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therapeutic hypothermia in neonates

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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28409761/the-question-of-whether-or-not-to-perform-therapeutic-hypothermia-a-case-of-neonatal-spinal-cord-injury
#9
K Yokoi, S Kobayashi, K Muramatsu, S Suzuki, H Gotou
Neonatal spinal cord injury is an extremely rare perinatal complication that often occurs concurrently with hypoxic ischemic encephalopathy (HIE), further complicating diagnosis of spinal cord injury. Although therapeutic hypothermia for moderate to severe HIE is widely recommended in Japan, it is difficult to determine whether it satisfies the neurological findings-related entry criteria in some patients.We describe a female infant with neonatal spinal cord injury after forceps delivery, who underwent therapeutic hypothermia upon diagnosis of HIE...
2017: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28401998/early-discontinuation-of-antiseizure-medications-in-neonates-with-hypoxic-ischemic-encephalopathy
#10
Mark P Fitzgerald, Sudha Kilaru Kessler, Nicholas S Abend
OBJECTIVE: Neonates with hypoxic-ischemic encephalopathy (HIE) managed with therapeutic hypothermia (TH) often experience acute symptomatic seizures, prompting treatment with antiseizure medications (ASMs). Because the risk of seizure occurrence after hospital discharge is unknown, the optimal ASM treatment duration is unclear. We aimed to determine the risk of seizure occurrence after hospital discharge and the impact of ASM treatment duration on this outcome. METHODS: We performed a single-center, retrospective study of consecutive neonates with HIE managed with TH who received ASMs for acute symptomatic seizures from June 2010 through December 2014...
April 12, 2017: Epilepsia
https://www.readbyqxmd.com/read/28393884/novel-wavelet-real-time-analysis-of-neurovascular-coupling-in-neonatal-encephalopathy
#11
Lina F Chalak, Fenghua Tian, Beverley Adams-Huet, Diana Vasil, Abbot Laptook, Takashi Tarumi, Rong Zhang
Birth asphyxia constitutes a major global public health burden for millions of infants, despite hypothermia therapy. There is a critical need for real time surrogate markers of therapeutic success, to aid in patient selection and/or modification of interventions in neonatal encephalopathy (NE). This is a proof of concept study aiming to quantify neurovascular coupling (NVC) using wavelet analysis of the dynamic coherence between amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in NE...
April 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28391258/dexmedetomidine-combined-with-therapeutic-hypothermia-is-associated-with-cardiovascular-instability-and-neurotoxicity-in-a-piglet-model-of-perinatal-asphyxia
#12
Mojgan Ezzati, Go Kawano, Eridan Rocha-Ferreira, Daniel Alonso-Alconada, Jane K Hassell, Kevin D Broad, Igor Fierens, Bobbi Fleiss, Alan Bainbridge, David L Price, Pardis Kaynezhad, Brian Anderson, Mariya Hristova, Ilias Tachtsidis, Xavier Golay, Pierre Gressens, Robert D Sanders, Nicola J Robertson
The selective α2-adrenoreceptor agonist dexmedetomidine has shown neuroprotective, analgesic, anti-inflammatory, and sympatholytic properties that may be beneficial in neonatal encephalopathy (NE). As therapeutic hypothermia is only partially effective, adjunct therapies are needed to optimize outcomes. The aim was to assess whether hypothermia + dexmedetomidine treatment augments neuroprotection compared to routine treatment (hypothermia + fentanyl sedation) in a piglet model of NE using magnetic resonance spectroscopy (MRS) biomarkers, which predict outcomes in babies with NE, and immunohistochemistry...
April 8, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28389438/management-and-investigation-of-neonatal-encephalopathy-2017-update
#13
Kathryn Martinello, Anthony R Hart, Sufin Yap, Subhabrata Mitra, Nicola J Robertson
This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help determine the cause. Over the last 7 years, infants with moderate to severe HIE have benefited from the introduction of routine therapeutic hypothermia; the number needed to treat for an additional beneficial outcome is 7 (95% CI 5 to 10)...
April 6, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28374415/biventricular-function-on-early-echocardiograms-in-neonatal-hypoxic-ischemic-encephalopathy
#14
Sanjeev Aggarwal, Girija Natarajan
AIM: To compare early (<24 hours) echocardiograms (ECHOs) in infants with perinatal hypoxic-ischemic encephalopathy (HIE) undergoing a)therapeutic hypothermia (TH) b) normothermia and c) normal controls. METHODS: This was a single center retrospective review of clinical early ECHOs of term infants with moderate or severe HIE and controls (with a normal ECHO <72 hours of age). Right (RVO) and left ventricular output (LVO), RV and LV myocardial performance index (MPI), systolic to diastolic duration ratio (S/D) and eccentricity indices (EI) in systole and diastole were compared using ANOVA...
April 4, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28369606/comparison-of-two-low-cost-methods-of-cooling-neonates-with-hypoxic-ischemic-encephalopathy
#15
Machilakath Panangandi Shabeer, Thangaraj Abiramalatha, Abhilasha Smith, Pradita Shrestha, Grace Rebekah, Arulmoorthy Meghala, Niranjan Thomas
Background: Several low-cost methods are used in resource-limited settings to provide therapeutic hypothermia in asphyxiated neonates. There is inadequate data about their efficacy and safety. This is a retrospective study comparing two low-cost cooling methods-frozen gel packs (FGP) and phase changing material (PCM). Results: There were 23 babies in FGP and 45 babies in the PCM group. Induction time was significantly shorter with FGP than PCM (45 vs. 90 minutes; p -value < 0...
October 5, 2016: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28359187/prediction-of-future-epilepsy-in-neonates-with-hypoxic-ischemic-encephalopathy-who-received-selective-head-cooling
#16
Tiffani L McDonough, Juliann M Paolicchi, Linda A Heier, Nikkan Das, Murray Engel, Jeffrey M Perlman, Zachary M Grinspan
Epilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians. Fifty neonates had 2-year follow-up. Nine developed epilepsy. Predictors included pH ≤6.8 on day of birth (adjusted odds ratio [OR] 19 [95% confidence interval (CI) 1-371]), burst suppression on EEG on day 4 (8...
January 1, 2017: Journal of Child Neurology
https://www.readbyqxmd.com/read/28355608/new-wavelet-neurovascular-bundle-for-bedside-evaluation-of-cerebral-autoregulation-and-neurovascular-coupling-in-newborns-with-hypoxic-ischemic-encephalopathy
#17
Lina F Chalak, Rong Zhang
Neonatal encephalopathy (NE) resulting from birth asphyxia constitutes a major global public health burden for millions of infants every year, and despite therapeutic hypothermia, half of these neonates have poor neurological outcomes. As new neuroprotective interventions are being studied in clinical trials, there is a critical need to establish physiological surrogate markers of therapeutic efficacy, to guide patient selection and/or to modify the therapeutic intervention. The challenge in the field of neonatal brain injury has been the difficulty of clinically discerning NE severity within the short therapeutic window after birth or of analyzing the dynamic aspects of the cerebral circulation in sick NE newborns...
March 30, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28351039/prognostic-value-of-the-apparent-diffusion-coefficient-in-newborns-with-hypoxic-ischaemic-encephalopathy-treated-with-therapeutic-hypothermia
#18
Eva-Marie Heursen, Amaya Zuazo Ojeda, Isabel Benavente Fernández, Gema Jimenez Gómez, Rosalía Campuzano Fernández-Colima, José Paz-Expósito, Simón Pedro Lubián López
BACKGROUND: Apparent diffusion coefficient (ADC) quantification has been proven to be of prognostic value in term newborns with hypoxic-ischaemic encephalopathy (HIE) who were treated under normothermia. OBJECTIVES: To evaluate the prognostic value of ADC in standardized brain regions in neonates with HIE who were treated with therapeutic hypothermia (TH). METHODS: This prospective cohort study included 54 term newborns who were admitted with HIE and treated with TH...
March 29, 2017: Neonatology
https://www.readbyqxmd.com/read/28288145/rectal-temperature-in-the-first-five-hours-after-hypoxia-ischaemia-critically-affects-neuropathological-outcomes-in-neonatal-rats
#19
Thomas Wood, Catherine Hobbs, Mari Falck, Anne Charlotte Brun, Else Marit Løberg, Marianne Thoresen
BACKGROUND: Hyperthermia after hypoxia-ischaemia (HI) in newborn infants is associated with worse neurological outcomes. Loss of thermoregulation may also be associated with greater injury. METHODS: In the postnatal-day 7 (P7) rat, the effect of 5h of graded hyperthermia (38°C or 39°C) immediately after unilateral HI was compared to normothermia (NT, 37°C), and therapeutic hypothermia (TH, 32°C). Early (negative geotaxis) and late (staircase test) behavioural testing was performed, as well as neuropathology scoring in adulthood...
March 13, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28282552/periictal-activity-in-cooled-asphyxiated-neonates-with-seizures
#20
Philippe Major, Anne Lortie, Mathieu Dehaes, Gregory Anton Lodygensky, Anne Gallagher, Lionel Carmant, Ala Birca
PURPOSE: Seizures are common in critically ill neonates. Both seizures and antiepileptic treatments may lead to short term complications and worsen the outcomes. Predicting the risks of seizure reoccurrence could enable individual treatment regimens and better outcomes. We aimed to identify EEG signatures of seizure reoccurrence by investigating periictal electrographic features and spectral power characteristics in hypothermic neonates with hypoxic-ischemic encephalopathy (HIE) with or without reoccurrence of seizures on rewarming...
April 2017: Seizure: the Journal of the British Epilepsy Association
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