Effect of Aminophylline in Preventing Renal Dysfunction among Neonates with Prenatal Asphyxia: A Clinical Trial

Background: As there are different views on the effects of aminophylline on neonatal renal function, we intended to observe the effects of aminophylline on renal dysfunction in neonates with prenatal asphyxia. Methods: This randomized trial was conducted in the Obstetrics and Gynecology Hospital, Tehran, Iran, from June 2016 to May 2017, in neonates with moderate to severe asphyxia during birth. Fifty-six neonates were divided randomly into two groups. The intervention group received one dose of 5mg/kg slow intravenous aminophylline injection and the placebo group received 2 mL/kg of intravenous 10% solution of dextrose saline during the first hour of life. They were monitored and compared for renal functional indices, electrolytes, and complications of asphyxia during the three days of life. Results: The mean of Cr (37.9 ± 8.8 vs 38.5 ± 9.4 and 20.8 ± 4.8 vs 30.1 ± 5.2 μmol/L), GFR (21.55 ± 4.7 vs 20.25 ± 4.4 and 30.8 ± 7.1 vs 20.1 ± 6.5 mL/minute/1.73 m2 ), Na (135.1 ± 12.4 vs134.5 ± 11.2 and 128.9 ± 11.5 vs 134.2 ± 10.9 mEq/L), and urine output (98.2 ± 25 vs 96.8 ± 23 and 148.7 ± 35 vs 108.8 ± 20 cc) were in the aminophylline treated and placebo group on the 1st and 3rd days, respectively. The mean difference of Cr (-9.3 (-8.9; -9.7) μmol/L); (P = 0.02), GFR (10.7 (10.1; 11.3) mL/minute/1.73 m2 ) (P = 0.009), Na (-5.3 (-5.9; -4.7) mEq/L) (P = 0.002), and urine volume (39.9 (24.9; 54.9) cc) (P = 0.001) presented statistically significant differences on the third day between the intervention and placebo group. Conclusion: Aminophylline was effective in preventing renal dysfunction in neonates with asphyxia. Neonates who received aminophylline indicated a significant improvement in GFR and urine output on the first day of life.

CIRCULATING MONOCYTES

Objective: This study was conducted to measure Monocytes HLA-DR expression in neonatal sepsis in comparison to otherdiseases with systemic inflammation and high risk of infection (respiratory distress syndrome "RDS" and prenatal asphyxia) and this may behelpful in early diagnosis of infection and therapeutic intervention. M e t h o d s : This study was carried out on 2007 and it conducted on 38 sickneonates, 22 with proven sepsis diagnosed clinically and by positive blood culture and 16 (8 had RDS and 8 had prenatal asphyxia) withpossible infection i.e. they had 2 or fewer clinical signs of sepsis and negative blood culture. Those Patients with possible infection were followedup (for 48 h). Seven out of the 8 RDS Babies developed sepsis as evidenced clinically and by positive blood culture and they considered aspatients with early sepsis at the time of admission. Forty healthy age and sex matched newborns were studied as controls. All Babies weresubjected to complete blood count (CBC), C-reactive protein (CRP) and flow cytometeric determination of HLA-DR expression on monocytes.Results: Neonates with proven sepsis and those with early sepsis (7/8 of RDS) had significantly lower HLA-DR% {15.9+7.8 and 11.4±5.9respectively) than controls (61.0±20.6). HLA-DR% was reduced below the lowest cut off values in all septicemic neonates (neonates with provenand those with early sepsis). At the time of admission CRP was positive in 91 % of neonates with proven sepsis and in only 57% of the neonatesof early sepsis. In addition, there was no significant difference between HLA-DR percent in neonates with prenatal asphyxia when comparedto control group. Monocytes HLA-DR% had higher sensitivity, specificity, positive and negative predictive values (100%, 85%, 87.5% and 100%respectively) compared to CRP (57.1%, 77.8%, 66.7%, 70% respectively) for neonatal sepsis at its early stages before evident clinical andlaboratory diagnosis. C o n c l u s i o n : HLA-DR % expression on monocytes is a sensitive test for both diagnosis of neonatal sepsis and its earlystage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensivecare units

Prenatal hypoxia decreases lung extracellular superoxide dismutase expression and activity

Extracellular superoxide dismutase (EC-SOD), which scavenges extracellular superoxide (O[Formula: see text]·), is highly regulated in the developing lung. In the prenatal rabbit, EC-SOD is predominantly intracellular and inactive, and postnatally, active EC-SOD is secreted. We hypothesized that prenatal hypoxia would delay the normal postnatal secretion of active EC-SOD in the lung. Pregnant New Zealand White rabbits were exposed to hypobaric hypoxia (15,000 ft × 36 h) to alter fetal O2tension or were maintained in room air. Lungs were harvested from preterm (28 days), term (30 ± 1 day), and 1-wk-old kits. After prenatal hypobaric hypoxia, EC-SOD mRNA expression was significantly decreased in lungs of full-term kits, whereas EC-SOD protein decreased at all ages. Immunohistochemical staining for EC-SOD showed that hypoxia delayed secretion of the isoenzyme in the airways and pulmonary vasculature. Furthermore, pulmonary EC-SOD enzyme activity was significantly decreased in the 1-wk-old kits exposed to prenatal hypoxia. We conclude that prenatal hypoxia downregulates EC-SOD expression at both the transcriptional and posttranslational levels. Furthermore, prenatal hypoxia delays secretion of active EC-SOD enzyme. These findings have important implications for the effects of prenatal asphyxia on postnatal response to oxidant stress.