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neonatal therapeutic hypothermia

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https://www.readbyqxmd.com/read/28695691/neonatal-therapeutic-hypothermia-outside-of-standard-guidelines-a-survey-of-u-s-neonatologists
#1
Jennifer Burnsed, Santina A Zanelli
AIM: Therapeutic hypothermia is standard of care in term infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The goal of this survey was to explore the attitudes of U.S. neonatologists caring for infants with HIE who fall outside of current guidelines. METHOD: Case-based survey administered to members of the Section on Neonatal-Perinatal Medicine of American Academy of Pediatrics. RESULTS: 447 responses were analyzed, i...
July 11, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28686927/servo-controlled-versus-manual-cooling-methods-in-neonates-with-hypoxic-ischemic-encephalopathy
#2
Ashok Buchiboyina, Eric Ma, Andrew Yip, Deepika Wagh, Jason Tan, Judy McMichael, Max Bulsara, Shripada Rao
BACKGROUND: Therapeutic hypothermia is known to improve outcomes in neonates with hypoxic ischemic encephalopathy (HIE). There are no studies that have compared servo controlled cooling (SCC) versus manually controlled cooling (MCC) methods in HIE. AIM: To compare the outcomes of SCC versus MCC in neonates with HIE. METHODS AND OUTCOME MEASURES: Between Jan 2008 and May 2011, MCC with cool-gel packs was used to achieve rectal temperatures of 33...
July 4, 2017: Early Human Development
https://www.readbyqxmd.com/read/28665923/non-invasive-continuous-cardiac-output-and-cerebral-perfusion-monitoring-in-term-infants-with-neonatal-encephalopathy-assessment-of-feasibility-and-reliability
#3
Eva Forman, Colm R Breatnach, Stephanie Ryan, Jana Semberova, Jan Miletin, Adrienne Foran, Afif El-Khuffash
BACKGROUND: None invasive hemodynamic monitoring of infants with neonatal encephalopathy (NE) undergoing therapeutic hypothermia (TH) would be a potentially useful clinical tool. We aimed assess the feasibility and reliability of non-invasive cardiac output monitoring (NICOM) and near infrared spectroscopy (NIRS) in this cohort. METHODS: NICOM and NIRS were commenced to measure cardiac output (CO), systemic vascular resistance (SVR), blood pressure (BP), and cerebral regional oxygen saturations (SctO2) during TH and rewarming...
June 30, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28665071/feasibility-and-safety-of-mild-therapeutic-hypothermia-in-poor-grade-subarachnoid-hemorrhage-prospective-pilot-study
#4
Wookjin Choi, Soon Chan Kwon, Won Joo Lee, Young Cheol Weon, Byungho Choi, Hyeji Lee, Eun Suk Park, Ryeok Ahn
Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups...
August 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28629243/effect-of-therapeutic-hypothermia-on-myocardial-dysfunction-in-term-neonates-with-perinatal-asphyxia-a-randomized-controlled-trial
#5
K Rakesh, B Vishnu Bhat, B Adhisivam, P Ajith
OBJECTIVE: To evaluate the effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia. MATERIAL AND METHODS: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 120 newborns with perinatal asphyxia that were randomized to two groups (therapeutic hypothermia and normothermia). Cardiac enzyme profile changes between groups were assessed at 0, 24, 72 h CPK-MB and troponin I levels were estimated by immune inhibition and quantitative immunochromatography methods, respectively...
July 6, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28628913/age-dependent-effects-of-alk5-inhibition-and-mechanism-of-neuroprotection-in-neonatal-hypoxic-ischemic-brain-injury
#6
Brian H Kim, Mariano Guardia Clausi, Michelle Frondelli, Israel C Nnah, Chaitali Saqcena, Radek Dobrowolski, Steven W Levison
Neonatal encephalopathy due to hypoxic-ischemic (HI) brain injury triggers a wave of neuroinflammatory events attributed to causing the progressive degeneration and functional deficits seen weeks after the initial insult. In a recent set of studies, we evaluated the therapeutic efficacy of a small molecule antagonist for ALK5 (activin-like kinase 5 ), TGF-β receptor in a rat model of moderate perinatal HI and found significant improvements in neurologic outcomes. Here, we have extended those studies to evaluate the efficacy of delayed TGF-β receptor antagonism on postnatal day (P) 6 and P9 HI rat pups with and without hypothermia...
June 20, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28623417/a-validated-clinical-mri-injury-scoring-system-in-neonatal-hypoxic-ischemic-encephalopathy
#7
Shamik B Trivedi, Zachary A Vesoulis, Rakesh Rao, Steve M Liao, Joshua S Shimony, Robert C McKinstry, Amit M Mathur
BACKGROUND: Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury. OBJECTIVES: To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24 months. MATERIALS AND METHODS: MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated...
June 16, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28619605/the-prognostic-value-of-proton-magnetic-resonance-spectroscopy-in-term-newborns-treated-with-therapeutic-hypothermia-following-asphyxia
#8
Paul E Sijens, Katharina Wischniowsky, Hendrik J Ter Horst
OBJECTIVE: The purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by (1)H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome. METHODS: At the age of 6.0±1.8days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30months the Bayley Scale of Infant Development-III was performed...
June 12, 2017: Magnetic Resonance Imaging
https://www.readbyqxmd.com/read/28573895/impacts-of-therapeutic-hypothermia-on-cardiovascular-hemodynamics-in-newborns-with-hypoxic-ischemic-encephalopathy-a-case-control-study-using-echocardiography
#9
Ji Hong Yoon, Eun-Jung Lee, Sook Kyung Yum, Cheong-Jun Moon, Youn Young-Ah, Yoo Jin Kwun, Jae Young Lee, In Kyung Sung
PURPOSE: The effects of therapeutic hypothermia (TH) on hemodynamics in newborns with hypoxic-ischemic encephalopathy (HIE) were evaluated. MATERIALS AND METHODS: Thirty-two neonates (gestational age, 39.4 ± 1.3 weeks) who had TH for HIE and echocardiographic hemodynamic assessments during TH and post-TH period were studied. Gestational-age-matched 34 healthy neonates were enrolled for comparison. RESULTS: During TH, patients had significantly decreased left ventricular cardiac output (LVCO), descending aorta blood flow (DABF), and DABF/LVCO ratio, and increased resistive index of DA compared to controls...
June 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28567061/therapeutic-hypothermia-in-asphyxiated-neonates-experience-from-neonatal-intensive-care-unit-of-university-hospital-of-marrakech
#10
F M R Maoulainine, M Elbaz, S Elfaiq, G Boufrioua, F Z Elalouani, M Barkane, Nadia El Idrissi Slitine
INTRODUCTION: Therapeutic hypothermia (TH) is now recommended for the treatment neonates with hypoxic-ischemic encephalopathy (HIE). This treatment protocol is applied in our department since June 2012. The aim of this study is to report the first experience with head cooling in asphyxiated neonates in Morocco. PATIENTS AND METHODS: Prospective study of newborns admitted for HIE from July 18, 2012, to May 15, 2014, in Neonatal Intensive Care Unit (NICU) of Mohamed VI University Hospital...
2017: International Journal of Pediatrics
https://www.readbyqxmd.com/read/28561815/effects-of-therapeutic-hypothermia-on-white-matter-injury-from-murine-neonatal-hypoxia-ischemia
#11
Elliot Koo, R Ann Sheldon, Byong Sop Lee, Zinaida S Vexler, Donna M Ferriero
BackgroundTherapeutic hypothermia (TH) is the standard of care for neonates with hypoxic-ischemic encephalopathy, but it is not fully protective in the clinical setting. Hypoxia-ischemia (HI) may cause white matter injury (WMI), leading to neurological and cognitive dysfunction.MethodsP9 mice were subjected to HI as previously described. Pups underwent 3.5 h of systemic hypothermia or normothermia. Cresyl violet and Perl's iron staining for histopathological scoring of brain sections was completed blindly on all brains...
May 31, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28556862/therapeutic-hypothermia-to-treat-a-newborn-with-perinatal-hypoxic-ischemic-encephalopathy
#12
Todd R Fredricks, Christopher Gibson, Francis Essien, Jeffrey S Benseler
Hypoxic-ischemic encephalopathy is caused by neonatal asphyxia and can lead to mortality or long-term neurodevelopmental morbidity in neonates. Therapeutic hypothermia (TH) is one of the few effective ways to manage mitigating neurologic sequelae. The authors describe the case of a neonate who had a perinatal hypoxic insult and sustained no long-term sequelae after being treated with TH. It is important that osteopathic physicians who provide obstetric and gynecologic, perinatal, and emergency medical care are able to recognize a perinatal hypoxic event, understand the stratification of hypoxic-ischemic encephalopathy risk factors, and implement early TH protocols...
June 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28549636/amplitude-integrated-electroencephalography-improves-the-identification-of-infants-with-encephalopathy-for-therapeutic-hypothermia-and-predicts-neurodevelopmental-outcomes-at-2-years-of-age
#13
Janne Helen Skranes, Gro Løhaugen, Eva Margrethe Schumacher, Damjan Osredkar, Andres Server, Frances Mary Cowan, Tom Stiris, Drude Fugelseth, Marianne Thoresen
OBJECTIVES: To examine whether using an amplitude-integrated electroencephalography (aEEG) severity pattern as an entry criterion for therapeutic hypothermia better selects infants with hypoxic-ischemic encephalopathy and to assess the time-to-normal trace for aEEG and magnetic resonance imaging (MRI) lesion load as 24-month outcome predictors. STUDY DESIGN: Forty-seven infants meeting Norwegian therapeutic hypothermia guidelines were enrolled prospectively. Eight-channel EEG/aEEG was recorded from 6 hours until after rewarming, and read after discharge...
May 23, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28504050/how-long-is-sufficient-for-optimal-neuroprotection-with-cerebral-cooling-after-ischemia-in-fetal-sheep
#14
Joanne O Davidson, Vittoria Draghi, Sean Whitham, Simerdeep K Dhillon, Guido Wassink, Laura Bennet, Alistair J Gunn
The optimal duration of mild "therapeutic" hypothermia for neonates with hypoxic-ischemic encephalopathy is surprisingly unclear. This study assessed the relative efficacy of cooling for 48 h versus 72 h. Fetal sheep (0.85 gestation) received sham ischemia (n = 9) or 30 min global cerebral ischemia followed by normothermia (n = 8) or delayed hypothermia from 3 h to 48 h (n = 8) or 72 h (n = 8). Ischemia was associated with profound loss of electroencephalogram (EEG) power, neurons in the cortex and hippocampus, and oligodendrocytes and myelin basic protein expression in the white matter, with increased Iba-1-positive microglia and proliferation...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28490023/cord-blood-il-16-is-associated-with-3-year-neurodevelopmental-outcomes-in-perinatal-asphyxia-and-hypoxic-ischaemic-encephalopathy
#15
Caroline E Ahearne, Ruby Y Chang, Brian H Walsh, Geraldine B Boylan, Deirdre M Murray
Activation of the inflammatory pathway is increasingly recognized as an important mechanism of injury following neonatal asphyxia and encephalopathy. This process may contribute to the poor prognosis seen in some cases, despite therapeutic hypothermia. Our group has previously identified raised interleukin (IL)-6 and IL-16, measured in umbilical cord blood at birth, to be predictive of grade of hypoxic-ischaemic encephalopathy (HIE). Our aim in this study was to examine the ability of these cytokines to predict the 3-year neurodevelopmental outcome in the same cohort...
May 11, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28486224/long-term-neuropathological-changes-associated-with-cerebral-palsy-in-a-nonhuman-primate-model-of-hypoxic-ischemic-encephalopathy
#16
Ryan M McAdams, Bobbi Fleiss, Christopher Traudt, Leslie Schwendimann, Jessica M Snyder, Robin L Haynes, Niranjana Natarajan, Pierre Gressens, Sandra E Juul
BACKGROUND: Cerebral palsy (CP) is the most common motor disability in childhood, with a worldwide prevalence of 1.5-4/1,000 live births. Hypoxic-ischemic encephalopathy (HIE) contributes to the burden of CP, but the long-term neuropathological findings of this association remain limited. METHODOLOGY: Thirty-four term Macaca nemestrina macaques were included in this long-term neuropathological study: 9 control animals delivered by cesarean section and 25 animals with perinatal asphyxia delivered by cesarean section after 15-18 min of umbilical cord occlusion (UCO)...
May 10, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28479101/the-frequency-and-severity-of-magnetic-resonance-imaging-abnormalities-in-infants-with-mild-neonatal-encephalopathy
#17
Brian H Walsh, Jeffrey Neil, JoAnn Morey, Edward Yang, Michelle V Silvera, Terrie E Inder, Cynthia Ortinau
OBJECTIVE: To assess and contrast the incidence and severity of abnormalities on cerebral magnetic resonance imaging (MRI) between infants with mild, moderate, and severe neonatal encephalopathy who received therapeutic hypothermia. STUDY DESIGN: This retrospective cohort studied infants with mild, moderate, and severe neonatal encephalopathy who received therapeutic hypothermia at a single tertiary neonatal intensive care unit between 2013 and 2015. Two neuroradiologists masked to the clinical condition evaluated brain MRIs for cerebral injury after therapeutic hypothermia using the Barkovich classification system...
May 4, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28471439/relationships-between-cerebral-autoregulation-and-markers-of-kidney-and-liver-injury-in-neonatal-encephalopathy-and-therapeutic-hypothermia
#18
J K Lee, J Perin, C Parkinson, M O'Connor, M M Gilmore, M Reyes, J Armstrong, J M Jennings, F J Northington, R Chavez-Valdez
OBJECTIVE: We studied whether cerebral blood pressure autoregulation and kidney and liver injuries are associated in neonatal encephalopathy (NE). STUDY DESIGN: We monitored autoregulation of 75 newborns who received hypothermia for NE in the neonatal intensive care unit to identify the mean arterial blood pressure with optimized autoregulation (MAPOPT). Autoregulation parameters and creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were analyzed using adjusted regression models...
May 4, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28456387/erythropoietin-and-brain-magnetic-resonance-imaging-findings-in-hypoxic-ischemic-encephalopathy-volume-of-acute-brain-injury-and-1-year-neurodevelopmental-outcome
#19
Sarah B Mulkey, Raghu H Ramakrishnaiah, Robert C McKinstry, Taeun Chang, Amit M Mathur, Dennis E Mayock, Krisa P Van Meurs, G Bradley Schaefer, Chunqiao Luo, Shasha Bai, Sandra E Juul, Yvonne W Wu
In the Neonatal Erythropoietin and Therapeutic Hypothermia Outcomes study, 9/20 erythropoietin-treated vs 12/24 placebo-treated infants with hypoxic-ischemic encephalopathy had acute brain injury. Among infants with acute brain injury, the injury volume was lower in the erythropoietin than the placebo group (P = .004). Higher injury volume correlated with lower 12-month neurodevelopmental scores. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01913340.
April 26, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28416250/therapeutic-hypothermia-for-neonates-with-hypoxic-ischemic-encephalopathy
#20
REVIEW
Ming-Chou Chiang, Yuh-Jyh Jong, Chyi-Her Lin
Therapeutic hypothermia (TH) is a recommended regimen for newborn infants who are at or near term with evolving moderate-to-severe hypoxic ischemic encephalopathy (HIE). The Task Force of the Taiwan Child Neurology Society and the Taiwan Society of Neonatology held a joint meeting in 2015 to establish recommendations for using TH on newborn patients with HIE. Based on current evidence and experts' experiences, this review article summarizes the key points and recommendations regarding TH for newborns with HIE, including: (1) selection criteria for TH; (2) choices of method and equipment for TH; (3) TH prior to and during transport; (4) methods for temperature maintenance, monitoring, and rewarming; (5) systemic care of patients during TH, including the care of respiratory and cardiovascular systems, management of fluids, electrolytes, and nutrition, as well as sedation and drug metabolism; (6) monitoring and management of seizures; (7) neuroimaging, prognostic factors, and outcomes; and (8) adjuvant therapy for TH...
March 27, 2017: Pediatrics and Neonatology
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