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hypoxic ischemic encephalopathy hypothermia

Iliana Bersani, Fabrizio Ferrari, Licia Lugli, Giorgio Ivani, Alessandra Conio, Bashir Moataza, Hanna Aboulgar, Hala Mufeed, Iman Iskander, Maria Kornacka, Darek Gruzfeld, Andrea Dotta, Immacolata Savarese, Natalia Chukhlantseva, Lucia Gabriella Tina, Francesco Nigro, Giovanni Livolti, Fabio Galvano, Laura Serpero, Micaela Colivicchi, Patrizia Ianniello, Francesca Pluchinotta, Luigi Anastasia, Ekaterina Baryshnikova, Diego Gazzolo
Background Perinatal asphyxia is a major cause of mortality and morbidity in neonates: The aim of the present study was to investigate, by means of longitudinal assessment of urinary S100B, the effectiveness of hypothermia, in infants complicated by perinatal asphyxia and hypoxic-ischemic encephalopathy. Methods We performed a retrospective case-control study in 108 asphyxiated infants, admitted to nine tertiary departments for neonatal intensive care from January 2004 to July 2017, of whom 54 underwent hypothermia treatment and 54 did not...
February 12, 2019: Clinical Chemistry and Laboratory Medicine: CCLM
P Sg, A Kadam, S Kadam, U Vaidya, P Kumar, I Bhagat, A Pandit, N Chouthai
BACKGROUND: Perinatal asphyxia is a prominent cause of neonatal mortality in the developing world. Growth in head circumference is associated with improved neurodevelopment. Previous studies found a positive correlation between additional dietary supplementation and growth in head circumference among newborns with perinatal brain injury. This study aims to evaluate the association between anthropometric parameters and developmental outcomes in newborns with hypoxic ischemic encephalopathy (HIE)...
February 4, 2019: Journal of Neonatal-perinatal Medicine
Walter Balduini, Michael D Weiss, Silvia Carloni, Marco Rocchi, Livia Sura, Candace Rossignol, Mariangela Longini, Francesco Bazzini, Serafina Perrone, Deborah Ott, Rajan Wadhawan, Giuseppe Buonocore
INTRODUCTION: Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing hypothermia may benefit from adjunctive therapy with melatonin. However, melatonin safety, pharmacokinetics (PK), and dosage in this sensitive population is still unknown. METHODS AND RESULTS: This study assessed the PK and safety of melatonin enteral administration to neonates with HIE undergoing hypothermia. Melatonin was infused at 0.5 mg/kg in five neonates with HIE undergoing hypothermia...
February 8, 2019: Journal of Pineal Research
Bushra Afzal, Praveen Chandrasekharan, Daniel J Tancredi, James Russell, Robin H Steinhorn, Satyan Lakshminrusimha
OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York...
February 2019: Pediatric Critical Care Medicine
Hannah C Glass, Donna M Ferriero, David H Rowitch, Thomas K Shimotake
PURPOSE OF REVIEW: With the advent of therapeutic hypothermia for treatment of hypoxic ischemic encephalopathy, and improvements in neuroimaging and bedside neuromonitoring, a new era of neonatal brain-focused care has emerged in recent years. We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes...
January 31, 2019: Current Opinion in Pediatrics
Ye Han, Na Fu, Wenjie Chen, Jingjing Liang, Yanan Cui, Ying Zhang, Jiong Qin
BACKGROUND: Electroencephalography (EEG) background activity is associated with neurological outcome in neonates with hypoxic-ischemic encephalopathy. There is uncertainty about the prognostic value of EEG background activity after hypothermia was introduced. METHODS: Searches were made on Pubmed, Embase, and the Cochrane Library, from inception to March 1, 2018. Pooled sensitivities and specificities were calculated to assess the diagnostic power of burst suppression, low voltage, and flat trace background activities in the prediction of an adverse neurological outcome in the follow-up period in hypothermia-treated neonates with hypoxic-ischemic encephalopathy...
December 28, 2018: Pediatric Neurology
Ohad Gluck, Michal Kovo, Daniel Tairy, Giulia Barda, Jacob Bar, Eran Weiner
OBJECTIVE: To study the association between bloody amniotic fluid (BAF) during labor and adverse pregnancy outcomes. STUDY DESIGN: In the last 10 years we have implemented an institutional protocol that mandates obstetricians/midwives to report their subjective impression of the color of amniotic fluid (clear, meconium stained, bloody) during labor. The medical records, and neonatal charts of all singleton deliveries ≥ 370/7 weeks between 2008-2018 were reviewed...
January 17, 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Vinzenz Boos, Anna Tietze, Felix Berger, Christoph Bührer
OBJECTIVES: Patients with severe congenital heart disease and cardiac anomalies such as restrictive foramen ovale, intact atrial septum, or narrowing of ductus arteriosus are at risk for perinatal asphyxia, leading to hypoxic-ischemic encephalopathy. We hypothesize that therapeutic hypothermia can be applied to these patients and seek to investigate feasibility and safety of this method. DESIGN: A retrospective observational study. SETTING: The Department of Neonatology of Charité, University Hospital, Berlin, Germany...
January 22, 2019: Pediatric Critical Care Medicine
María Arriaga-Redondo, Juan Arnaez, Isabel Benavente-Fernández, Simón Lubián-López, Montesclaros Hortigüela, Cristina Vega-Del-Val, Alfredo Garcia-Alix
Cerebral oximetry using near-infrared spectroscopy (NIRS) provides continuous, noninvasive assessment of the degree of hemoglobin saturation of the brain tissue. Previous studies suggest that high values of regional cerebral tissue oxygen saturation (rScO2 ) during the first days in neonates with significant hypoxic-ischemic encephalopathy (HIE) are correlated with an adverse neurological outcome. However, the results are not consistent among the studies. To examine the correlation of rScO2 values and their variability over time with HIE severity, amplitude integrated electroencephalography (aEEG) background and seizure activity, neuron-specific enolase levels in cerebrospinal fluid, magnetic resonance imaging (MRI) findings, and neurological outcome...
January 24, 2019: Therapeutic Hypothermia and Temperature Management
Brigitte Lemyre, Vann Chau
Therapeutic hypothermia is a standard of care for infants ≥36 weeks gestational age (GA) with moderate-to-severe hypoxic-ischemic encephalopathy. Because some studies included infants born at 35 weeks GA, hypothermia should be considered if they meet other criteria. Cooling for infants <35 weeks GA is not recommended. Passive cooling should be started promptly in community centres, in consultation with a tertiary care centre neonatologist, while closely monitoring the infant's temperature. Best evidence suggests that maintaining core body temperature between 33°C and 34°C for 72 hours, followed by a period of rewarming of 6 to 12 hours, is optimal...
July 2018: Paediatrics & Child Health
Andrea Laudi, Eric Peeples
PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is a type of brain injury resulting from insufficient oxygen and blood supply. The standard treatment for HIE is therapeutic hypothermia, which involves a 72-hour period of hypothermia, during which time the infant is isolated from his/her parents. The primary objective of this study was to assess the effects of the diagnosis of neonatal encephalopathy and subsequent separation on rates of maternal postpartum depression (PPD) as compared to other hospitalized infants...
January 16, 2019: Journal of Maternal-fetal & Neonatal Medicine
Qi Xu, Vann Chau, Chinnuwat Sanguansermsri, Katherine E Muir, Emily W Y Tam, Steven P Miller, Darren S T Wong, Hao Chen, Peter K H Wong, Jill G Zwicker, Kenneth J Poskitt, Alan Hill, Elke H Roland
OBJECTIVE: To determine if patterns of hypoxic-ischemic brain injury on magnetic resonance imaging (MRI) in term newborns predict subsequent childhood epilepsy. Methods: This retrospective cohort study includes term newborns with encephalopathy (n = 181) born between 2004-2012 and admitted to British Columbia Children's Hospital. MRI was performed between 3 and 5 days of age. The predominant patterns of hypoxic-ischemic injury were classified as Normal, Watershed, Basal Nuclei, Total, and Focal-Multifocal...
January 15, 2019: Journal of Child Neurology
Guido Wassink, Joanne O Davidson, Simerdeep K Dhillon, Kelly Zhou, Laura Bennet, Marianne Thoresen, Alistair J Gunn
PURPOSE OF REVIEW: Therapeutic hypothermia reduces death or disability in term and near-term infants with moderate-severe hypoxic-ischemic encephalopathy. Nevertheless, many infants still survive with disability, despite hypothermia, supporting further research in to ways to further improve neurologic outcomes. RECENT FINDINGS: Recent clinical and experimental studies have refined our understanding of the key parameters for hypothermic neuroprotection, including timing of initiation, depth, and duration of hypothermia, and subsequent rewarming rate...
January 14, 2019: Current Neurology and Neuroscience Reports
Miho Nonomura, Sayaka Harada, Yuki Asada, Hisako Matsumura, Hiroko Iwami, Yuko Tanaka, Hiroyuki Ichiba
BACKGROUND: Although therapeutic hypothermia improves the outcome of neonatal hypoxic-ischemic encephalopathy (HIE), its efficacy is still limited. This preliminary study evaluates the safety and feasibility of the combination therapy with erythropoietin (Epo), magnesium sulfate and hypothermia in neonates with HIE. METHODS: A combination therapy with Epo (300 U/kg every other day for 2 weeks), magnesium sulfate (250 mg/kg for 3 days) and hypothermia was started within 6 h of birth in neonates who met the institutional criteria for hypothermia therapy...
January 8, 2019: BMC Pediatrics
Rakesh Rao, Shamik Trivedi, Amy Distler, Steve Liao, Zachary Vesoulis, Christopher Smyser, Amit M Mathur
OBJECTIVE:  To review developmental outcomes of neonates with mild hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). STUDY DESIGN:  Neonates ≥35 weeks' gestation with mild HIE/TH (TH group, n  = 30) were matched with healthy term-born infants (control group, n  = 30) and reviewed for the presence and severity of magnetic resonance imaging (MRI)-detected neurological injury. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant Development (BSID)...
January 4, 2019: American Journal of Perinatology
Marc Paul O'Sullivan, Ann Marie Looney, Gerard M Moloney, Mikael Finder, Boubou Hallberg, Gerard Clarke, Geraldine B Boylan, Deirdre M Murray
Importance: Neonatal hypoxic-ischemic encephalopathy (HIE) remains a significant cause of neurologic disability. Identifying infants suitable for therapeutic hypothermia (TH) within a narrow therapeutic time is difficult. No single robust biochemical marker is available to clinicians. Objective: To assess the ability of a panel of candidate microRNA (miRNA) to evaluate the development and severity of encephalopathy following perinatal asphyxia (PA). Design, Setting, and Participants: This validation study included 2 cohorts...
December 28, 2018: JAMA Neurology
Lisa Anne Rasmussen, M Ariel Cascio, Amaryllis Ferrand, Michael Shevell, Eric Racine
OBJECTIVE: Prognosis of Hypoxic-Ischemic Encephalopathy (HIE) remains challenging and uncertain. This paper investigates how physicians understand and address the ethical challenges of prognostic uncertainty in the case of neonatal HIE, contextualized within the social science literature. STUDY DESIGN: Semi-structured interviews were conducted with 12 Canadian neurologists and neonatologists, addressing their perspectives and clinical experiences concerning neonatal HIE prognostication...
February 2019: Journal of Perinatology: Official Journal of the California Perinatal Association
Y Moral, N J Robertson, F Goni-de-Cerio, D Alonso-Alconada
INTRODUCTION: Perinatal asphyxia remains a major cause of both mortality and neurological morbidity. Neonatal encephalopathy affects to 1-3/1,000 newborns, leading to significant brain damage and childhood disability. The only standard therapy is moderate hypothermia, whose efficacy, despite proved, is limited, being partially effective. DEVELOPMENT: The capacity of hypothermia in promoting cell proliferation in the neurogenic niches of the central nervous system remains subject of investigation...
January 1, 2019: Revista de Neurologia
Girija Natarajan, Amit Mathur, Isabella Zaniletti, Robert DiGeronimo, Kyong-Soon Lee, Rakesh Rao, Maria Dizon, Shannon Hamrick, Anthony Rudine, Noah Cook, Danielle Smith, John Flibotte, Karna Murthy, An Massaro
PURPOSE: We describe the frequency and timing of withdrawal of life-support (WLS) in moderate or severe hypoxic-ischemic encephalopathy (HIE) and examine its associations with medical and sociodemographic factors. PROCEDURES: We undertook a secondary data analysis of a prospective multicenter data registry of regional level IV Neonatal Intensive Care Units participating in the Children's Hospitals Neonatal Database. Infants ≥36 weeks gestational age with HIE admitted to a Children's Hospitals Neonatal Database Neonatal Intensive Care Unit between 2010 and 2016, who underwent therapeutic hypothermia were categorized as (1) infants who died following WLST and (2) survivors with severe HIE (requiring tube feedings at discharge)...
November 23, 2018: Pediatric Neurology
Tomohisa Akamatsu, Takehiro Sugiyama, Yoshinori Aoki, Ken Kawabata, Masaki Shimizu, Kaoru Okazaki, Masatoshi Kondo, Kan Takahashi, Yoshiki Yokoyama, Naoto Takahashi, Yu-Ichi Goto, Akira Oka, Masayuki Itoh
OBJECTIVE: To evaluate the soluble form of lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) as a biomarker of severity staging and prognosis in neonatal hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: We performed an observational study enrolling 27 infants with HIE and 45 control infants of gestational age ≥36 weeks and birth weight ≥1800 g. The HIE criteria were pH ≤7.0 or a base deficit ≥16 mmol/L within 60 minutes after birth, and a 10-minute Apgar score ≤5 or resuscitation time ≥10 minutes...
December 11, 2018: Journal of Pediatrics
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