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Neonatal Neurology

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Linda S de Vries, Floris Groenendaal, Kian D Liem, Axel Heep, Annemieke J Brouwer, Ellen van 't Verlaat, Isabel Benavente-Fernández, Henrica Lm van Straaten, Gerda van Wezel-Meijler, Bert J Smit, Paul Govaert, Peter A Woerdeman, Andrew Whitelaw
OBJECTIVE: To compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation. DESIGN: Multicentre randomised controlled trial (ISRCTN43171322). SETTING: 14 neonatal intensive care units in six countries. PATIENTS: 126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III-IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm)...
January 2019: Archives of Disease in Childhood. Fetal and Neonatal Edition
Deshui Yu, Linji Li, Weiguo Yuan
Mounting animal studies have demonstrated that almost all the clinically used general anesthetics could induce widespread neuroapoptosis in the immature brain. Alarmingly, some published findings have reported long-term neurocognitive deficits in response to early anesthesia exposure which deeply stresses the potential seriousness of developmental anesthetic neurotoxicity. However, the connection between anesthesia induced neuroapoptosis and subsequent neurocognitive deficits remains controversial. It should be noted that developmental anesthesia related neurotoxicity is not limited to neuroapoptosis...
March 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Charlotte L Lea, Adam Smith-Collins, Karen Luyt
Improving neurodevelopmental outcome for preterm infants is an important challenge for neonatal medicine. The disruption of normal brain growth and neurological development is a significant consequence of preterm birth and can result in physical and cognitive impairments. While advances in neonatal medicine have led to progressively better survival rates for preterm infants, there has only been a modest improvement in the proportion of surviving infants without neurological impairment, and no change in the proportion with severe disability...
March 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
David H Adamkin, Richard A Polin
No abstract text is available yet for this article.
September 2016: Journal of Pediatrics
D H Adamkin, R Polin
No abstract text is available yet for this article.
January 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Rosa Maria Cerbo, Luigia Scudeller, Roberta Maragliano, Rita Cabano, Margherita Pozzi, Carmine Tinelli, Lina Bollani, Mauro Stronati
BACKGROUND: Brain vulnerability in the critically ill preterm newborn may be related to the burden of cerebral hypoxygenation and hypoperfusion during the immediate postnatal period. OBJECTIVE: We determined the association between adverse outcomes [death or high grade intraventricular hemorrhage (IVH)] and continuous cerebral tissue oxygen saturation (rSO2), superior vena cava flow (SVCf) and cerebral fractional oxygen extraction (CFOE) in very low birth weight (VLBW) infants during the first 48 h of life...
2015: Neonatology
Deborah G Hirtz, Steven J Weiner, Dorothy Bulas, Michael DiPietro, Joanna Seibert, Dwight J Rouse, Brian M Mercer, Michael W Varner, Uma M Reddy, Jay D Iams, Ronald J Wapner, Yoram Sorokin, John M Thorp, Susan M Ramin, Fergal D Malone, Marshall W Carpenter, Mary J O'Sullivan, Alan M Peaceman, Gary D V Hankins, Donald Dudley, Steve N Caritis
OBJECTIVE: To evaluate the relationship of maternal antenatal magnesium sulfate (MgSO4) with neonatal cranial ultrasound abnormalities and cerebral palsy (CP). STUDY DESIGN: In a randomized trial of MgSO4 or placebo in women at high risk of preterm delivery, up to 3 cranial ultrasounds were obtained in the neonatal period. Images were reviewed by at least 2 pediatric radiologists masked to treatment and other clinical conditions. Diagnoses were predefined for intraventricular hemorrhage, periventricular leukomalacia, intracerebral echolucency or echodensity, and ventriculomegaly...
October 2015: Journal of Pediatrics
Piyush Shah, Ajay Anvekar, Judy McMichael, Shripada Rao
BACKGROUND: Infants who have an Apgar score of zero at 10 min of age are known to have poor long-term prognosis. Expert committee guidelines suggest that it is reasonable to cease resuscitation efforts if the asphyxiated infant does not demonstrate a heart beat by 10 min of life. These guidelines are based on data from the era when therapeutic hypothermia was not the standard of care for hypoxic ischaemic encephalopathy (HIE). Hence, we aimed to review our unit data from the era of therapeutic hypothermia to evaluate the outcomes of infants who had an Apgar score of zero at 10 min and had survived to reach the neonatal intensive care unit...
November 2015: Archives of Disease in Childhood. Fetal and Neonatal Edition
Subrata Sarkar, Seetha Shankaran, Abbot R Laptook, Beena G Sood, Barbara Do, Barbara J Stoll, Krisa P Van Meurs, Edward F Bell, Abhik Das, John Barks
OBJECTIVE: The aim of this study is to determine whether the cystic periventricular leukomalacia (cPVL) detection rate differs between imaging studies performed at different time points. DESIGN: We retrospectively reviewed the prospectively collected data of 31,708 infants from the NICHD Neonatal Research Network. Inclusion criteria were infants < 1,000 g birth weight or < 29 weeks' gestational age who had cranial imaging performed using both early criterion (cranial ultrasound [CUS] < 28 days chronological age) and late criterion (CUS, magnetic resonance imaging, or computed tomography closest to 36 weeks postmenstrual age [PMA])...
August 2015: American Journal of Perinatology
Peter J Anderson, Jeanie L Y Cheong, Deanne K Thompson
Very preterm children are at a high risk for neurodevelopmental impairments, but there is variability in the pattern and severity of outcome. Neonatal magnetic resonance imaging (MRI) enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. This review describes the application of conventional and advanced MRI with very preterm neonates, specifically focusing on the relationship between neonatal MRI findings and later neurodevelopmental outcome...
March 2015: Seminars in Perinatology
Geraldine B Boylan, Liudmila Kharoshankaya, Courtney J Wusthoff
Hypoxic-ischemic encephalopathy is a common cause of seizures in neonates. Despite the introduction of therapeutic hypothermia, seizure rates are similar to those reported in the pre-therapeutic hypothermia era. However, the seizure profile has been altered resulting in a lower overall seizure burden, shorter individual seizure durations, and seizures that are harder to detect. Electroencephalographic (EEG) monitoring is the gold standard for detecting all seizures in neonates and this is even more critical in neonates who are cooled, as they are often sedated, making seizures more difficult to detect...
April 2015: Seminars in Fetal & Neonatal Medicine
Denis Azzopardi
The cerebral function monitor is a device for trend monitoring of changes in the amplitude of the electroencephalogram, typically recorded from one or two pairs of electrodes. Initially developed and introduced to monitor cerebral activity in encephalopathic adult patients or during anaesthesia, it is now most widely used in newborns to assess the severity of encephalopathy and for determining prognosis. The duration and severity of abnormalities of the amplitude-integrated electroencephalogram tracing is highly predictive of subsequent neurologic outcome following neonatal hypoxic-ischemic encephalopathy, including in newborns receiving neuroprotective treatment with prolonged moderate hypothermia...
June 2015: Seminars in Fetal & Neonatal Medicine
An N Massaro
MRI performed in the neonatal period has become a tool widely used by clinicians and researchers to evaluate the developing brain. MRI can provide detailed anatomical resolution, enabling identification of brain injuries due to various perinatal insults. This review will focus on the link between neonatal MRI findings and later neurodevelopmental outcomes in high-risk term infants. In particular, the role of conventional and advanced MR imaging in prognosticating outcomes in neonates with hypoxic-ischemic encephalopathy, ischemic perinatal stroke, need for extracorporeal membrane oxygenation life support, congenital heart disease, and other neonatal neurological conditions will be discussed...
March 2015: Seminars in Perinatology
Vera Neubauer, Daniel Junker, Elke Griesmaier, Michael Schocke, Ursula Kiechl-Kohlendorfer
BACKGROUND: In recent years, cerebral magnetic resonance imaging (MRI) has been increasingly used to depict the wide spectrum of preterm brain injury. Furthermore, it has already been demonstrated by MRI at term-equivalent age (TEA) that preterm infants show delayed brain maturation as compared to term infants, and this delay has been related to neurobehavioral outcome. OBJECTIVES: The aim of the current study was to investigate the influence of prevalent neonatal risk factors for adverse outcome on structural brain maturation in very preterm infants at TEA...
2015: Neonatology
Renée A Shellhaas
Newborn infants at risk for cerebral dysfunction, such as those with acute brain injury or with disorders of brain development, often have encephalopathy and seizures. Conventional electroencephalography (EEG) monitoring can enhance the care of these highly vulnerable patients, through identification of prognostically significant EEG background patterns and accurate diagnosis of seizures and non-seizure paroxysmal events. Neonatal seizures are usually subclinical, and abnormal neonatal movements are often not the result of seizures...
June 2015: Seminars in Fetal & Neonatal Medicine
Vinod K Bhutani, Lois Johnson-Hamerman
Clinicians have hypothesized a spectrum of minor neurologic manifestations, consistent with neuroanatomical reports and collectively termed as a "syndrome of bilirubin-induced neurologic dysfunction (BIND)," which can occur in the absence of classical kernicterus. The current review builds on these initial reports with a focus on clinical signs and symptoms that are assessed by standardized tools and manifest from neonatal age to childhood. These clinical manifestations are characterized by the following domains: (i) neuromotor signs; (ii) muscle tone abnormalities; (iii) hyperexcitable neonatal reflexes; (iv) variety of neurobehavior manifestations; (v) speech and language abnormalities; and (vi) evolving array of central processing abnormalities, such as sensorineural audiology and visuomotor dysfunctions...
February 2015: Seminars in Fetal & Neonatal Medicine
Elisa Smit, Xun Liu, Sally Jary, Frances Cowan, Marianne Thoresen
AIM: Therapeutic hypothermia is effective and without serious adverse effects in term infants with hypoxic-ischaemic encephalopathy. It is unknown whether other neonatal patient groups could benefit from therapeutic hypothermia. Since 2006, our centre has offered cooling to infants fulfilling the standard cooling criteria, but also to those who did not. METHODS: Observational study with prospective data collection over a 6-year period in a regional cooling centre...
February 2015: Acta Paediatrica
S L Bonifacio, L S deVries, F Groenendaal
Therapeutic hypothermia is now considered the standard of care for neonates with neonatal encephalopathy due to perinatal asphyxia. Outcomes following hypothermia treatment are favorable, as demonstrated in recent meta-analyses, but 45-50% of these neonates still suffer major disability or die due to global multi-organ injury or after redirection of care from life support due to severe brain injury. The ability to determine which patients are at highest risk of severe neurologic impairment and death and those in whom redirection of care should be considered is limited...
April 2015: Seminars in Fetal & Neonatal Medicine
Ronald J Wong, David K Stevenson
The pathologic phenotype of severe hyperbilirubinemia in the newborn infant is primarily due to excessive bilirubin production and/or impaired conjugation, resulting in an increased bilirubin load. This may, in turn, increase an infant's risk for the development of bilirubin-induced neurologic dysfunction (BIND). The highest-risk infants are those with increased bilirubin production rates due to hemolysis. Several immune and non-immune conditions have been found to cause severe hemolysis, and these are often exacerbated in those infants with perinatal sepsis and genetic predispositions...
February 2015: Seminars in Fetal & Neonatal Medicine
Yvonne W Wu, Michael W Kuzniewicz, Andrea C Wickremasinghe, Eileen M Walsh, Soora Wi, Charles E McCulloch, Thomas B Newman
IMPORTANCE: Exchange transfusion is recommended for newborns with total serum bilirubin (TSB) levels thought to place them at risk for cerebral palsy (CP). However, the excess risk for CP among these infants is unknown. OBJECTIVE: To quantify the risks for CP and CP consistent with kernicterus that are associated with high TSB levels based on the 2004 American Academy of Pediatrics exchange transfusion threshold (ETT) guidelines. DESIGN, SETTING, AND PARTICIPANTS: We enrolled 2 cohorts from a population of 525,409 infants in the Late Impact of Getting Hyperbilirubinemia or Phototherapy (LIGHT) birth cohort...
March 2015: JAMA Pediatrics
2015-01-16 06:11:03
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