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Caroline E Ahearne, Geraldine B Boylan, Deirdre M Murray
Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear...
February 8, 2016: World Journal of Clinical Pediatrics
Preethi Srinivasakumar, John Zempel, Shamik Trivedi, Michael Wallendorf, Rakesh Rao, Barbara Smith, Terrie Inder, Amit M Mathur
BACKGROUND: The impact of treating electrographic seizures in hypoxic ischemic encephalopathy (HIE) is unknown. METHODS: Neonates ≥36 weeks with moderate or severe HIE were randomly assigned to either treatment of electrographic seizures alone (ESG) or treatment of clinical seizures (CSG). Conventional EEG video was monitored in both groups for up to 96 hours. Cumulative electrographic seizure burden (SB) was calculated in seconds and converted to log units for analysis...
November 2015: Pediatrics
K Jane Hassell, Mojgan Ezzati, Daniel Alonso-Alconada, Derek J Hausenloy, Nicola J Robertson
Intrapartum-related events are the third leading cause of childhood mortality worldwide and result in one million neurodisabled survivors each year. Infants exposed to a perinatal insult typically present with neonatal encephalopathy (NE). The contribution of pure hypoxia-ischaemia (HI) to NE has been debated; over the last decade, the sensitising effect of inflammation in the aetiology of NE and neurodisability is recognised. Therapeutic hypothermia is standard care for NE in high-income countries; however, its benefit in encephalopathic babies with sepsis or in those born following chorioamnionitis is unclear...
November 2015: Archives of Disease in Childhood. Fetal and Neonatal Edition
Seetha Shankaran, Abbot R Laptook, Athina Pappas, Scott A McDonald, Abhik Das, Jon E Tyson, Brenda B Poindexter, Kurt Schibler, Edward F Bell, Roy J Heyne, Claudia Pedroza, Rebecca Bara, Krisa P Van Meurs, Cathy Grisby, Carolyn M Petrie Huitema, Meena Garg, Richard A Ehrenkranz, Edward G Shepherd, Lina F Chalak, Shannon E G Hamrick, Amir M Khan, Anne Marie Reynolds, Matthew M Laughon, William E Truog, Kevin C Dysart, Waldemar A Carlo, Michele C Walsh, Kristi L Watterberg, Rosemary D Higgins
IMPORTANCE: Hypothermia at 33.5°C for 72 hours for neonatal hypoxic ischemic encephalopathy reduces death or disability to 44% to 55%; longer cooling and deeper cooling are neuroprotective in animal models. OBJECTIVE: To determine if longer duration cooling (120 hours), deeper cooling (32.0°C), or both are superior to cooling at 33.5°C for 72 hours in neonates who are full-term with moderate or severe hypoxic ischemic encephalopathy. DESIGN, SETTING, AND PARTICIPANTS: A randomized, 2 × 2 factorial design clinical trial performed in 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network between October 2010 and November 2013...
December 24, 2014: JAMA: the Journal of the American Medical Association
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
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
Subrata Sarkar, John Barks
Although the primary goal of therapeutic hypothermia is to improve the neurodevelopmental outcome in asphyxiated infants, optimal management of the full range of multi-organ system complications typically presented by such infants during cooling treatment is necessary for improvement of the overall outcome. For this reason, adequate knowledge of how cooling affects all organ systems of asphyxiated infants with multi-organ hypoxic-ischemic injury is essential. Adequate diagnostic resources, readily available subspecialty consultant services and trained multidisciplinary staff to monitor and manage multi-organ system complications in asphyxiated infants during therapeutic cooling must be ensured during implementation of a cooling program...
April 2015: Seminars in Fetal & Neonatal Medicine
Martha Douglas-Escobar, Michael D Weiss
IMPORTANCE: Hypoxic-ischemic encephalopathy (HIE) occurs in 1 to 8 per 1000 live births in developed countries. Historically, the clinician has had little to offer neonates with HIE other than systemic supportive care. Recently, the neuroprotective therapy of hypothermia has emerged as the standard of care, and other complementary therapies are rapidly transitioning from the basic science to clinical care. OBJECTIVE: To examine the pathophysiology of HIE and the state of the art for the clinical care of neonates with HIE...
April 2015: JAMA Pediatrics
Marcel P H van den Broek, Henrica L M van Straaten, Alwin D R Huitema, Toine Egberts, Mona C Toet, Linda S de Vries, Karin Rademaker, Floris Groenendaal
BACKGROUND: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. OBJECTIVES: The objective was to evaluate the anticonvulsant effectiveness and hemodynamic safety of midazolam in hypothermic newborns and to provide dosing guidance. METHODS: Hypothermic newborns with perinatal asphyxia and treated with midazolam were included...
2015: Neonatology
Marianne Thoresen
Three ongoing challenges have arisen after the introduction of therapeutic hypothermia (TH) as standard of care for term newborns with moderate or severe perinatal asphyxia: (i) to ensure that the correct group of infants are cooled; (ii) to optimize the delivery of TH and intensive care in relation to the severity of the encephalopathy; (iii) to systematically follow up the long-term efficacy of TH using comparable outcome data between centers and countries. This review addresses the entry criteria for TH, and discusses potential issues regarding patient selection, and management of TH: cooling mild, moderate, and very severe perinatal asphyxia, cooling longer or deeper, and/or starting with a greater delay...
April 2015: Seminars in Fetal & Neonatal Medicine
Akshay Mehta, Deepak Chawla, Jasbinder Kaur, Vidushi Mahajan, Vishal Guglani
AIM: Timely detection of hypoxic-ischaemic encephalopathy (HIE) is crucial for selecting neonates who are likely to benefit from neuroprotective therapy. This study evaluated the efficacy of salivary lactate dehydrogenase (LDH) in the early diagnosis of HIE among neonates with perinatal asphyxia. METHODS: We prospectively enrolled 30 neonates who needed resuscitation at birth or had a history of delayed cry into the HIE group if they developed HIE within 12 h of birth...
June 2015: Acta Paediatrica
Elodie Boudes, Xianming Tan, Christine Saint-Martin, Michael Shevell, Pia Wintermark
OBJECTIVE: To assess whether the brain MRI results obtained during hypothermia identify the later brain injury observed in asphyxiated newborns after therapy is completed. PATIENTS AND METHODS: Asphyxiated newborns treated with hypothermia were prospectively enrolled in this study if they had at least one MRI performed during hypothermia treatment and then another MRI performed around day 10 of life. RESULTS: A total of 129 MRI scans were obtained from 43 asphyxiated newborns treated with hypothermia...
May 2015: Archives of Disease in Childhood. Fetal and Neonatal Edition
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
Guido Wassink, Christopher A Lear, Katherine C Gunn, Justin M Dean, Laura Bennet, Alistair J Gunn
Multiple randomized controlled trials have shown that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia-ischemia and continued until resolution of the acute phase of delayed cell death reduces mortality and improves neurodevelopmental outcome in term infants. The challenge is now to find ways to further improve outcomes. In the present review, we critically examine the evidence that conventional analgesic, sedative, or anticonvulsant agents might improve outcomes, in relation to the known window of opportunity for effective protection with hypothermia...
April 2015: Seminars in Fetal & Neonatal Medicine
Lu-Ann Papile, Jill E Baley, William Benitz, James Cummings, Waldemar A Carlo, Eric Eichenwald, Praveen Kumar, Richard A Polin, Rosemarie C Tan, Kasper S Wang
Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Infants selected for cooling must meet the criteria outlined in published clinical trials. The implementation of cooling needs to be performed at centers that have the capability to manage medically complex infants. Because the majority of infants who have neonatal encephalopathy are born at community hospitals, centers that perform cooling should work with their referring hospitals to implement education programs focused on increasing the awareness and identification of infants at risk for encephalopathy, and the initial clinical management of affected infants...
June 2014: Pediatrics
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