2 Minute Medicine ® - Neonatal/Perinatal Medicine

1. The 90-day modified Ranking Scale score was comparable for patients in intravenous thrombolysis plus endovascular treatment versus endovascular treatment alone. 2. Intracranial hemorrhage was less frequent in the endovascular treatment alone group. Evidence Rating Level: 1 (Excellent) Study Rundown : Intravenous thrombolysis before endovascular treatment is the preferred therapy among patients with acute ischemic stroke; however, its utility among patients directly admitted to endovascular treatment centers remains unknown...

1. Intravenous dihydroergotamine (DHE) was found in this retrospective study to be an effective therapeutic option for refractory chronic migraine.  2. DHE was additionally safe for individuals with elevated risk for cardiovascular events and other cardiovascular risk factors.  Evidence Rating Level: 2 (Good) Chronic migraine is a debilitating condition that severely impacts the quality of life for many individuals. For those with cardiovascular risk factors (e.g., ischemic heart disease, prior coronary vasospasm, etc...

1. Monthly migraine days were significantly reduced in atogepant 30 mg twice daily and atogepant 60 mg once daily groups compared to placebo. 2. The frequency of acute medication use for headaches was reduced among patients receiving atogepant compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Migraine is a chronic neurological disease affecting more than 1 billion people globally. Injectable chronic migraine therapy includes calcitonin gene-related peptide (CGRP) receptor antagonists (gepants) and onabotulinumtoxinA...

1. This retrospective cohort study found that higher low-grade inflammation (LGI) scores were associated with significantly higher acute ischemic stroke (AIS) severity, worse early neurological deterioration (END), and poor outcomes at 90 days after stroke onset. Evidence Rating Level : 2 (Good) Ischemic stroke is a significant global cause of neurological morbidity and mortality. Inflammation, both systemic and local, plays a key role in its pathogenesis. There has been growing interest in using serum biomarkers to predict outcomes in AIS...

1. In this randomized controlled trial, a maternally administered vaccine for infant group B streptococcus (GBS) demonstrated a reduced risk of invasive GBS. 2. There was no significant difference in number of adverse events seen in patients who received the vaccine. Evidence Rating Level: 1 (Excellent) Study Rundown: GBS can cause sepsis and meningitis in newborns, with the primary risk factor being exposure to maternal rectovaginal group B streptococcal colonization during delivery. Often, pregnant women receive intrapartum antibiotic prophylaxis if they test positive for the GBS screen...

1. In this randomized controlled trial, an oral orexin receptor 2 (OX2R) agonist (TAK-994) was associated with improvements in wakefulness, sleepiness, and cataplexy incidence among patients with narcolepsy type 1. 2. TAK-994 was also associated with liver enzyme elevation and drug-induced hepatotoxicity. Evidence Rating Level: 1 (Excellent) Study Rundown: Narcolepsy is a rare chronic disorder of the central nervous system resulting in excessive daytime sleepiness, disrupted nighttime sleep, and cataplexy...

1. In this randomized controlled trial, there were no significant differences in the Montreal Cognitive Assessment (MoCA) scores of older adults on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) versus a control caloric restriction diet at three-year follow-up.  2. There were also no significant differences in brain magnetic resonance imaging (MRI) findings between the two groups at the end of three years. Evidence Rating Level: 1 (Excellent) Study Rundown: There has been growing interest in identifying strategies possibly beneficial towards the prevention of dementia...

1. Compared to healthy controls, participants with a first episode of schizophrenia had reduced expression of a microglia-associated protein, CSF1R.  2. CSF1R inhibition worsened anxiety behaviors in mice exposed to chronic unpredictable stress.  Evidence-rating level: 3 (Average) Psychosocial stress is thought to contribute to the development of schizophrenia, mainly for those with underlying genetic susceptibility. Though microglia are important regulators of stress in the brain, the role of microglia in the development of schizophrenia has not previously been thoroughly investigated...

1. In this randomized controlled trial, for patients in a coma post-cardiac arrest, neurologic outcomes were similar at six months between those receiving targeted mild hypercapnia compared to normocapnia. 2. Mortality rates were also comparable at six months between the mild hypercapnia and normocapnia groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Hypoxic-ischemic encephalopathy results from brain hypoxia during cardiac arrest and hypoperfusion after return of spontaneous circulation. For patients with coma who have been resuscitated following out-of-hospital cardiac arrest, the risk of this injury and subsequent poor neurologic outcomes is especially high...

1. In this randomized controlled trial, the E-MOTIVE bundle, consisting of early detection and treatment of postpartum hemorrhage, was associated with a lower risk of complications than usual care.  2. The E-MOTIVE treatment bundle also resulted in higher detection rates of postpartum hemorrhage and treatment adherence compared to usual care. Evidence Rating Level: 1 (Excellent) Study Rundown: The adoption of the World Health Organization (WHO) recommendations for the prevention and treatment of postpartum hemorrhage is poor...

1. For obese patients with minor stroke or transient ischemic attacks (TIA), subsequent therapy with ticagrelor-acetylsalicylic acid (ASA) was associated with lower risk of subsequent stroke compared to clopidogrel-ASA. 2. This difference in risk reduction was not observed in nonobese patients.  Evidence Rating Level : 1 (Excellent) The treatment of patients with minor ischemic stroke and TIA with dual antiplatelet therapy, namely clopidogrel and ASA or with ticagrelor and ASA, is well established as efficacious...

1. In this randomized controlled trial, the Eat, Sleep, Console approach resulted in a significantly shortened time to medical readiness for discharge in neonates with opioid withdrawal syndrome.  2. There was no significant difference between usual care and the Eat, Sleep, Console approach in the incidence of adverse outcomes.  Evidence Rating Level: 1 (Excellent) Study Rundown: Neonatal opioid withdrawal syndrome results from exposure to opioids in utero. Clinical signs can include seizures, irritability, and gastrointestinal issues...

1. In this randomized controlled trial of patients with atrial fibrillation who had an acute ischemic stroke, early versus late anticoagulation resulted in a comparable incidence of 30-day adverse events.  2. Risk of death from any cause or disability was similar at 90 days between the early and late anticoagulation groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Patients with atrial fibrillation are at an increased risk for developing ischemic stroke and emboli. Anticoagulation with direct oral anticoagulants (DOACs) is essential for prophylaxis...

1. In a cohort of young participants, dobutamine stress tests were found to reduce cerebral blood flow on magnetic resonance angiography. Evidence Rating Level: 3 (Average) Dobutamine is a sympathomimetic medication used in echocardiography and the acute care of congestive heart failure. Previous research has not established whether this medication impacts cerebral blood flow (CBF). This self-controlled study included 48 participants, aged 23 to 34 years, all non-smokers, with no previous cardiovascular or cerebrovascular disease...

1. In this randomized controlled trial, ketamine was noninferior to electroconvulsive therapy (ECT) for reducing symptoms of treatment-resistant major depression (TRMD) . 2. ECT was associated with temporarily decreased memory recall and musculoskeletal adverse effects, while ketamine was associated with dissociation. Evidence Rating Level: 1 (Excellent) Study Rundown: Major depressive disorder is a leading cause of disability worldwide. Although pharmacologic antidepressants are standard of care, approximately one-third of patients have suboptimal responses...

1. In this prospective cohort study, it was found that the lateral ventricles, front and temporal lobes, and anterior and inferior white matter regions exhibited the greatest age dependency on volume change, though all structures examined appeared to accelerate in volume loss with age,  Evidence Rating: 1 (Excellent) The literature indicates that many neurodegenerative diseases begin to take place decades prior to symptom onset. Gathering a better understanding of the longitudinal patterns of change in different regions of the brain could provide insights into these early processes...

1. In this randomized controlled trial, tirofiban was associated with better outcomes than low-dose aspirin for patients with stroke without large or medium-sized vessel occlusion. 2. For patients with recent onset stroke or progression of stroke symptoms, tirofiban showed a slightly higher incidence of intracranial hemorrhage as compared with low-dose aspirin. Evidence Rating Level: 1 (Excellent) Study Rundown: Many currently available therapies may not be appropriate for patients with stroke without occlusion of large or medium-sized arteries...

1. In this randomized controlled trial, dexamethasone treatment was not noninferior to burr-hole drainage regarding functional outcomes in patients with chronic subdural hematoma. 2. Dexamethasone treatment led to more complications and a greater likelihood of surgery as compared to burr-hole drainage for patients with chronic subdural hematoma. Evidence Rating Level: 1 (Excellent) Study Rundown: Chronic subdural hematoma is a condition that has a relatively high prevalence in the geriatric population. Burr-hole craniostomy is often the mainstay of treatment in symptomatic patients, which is a form of surgical evacuation of the hematoma...

1. In this randomized controlled trial, craniotomy and decompressive craniectomy resulted in similar disability and quality-of-life outcomes for patients following traumatic acute subdural hematoma. 2. Additional surgery was performed more frequently after craniotomy, but craniectomy was associated with more wound complications. Evidence Rating Level: 1 (Excellent) Study Rundown: Post-traumatic subdural hematoma is associated with high risks of mortality and disability, requiring urgent surgical evacuation...

1. In this randomized controlled trial, the treatment of gestational diabetes before 20 weeks’ gestation was associated with a lower risk of adverse neonatal outcomes compared to no treatment.  2. There was no significant difference between treatment and no treatment with respect to maternal hypertension or neonatal lean body mass. Evidence Rating Level: 1 (Excellent) Study Rundown: Gestational diabetes occurs when the human body is unable to make sufficient amounts of insulin, resulting in high blood glucose levels...