage to the brain. The aim of this study was to investigate the brain diffusion changes of patients with PA and examine the relationship with brain damage.
METHODS: This retrospective study included 55 patients diagnosed with PA, separated into mild and severe PA groups. For the evaluation of brain damage in all the study neonates, brain and diffusion MRI scans were performed using a 3T device. The scans were taken between 5 and 10 days postnatal, after completion of hypothermia treatment, in accordance with the standard clinical protocol of our institution. Apparent diffusion coefficient (ADC) values of the lentiform nucleus, thalamus, frontal white matter, and posterior limbs of the internal capsule were measured. Minitab package programs and SPSS version 20.0 software were used for statistical analysis and graphic drawing. Spearman\'s rank correlation analysis was used.
RESULTS: The bilateral lentiform nucleus, thalamus, frontal white matter, and posterior limbs of the internal capsule ADC values were significantly higher in the severe PA group than in the mild PA group.
CONCLUSIONS: In neonates with severe perinatal asphyxia, brain damage can be evaluated on diffusion-weighted imaging (DWI) of the cerebral deep white matter and basal ganglia. DWI, imaging with conventional brain MRI comes to the fore in clinical importance in PA patients.

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This article summarizes the current evidence regarding inflammatory biomarkers (placental and postnatal) and provides a comprehensive understanding of their roles: (1) diagnostic accuracy to predict the severity of hypoxic-ischemia encephalopathy (HIE), (2) value in assessing treatment responses, and (3) prediction of both short- and long-term neurodevelopmental outcomes. In the early critical stages of perinatal asphyxia, inflammatory biomarkers may guide clinical decision-making. Additional research is required to increase our understanding of the optimal utility of biomarkers to predict the severity, evolution, and developmental outcomes after exposure to HIE.

The etiology of perinatal brain injury is multifactorial, but exposure to perinatal hypoxiaischemia (HI) is a major underlying factor. This review discusses the role of exposure to infection/inflammation in the evolution of HI brain injury, changes in immune responsiveness to subsequent inflammatory challenges after HI and modulation of neural outcomes with interaction between perinatal HI and inflammatory insults. The authors critically assess the clinical and preclinical evidence for the neuroprotective efficacy of therapeutic hypothermia and other anti-inflammatory treatments for inflammation-sensitized HI injury.

Neurologic depression in term/near-term neonates (neonatal encephalopathy, NE) is uncommon with modern obstetric care. Asphyxial birth, with or without co-factors, accounts for a minority of NE, while maldevelopment (congenital malformations, growth aberrations, genetic, metabolic and placental abnormalities) plays an enlarging role in identifying etiologic subgroups of NE. The terms NE and hypoxic-ischemic encephalopathy (HIE) have not been employed uniformly, hampering research and clinical care. The authors propose the term NE as an early working-diagnosis, to be supplemented by a diagnosis of NE due to HIE or to other factors, as a final diagnosis once workup is complete.

BACKGROUND: Neonatal asphyxia is a leading cause of early neonatal mortality, accounting for approximately 900,000 deaths each year. Assessing survival rates, recovery time and predictors of mortality among asphyxiated neonates can help policymakers design, implement, and evaluate programs to achieve the sustainable development goal of reducing neonatal mortality to 12/1,000 live births by 2030. The current study sought to ascertain the survival status, recovery time, and predictors of neonatal asphyxia.
METHODS: A retrospective follow-up study conducted in Debre Berhan Comprehensive Specialized Hospital, which carried out from May 20th to June 20th, 2023 using records of asphyxiated babies in NICUs from January 1st, 2020 to December 31st, 2022, involving a sample size of 330. Pre-structured questionnaires created in Google Form were used to collect data, and STATA Version 14.0 was utilized for data entry and analysis, respectively. The Kaplan-Meier survival curve, log rank test, and median time were calculated. A multivariable Cox proportional hazards regression model was fitted in order to determine the predictors of time to recovery. Variables were statistically significant if their p-value was less than 0.05.
RESULTS: Three hundred thirty admitted asphyxiated neonates were followed a total of 2706 neonate -days with a minimum of 1 day to 18 days. The overall incidence density rate of survival was 9.9 per 100 neonates\' days of observation (95% CI: 8.85-11.24) with a median recovery time of 9 days (95% CI: 0.82-0.93). Prolonged labor (Adjusted hazard ratio (AHR: 0.42,95%CI:0.21-0.81), normal birth weight (AHR:2.21,95% CI: 1.30-3.70),non-altered consciousness (AHR:2.52,CI:1.50-4.24),non-depressed moro reflex of the newborn (AHR:2.40,95%CI: 1.03-5.61), stage I HIE (AHR: 5.11,95% CI: 1.98-13.19),and direct oxygen administration via the nose (AHR: 4.18,95% CI: 2.21-7.89) were found to be independent predictors of time to recovery of asphyxiated neonates..
CONCLUSIONS: In the current findings, the recovery time was prolonged compared to other findings. This implies early diagnosis, strict monitoring and provision of appropriate measures timely is necessary before the babies complicated into the highest stage of hypoxic -ischemic encephalopathy(HIE) and managing complications are the recommended to hasten recovery time and increase the survival of neonates.

BACKGROUND: Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward.
OBJECTIVE: This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility.
METHODS: A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P < 0.05.
RESULTS: The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P < 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery.
CONCLUSIONS: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological.
Résumé Contexte:La cardiotocographie d’admission (CTG), une procédure non invasive, est utilisée pour indiquer l’état d’oxygénation du fœtus lors de son admission en salle de travail.Objectif:Cette étude a évalué l’association entre les résultats du CTG à l’admission et l’issue néonatale dans un établissement de santé tertiaire.Matériels et méthodes:Une étude observationnelle prospective portant sur 206 femmes enceintes admises en salle de travail avec des grossesses vivantes uniques. Des informations sur les caractéristiques démographiques, les antécédents obstétricaux et médicaux, le traçage CTG à l’admission et les résultats néonatals ont été obtenues à l’aide d’un formulaire de collecte de données structuré. Les données ont été analysées à l’aide du logiciel SPSS version 20.0 avec le niveau de signification fixé à P <0,05.Résultats:Les résultats du CTG à l’admission étaient normaux chez 73,3 %, suspects chez 13,6 % et pathologiques chez 13,1 % des femmes. La survenue d’un faible poids à la naissance, d’une admission dans une unité de soins spéciaux pour bébés (SCBU), de nouveau-nés asphyxiés, de décès néonatals et d’une hospitalisation prolongée était significativement plus fréquente chez les personnes ayant des résultats CTG d’admission pathologiques par rapport aux résultats normaux et suspects (P < 0,05). L’incidence des accouchements par voie basse était plus fréquente lorsque les résultats du CTG étaient normaux, alors que toutes les femmes présentant un résultat pathologique du CTG avaient accouché par césarienne.Conclusion:L’admission CTG s’est avérée efficace pour identifier les fœtus présentant une incidence plus élevée d’asphyxie périnatale. Les résultats néonatals tels qu’un faible poids à la naissance, le score APGAR, l’admission au SCBU et l’hospitalisation prolongée étaient significativement associés aux résultats pathologiques du CTG. En l’absence de moyens permettant des investigations plus approfondies, une intervention rapide pour l’accouchement doit être assurée si l’admission du CTG est pathologique.