Boskabadi Hassan, Zakerihamidi Maryam, Moradi Ali
Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Caspian J Intern Med. 2020 Fall;11(4):377-383. doi: 10.22088/cjim.11.4.377.
Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in the prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications.
In this cohort with a two-year follow-up study with availability sampling, 196 term asphyxic infants were involved from 2009 to 2018. A researcher-designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1β(IL-1β), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student t- test, chi-square, ROC curve, and regression models.
IL-6, IL-1β, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in the prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in the prediction of complications of asphyxia were found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1β were associated with increased unfavorable outcomes.
Combinations of: IL-1β+ IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6+ HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.
窒息是婴儿死亡和长期神经并发症的主要原因之一。鉴于窒息及其并发症的高发生率，本队列研究旨在比较血液学和生化因素在预测窒息预后方面的诊断价值。
在这项采用便利抽样的为期两年的随访队列研究中，纳入了2009年至2018年的196名足月儿窒息婴儿。使用研究人员设计的问卷作为数据收集工具，其中包含婴儿和母亲的详细信息以及临床和实验室评估。检测围产期窒息婴儿的血清白细胞介素-1β（IL-1β）、IL-6、促氧化剂/抗氧化剂平衡（PAB）、热休克蛋白（HSP）和有核红细胞（NRBC）水平。在出院后6、12、18和24个月的随访中进行丹佛发育筛查测试（DDST-II）。使用学生t检验、卡方检验、ROC曲线和回归模型对正常和异常结局的婴儿进行数据分析以作比较。
IL-6、IL-1β、PAB和NRBC计数是窒息新生儿异常并发症的最重要预测指标。PAB>22（HK）在预测窒息并发症方面的敏感性和特异性分别为88.6%和71.6%。发现IL-6高于28（pg/mL）在预测窒息并发症方面的敏感性和特异性分别为96.1%和78.6%。IL-6和IL-1β水平升高与不良结局增加相关。
IL-1β + IL-6 + NRBC；IL-6 + 缺氧缺血性脑病分级 + PAB；以及IL-6 + 缺氧缺血性脑病分级 + NRBC的组合对窒息婴儿的预后具有最高的预测价值（100%）。
