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Abstract Hypoxic Ischemic brain injury in newborn full term and premature infants is a common and pervasive source of life time disabilities in cognitive and locomotors function (Hilton et al., 2006). The incidence of hypoxic-ischemic encephalopathy is reportedly high in countries with limited resources; however, precise figures are not available. Birth asphyxia is the cause of 23% of all neonatal deaths worldwide. It is one of the top 20 leading causes of burden of disease in all age groups (in terms of disability life adjusted years) by the World Health Organization and is the fifth largest cause of death of children younger than 5 years (8%) (Bryce et al., 2005). In Egypt and other developing countries perinatal asphyxia is the most important cause of hypoxic ischemic brain damage in full term babies and it is known to be a leader for higher morbidity and mortality among these infants (Boo et al., 2000). In severe hypoxic ischemic encephalopathy, the mortality rate is reportedly 25-50% (Lawn J et al., 2005). As many as 80% of infants who survive severe hypoxic ischemic encephalopathy develop serious complications, 10-20% develop moderately serious disabilities and as many as 10% are healthy. Among the infants who survive severe hypoxic ischemic encephalopathy, 30-50% may have serious long-term complications and 10-20% have minor neurological morbidities (Santina Zanelli et al., 2012). Ninety percent of the asphyxia insults occur in the antepartum and intrapartum periods. The remainders are postpartum (Snyder and Cloherty, 1998). Summary Summary & Conclusion 111 Estradiol (17 β Estradiol) is sex hormone - mislabeled the “Female Hormone” - it is also present in males; it represents the major estrogen in humans (Pentikainen et al., 2006). Estradiol is a pleiotropic hormone that enhances plasticity and survival of the brain in multiple models of injury (Wise et al., 2005). Studies data strongly suggest a positive role for estradiol receptors (ER), specifically for ERα, in protection against delayed cell death resulting from neurodegeneration due to ischemia (Dena Dubal et al., 2006). The aim of the present study is to detect Serum levels of 17 Beta estradiol in newborns with hypoxic ischemic encephalopathy and correlate the levels with the severity of insult and thus predict the possible role of 17 Beta estradiol in identification of infants at high risk and the possible early therapeutic intervention. This study is a prospective case-control study; it was carried out on 40 newborn infants 26 males and 14 females in the neonatal intensive care unit at Beni Suef University hospital. All newborns were subjected to detailed history taking, full clinical examination and variable laboratory investigations as complete blood picture, CRP, RBS and estimation of serum level of 17 beta estradiol using ELISA technique. Summary Summary & Conclusion 112 The neonates in the present study were classified into two groups: Patients group: this included 20 neonates; 15 full term infants and 5 preterm infants and also included 13 males and 7 females. Newborns of patients group were further subdivided into 3 subgroups according to severity of hypoxia; mild hypoxia, moderate hypoxia and severe hypoxia according to Sarnat and Sarnat (1976) classification. Control group: this group included 20 healthy neonates; their gestational age and sex nearly matched with patients group but with normal clinical examination. Our study results revealed that, there was a highly statistically significant increase in serum level of 17 beta estradiol in patients group compared to control group and it was even higher in patients with severe hypoxia compared to patients with moderate and mild hypoxia. Also there was a highly statistically significant increase in mean value of 17 beta estradiol in patients with decreased conscious level or abnormal muscle tone and low Apgar score at 5th minute. Whereas, there was a statistically significant increase in mean value of 17 beta estradiol in patients with abnormal stretch reflex, Moro reflex and also in patients with anemia and low Apgar score at 1st minute. There was a highly statistically significant increase in mean value of 17 beta estradiol in female when compared to male in control group but there was no statistically significant difference between mean value in males when compared to female in patients group. There was no statistically significant difference in mean value of 17 beta estradiol in different prenatal history, different natal history Summary Summary & Conclusion 113 and patients with seizures, abnormal suckling reflex and positive CRP. Assessment of the sensitivity and specificity of serum 17 beta estradiol as marker for hypoxic insult was done and showed that it has 100% sensitivity and 90% specificity with a cut-off value 152.5 pg/ml. from the results of the current study, we can conclude that 17 beta estradiol levels can be used as a diagnostic test having a high sensitivity and specificity for newborns with hypoxia and its level increases with the increase in the severity of hypoxia, but its utility as a neuroprotective agent could not be proven yet. |