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Attini R, Montersino B, Versino E, Messina A, Mastretta E, Parisi S, Germano C, Quattromani M, Casula V, Mappa I, Revelli A, Masturzo B. Analysis of CTG patterns in cases with metabolic acidosis at birth with and without neonatal neurological alterations. J Matern Fetal Neonatal Med 2024; 37:2377718. [PMID: 39128870 DOI: 10.1080/14767058.2024.2377718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To determine cardiotocographic patterns in newborns with metabolic acidosis, based on clinical signs of neurological alteration (NA) and the need for hypothermic treatment. METHODS All term newborns with metabolic acidosis in a single center from 2016 to 2020 were included in the study. Three segments of intrapartum CTG (cardiotocography) were considered (first 30 min of active labor, 90 to 30 min before birth, and last 30 min before delivery) and a longitudinal analysis of CTG pattern was performed according to the 2015 FIGO classification. RESULTS Three hundred and twenty-four neonates with metabolic acidosis diagnosed at birth were divided into three groups: the first group included all neonates with any clinical sign of neurological alteration, requiring hypothermia according to the recommendation of the Italian Society of Neonatology (group TNA-Treated neurological Alteration, n = 17), the second encompassed neonates with any clinical sign of neurological alteration not requiring hypothermia (group NTNA-Not Treated neurological Alteration, n = 83), and the third enclosed all neonates without any sign of clinical neurological involvement (group NoNA-No neurological Alteration, n = 224). The most frequent alterations of CTG in TNA group were late decelerations, reduced variability, bradycardia, and tachysystole. Unexpectedly, from the longitudinal analysis of the CTG, 49% of all cases with metabolic acidosis never showed a pathological CTG with normal trace at the beginning of labor followed by normal or suspicious trace in the final part of labor, the same as in TNA and NTNA groups (10 and 39%, respectively). CONCLUSIONS CTG has limited specificity in identifying cases of acidosis at birth, even in babies who will develop NA.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Benedetta Montersino
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Elisabetta Versino
- Department of Epidemiology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandro Messina
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Emmanuele Mastretta
- Department of Neonatology, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Silvia Parisi
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Chiara Germano
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Martina Quattromani
- Department of Pediatrics and Neonatology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Viola Casula
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Tor Vergata University Hospital, Rome, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
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Ali MAM, Farghaly MAA, El-Dib I, Karnati S, Aly H, Acun C. Glucose instability and outcomes of neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. Brain Dev 2024; 46:262-267. [PMID: 38782623 DOI: 10.1016/j.braindev.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To investigate the prevalence and associated outcomes of glucose abnormalities in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). METHODS Glucose values were reviewed in all HIE infants. Pearson's correlation was used to assess the association of hypo- and hyperglycemic episodes with neonatal brain MRI and neurodevelopmental outcomes (NDO) at 12 & 24 months. RESULTS Of 153 infants included, 31, 56 and 43 had episodes of hypo-, hyperglycemia and combined, respectively. Hyperglycemia and combined hypo/hyper had higher mortality (p = 0.035), seizures (p = 0.009), and longer hospitalization (p = 0.023). Hypo- and hyperglycemia were associated with parenchymal hemorrhages (p = 0.028 & p = 0.027, respectively). Hypoglycemia was associated with restricted diffusion (p = 0.014), while hyperglycemia was associated with cortical injuries (p = 0.045). Each hour of hyper- or hypoglycemia was associated with 5.2-5.8 times unfavorable outcomes (p < 0.001). CONCLUSION Blood glucose aberrations were detrimental in HIE infants treated with TH. Optimizing glucose management is crucial in this setting.
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Affiliation(s)
- Mahmoud A M Ali
- West Virginia University School of Medicine, Department of Pediatrics, Morgantown, WV 26505, USA; MetroHealth Medical Center, Case Western Reserve University, Department of Pediatrics, Division of Neonatology, Cleveland, OH 44109, USA.
| | - Mohsen A A Farghaly
- Cleveland Clinic Children's Hospital, Department of Neonatology, Cleveland, OH 44106, USA
| | - Injy El-Dib
- Biomedical Engineering Student, School of Engineering, Brown University, Providence, RI, USA
| | - Sreenivas Karnati
- Cleveland Clinic Children's Hospital, Department of Neonatology, Cleveland, OH 44106, USA
| | - Hany Aly
- Cleveland Clinic Children's Hospital, Department of Neonatology, Cleveland, OH 44106, USA
| | - Ceyda Acun
- Cleveland Clinic Children's Hospital, Department of Neonatology, Cleveland, OH 44106, USA
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Guo Y, Chen Y, Zhang H, Zhang Q, Jin M, Wang S, Du X, Du Y, Xu D, Wang M, Li L, Luo L. Emodin attenuates hypoxic-ischemic brain damage by inhibiting neuronal apoptosis in neonatal mice. Neuroscience 2024; 554:83-95. [PMID: 38944149 DOI: 10.1016/j.neuroscience.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
Neonatal hypoxic-ischemic brain damage (HIBD) can lead to mortality and severe neurological dysfunction. Emodin is a natural anthraquinone derivative that is easy to obtain and has good neuroprotective effects. This study aimed to investigate the neuroprotective effect of emodin on neonatal mouse HIBD. The modified Rice-Vannucci method was used to induce HIBD in mouse pups. Eighty postnatal 7-day (P7) C57BL/6 neonatal mice were randomly divided into the sham group (sham), vehicle group (vehicle), and emodin group (emodin). TTC staining and whole-brain morphology were used to evaluate the infarct volume and morphology of the brain tissue. The condition of the neurons was observed through Nissl staining, HE staining, FJC staining, immunofluorescence and Western blot for NeuN, IBA-1, and GFAP. The physiological status of the mice was evaluated using weight measurements. The neural function of the mice was assessed using the negative geotaxis test, righting reflex test, and grip test. TUNEL staining was used to detect apoptosis in brain cells. Finally, Western blot and immunofluorescence were used to detect the expression levels of apoptosis-related proteins, such as P53, cleaved caspase-3, Bax and Bcl-2, in the brain. Experiments have shown that emodin can reduce the cerebral infarct volume, brain oedema, neuronal apoptosis, and degeneration and improve the reconstruction of brain tissue morphology, neuronal morphology, physiological conditions, and neural function. Additionally, emodin inhibited the expression of proapoptotic proteins such as P53, Bax and cleaved caspase-3 and promoted the expression of the antiapoptotic protein Bcl-2. Emodin attenuates HIBD by inhibiting neuronal apoptosis in neonatal mice.
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Affiliation(s)
- Yingqi Guo
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yingxiu Chen
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Huimei Zhang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Qi Zhang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Mingrui Jin
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Sijia Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xinyu Du
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yunjing Du
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Danyang Xu
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Mengxia Wang
- Intensive Care Unit, Guangdong Second Provincial General Hospital, Guangzhou 510317, China.
| | - Lixia Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China.
| | - Li Luo
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China; Guangdong Medical Association, Guangzhou 510180, China.
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Lenells M, Prescott MG, Wróblewska-Seniuk K, Fiander M, Soll R, Bruschettini M. Olfactory stimulation for promoting development and preventing morbidity in preterm infants. Cochrane Database Syst Rev 2024; 8:CD016074. [PMID: 39140364 PMCID: PMC11323270 DOI: 10.1002/14651858.cd016074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of olfactory stimulation with different odorants in the NICU for promoting development and preventing morbidity in preterm infants.
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Affiliation(s)
- Mikaela Lenells
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- FoUU, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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Prakash R, Verónica Reyes-García D, Somanath Hansoge S, Rosenkrantz TS. Therapeutic hypothermia for neonates with hypoxic-ischaemic encephalopathy in low- and lower-middle-income countries: a systematic review and meta-analysis. J Trop Pediatr 2024; 70:fmae019. [PMID: 39152040 DOI: 10.1093/tropej/fmae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
Hypoxic-ischaemic encephalopathy (HIE) is a major cause of mortality and neurodevelopmental disability, especially in low-income countries. While therapeutic hypothermia has been shown to reduce morbidity and mortality in infants with HIE, some clinical trials in low-income countries have reported an increase in the risk of mortality. We conducted a systematic review and meta-analysis of all randomized and quasi-randomized controlled trials conducted in low-income and lower-middle-income countries that compared cooling therapy with standard care for HIE. Our primary outcome was composite of neonatal mortality and neurodevelopmental disability at 6 months or beyond. The review was registered with PROSPERO (CRD42022352728). Our review included 11 randomized controlled trials with 1324 infants with HIE. The composite of death or disability at 6 months or beyond was lower in therapeutic hypothermia group (RR 0.78, 95% CI 0.66-0.92, I2 = 85%). Neonatal mortality rate did not differ significantly between cooling therapy and standard care (RR 0.92, 95% CI 0.76-1.13, I2 = 61%). Additionally, the cooled group exhibited significantly lower rates of neurodevelopmental disability at or beyond 6 months (RR 0.34, 95%CI 0.22-0.52, I2 = 0%). Our analysis found that neonatal mortality rate did not differ between cooled and noncooled infants in low- and lower-middle-income countries. Cooling may have a beneficial effect on neurodevelopmental disability and the composite of death or disability at 6 months or beyond.
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Affiliation(s)
- Raj Prakash
- Department of Neonatology, Northern Care Alliance NHS Trust, Royal Oldham Hospital, Manchester, OL1 2JH, United Kingdom
| | - Diana Verónica Reyes-García
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
- Department of Neonatology, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City 11000, Mexico
| | - Sanjana Somanath Hansoge
- Department of Neonatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 522503, India
| | - Ted S Rosenkrantz
- Department Paediatrics and Obstetrics, University of Connecticut School of Medicine, Farmington, CT 06030, United States
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Tran HTT, Tran DM, Le HT, Hellström-Westas L, Alfvén T, Olson L. Cooling during transportation of newborns with hypoxic ischemic encephalopathy using phase change material mattresses in low-resource settings: a randomized controlled trial in Hanoi, Vietnam. BMC Pediatr 2024; 24:509. [PMID: 39118070 PMCID: PMC11308214 DOI: 10.1186/s12887-024-04987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To determine the effectiveness of phase-change-material mattress (PCM) during transportation of newborns with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN Randomized controlled trial of newborns with HIE from June 2016 to December 2019. Patients were randomized to transport with PCM or without PCM (control) when transferred to a cooling center in northern Vietnam. Primary outcome measure was mortality rate, secondary outcomes including temperature control and adverse effects. RESULT Fifty-Two patients in PCM-group and 61 in control group. Median rectal temperature upon arrival was 34.5 °C (IQR 33.5-34.8) in PCM-group and 35.1 °C (IQR 34.5-35.9) in control group (p = 0.023). Median time from birth to reach target temperature was 5.0 ± 1.4 h and 5.5 ± 1.2 h in the respective groups (p = 0.065). 81% of those transported with PCM versus 62% of infants transported without (p = 0.049) had reached target temperature within the 6-h timeframe. There was no record of overcooling (< 32 °C) in any of the groups. The was no difference in mortality rate between the two groups (33% and 34% respectively (p > 0.05)). CONCLUSION Phase-change-material can be used as a safe and effective cooling method during transportation of newborns with HIE in low-resource settings. TRIAL REGISTRATION The study was retro-prospectively registered in Clinical Trials (04/05/2022, NCT05361473).
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Affiliation(s)
- Hang T T Tran
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Vietnam National Children's Hospital, Hanoi, Vietnam.
| | - Dien M Tran
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T Le
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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7
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Peebles PJ, Christ L, Flibotte J, Presser L, Carr LH. Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices. J Perinatol 2024; 44:1216-1221. [PMID: 38424232 DOI: 10.1038/s41372-024-01916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Infants at risk for hypoxic ischemic encephalopathy (HIE) require a time sensitive evaluation and decision-making regarding treatment with therapeutic hypothermia (TH). Prior to this project, there was no standardized approach to evaluating these infants locally. METHODS Included infants were "at risk for HIE," defined as meeting the "patient characteristics" and "biochemical criteria" per the institutional HIE pathway. Our primary outcome was documentation of an HIE therapeutic hypothermia evaluation (HIETHE) within the first six hours of life which included: (1) recognition of at-risk status, (2) an encephalopathy exam, and (3) a decision regarding TH. Plan-Do-Study-Act cycles included novel clinical decision support. RESULTS From October 2020 to May 2023, among infants at-risk for HIE, the average percentage with an HIETHE documented improved from 47% to 82%. CONCLUSIONS We standardized the approach to infants at risk for HIE and improved the presence of a complete and timely evaluation regarding TH eligibility.
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Affiliation(s)
- Patrick J Peebles
- Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Lori Christ
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Flibotte
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Liandra Presser
- Division of Neonatology, Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA, USA
| | - Leah H Carr
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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8
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Vasquez AM, Bischoff AR, Giesinger RE, McNamara PJ. Impact of therapeutic hypothermia (TH) on echocardiography indices of pulmonary hemodynamics among neonates with hypoxic ischemic encephalopathy (HIE). J Perinatol 2024; 44:1212-1215. [PMID: 38565651 DOI: 10.1038/s41372-024-01958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Angelica M Vasquez
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, New York, NY, 10032, USA
| | - Adrianne R Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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9
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Prial J, El-Shibiny H, El-Dib M, Benjamin J, Erdei C, Dodrill P, Szakmar E, Bell KA. Growth trajectories and need for oral feeding support among infants with neonatal encephalopathy treated with therapeutic hypothermia. J Perinatol 2024; 44:1163-1171. [PMID: 38702507 DOI: 10.1038/s41372-024-01983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Identify feeding supports required among infants with neonatal encephalopathy and determine growth trajectories to 3 years. STUDY DESIGN Single-center retrospective cohort study of 120 infants undergoing therapeutic hypothermia. Logistic regression and stratified analyses identified whether clinical factors, EEG-determined encephalopathy severity, and MRI-based brain injury predict feeding supports (nasogastric tube, oral feeding compensations) and growth. RESULTS 50.8% of infants required feeding supports in the hospital, decreasing to 14% at discharge. Moderate-to-severe encephalopathy and basal ganglia injury predicted feeding support needs. Yet, 35% of mildly encephalopathic infants required gavage tubes. Growth trajectories approximated expected growth of healthy infants. CONCLUSION Infants with neonatal encephalopathy-even if mild-frequently experience feeding difficulties during initial hospitalization. With support, most achieve full oral feeds by discharge and adequate early childhood growth. Clinical factors may help identify infants requiring feeding support, but do not detect all at-risk infants, supporting routine screening of this high-risk population.
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Affiliation(s)
- Jennifer Prial
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Hoda El-Shibiny
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer Benjamin
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Dodrill
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eniko Szakmar
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Katherine A Bell
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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10
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Kong W, Lu C. Role of mitochondria in neonatal hypoxic-ischemic encephalopathy. Histol Histopathol 2024; 39:991-1000. [PMID: 38314617 DOI: 10.14670/hh-18-710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Neonatal hypoxic-ischemic encephalopathy, an important cause of death as well as long-term disability in survivors, is caused by oxygen and glucose deprivation, and limited blood flow. Following hypoxic-ischemic injury in the neonatal brain, three main biochemical damages (excitotoxicity, oxidative stress, and exacerbated inflammation) are triggered. Mitochondria are involved in all three cascades. Mitochondria are the nexus of metabolic pathways to offer most of the energy that our body needs. Hypoxic-ischemic injury affects the characteristics of mitochondria, including dynamics, permeability, and ATP production, which also feed back into the process of neonatal hypoxic-ischemic encephalopathy. Mitochondria can be a cellular hub in inflammation, which is another main response of the injured neonatal brain. Some treatments for neonatal hypoxic-ischemic encephalopathy affect the function of mitochondria or target mitochondria, including therapeutic hypothermia and erythropoietin. This review presents the main roles of mitochondria in neonatal hypoxic-ischemic encephalopathy and discusses some potential treatments directed at mitochondria, which may foster the development of new therapeutic strategies for this encephalopathy.
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Affiliation(s)
- Weijing Kong
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Cheng Lu
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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11
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Urru SA, Geist M, Carlinger R, Bodrero E, Bruschettini M. Strategies for cessation of caffeine administration in preterm infants. Cochrane Database Syst Rev 2024; 7:CD015802. [PMID: 39045901 PMCID: PMC11267609 DOI: 10.1002/14651858.cd015802.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Apnea and intermittent hypoxemia (IH) are common developmental disorders in infants born earlier than 37 weeks' gestation. Caffeine administration has been shown to lower the incidence of these disorders in preterm infants. Cessation of caffeine treatment is based on different post-menstrual ages (PMA) and resolution of symptoms. There is uncertainty about the best timing for caffeine discontinuation. OBJECTIVES To evaluate the effects of early versus late discontinuation of caffeine administration in preterm infants. SEARCH METHODS We searched CENTRAL, PubMed, Embase, and three trial registries in August 2023; we applied no date limits. We checked the references of included studies and related systematic reviews. SELECTION CRITERIA We included randomized controlled trials (RCTs) in preterm infants born earlier than 37 weeks' gestation, up to a PMA of 44 weeks and 0 days, who received caffeine for any indication for at least seven days. We compared three different strategies for caffeine cessation: 1. at different PMAs, 2. before or after five days without symptoms, and 3. at a predetermined PMA versus at the resolution of symptoms. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were: restarting caffeine therapy, intubation within one week of treatment discontinuation, and the need for non-invasive respiratory support within one week of treatment discontinuation. Secondary outcomes were: number of episodes of apnea in the seven days after treatment discontinuation, number of infants with at least one episode of apnea in the seven days after treatment discontinuation, number of episodes of intermittent hypoxemia (IH) within seven days of treatment discontinuation, number of infants with at least one episode of IH in the seven days after of treatment discontinuation, all-cause mortality prior to hospital discharge, major neurodevelopmental disability, number of days of respiratory support after treatment discontinuation, duration of hospital stay, and cost of neonatal care. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included three RCTs (392 preterm infants). Discontinuation of caffeine at PMA less than 35 weeks' gestation versus PMA equal to or longer than 35 weeks' gestation This comparison included one single completed RCT with 98 premature infants with a gestational age between 25 + 0 and 32 + 0 weeks at birth. All infants had discontinued caffeine treatment for five days at randomization. The infants received either an oral loading dose of caffeine citrate (20 mg/kg) at randomization followed by oral maintenance dosage (6 mg/kg/day) until 40 weeks PMA, or usual care (controls), during which caffeine was stopped before 37 weeks PMA. Early cessation of caffeine administration in preterm infants at PMA less than 35 weeks' gestation may result in an increase in the number of IH episodes in the seven days after discontinuation of treatment, compared to prolonged caffeine treatment beyond 35 weeks' gestation (mean difference [MD] 4.80, 95% confidence interval [CI] 2.21 to 7.39; 1 RCT, 98 infants; low-certainty evidence). Early cessation may result in little to no difference in all-cause mortality prior to hospital discharge compared to late discontinuation after 35 weeks PMA (risk ratio [RR] not estimable; 98 infants; low-certainty evidence). No data were available for the following outcomes: restarting caffeine therapy, intubation within one week of treatment discontinuation, need for non-invasive respiratory support within one week of treatment discontinuation, number of episodes of apnea, number of infants with at least one episode of apnea in the seven days after discontinuation of treatment, or number of infants with at least one episode of IH in the seven days after discontinuation of treatment. Discontinuation based on PMA versus resolution of symptoms This comparison included two RCTs with a total of 294 preterm infants. Discontinuing caffeine at the resolution of symptoms compared to discontinuing treatment at a predetermined PMA may result in little to no difference in all-cause mortality prior to hospital discharge (RR 1.00, 95% CI 0.14 to 7.03; 2 studies, 294 participants; low-certainty evidence), or in the number of infants with at least one episode of apnea within the seven days after discontinuing treatment (RR 0.60, 95% CI 0.31 to 1.18; 2 studies; 294 infants; low-certainty evidence). Discontinuing caffeine based on the resolution of symptoms probably results in more infants with IH in the seven days after discontinuation of treatment (RR 0.38, 95% CI 0.20 to 0.75; 1 study; 174 participants; moderate-certainty evidence). No data were available for the following outcomes: restarting caffeine therapy, intubation within one week of treatment discontinuation, need for non-invasive respiratory support within one week of treatment discontinuation, or number of episodes of IH in the seven days after treatment discontinuation. Adverse effects In the Rhein 2014 study, five of the infants randomized to caffeine had the caffeine treatment discontinued at the discretion of the clinical team, because of tachycardia. The Pradhap 2023 study reported adverse events, including recurrence of apnea of prematurity (15% in the short and 13% in the regular course caffeine therapy group), varying severities of bronchopulmonary dysplasia, hyperglycemia, extrauterine growth restriction, retinopathy of prematurity requiring laser treatment, feeding intolerance, osteopenia, and tachycardia, with no significant differences between the groups. The Prakash 2021 study reported that adverse effects of caffeine therapy for apnea of prematurity included tachycardia, feeding intolerance, and potential neurodevelopmental impacts, though most were mild and transient. We identified three ongoing studies. AUTHORS' CONCLUSIONS There may be little or no difference in the incidence of all-cause mortality and apnea in infants who were randomized to later discontinuation of caffeine treatment. However, the number of infants with at least one episode of IH was probably reduced with later cessation. No data were found to evaluate the benefits and harms of later caffeine discontinuation for: restarting caffeine therapy, intubation within one week of treatment discontinuation, or need for non-invasive respiratory support within one week of treatment discontinuation. Further studies are needed to evaluate the short-term and long-term effects of different caffeine cessation strategies in premature infants.
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Affiliation(s)
- Silvana Am Urru
- Hospital Pharmacy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
- Department of Chemistry and Pharmacy, School of Hospital Pharmacy, University of Sassari, Sassari, Italy
| | - Milena Geist
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | - Enrico Bodrero
- Neonatal Intensive Care Unit, Ospedale S. Croce e Carle, Cuneo, Italy
| | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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12
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Meurer WJ, Schmitzberger FF, Yeatts S, Ramakrishnan V, Abella B, Aufderheide T, Barsan W, Benoit J, Berry S, Black J, Bozeman N, Broglio K, Brown J, Brown K, Carlozzi N, Caveney A, Cho SM, Chung-Esaki H, Clevenger R, Conwit R, Cooper R, Crudo V, Daya M, Harney D, Hsu C, Johnson NJ, Khan I, Khosla S, Kline P, Kratz A, Kudenchuk P, Lewis RJ, Madiyal C, Meyer S, Mosier J, Mouammar M, Neth M, O'Neil B, Paxton J, Perez S, Perman S, Sozener C, Speers M, Spiteri A, Stevenson V, Sunthankar K, Tonna J, Youngquist S, Geocadin R, Silbergleit R. Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest. Trials 2024; 25:502. [PMID: 39044295 PMCID: PMC11264458 DOI: 10.1186/s13063-024-08280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. METHODS This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures. DISCUSSION In vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. TRIAL REGISTRATION ClinicalTrials.gov NCT04217551. Registered on 30 December 2019.
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Affiliation(s)
- William J Meurer
- Emergency Medicine, Neurology, University of Michigan, TC B1-354, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5301, USA.
| | | | - Sharon Yeatts
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Benjamin Abella
- Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tom Aufderheide
- Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William Barsan
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Justin Benoit
- Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Joy Black
- Emergency Medicine, Neuroscience, University of Michigan, Thermo Fisher Scientific, Ann Arbor, MI, USA
| | - Nia Bozeman
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kristine Broglio
- Berry Consultants, Oncology Statistical Innovation, Gaithersburg, MD, USA
| | - Jeremy Brown
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Kimberly Brown
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Noelle Carlozzi
- Physical Medicine and Rehabilitation, Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Angela Caveney
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sung-Min Cho
- Critical Care Medicine, Johns Hopkins Hospital, Anesthesia, Baltimore, MD, USA
| | - Hangyul Chung-Esaki
- The Queen's Medical Center, University of Hawaii John A. Burns School of Medicine, Critical Care, Honolulu, HI, USA
| | - Robert Clevenger
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robin Conwit
- Neurology, Indiana University, Indianapolis, IN, USA
| | - Richelle Cooper
- Emergency Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Valentina Crudo
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mohamud Daya
- Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Deneil Harney
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Cindy Hsu
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas J Johnson
- Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Medicine, University of Washington, Seattle, WA, USA
| | - Imad Khan
- Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shaveta Khosla
- Emergency Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Peyton Kline
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Anna Kratz
- Physical Medicine and Rehabilitation, Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Peter Kudenchuk
- Division of Cardiology, Medicine, University of Washington, Seattle, WA, USA
| | - Roger J Lewis
- Emergency Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Chaitra Madiyal
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sara Meyer
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jarrod Mosier
- Emergency Medicine, Medicine, University of Arizona, Tucson, AZ, USA
| | - Marwan Mouammar
- Medicine, Critical Care Medicine, OHSU Portland Adventist Medical Center, Portland, OR, USA
| | - Matthew Neth
- Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian O'Neil
- Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - James Paxton
- Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Sofia Perez
- Emergency Medicine Research, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Perman
- Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cemal Sozener
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mickie Speers
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aimee Spiteri
- Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Kavita Sunthankar
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Tonna
- Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Scott Youngquist
- Emergency Medicine, Spencer Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Romergryko Geocadin
- Neurology, Anesthesiology-Critical Care Medicine, Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Arslan Z, Okbay Gunes A, Deveci MF, Unal Yuksekgonul A, Kasali K. The Association Between Neonatal Intensive Care Unit Arrival Temperatures and Short-Term Outcomes of Neonates with Moderate and Severe Hypoxic-Ischemic Encephalopathy. Ther Hypothermia Temp Manag 2024. [PMID: 39037033 DOI: 10.1089/ther.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Therapeutic hypothermia (TH) is the only treatment method that is known to reduce mortality and neurological sequela rates in newborns with moderate and severe hypoxic-ischemic encephalopathy (HIE). We aimed to evaluate the relationship between rectal temperatures measured upon arrival to our unit and short-term outcomes in newborns with HIE/TH. This was a retrospective study conducted between January 2022 and January 2023. The neonates were divided into three groups according to their rectal temperatures measured upon arrival at our unit as follows: Group 1) <33°C, Group 2) 33-34°C (group arriving at target temperature), and Group 3) >34°C. Short-term outcomes and mortality were compared between the groups. Group 1 consisted of 17 (19.8%) neonates, Group 2 consisted of 34 (39.5%) neonates, and Group 3 consisted of 35 (40.7%) neonates who had HIE and an indication for TH. Rectal temperature on arrival to the unit was not related to the rate of clinical convulsions, rates of abnormal attenuated electroencephalography and magnetic resonance imaging findings, rate of pulmonary hypertension, duration of mechanical ventilation and length of hospital stay. Although the mortality rate was 29% in Group 1, it was 3% and 6% in Groups 2 and 3, respectively (p = 0.016). No relationship was found between the rectal temperature upon arrival to the NICU and the short-term outcomes in HIE/TH neonates. However, the mortality rate in those who were overcooled was significantly higher compared with the other groups.
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Affiliation(s)
- Zehra Arslan
- Neonatal Intensive Care Unit, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Asli Okbay Gunes
- Neonatal Intensive Care Unit, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Mehmet Fatih Deveci
- Neonatal Intensive Care Unit, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Ayse Unal Yuksekgonul
- Pediatric Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Kamber Kasali
- Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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14
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Garnaud H, Cressens S, Arbaoui H, Ayachi A. Servo-controlled therapeutic hypothermia during neonatal transport: a before-and-after quality improvement project. Eur J Pediatr 2024:10.1007/s00431-024-05691-4. [PMID: 39028371 DOI: 10.1007/s00431-024-05691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/25/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
The purpose of this paper is to compare the achievement of target temperature and the short-term neurological outcome according to the use of servo-controlled hypothermia in transport. This is a monocentric retrospective observational before-and-after uncontrolled study of newborns transported for neonatal encephalopathy. The first group was transported from 01/01/2019 to 12/31/2019 in passive hypothermia and the second group from 01/01/2021 to 12/31/2021 in controlled hypothermia. We included patients who had a total of 72 h of servo-controlled therapeutic hypothermia (CTH). We excluded those who had no or less than 72 h of CTH. There were 33 children transported in passive hypothermia in 2019 and 23 children transported in CTH in 2021. There were 9/28 (32%) patients in 2019 who reached the target temperature on arrival at the NICU compared with 20/20 (100%) in 2021 (p value < 0.01). There was a trend towards earlier age of therapeutic hypothermia if started in transport: 3.1 h ± 1.0 vs 4.0 h ± 2.4 for passive hypothermia (p value 0.07). There was no difference in age of arrival in NICU (4.0 h ± 1.2 with CTH vs 3.8 h ± 2.2 without CTH). We found no difference in short-term outcome (survival, abnormal MRI, seizures on EEG) between the two groups. CONCLUSION The use of servo-controlled therapeutic hypothermia makes it possible to reach the temperature target, without increasing the age of arrival in the NICU. WHAT IS KNOWN • CTH is rarely used during transport in France even if passive hypothermia rarely reaches temperature target, inducing overcooling and hyperthermia. WHAT IS NEW • This study shows better temperature control on arrival in the NICU with CTH compared to passive hypothermia, with no increase in arrival time.
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Affiliation(s)
- Hélèna Garnaud
- Neonatal Intensive Care Medicine, Port-Royal Hospital, APHP, 75014, Paris, France.
| | | | | | - Azzedine Ayachi
- Division of Pediatrics and Neonatal Critical Care, SMUR Pédiatrique 92, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France
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15
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Garegrat R, Montaldo P, Burgod C, Pant S, Mazlan M, Palanisami B, Chakkarapani E, Woolfall K, Johnson S, Grant PE, Land S, Mahmoud M, Brady T, Cornelius V, Adams E, Dorling J, Aladangadi N, Fleming P, Pressler R, Shennan A, Petrou S, Soe A, Basset P, Shankaran S, Thayyil S. Whole-body hypothermia in mild neonatal encephalopathy: protocol for a multicentre phase III randomised controlled trial. BMC Pediatr 2024; 24:460. [PMID: 39026197 PMCID: PMC11256637 DOI: 10.1186/s12887-024-04935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Mild hypoxic ischemic encephalopathy is associated with sub optimal cognition and learning difficulties at school age. Although whole-body hypothermia reduces death and disability after moderate or severe encephalopathy in high-income countries, the safety and efficacy of hypothermia in mild encephalopathy is not known. The cooling in mild encephalopathy (COMET) trial will examine if whole-body hypothermia improves cognitive development of neonates with mild encephalopathy. METHODS The COMET trial is a phase III multicentre open label two-arm randomised controlled trial with masked outcome assessments. A total of 426 neonates with mild encephalopathy will be recruited from 50 to 60 NHS hospitals over 2 ½ years following parental consent. The neonates will be randomised to 72 h of whole-body hypothermia (33.5 ± 0.5 C) or normothermia (37.0 ± 0.5 C) within six hours or age. Prior to the recruitment front line clinical staff will be trained and certified on expanded modified Sarnat staging for encephalopathy. The neurological assessment of all screened and recruited cases will be video recorded and centrally assessed for quality assurance. If recruitment occurs at a non-cooling centre, neonates in both arms will be transferred to a cooling centre for continued care, after randomisation. All neonates will have continuous amplitude integrated electroencephalography (aEEG) at least for the first 48 h to monitor for seizures. Predefined safety outcomes will be documented, and data collected to assess resource utilization of health care. A central team masked to trial group allocation will assess neurodevelopmental outcomes at 2 years of age. The primary outcome is mean difference in composite cognitive scores on Bayley scales of Infant and Toddler development 4th Edition. DISCUSSION The COMET trial will establish the safety and efficacy of whole-body hypothermia for mild hypoxic ischaemic encephalopathy and inform national and international guidelines in high income countries. It will also provide an economic assessment of whole-body hypothermia therapy for mild encephalopathy in the NHS on cost-effectiveness grounds. TRIAL REGISTRATION NUMBER NCT05889507 June 5, 2023.
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Affiliation(s)
- Reema Garegrat
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England.
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Constance Burgod
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England
| | - Munirah Mazlan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England
| | | | - Ela Chakkarapani
- University of Bristol and St Michaels Hospital NHS Trust, Bristol, UK
| | - Kerry Woolfall
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Patricia Ellen Grant
- Departments of Radiology and Pediatrics, Boston Children,s Hospital, Harvard Medical School, Boston, USA
| | | | | | | | | | - Eleri Adams
- Neonatal Medicine, John Radcliffe Hospital NHS Trust, London, UK
| | - Jon Dorling
- Neonatal Medicine, University Hospital Southampton NHS Trust, London, UK
| | | | - Paul Fleming
- Neonatal Medicine, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Ronit Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | - Andrew Shennan
- Department of Obstetrics, Kings College London, London, UK
| | - Stavros Petrou
- Professor of Health Economics, University of Oxford, Oxford, UK
| | - Aung Soe
- Oliver Fisher Neonatal Intensive Care Unit, Medway Maritime Hospital, Medway NHS Foundation Trust, Kent, UK
| | | | - Seetha Shankaran
- Department of Neonatal-Perinatal Medicine, Wayne State University, Detroit, MI, USA
- University of Texas at Austin, Dell Children's Hospital, Austin, USA
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, Du Cane Road, London, W12 0HS, England
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16
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Wróblewska-Seniuk K, Lenells M, Prescott MG, Fiander M, Soll R, Bruschettini M. Multisensory stimulation for promoting development and preventing morbidity in preterm infants. Cochrane Database Syst Rev 2024; 7:CD016073. [PMID: 38989978 PMCID: PMC11238622 DOI: 10.1002/14651858.cd016073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of multisensory stimulation compared to any single sensory intervention or standard care for physical and neurological development in preterm infants.
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Affiliation(s)
| | - Mikaela Lenells
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden
- FoUU, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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17
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Scher MS. Interdisciplinary fetal-neonatal neurology training improves brain health across the lifespan. Front Neurol 2024; 15:1411987. [PMID: 39026582 PMCID: PMC11254674 DOI: 10.3389/fneur.2024.1411987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year program. Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene-environment interactions. Maternal-placental-fetal triad, neonatal, or childhood diseases require diagnostic and therapeutic decisions during the first 1,000 days when 80 % of neural connections contribute to life-course phenotypic expression. Pediatric follow-up through 3 years adjusts to gestational ages of preterm survivors. Cumulative reproductive, pregnancy, pediatric and adult exposome effects require educational experiences that emphasize a principle-to-practice approach to a brain capital strategy across the lifespan. More rigorous training during fetal, neonatal, and pediatric rotations will be offered to full time trainees. Adult neurology residents, medical students, and trainees from diverse disciplines will learn essential topics during time-limited rotations. Curriculum content will require periodic re-assessments using educational science standards that maintain competence while promoting creative and collaborative problem-solving. Continued career-long learning by FNN graduates will strengthen shared healthcare decisions by all stakeholders. Recognition of adaptive or maladaptive neuroplasticity mechanisms requires analytic skills that identify phenotypes associated with disease pathways. Developmental origins and life-course concepts emphasize brain health across the developmental-aging continuum, applicable to interdisciplinary research collaborations. Social determinants of health recognize diversity, equity, and inclusion priorities with each neurological intervention, particularly for those challenged with disparities. Diagnostic and therapeutic strategies must address resource challenges particularly throughout the Global South to effectively lower the worldwide burden of neurologic disease. Sustainable development goals proposed by the World Health Organization offer universally applicable guidelines in response to ongoing global and regional polycrises. Gender, race, ethnicity, and socio-economic equality promote effective preventive, rescue and reparative neuroprotective interventions. Global synergistic efforts can be enhanced by establishing leadership within academic teaching hubs in FNN training to assist with structure and guidance for smaller healthcare facilities in each community that will improve practice, education and research objectives. Reduced mortality with an improved quality of life must prioritize maternal-pediatric health and well-being to sustain brain health across each lifespan with transgenerational benefits.
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Affiliation(s)
- Mark S. Scher
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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18
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Güneş AO, Bozkaya A, Avlanmis ME. Factors Associated with Post-rewarming Procalcitonin Levels in Newborns with Hypoxic Ischemic Encephalopathy. Turk Arch Pediatr 2024; 59:404-409. [PMID: 39141411 PMCID: PMC11332431 DOI: 10.5152/turkarchpediatr.2024.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024]
Abstract
To determine the factors associated with the procalcitonin levels in newborns with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia (TH). The neonates, who had moderate/severe HIE and were treated with TH, were included. The neonates were arranged into 2 groups by procalcitonin (PCT) level after rewarming was completed. The neonates who had a procalcitonin level of < 2.5 ng/ml constituted Group 1 and the ones who had a procalcitonin level of ≥ 2.5 ng/ml constituted Group 2. Univariate and multivariate logistic regression was used to assess the factors related with PCT level. The first group included 123 (87.9%) neonates and the second group included 17 (12.1%) neonates. The median gestational age was 38 (36-39) weeks and the mean birth weight was 3081.7 ± 552.8 grams. In group 2, the rates for severe HIE, cesarean section, antibiotic switch, convulsion, inotrope use and mortality were higher, and duration of hospitalization was longer, whereas Apgar scores were lower (P < .05). The risk of a high procalcitonin level was found to be 6-fold (95% CI 1.9-19.1) higher in severe HIE and 5.2-fold higher (95% CI 1.7-16) in cesarean delivery. In neonates with HIE/TH, high post-rewarming procalcitonin levels were related with severe HIE and cesarean delivery. Some other clinical and laboratory findings, which may reflect worse clinical status, were also associated with high procalcitonin levels.
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Affiliation(s)
- Aslı Okbay Güneş
- Neonatal Intensive Care Unit, Şanlıurfa Training and Research Hospital, Şanlıurfa, Türkiye
| | - Aydın Bozkaya
- Neonatal Intensive Care Unit, Şanlıurfa Training and Research Hospital, Şanlıurfa, Türkiye
| | - Mehmet Emin Avlanmis
- Neonatal Intensive Care Unit, Şanlıurfa Training and Research Hospital, Şanlıurfa, Türkiye
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Branagan A, Hurley T, Quirke F, Devane D, Taneri PE, Badawi N, Sinha B, Bearer C, Bloomfield FH, Bonifacio SL, Boylan G, Campbell SK, Chalak L, D'Alton M, deVries LS, El Dib M, Ferriero DM, Gale C, Gressens P, Gunn AJ, Kay S, Maeso B, Mulkey SB, Murray DM, Nelson KB, Nesterenko TH, Pilon B, Robertson NJ, Walker K, Wusthoff CJ, Molloy EJ. Consensus definition and diagnostic criteria for neonatal encephalopathy-study protocol for a real-time modified delphi study. Pediatr Res 2024:10.1038/s41390-024-03303-3. [PMID: 38902453 DOI: 10.1038/s41390-024-03303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 05/06/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND 'Neonatal encephalopathy' (NE) describes a group of conditions in term infants presenting in the earliest days after birth with disturbed neurological function of cerebral origin. NE is aetiologically heterogenous; one cause is peripartum hypoxic ischaemia. Lack of uniformity in the terminology used to describe NE and its diagnostic criteria creates difficulty in the design and interpretation of research and complicates communication with families. The DEFINE study aims to use a modified Delphi approach to form a consensus definition for NE, and diagnostic criteria. METHODS Directed by an international steering group, we will conduct a systematic review of the literature to assess the terminology used in trials of NE, and with their guidance perform an online Real-time Delphi survey to develop a consensus diagnosis and criteria for NE. A consensus meeting will be held to agree on the final terminology and criteria, and the outcome disseminated widely. DISCUSSION A clear and consistent consensus-based definition of NE and criteria for its diagnosis, achieved by use of a modified Delphi technique, will enable more comparability of research results and improved communication among professionals and with families. IMPACT The terms Neonatal Encephalopathy and Hypoxic Ischaemic Encephalopathy tend to be used interchangeably in the literature to describe a term newborn with signs of encephalopathy at birth. This creates difficulty in communication with families and carers, and between medical professionals and researchers, as well as creating difficulty with performance of research. The DEFINE project will use a Real-time Delphi approach to create a consensus definition for the term 'Neonatal Encephalopathy'. A definition formed by this consensus approach will be accepted and utilised by the neonatal community to improve research, outcomes, and parental experience.
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Affiliation(s)
- Aoife Branagan
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
- Neonatology, The Coombe Hospital, Dublin, Ireland
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
| | - Tim Hurley
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
| | - Fiona Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Health Research Board-Trials Methodology, Research Network (HRB-TMRN), University of Galway, Galway, Ireland
| | - Declan Devane
- Health Research Board-Trials Methodology, Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
| | - Petek E Taneri
- Health Research Board-Trials Methodology, Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Westmead, NSW, Australia
| | - Bharati Sinha
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Cynthia Bearer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Sonia L Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Geraldine Boylan
- INFANT Research Centre, Cork, Ireland
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland
| | - Suzann K Campbell
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Lina Chalak
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Linda S deVries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mohamed El Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Donna M Ferriero
- Departments of Neurology and Pediatrics, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK
| | - Pierre Gressens
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France
| | - Alistair J Gunn
- Departments of Physiology and Paediatrics, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | - Beccy Maeso
- James Lind Alliance, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA
- Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deirdre M Murray
- INFANT Research Centre, Cork, Ireland
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland
| | - Karin B Nelson
- National Institutes of Health, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | - Tetyana H Nesterenko
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Local Health District, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland.
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.
- Neonatology, The Coombe Hospital, Dublin, Ireland.
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland.
- Neonatology, Children's Health Ireland, Dublin, Ireland.
- Neurodisability, Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.
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20
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Seber T, Uylar Seber T, Özdemir A, Baştuğ O, Keskin Ş, Aktaş E. Volumetric apparent diffusion coefficient histogram analysis in term neonatal asphyxia treated with hypothermia. Br J Radiol 2024; 97:1302-1310. [PMID: 38775658 PMCID: PMC11186576 DOI: 10.1093/bjr/tqae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/07/2023] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). METHODS Brain MRI studies of 83 term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) fourth and sixth days were retrospectively re-evaluated by 2 radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major, and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. RESULTS With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (P = .02 and P = .03, respectively) and ADCmin (P = .03 and P = .04, respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (P = .04) and normal development (P = .04) via cytotoxic oedema of the thalamus, corpus striatum, and diffuse cerebral cortical. CONCLUSION The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimated similarly with volumetric ADC-HA and the conventional assessment of the ADC map. ADVANCES IN KNOWLEDGE This study compares early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We could not find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA.
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Affiliation(s)
- Turgut Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Tuğba Uylar Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Ahmet Özdemir
- Department of Neonatology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Osman Baştuğ
- Department of Neonatology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Şuayip Keskin
- Department of Child Health and Diseases, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Elif Aktaş
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
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21
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Roto S, Nupponen I, Kalliala I, Kaijomaa M. Risk factors for neonatal hypoxic ischemic encephalopathy and therapeutic hypothermia: a matched case-control study. BMC Pregnancy Childbirth 2024; 24:421. [PMID: 38867160 PMCID: PMC11167761 DOI: 10.1186/s12884-024-06596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia. METHODS We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated. RESULTS Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia. CONCLUSIONS Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.
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Affiliation(s)
- Suoma Roto
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland
| | - Irmeli Nupponen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kalliala
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland
| | - Marja Kaijomaa
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland.
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22
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Wu L, Chang E, Zhao H, Ma D. Regulated cell death in hypoxic-ischaemic encephalopathy: recent development and mechanistic overview. Cell Death Discov 2024; 10:277. [PMID: 38862503 PMCID: PMC11167026 DOI: 10.1038/s41420-024-02014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Hypoxic-ischaemic encephalopathy (HIE) in termed infants remains a significant cause of morbidity and mortality worldwide despite the introduction of therapeutic hypothermia. Depending on the cell type, cellular context, metabolic predisposition and insult severity, cell death in the injured immature brain can be highly heterogenous. A continuum of cell death exists in the H/I-injured immature brain. Aside from apoptosis, emerging evidence supports the pathological activation of necroptosis, pyroptosis and ferroptosis as alternative regulated cell death (RCD) in HIE to trigger neuroinflammation and metabolic disturbances in addition to cell loss. Upregulation of autophagy and mitophagy in HIE represents an intrinsic neuroprotective strategy. Molecular crosstalk between RCD pathways implies one RCD mechanism may compensate for the loss of function of another. Moreover, mitochondrion was identified as the signalling "hub" where different RCD pathways converge. The highly-orchestrated nature of RCD makes them promising therapeutic targets. Better understanding of RCD mechanisms and crosstalk between RCD subtypes likely shed light on novel therapy development for HIE. The identification of a potential RCD converging node may open up the opportunity for simultaneous and synergistic inhibition of cell death in the immature brain.
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Affiliation(s)
- Lingzhi Wu
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Enqiang Chang
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Hailin Zhao
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK.
- Perioperative and Systems Medicine Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
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23
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Dresbach T, Rigoni V, Groteklaes A, Hoehn T, Stein A, Felderhoff-Mueser U, Mueller A, Sabir H. The Impact of Time to Initiate Therapeutic Hypothermia on Short-Term Neurological Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy. CHILDREN (BASEL, SWITZERLAND) 2024; 11:686. [PMID: 38929265 PMCID: PMC11201975 DOI: 10.3390/children11060686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Therapeutic hypothermia is the standard treatment for neonates with hypoxic-ischemic encephalopathy. Preclinical evidence indicates that the time to initiate therapeutic hypothermia correlates with its therapeutic success. This study aims to explore whether there is a correlation between the early initiation of therapeutic hypothermia and improved short-term neurological outcomes in cooled asphyxiated newborns. METHODS A retrospective analysis was conducted, involving 68 neonates from two different neonatal intensive care units. The impact of time to initiate treatment, time to reach the target temperature, and time between initiation and target temperature was correlated with short-term outcomes on MRI. RESULTS We did not find a significant difference between outcomes regarding the time to start treatment and the time to achieve the target temperature. Interestingly, neonates with a poor outcome were treated on average earlier than neonates with a favorable outcome but required more time to reach the target temperature. Additionally, the study results did not support the hypothesis that a shorter time to initiate treatment would lead to shorter times to achieve the target temperature. CONCLUSION Based on our findings, it is recommended to prioritize a thorough evaluation of neonatal encephalopathy before initiating therapeutic hypothermia. Early initiation of treatment should be balanced with the time required for precise assessment to ensure better outcomes.
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Affiliation(s)
- Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hopsital Bonn, 53127 Bonn, Germany; (T.D.); (V.R.); (A.G.); (A.M.)
| | - Viktoria Rigoni
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hopsital Bonn, 53127 Bonn, Germany; (T.D.); (V.R.); (A.G.); (A.M.)
| | - Anne Groteklaes
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hopsital Bonn, 53127 Bonn, Germany; (T.D.); (V.R.); (A.G.); (A.M.)
| | - Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children’s Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany;
| | - Anja Stein
- Department of Pediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (A.S.); (U.F.-M.)
- Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (A.S.); (U.F.-M.)
- Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hopsital Bonn, 53127 Bonn, Germany; (T.D.); (V.R.); (A.G.); (A.M.)
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hopsital Bonn, 53127 Bonn, Germany; (T.D.); (V.R.); (A.G.); (A.M.)
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24
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Schmidbauer VU, Yildirim MS, Dovjak GO, Goeral K, Buchmayer J, Weber M, Kienast P, Diogo MC, Prayer F, Stuempflen M, Kittinger J, Malik J, Nowak NM, Klebermass-Schrehof K, Fuiko R, Berger A, Prayer D, Kasprian G, Giordano V. Quantitative Magnetic Resonance Imaging for Neurodevelopmental Outcome Prediction in Neonates Born Extremely Premature-An Exploratory Study. Clin Neuroradiol 2024; 34:421-429. [PMID: 38289377 PMCID: PMC11129968 DOI: 10.1007/s00062-023-01378-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/26/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE Neonates born at < 28 weeks of gestation are at risk for neurodevelopmental delay. The aim of this study was to identify quantitative MR-based metrics for the prediction of neurodevelopmental outcomes in extremely preterm neonates. METHODS T1-/T2-relaxation times (T1R/T2R), ADC, and fractional anisotropy (FA) of the left/right posterior limb of the internal capsule (PLIC) and the brainstem were determined at term-equivalent ages in a sample of extremely preterm infants (n = 33). Scores for cognitive, language, and motor outcomes were collected at one year corrected-age. Pearson's correlation analyses detected relationships between quantitative measures and outcome data. Stepwise regression procedures identified imaging metrics to estimate neurodevelopmental outcomes. RESULTS Cognitive outcomes correlated significantly with T2R (r = 0.412; p = 0.017) and ADC (r = -0.401; p = 0.021) (medulla oblongata). Furthermore, there were significant correlations between motor outcomes and T1R (pontine tegmentum (r = 0.346; p = 0.049), midbrain (r = 0.415; p = 0.016), right PLIC (r = 0.513; p = 0.002), and left PLIC (r = 0.504; p = 0.003)); T2R (right PLIC (r = 0.405; p = 0.019)); ADC (medulla oblongata (r = -0.408; p = 0.018) and pontine tegmentum (r = -0.414; p = 0.017)); and FA (pontine tegmentum (r = -0.352; p = 0.045)). T2R/ADC (medulla oblongata) (cognitive outcomes (R2 = 0.296; p = 0.037)) and T1R (right PLIC)/ADC (medulla oblongata) (motor outcomes (R2 = 0.405; p = 0.009)) revealed predictive potential for neurodevelopmental outcomes. CONCLUSION There are relationships between relaxometry‑/DTI-based metrics determined by neuroimaging near term and neurodevelopmental outcomes collected at one year of age. Both modalities bear prognostic potential for the prediction of cognitive and motor outcomes. Thus, quantitative MRI at term-equivalent ages represents a promising approach with which to estimate neurologic development in extremely preterm infants.
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Affiliation(s)
- Victor U Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Mehmet S Yildirim
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Goeral
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Patric Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mariana C Diogo
- Department of Neuroradiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Stuempflen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Kittinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Malik
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nikolaus M Nowak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Renate Fuiko
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Angelika Berger
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Vito Giordano
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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25
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Foster J, Pathrose SP, Briguglio L, Trajkovski S, Lowe P, Muirhead R, Jyoti J, Ng L, Blay N, Spence K, Chetty N, Broom M. Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery. J Clin Nurs 2024; 33:2123-2137. [PMID: 38339771 DOI: 10.1111/jocn.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
AIM(S) To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery. DESIGN This scoping review was conducted according to the JBI scoping review framework. METHODS Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria. DATA SOURCES Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023. RESULTS A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%). CONCLUSIONS This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement in this scoping review.
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Affiliation(s)
- Jann Foster
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Nursing and Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- Ingham Research Institute, Liverpool, New South Wales, Australia
- NSW Centre for Evidence Based Health Care: A JBI Affiliated Group, Penrith, New South Wales, Australia
| | - Sheeja Perumbil Pathrose
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- NSW Centre for Evidence Based Health Care: A JBI Affiliated Group, Penrith, New South Wales, Australia
| | - Laura Briguglio
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
| | - Suza Trajkovski
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Patricia Lowe
- Australian College of Nursing, Sydney, New South Wales, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Renee Muirhead
- Neonatal Critical Care Unit, Mater Mothers' Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, Queensland, Australia
| | - Jeewan Jyoti
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Linda Ng
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Nicole Blay
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Kaye Spence
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- Australasian NIDCAP Training Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natasha Chetty
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Broom
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Nursing and Midwifery, University of Canberra, Canberra, Australian Capital Territory, Australia
- Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
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Zhang Y, Jiang M, Baoying S, Gao Y, Xu Y, Qi Z, Wu D, Li M, Ji X. Trends and hotspots of the neuroprotection of hypothermia treatment: A bibliometric and visualized analysis of research from 1992 to 2023. CNS Neurosci Ther 2024; 30:e14795. [PMID: 38867401 PMCID: PMC11168963 DOI: 10.1111/cns.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
AIM Recent studies have extensively investigated hypothermia as a therapeutic approach for mitigating neural damage. Despite this, bibliometric analyses specifically focusing on this area remain scarce. Consequently, this study aims to comprehensively outline the historical framework of research and to pinpoint future research directions and trends. METHODS Articles spanning from 2003 to 2023, relevant to both "neuroprotection" and "hypothermia", were sourced from the Web of Science Core Collection. The CiteSpace software facilitated a comprehensive evaluation and analysis of these publications. This analysis included examining the annual productivity, collaboration among nations, institutions, and authors, as well as the network of co-cited references, authors and journals, and the co-occurrence of keywords, and their respective clusters and trends, all of which were visualized. RESULTS This study included 2103 articles on the neuroprotection effects of hypothermia, noting a consistent increase in publications since 1992. The United States, the University of California System, and Ji Xunming emerged as the most productive nation, institution, and author, respectively. Analysis of the top 10 co-cited publications revealed that seven articles focused on the effects of hypothermia in infants with hypoxic-ischemic encephalopathy, while three studies addressed cardiac arrest. Shankaran S and the journal Stroke were the most frequently co-cited author and journal, respectively. Keyword cluster analysis identified ischemic stroke as the primary focus of hypothermia therapy historically, with cardiac arrest and neonatal hypoxic-ischemic encephalopathy emerging as current research foci. CONCLUSIONS Recent studies on the neuroprotective effects of hypothermia in cardiac arrest and neonatal hypoxic-ischemic encephalopathy suggest that hypothermia may mitigate neural damage associated with these conditions. However, the application of hypothermia in the treatment of ischemic stroke remains confined to animal models and in vitro studies, with a notable absence of evidence from multicenter randomized controlled trials (RCTs). Further research is required to address this gap.
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Affiliation(s)
- Yang Zhang
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Miaowen Jiang
- Beijing Institute for Brain Disorders, Capital Medical UniversityBeijingChina
| | - Song Baoying
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yuan Gao
- School of Instrumentation and Optoelectronic Engineering, Beihang UniversityBeijingChina
| | - Yi Xu
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Zhengfei Qi
- Beijing Institute for Brain Disorders, Capital Medical UniversityBeijingChina
| | - Di Wu
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Ming Li
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xunming Ji
- China‐America Institute of Neurology, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute for Brain Disorders, Capital Medical UniversityBeijingChina
- Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijingChina
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27
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Herrmann JR, Fink EL, Fabio A, Berger RP, Janesko-Feldman K, Gorse K, Clark RSB, Kochanek PM, Jackson TC. Characterization of Circulating Cold Shock Proteins FGF21 and RBM3 in a Multi-Center Study of Pediatric Cardiac Arrest. Ther Hypothermia Temp Manag 2024; 14:99-109. [PMID: 37669029 DOI: 10.1089/ther.2023.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Fibroblast Growth Factor 21 (FGF21) is a neuroprotective hormone induced by cold exposure that targets the β-klotho co-receptor. β-klotho is abundant in the newborn brain but decreases rapidly with age. RNA-Binding Motif 3 (RBM3) is a potent neuroprotectant upregulated by FGF21 in hypothermic conditions. We characterized serum FGF21 and RBM3 levels in patients enrolled in a prospective multi-center study of pediatric cardiac arrest (CA) via a secondary analysis of samples collected to evaluate brain injury biomarkers. Patients (n = 111) with remnant serum samples available from at least two of three available timepoints (0-24, 24-48 or 48-72 hours post-resuscitation) were included. Serum samples from 20 healthy controls were used for comparison. FGF21 was measured by Luminex and internally validated enzyme-linked immunoassay (ELISA). RBM3 was measured by internally validated ELISA. Of postarrest patients, 98 were managed with normothermia, while 13 were treated with therapeutic hypothermia (TH). FGF21 increased >20-fold in the first 24 hours postarrest versus controls (681 pg/mL [200-1864] vs. 29 pg/mL [15-51], n = 99 vs. 19, respectively, p < 0.0001, median [interquartile range]) with no difference in RBM3. FGF21 did not differ by sex, while RBM3 was increased in females versus males at 48-72 hours postarrest (1866 pg/mL [873-5176] vs. 1045 pg/mL [535-2728], n = 40 vs. 54, respectively, p < 0.05). Patients requiring extracorporeal membrane oxygenation (ECMO) postresuscitation had increased FGF21 versus those who did not at 48-72 hours (6550 pg/mL [1455-66,781] vs. 1213 pg/mL [480-3117], n = 7 vs 74, respectively, p < 0.05). FGF21 and RBM3 did not correlate (Spearman's rho = 0.004, p = 0.97). We conclude that in a multi-center study of pediatric CA patients where normothermic targeted temperature management was largely used, FGF21 was markedly increased postarrest versus control and highest in patients requiring ECMO postresuscitation. RBM3 was sex-dependent. We provide a framework for future studies examining the effect of TH on FGF21 or use of FGF21 therapy after pediatric CA.
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Affiliation(s)
- Jeremy R Herrmann
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ericka L Fink
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony Fabio
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel P Berger
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keri Janesko-Feldman
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kiersten Gorse
- Department of Molecular Pharmacology & Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Robert S B Clark
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Travis C Jackson
- Department of Molecular Pharmacology & Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Sibrecht G, Wróblewska-Seniuk K, Bruschettini M. Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev 2024; 5:CD010333. [PMID: 38813836 PMCID: PMC11137833 DOI: 10.1002/14651858.cd010333.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are subjected to different types of stress, including sounds of high intensity. The sound levels in NICUs often exceed the maximum acceptable level recommended by the American Academy of Pediatrics, which is 45 decibels (dB). Hearing impairment is diagnosed in 2% to 10% of preterm infants compared to only 0.1% of the general paediatric population. Bringing sound levels under 45 dB can be achieved by lowering the sound levels in an entire unit; by treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled; or by reducing sound levels at the individual level using earmuffs or earplugs. By lowering sound levels, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. This review is an update of one originally published in 2015 and first updated in 2020. OBJECTIVES To determine the benefits and harms of sound reduction on the growth and long-term neurodevelopmental outcomes of neonates. SEARCH METHODS We used standard, extensive Cochrane search methods. On 21 and 22 August 2023, a Cochrane Information Specialist searched CENTRAL, PubMed, Embase, two other databases, two trials registers, and grey literature via Google Scholar and conference abstracts from Pediatric Academic Societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (less than 32 weeks' postmenstrual age (PMA) or less than 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or stepdown unit. We specified three types of intervention: 1) intervention at the unit level (i.e. the entire neonatal department), 2) at the section or room level, or 3) at the individual level (e.g. hearing protection). DATA COLLECTION AND ANALYSIS We used the standardised review methods of Cochrane Neonatal to assess the risk of bias in the studies. We used the risk ratio (RR) and risk difference (RD), with their 95% confidence intervals (CIs), for dichotomous data. We used the mean difference (MD) for continuous data. Our primary outcome was major neurodevelopmental disability. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included one RCT, which enroled 34 newborn infants randomised to the use of silicone earplugs versus no earplugs for hearing protection. It was a single-centre study conducted at the University of Texas Medical School in Houston, Texas, USA. Earplugs were positioned at the time of randomisation and worn continuously until the infants were 35 weeks' postmenstrual age (PMA) or discharged (whichever came first). Newborns in the control group received standard care. The evidence is very uncertain about the effects of silicone earplugs on the following outcomes. • Cerebral palsy (RR 3.00, 95% CI 0.15 to 61.74)and Mental Developmental Index (MDI) (Bayley II) at 18 to 22 months' corrected age (MD 14.00, 95% CI 3.13 to 24.87); no other indicators of major neurodevelopmental disability were reported. • Normal auditory functioning at discharge (RR 1.65, 95% CI 0.93 to 2.94) • All-cause mortality during hospital stay (RR 2.07, 95% CI 0.64 to 6.70; RD 0.20, 95% CI -0.09 to 0.50) • Weight (kg) at 18 to 22 months' corrected age (MD 0.31, 95% CI -1.53 to 2.16) • Height (cm) at 18 to 22 months' corrected age (MD 2.70, 95% CI -3.13 to 8.53) • Days of assisted ventilation (MD -1.44, 95% CI -23.29 to 20.41) • Days of initial hospitalisation (MD 1.36, 95% CI -31.03 to 33.75) For all outcomes, we judged the certainty of evidence as very low. We identified one ongoing RCT that will compare the effects of reduced noise levels and cycled light on visual and neural development in preterm infants. AUTHORS' CONCLUSIONS No studies evaluated interventions to reduce sound levels below 45 dB across the whole neonatal unit or in a room within it. We found only one study that evaluated the benefits of sound reduction in the neonatal intensive care unit for hearing protection in preterm infants. The study compared the use of silicone earplugs versus no earplugs in newborns of very low birth weight (less than 1500 g). Considering the very small sample size, imprecise results, and high risk of attrition bias, the evidence based on this research is very uncertain and no conclusions can be drawn. As there is a lack of evidence to inform healthcare or policy decisions, large, well designed, well conducted, and fully reported RCTs that analyse different aspects of noise reduction in NICUs are needed. They should report both short- and long-term outcomes.
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Affiliation(s)
- Greta Sibrecht
- II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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29
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Pawale D, Fursule A, Tan J, Wagh D, Patole S, Rao S. Prevalence of hearing impairment in neonatal encephalopathy due to hypoxia-ischemia: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03261-w. [PMID: 38769399 DOI: 10.1038/s41390-024-03261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND This systematic review was undertaken to estimate the overall prevalence of hearing impairment in survivors of neonatal HIE. METHODS PubMed, EMBASE, CINAHL, EMCARE and Cochrane databases, mednar (gray literature) were searched till January 2023. Randomized controlled trials and observational studies were included. The main outcome was estimation of overall prevalence of hearing impairment in survivors of HIE. RESULTS A total of 71studies (5821 infants assessed for hearing impairment) were included of which 56 were from high income countries (HIC) and 15 from low- or middle-income countries (LMIC). Overall prevalence rate of hearing impairment in cooled infants was 5% (95% CI: 3-6%, n = 4868) and 3% (95% CI: 1-6%, n = 953) in non-cooled HIE infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). CONCLUSIONS These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE. There is a need for more data from LMICs and standardization of reporting hearing impairment. IMPACT The overall prevalence rate of hearing impairment in cooled infants with HIE was 5% (95% CI: 3-6%) and 3% (95% CI: 1-6%) in the non-cooled infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE.
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Affiliation(s)
- Dinesh Pawale
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Anurag Fursule
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Jason Tan
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Deepika Wagh
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Sanjay Patole
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Neonatology, King Edwards Memorial Hospital, Perth, WA, Australia
| | - Shripada Rao
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia.
- School of Medicine, University of Western Australia, Crawley, WA, Australia.
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Yang Y, Li Y, Yang W, Yang X, Luo M, Qin L, Zhu J. Protecting effects of 4-octyl itaconate on neonatal hypoxic-ischemic encephalopathy via Nrf2 pathway in astrocytes. J Neuroinflammation 2024; 21:132. [PMID: 38760862 PMCID: PMC11102208 DOI: 10.1186/s12974-024-03121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common neurological problems occurring in the perinatal period. However, there still is not a promising approach to reduce long-term neurodevelopmental outcomes of HIE. Recently, itaconate has been found to exhibit anti-oxidative and anti-inflammatory effects. However, the therapeutic efficacy of itaconate in HIE remains inconclusive. Therefore, this study attempts to explore the pathophysiological mechanisms of oxidative stress and inflammatory responses in HIE as well as the potential therapeutic role of a derivative of itaconate, 4-octyl itaconate (4OI). METHODS We used 7-day-old mice to induce hypoxic-ischemic (HI) model by right common carotid artery ligation followed by 1 h of hypoxia. Behavioral experiments including the Y-maze and novel object recognition test were performed on HI mice at P60 to evaluate long-term neurodevelopmental outcomes. We employed an approach combining non-targeted metabolomics with transcriptomics to screen alterations in metabolic profiles and gene expression in the hippocampal tissue of the mice at 8 h after hypoxia. Immunofluorescence staining and RT-PCR were used to evaluate the pathological changes in brain tissue cells and the expression of mRNA and proteins. 4OI was intraperitoneally injected into HI model mice to assess its anti-inflammatory and antioxidant effects. BV2 and C8D1A cells were cultured in vitro to study the effect of 4OI on the expression and nuclear translocation of Nrf2. We also used Nrf2-siRNA to further validate 4OI-induced Nrf2 pathway in astrocytes. RESULTS We found that in the acute phase of HI, there was an accumulation of pyruvate and lactate in the hippocampal tissue, accompanied by oxidative stress and pro-inflammatory, as well as increased expression of antioxidative stress and anti-inflammatory genes. Treatment of 4OI could inhibit activation and proliferation of microglial cells and astrocytes, reduce neuronal death and relieve cognitive dysfunction in HI mice. Furthermore, 4OI enhanced nuclear factor erythroid-2-related factor (Nfe2l2; Nrf2) expression and nuclear translocation in astrocytes, reduced pro-inflammatory cytokine production, and increased antioxidant enzyme expression. CONCLUSION Our study demonstrates that 4OI has a potential therapeutic effect on neuronal damage and cognitive deficits in HIE, potentially through the modulation of inflammation and oxidative stress pathways by Nrf2 in astrocytes.
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Affiliation(s)
- Yanping Yang
- Department of Anesthesiology, The Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yang Li
- Department of Anesthesiology, The Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenyi Yang
- Department of Anesthesiology, The Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xueying Yang
- Department of Physiology, China Medical University, Shenyang, Liaoning, China
| | - Man Luo
- Department of Anesthesiology, Shenzhen Cancer Hospital, Shenzhen, China
| | - Ling Qin
- Department of Physiology, China Medical University, Shenyang, Liaoning, China.
| | - Junchao Zhu
- Department of Anesthesiology, The Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Han Y, Han Z, Huang X, Li S, Jin G, Feng J, Wu D, Liu H. An injectable refrigerated hydrogel for inducing local hypothermia and neuroprotection against traumatic brain injury in mice. J Nanobiotechnology 2024; 22:251. [PMID: 38750597 PMCID: PMC11095020 DOI: 10.1186/s12951-024-02454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Hypothermia is a promising therapy for traumatic brain injury (TBI) in the clinic. However, the neuroprotective outcomes of hypothermia-treated TBI patients in clinical studies are inconsistent due to several severe side effects. Here, an injectable refrigerated hydrogel was designed to deliver 3-iodothyronamine (T1AM) to achieve a longer period of local hypothermia for TBI treatment. Hydrogel has four advantages: (1) It can be injected into injured sites after TBI, where it forms a hydrogel and avoids the side effects of whole-body cooling. (2) Hydrogels can biodegrade and be used for controlled drug release. (3) Released T1AM can induce hypothermia. (4) This hydrogel has increased medical value given its simple operation and ability to achieve timely treatment. METHODS Pol/T hydrogels were prepared by a low-temperature mixing method and characterized. The effect of the Pol/T hydrogel on traumatic brain injury in mice was studied. The degradation of the hydrogel at the body level was observed with a small animal imager. Brain temperature and body temperature were measured by brain thermometer and body thermometer, respectively. The apoptosis of peripheral nerve cells was detected by immunohistochemical staining. The protective effect of the hydrogels on the blood-brain barrier (BBB) after TBI was evaluated by the Evans blue penetration test. The protective effect of hydrogel on brain edema after injury in mice was detected by Magnetic resonance (MR) in small animals. The enzyme linked immunosorbent assay (ELISA) method was used to measure the levels of inflammatory factors. The effects of behavioral tests on the learning ability and exercise ability of mice after injury were evaluated. RESULTS This hydrogel was able to cool the brain to hypothermia for 12 h while maintaining body temperature within the normal range after TBI in mice. More importantly, hypothermia induced by this hydrogel leads to the maintenance of BBB integrity, the prevention of cell death, the reduction of the inflammatory response and brain edema, and the promotion of functional recovery after TBI in mice. This cooling method could be developed as a new approach for hypothermia treatment in TBI patients. CONCLUSION Our study showed that injectable and biodegradable frozen Pol/T hydrogels to induce local hypothermia in TBI mice can be used for the treatment of traumatic brain injury.
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Affiliation(s)
- Yuhan Han
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Head Trauma, Shanghai, 200127, China
| | - Zhengzhong Han
- Department of Neurosurgery, Xuzhou Children's Hospital, Xuzhou, 221000, Jiangsu, China
| | - Xuyang Huang
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
- Department of Intensive Care Medicine, The Second Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China
| | - Shanshan Li
- Department of Forensic Medicine, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Guoliang Jin
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Junfeng Feng
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Head Trauma, Shanghai, 200127, China.
| | - Decheng Wu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China.
| | - Hongmei Liu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China.
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Tuiskula A, Pospelov AS, Nevalainen P, Montazeri S, Metsäranta M, Haataja L, Stevenson N, Tokariev A, Vanhatalo S. Quantitative EEG features during the first day correlate to clinical outcome in perinatal asphyxia. Pediatr Res 2024:10.1038/s41390-024-03235-y. [PMID: 38745028 DOI: 10.1038/s41390-024-03235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To assess whether computational electroencephalogram (EEG) measures during the first day of life correlate to clinical outcomes in infants with perinatal asphyxia with or without hypoxic-ischemic encephalopathy (HIE). METHODS We analyzed four-channel EEG monitoring data from 91 newborn infants after perinatal asphyxia. Altogether 42 automatically computed amplitude- and synchrony-related EEG features were extracted as 2-hourly average at very early (6 h) and early (24 h) postnatal age; they were correlated to the severity of HIE in all infants, and to four clinical outcomes available in a subcohort of 40 newborns: time to full oral feeding (nasogastric tube NGT), neonatal brain MRI, Hammersmith Infant Neurological Examination (HINE) at three months, and Griffiths Scales at two years. RESULTS At 6 h, altogether 14 (33%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.61, p < 0.05), and one feature correlated to NGT ([r]= 0.50). At 24 h, altogether 13 (31%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.56), six features correlated to NGT ([r]= 0.36-0.49) and HINE ([r]= 0.39-0.61), while no features correlated to MRI or Griffiths Scales. CONCLUSIONS Our results show that the automatically computed measures of early cortical activity may provide outcome biomarkers for clinical and research purposes. IMPACT The early EEG background and its recovery after perinatal asphyxia reflect initial severity of encephalopathy and its clinical recovery, respectively. Computational EEG features from the early hours of life show robust correlations to HIE grades and to early clinical outcomes. Computational EEG features may have potential to be used as cortical activity biomarkers in early hours after perinatal asphyxia.
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Affiliation(s)
- Anna Tuiskula
- Department of Pediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Alexey S Pospelov
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Päivi Nevalainen
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neurophysiology, Children's Hospital, HUS Diagnostic Center, and Epilepsia Helsinki, full member of ERN EpiCare University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saeed Montazeri
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Marjo Metsäranta
- Department of Pediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Haataja
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nathan Stevenson
- Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Anton Tokariev
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- BABA Center, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
- Department of Clinical Neurophysiology, Children's Hospital, HUS Diagnostic Center, and Epilepsia Helsinki, full member of ERN EpiCare University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lv H, Wang Q, Liu F, Jin L, Ren P, Li L. A biochemical feedback signal for hypothermia treatment for neonatal hypoxic-ischemic encephalopathy: focusing on central nervous system proteins in biofluids. Front Pediatr 2024; 12:1288853. [PMID: 38766393 PMCID: PMC11100326 DOI: 10.3389/fped.2024.1288853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Hypothermia has been widely used to treat moderate to severe neonatal hypoxic-ischemic encephalopathy (HIE), yet evaluating the effects of hypothermia relies on clinical neurology, neuroimaging, amplitude-integrated electroencephalography, and follow-up data on patient outcomes. Biomarkers of brain injury have been considered for estimating the effects of hypothermia. Proteins specific to the central nervous system (CNS) are components of nervous tissue, and once the CNS is damaged, these proteins are released into biofluids (cerebrospinal fluid, blood, urine, tears, saliva), and they can be used as markers of brain damage. Clinical reports have shown that CNS-specific marker proteins (CNSPs) were early expressed in biofluids after brain damage and formed unique biochemical profiles. As a result, these markers may serve as an indicator for screening brain injury in infants, monitoring disease progression, identifying damage region of brain, and assessing the efficacy of neuroprotective measures. In clinical work, we have found that there are few reports on using CNSPs as biological signals in hypothermia for neonatal HIE. The aim of this article is to review the classification, origin, biochemical composition, and physiological function of CNSPs with changes in their expression levels after hypothermia for neonatal HIE. Hopefully, this review will improve the awareness of CNSPs among pediatricians, and encourage future studies exploring the mechanisms behind the effects of hypothermia on these CNSPs, in order to reduce the adverse outcome of neonatal HIE.
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Affiliation(s)
- Hongyan Lv
- Department of Neonatology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
- Department of Neonatal Pathology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
| | - Qiuli Wang
- Department of Neonatology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
| | - Fang Liu
- Department of Pediatrics, The 980 Hospital of the PLA Joint Logistics Support Force, Shijiazhuang, China
| | - Linhong Jin
- Department of Neonatology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
| | - Pengshun Ren
- Department of Neonatology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
| | - Lianxiang Li
- Department of Neonatal Pathology, Handan Maternal and Child Health Care Hospital, Handan, Hebei, China
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Boos V, Bührer C. Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008-2022. Eur J Pediatr 2024; 183:2163-2172. [PMID: 38367065 PMCID: PMC11035475 DOI: 10.1007/s00431-024-05475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
Low Apgar scores and low umbilical arterial (UA) blood pH are considered indicators of adverse perinatal events. This study investigated trends of these perinatal health indicators in Germany. Perinatal data on 10,696,831 in-hospital live births from 2008 to 2022 were obtained from quality assurance institutes. Joinpoint regression analysis was used to quantify trends of low Apgar score and UA pH. Additional analyses stratified by mode of delivery were performed on term singletons with cephalic presentation. Robustness against unmeasured confounding was analyzed using the E-value sensitivity analysis. The overall rates of 5-min Apgar scores < 7 and UA pH < 7.10 in liveborn infants were 1.17% and 1.98%, respectively. For low Apgar scores, joinpoint analysis revealed an increase from 2008 to 2011 (annual percent change (APC) 5.19; 95% CI 3.66-9.00) followed by a slower increase from 2011 to 2019 (APC 2.56; 95% CI 2.00-3.03) and a stabilization from 2019 onwards (APC - 0.64; 95% CI - 3.60 to 0.62). The rate of UA blood pH < 7.10 increased significantly between 2011 and 2017 (APC 5.90; 95% CI 5.15-7.42). For term singletons in cephalic presentation, the risk amplification of low Apgar scores was highest after instrumental delivery (risk ratio 1.623, 95% CI 1.509-1.745), whereas those born spontaneous had the highest increase in pH < 7.10 (risk ratio 1.648, 95% CI 1.615-1.682). Conclusion: Rates of low 5-min Apgar scores and UA pH in liveborn infants increased from 2008 to 2022 in Germany. What is Known: • Low Apgar scores at 5 min after birth and umbilical arterial blood pH are associated with adverse perinatal outcomes. • Prospective collection of Apgar scores and arterial blood pH data allows for nationwide quality assurance. What is New: • The rates of liveborn infants with 5-min Apgar scores < 7 rose from 0.97 to 1.30% and that of umbilical arterial blood pH < 7.10 from 1.55 to 2.30% between 2008-2010 and 2020-2022. • In spontaneously born term singletons in cephalic presentation, the rate of metabolic acidosis with pH < 7.10 and BE < -5 mmol/L in umbilical arterial blood roughly doubled between the periods 2008-2010 and 2020-2022.
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Affiliation(s)
- Vinzenz Boos
- Department of Neonatology, Newborn Research, University Hospital Zurich (USZ), University of Zurich (UZH), Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Tsuchiya T, Nakamura S, Sugiyama Y, Nakao Y, Mitsuie T, Inoue K, Inoue E, Htun Y, Arioka M, Ohta K, Morita H, Fuke N, Kondo S, Koyano K, Miki T, Ueno M, Kusaka T. Hydrogen gas can ameliorate seizure burden during therapeutic hypothermia in asphyxiated newborn piglets. Pediatr Res 2024; 95:1536-1542. [PMID: 38267709 DOI: 10.1038/s41390-024-03041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND We previously reported that hydrogen (H2) gas combined with therapeutic hypothermia (TH) improved short-term neurological outcomes in asphyxiated piglets. However, the effect on seizure burden was unclear. Using amplitude-integrated electroencephalography (aEEG), we compared TH + H2 with TH alone in piglets 24 h after hypoxic-ischemic (HI) insult. METHODS After a 40-min insult and resuscitation, 36 piglets ≤24 h old were divided into three groups: normothermia (NT, n = 14), TH alone (33.5 ± 0.5 °C, 24 h, n = 13), and TH + H2 (2.1-2.7% H2 gas, 24 h, n = 9). aEEG was recorded for 24 h post-insult and its background pattern, status epilepticus (SE; recurrent seizures lasting >5 min), and seizure occurrence (Sz; occurring at least once but not fitting the definition of SE) were evaluated. Background findings with a continuous low voltage and burst suppression were considered abnormal. RESULTS The percentage of piglets with an abnormal aEEG background (aEEG-BG), abnormal aEEG-BG+Sz and SE was lower with TH + H2 than with TH at 24 h after HI insult. The duration of SE was shorter with TH + H2 and significantly shorter than with NT. CONCLUSIONS H2 gas combined with TH ameliorated seizure burden 24 h after HI insult. IMPACT In this asphyxiated piglet model, there was a high percentage of animals with an abnormal amplitude-integrated electroencephalography background (aEEG-BG) after hypoxic-ischemic (HI) insult, which may correspond to moderate and severe hypoxic-ischemic encephalopathy (HIE). Therapeutic hypothermia (TH) was associated with a low percentage of piglets with EEG abnormalities up to 6 h after HI insult but this percentage increased greatly after 12 h, and TH was not effective in attenuating seizure development. H2 gas combined with TH was associated with a low percentage of piglets with an abnormal aEEG-BG and with a shorter duration of status epilepticus at 24 h after HI insult.
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Affiliation(s)
- Toui Tsuchiya
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Yuichiro Sugiyama
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Nakao
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tsutomu Mitsuie
- Medical Engineering Equipment Management Center, Kagawa University Hospital, Kagawa University, Kagawa, Japan
| | - Kota Inoue
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Eri Inoue
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yinmon Htun
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Makoto Arioka
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kenichi Ohta
- Department of Anatomy and Neurobiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hirosuke Morita
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Noriko Fuke
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Sonoko Kondo
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kosuke Koyano
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takanori Miki
- Department of Anatomy and Neurobiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masaki Ueno
- Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Spencer APC, Goodfellow M, Chakkarapani E, Brooks JCW. Resting-state functional connectivity in children cooled for neonatal encephalopathy. Brain Commun 2024; 6:fcae154. [PMID: 38741661 PMCID: PMC11089421 DOI: 10.1093/braincomms/fcae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/21/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
Therapeutic hypothermia improves outcomes following neonatal hypoxic-ischaemic encephalopathy, reducing cases of death and severe disability such as cerebral palsy compared with normothermia management. However, when cooled children reach early school-age, they have cognitive and motor impairments which are associated with underlying alterations to brain structure and white matter connectivity. It is unknown whether these differences in structural connectivity are associated with differences in functional connectivity between cooled children and healthy controls. Resting-state functional MRI has been used to characterize static and dynamic functional connectivity in children, both with typical development and those with neurodevelopmental disorders. Previous studies of resting-state brain networks in children with hypoxic-ischaemic encephalopathy have focussed on the neonatal period. In this study, we used resting-state fMRI to investigate static and dynamic functional connectivity in children aged 6-8 years who were cooled for neonatal hypoxic-ischaemic without cerebral palsy [n = 22, median age (interquartile range) 7.08 (6.85-7.52) years] and healthy controls matched for age, sex and socioeconomic status [n = 20, median age (interquartile range) 6.75 (6.48-7.25) years]. Using group independent component analysis, we identified 31 intrinsic functional connectivity networks consistent with those previously reported in children and adults. We found no case-control differences in the spatial maps of these intrinsic connectivity networks. We constructed subject-specific static functional connectivity networks by measuring pairwise Pearson correlations between component time courses and found no case-control differences in functional connectivity after false discovery rate correction. To study the time-varying organization of resting-state networks, we used sliding window correlations and deep clustering to investigate dynamic functional connectivity characteristics. We found k = 4 repetitively occurring functional connectivity states, which exhibited no case-control differences in dwell time, fractional occupancy or state functional connectivity matrices. In this small cohort, the spatiotemporal characteristics of resting-state brain networks in cooled children without severe disability were too subtle to be differentiated from healthy controls at early school-age, despite underlying differences in brain structure and white matter connectivity, possibly reflecting a level of recovery of healthy resting-state brain function. To our knowledge, this is the first study to investigate resting-state functional connectivity in children with hypoxic-ischaemic encephalopathy beyond the neonatal period and the first to investigate dynamic functional connectivity in any children with hypoxic-ischaemic encephalopathy.
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Affiliation(s)
- Arthur P C Spencer
- Clinical Research and Imaging Centre, University of Bristol, Bristol BS2 8DX, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK
- Department of Radiology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Marc Goodfellow
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK
- Department of Mathematics and Statistics, University of Exeter, Exeter EX4 4QF, UK
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK
- Neonatal Intensive Care Unit, St Michaels Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8EG, UK
| | - Jonathan C W Brooks
- Clinical Research and Imaging Centre, University of Bristol, Bristol BS2 8DX, UK
- University of East Anglia Wellcome Wolfson Brain Imaging Centre (UWWBIC), University of East Anglia, Norwich NR4 7TJ, UK
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Proietti J, Boylan GB, Walsh BH. Regional variability in therapeutic hypothermia eligibility criteria for neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2024:10.1038/s41390-024-03184-6. [PMID: 38649726 DOI: 10.1038/s41390-024-03184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
Early induced therapeutic hypothermia represents the cornerstone treatment in neonates with probable hypoxic-ischemic encephalopathy. The selection of patients for treatment usually involves meeting criteria indicating evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. In this review, we highlight the variability that exists between some of the different regional and national eligibility guidelines. Determining the potential presence of perinatal hypoxia-ischemia may require either one, two or three signs amongst history of acute perinatal event, prolonged resuscitation at delivery, abnormal blood gases and low Apgar score, with a range of cutoff values. Clinical neurological exams often define the severity of encephalopathy differently, with varying number of domains required for determining eligibility and blurred interpretation of findings assigned to different severity grades in different systems. The role of early electrophysiological assessment is weighted differently. A clinical implication is that infants may receive different care depending on the location in which they are born. This could also impact epidemiological data, as inference of rates of moderate-severe encephalopathy based on therapeutic hypothermia rates are misleading and influenced by different eligibility methods used. We would advocate that a universally endorsed single severity staging of encephalopathy is vital for standardizing management and neonatal outcome. IMPACT: Variability exists between regional and national therapeutic hypothermia eligibility guidelines for neonates with probable hypoxic-ischemic encephalopathy. Differences are common in both criteria indicating perinatal hypoxia-ischemia and criteria defining moderate or severe encephalopathy. The role of early electrophysiological assessment is also weighted unequally. This reflects in different individual care and impacts research data. A universally endorsed single severity staging of encephalopathy would be crucial for standardizing management.
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Affiliation(s)
- Jacopo Proietti
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Engineering for Innovation Medicine, Innovation Biomedicine section, University of Verona, Verona, Italy
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland.
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Mietzsch U, Kolnik SE, Wood TR, Natarajan N, Gonzalez FF, Glass H, Mayock DE, Bonifacio SL, Van Meurs K, Comstock BA, Heagerty PJ, Wu TW, Wu YW, Juul SE. Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:308-316. [PMID: 38071538 PMCID: PMC11031347 DOI: 10.1136/archdischild-2023-326102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/09/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). DESIGN Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. SETTING Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). INTERVENTIONS Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME MEASURES Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months. RESULTS Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. CONCLUSION Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22-36 months in infants with moderate or severe HIE.
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Affiliation(s)
- Ulrike Mietzsch
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah E Kolnik
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas Ragnar Wood
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Niranjana Natarajan
- Child Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Neurology, Division of Child Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Fernando F Gonzalez
- Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
- Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Hannah Glass
- Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
- Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
- Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Dennis E Mayock
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sonia L Bonifacio
- Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Pediatrics, Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital School, Palo Alto, California, USA
| | - Krisa Van Meurs
- Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Pediatrics, Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital School, Palo Alto, California, USA
| | - Bryan A Comstock
- Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Patrick J Heagerty
- Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tai-Wei Wu
- Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Pediatrics, Children's Hospital Los Angeles Division of Neonatology, Los Angeles, California, USA
| | - Yvonne W Wu
- Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
- Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Sandra E Juul
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
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Andorka C, Barta H, Sesztak T, Nyilas N, Kovacs K, Dunai L, Rudas G, Jermendy A, Szabo M, Szakmar E. The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy. Pediatr Res 2024:10.1038/s41390-024-03189-1. [PMID: 38637693 DOI: 10.1038/s41390-024-03189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE. METHODS Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70). RESULTS Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h. CONCLUSION A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure. IMPACT STATEMENTS A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.
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Affiliation(s)
- Csilla Andorka
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Hajnalka Barta
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Timea Sesztak
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Nora Nyilas
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Kata Kovacs
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Ludovika Dunai
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Gabor Rudas
- Department of Neuroradiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Miklos Szabo
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Eniko Szakmar
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary.
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Genaro-Mattos TC, Korade Z, Sahar NE, Angeli JPF, Mirnics K, Peeples ES. Enhancing 7-dehydrocholesterol suppresses brain ferroptosis and tissue injury after neonatal hypoxia-ischemia. Sci Rep 2024; 14:7924. [PMID: 38575644 PMCID: PMC10994918 DOI: 10.1038/s41598-024-58579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
Neonatal hypoxic-ischemic brain injury (HIBI) results in part from excess reactive oxygen species and iron-dependent lipid peroxidation (i.e. ferroptosis). The vitamin D precursor 7-dehydrocholesterol (7-DHC) may inhibit iron-dependent lipid peroxidation. Primary neurons underwent oxygen and glucose deprivation (OGD) injury and treatment with 7-DHC-elevating medications such as cariprazine (CAR) or vehicle. Postnatal day 9 mice underwent sham surgery or carotid artery ligation and hypoxia and received intraperitoneal CAR. In neurons, CAR administration resulted in significantly increased cell survival compared to vehicle controls, whether administered 48 h prior to or 30 min after OGD, and was associated with increased 7-DHC. In the mouse model, malondialdehyde and infarct area significantly increased after HIBI in the vehicle group, which were attenuated by post-treatment with CAR and were negatively correlated with tissue 7-DHC concentrations. Elevating 7-DHC concentrations with CAR was associated with improved cellular and tissue viability after hypoxic-ischemic injury, suggesting a novel therapeutic avenue.
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Affiliation(s)
- Thiago C Genaro-Mattos
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68106, USA
| | - Zeljka Korade
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Child Health Research Institute, Omaha, NE, 68198, USA
| | - Namood-E Sahar
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Child Health Research Institute, Omaha, NE, 68198, USA
| | - Jose Pedro Friedmann Angeli
- Rudolf Virchow Zentrum - Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Károly Mirnics
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68106, USA
- Child Health Research Institute, Omaha, NE, 68198, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
- Child Health Research Institute, Omaha, NE, 68198, USA.
- Department of Pediatrics, Children's Nebraska, Omaha, NE, 68114, USA.
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41
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Aydın B, Okumuş N, Özkan MB, Zenciroğlu A, Dilli D, Beken S. Renal artery flow alterations in neonates with hypoxic ischemic encephalopathy. Pediatr Nephrol 2024; 39:1253-1261. [PMID: 37889282 DOI: 10.1007/s00467-023-06193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life. METHODS Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life. RESULTS Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2. CONCLUSIONS Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties.
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Affiliation(s)
- Banu Aydın
- Neonatology Unit, Department of Pediatrics, Faculty of Medicine, Lokman Hekim University, Söğütözü Mh. 2179 Cd. No: 6, Ankara, Turkey.
| | - Nurullah Okumuş
- Neonatology Unit, Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Mehmet Burak Özkan
- Department of Radiology, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Zenciroğlu
- Neonatology Unit, Department of Pediatrics, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Dilek Dilli
- Neonatology Unit, Department of Pediatrics, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serdar Beken
- Neonatology Unit, Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Molloy EJ, El-Dib M, Soul J, Juul S, Gunn AJ, Bender M, Gonzalez F, Bearer C, Wu Y, Robertson NJ, Cotton M, Branagan A, Hurley T, Tan S, Laptook A, Austin T, Mohammad K, Rogers E, Luyt K, Wintermark P, Bonifacio SL. Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series). Pediatr Res 2024; 95:1224-1236. [PMID: 38114609 PMCID: PMC11035150 DOI: 10.1038/s41390-023-02895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. IMPACT: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.
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Affiliation(s)
- Eleanor J Molloy
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland.
- Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.
- Neonatology, CHI at Crumlin, Dublin, Ireland.
- Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland.
| | - Mohamed El-Dib
- Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janet Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Juul
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Alistair J Gunn
- Departments of Physiology and Paediatrics, School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Manon Bender
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Gonzalez
- Department of Neurology, Division of Child Neurology, University of California, San Francisco, California, USA
| | - Cynthia Bearer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yvonne Wu
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mike Cotton
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Aoife Branagan
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland
- Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Tim Hurley
- Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland
| | - Sidhartha Tan
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abbot Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island, USA
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Rogers
- Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Karen Luyt
- Translational Health Sciences, University of Bristol, Bristol, UK
- Neonatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Pia Wintermark
- Division of Neonatology, Montreal Children's Hospital, Montreal, Quebec, Canada
- McGill University Health Centre - Research Institute, Montreal, Quebec, Canada
| | - Sonia Lomeli Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Kim SH, El-Shibiny H, Inder T, El-Dib M. Therapeutic hypothermia for preterm infants 34-35 weeks gestational age with neonatal encephalopathy. J Perinatol 2024; 44:528-531. [PMID: 38228763 DOI: 10.1038/s41372-024-01874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To evaluate the short-term outcomes and safety of therapeutic hypothermia (TH) for neonatal encephalopathy in preterm infants at 34-35 weeks of gestation. STUDY DESIGN A matched retrospective cohort study of 20 preterm infants at 34-35 weeks of gestation and 40 infants at 36 weeks of gestation or more who received TH between the years 2015-2021. RESULT Short-term outcomes of preterm infants at 34-35 weeks of gestation who received TH were comparable with infants at 36 weeks or more of gestation who received TH regarding seizures, intraventricular hemorrhage, blood transfusions, subcutaneous fat necrosis, brain injury on magnetic resonance imaging, and mortality. These findings were consistent when short-term outcomes were adjusted for birthweight. CONCLUSION TH in preterm infants at 34-35 weeks of gestation is feasible and safe in our study population.
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Affiliation(s)
- Seh Hyun Kim
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hoda El-Shibiny
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Terrie Inder
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Children's Hospital of Orange County, University of California Irvine, Irvine, CA, USA
| | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Fortin O, Husein N, Oskoui M, Shevell MI, Kirton A, Dunbar M. Risk Factors and Outcomes for Cerebral Palsy With Hypoxic-Ischemic Brain Injury Patterns Without Documented Neonatal Encephalopathy. Neurology 2024; 102:e208111. [PMID: 38422458 DOI: 10.1212/wnl.0000000000208111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Perinatal hypoxic-ischemic brain injury is a leading cause of term-born cerebral palsy, the most common lifelong physical disability. Diagnosis is commonly made in the neonatal period by the combination of neonatal encephalopathy (NE) and typical neuroimaging findings. However, children without a history of neonatal encephalopathy may present later in childhood with motor disability and neuroimaging findings consistent with perinatal hypoxic-ischemic injury. We sought to determine the prevalence of such presentations using the retrospective viewpoint of a large multiregional cerebral palsy registry. METHODS Patient cases were extracted from the Canadian Cerebral Palsy Registry with gestational age >36 weeks, an MRI pattern consistent with hypoxic-ischemic injury (HII, acute total, partial prolonged, or combined), and an absence of postnatal cause for HII. Documentation of NE was noted. Maternal-fetal risk factors, labor and delivery, neonatal course, and clinical outcome were extracted. Comparisons were performed using χ2 tests and multivariable logistic regression with multiple imputation. Propensity scores were used to assess for bias. RESULTS Of the 170 children with MRI findings typical for HII, 140 (82.4%, 95% confidence interval [CI] 75.7%-87.7%) had documented NE and 29 (17.0%, 95% CI 11.7%-23.6%) did not. The group without NE had more abnormalities of amniotic fluid volume (odds ratio [OR] 15.8, 95% CI 1.2-835), had fetal growth restriction (OR 4.7, 95% CI 1.0-19.9), had less resuscitation (OR 0.03, 95% CI 0.007-0.08), had higher 5-minute Apgar scores (OR 2.2, 95% CI 1.6-3.0), were less likely to have neonatal seizures (OR 0.004, 95% CI 0.00009-0.03), and did not receive therapeutic hypothermia. MRI was performed at a median 1.1 months (interquartile range [IQR] 0.67-12.8 months) for those with NE and 12.2 months (IQR 6.6-25.9) for those without (p = 0.011). Patterns of injury on MRI were seen in similar proportions. Hemiplegia was more common in those without documented NE (OR 5.1, 95% CI 1.5-16.1); rates of preserved ambulatory function were similar. DISCUSSION Approximately one-sixth of term-born children with an eventual diagnosis of cerebral palsy and MRI findings consistent with perinatal hypoxic-ischemic brain injury do not have documented neonatal encephalopathy, which was associated with abnormalities of fetal growth and amniotic fluid volume, and a less complex neonatal course. Long-term outcomes seem comparable with their peers with encephalopathy. The absence of documented neonatal encephalopathy does not exclude perinatal hypoxic-ischemic injury, which may have occurred antenatally and must be carefully evaluated with MRI.
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Affiliation(s)
- Olivier Fortin
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
| | - Nafisa Husein
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
| | - Maryam Oskoui
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
| | - Michael I Shevell
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
| | - Adam Kirton
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
| | - Mary Dunbar
- From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta
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Malliou A, Mitsiou C, Kyritsis AP, Alexiou GA. Therapeutic Hypothermia in Treating Glioblastoma: A Review. Ther Hypothermia Temp Manag 2024; 14:2-9. [PMID: 37184912 DOI: 10.1089/ther.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Glioblastoma (GBM) is the most commonly occurring of all malignant central nervous system (CNS) tumors in adults. Considering the low median survival of only ∼15 months and poor prognosis in GBM patients, despite surgical resection with adjuvant radiation and chemotherapy, it is vital to seek brand new and innovative treatment in combination with already existing methods. Hypothermia participates in many metabolic pathways, inflammatory responses, and apoptotic processes, while also promoting the integrity of neurons. Following the successful application of therapeutic hypothermia across a spectrum of disorders such as traumatic CNS injury, cardiac arrest, and epilepsy, several clinical trials have set to evaluate the potency of hypothermia in treating a variety of cancers, including breast and ovaries cancer. In regard to primary neoplasms and more specifically, GBM, hypothermia has recently shown promising results as an auxiliary treatment, reinforcing chemotherapy's efficacy. In this review, we discuss the recent advances in utilizing hypothermia as treatment for GBM and other cancers.
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Affiliation(s)
- Athina Malliou
- Neurosurgical Institute, University of Ioannina, Ioannina, Greece
| | | | | | - George A Alexiou
- Neurosurgical Institute, University of Ioannina, Ioannina, Greece
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Rao R, Comstock BA, Wu TW, Mietzsch U, Mayock DE, Gonzalez FF, Wood TR, Heagerty PJ, Juul SE, Wu YW. Time to Reaching Target Cooling Temperature and 2-year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy. J Pediatr 2024; 266:113853. [PMID: 38006967 DOI: 10.1016/j.jpeds.2023.113853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/19/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To determine if time to reaching target temperature (TT) is associated with death or neurodevelopmental impairment (NDI) at 2 years of age in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Newborn infants ≥36 weeks of gestation diagnosed with moderate or severe HIE and treated with therapeutic hypothermia were stratified based on time at which TT was reached, defined as early (ie, ≤4 hours of age) or late (>4 hours of age). Primary outcomes were death or NDI. Secondary outcomes included neurodevelopmental assessment with Bayley Scales of Infant and Toddler Development, third edition (BSID-III) at age 2. RESULTS Among 500 infants, the median time to reaching TT was 4.3 hours (IWR, 3.2-5.7 hours). Infants in early TT group (n = 211 [42%]) compared with the late TT group (n = 289 [58%]) were more likely to be inborn (23% vs 13%; P < .001) and have severe HIE (28% vs 19%; P = .03). The early and late TT groups did not differ in the primary outcome of death or any NDI (adjusted RR, 1.05; 95% CI, 0.85-0.30; P = .62). Among survivors, neurodevelopmental outcomes did not differ significantly in the 2 groups (adjusted mean difference in Bayley Scales of Infant Development-III scores: cognitive, -2.8 [95% CI, -6.1 to 0.5], language -3.3 [95% CI, -7.4 to 0.8], and motor -3.5 [95% CI, -7.3 to 0.3]). CONCLUSIONS In infants with HIE, time to reach TT is not independently associated with risk of death or NDI at age 2 years. Among survivors, developmental outcomes are similar between those who reached TT at <4 and ≥4 hours of age. TRIAL REGISTRATION High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL); NCT02811263; https://beta. CLINICALTRIALS gov/study/NCT02811263.
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Affiliation(s)
- Rakesh Rao
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St. Louis, MO.
| | - Bryan A Comstock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Tai-Wei Wu
- Division of Neonatology, Department of Pediatrics, University of Southern California, Los Angeles, CA
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Dennis E Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Fernando F Gonzalez
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, CA
| | - Thomas R Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Patrick J Heagerty
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Yvonne W Wu
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, CA
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Quirke FA, Ariff S, Battin MR, Bernard C, Biesty L, Bloomfield FH, Daly M, Finucane E, Healy P, Haas DM, Kirkham JJ, Kibet V, Koskei S, Meher S, Molloy EJ, Niaz M, Bhraonáin EN, Okaronon CO, Parkes MJ, Tabassum F, Walker K, Webbe JWH, Devane D. COHESION: a core outcome set for the treatment of neonatal encephalopathy. Pediatr Res 2024; 95:922-930. [PMID: 38135724 PMCID: PMC10920183 DOI: 10.1038/s41390-023-02938-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis. Therefore, we aimed to develop a core outcome set for treating NE. METHODS Outcomes identified from a systematic review of the literature and interviews with parents were prioritised by stakeholders (n = 99 parents/caregivers, n = 101 healthcare providers, and n = 22 researchers/ academics) in online Delphi surveys. Agreement on the outcomes was achieved at online consensus meetings attended by n = 10 parents, n = 18 healthcare providers, and n = 13 researchers/ academics. RESULTS Seven outcomes were included in the final core outcome set: survival; brain injury on imaging; neurological status at discharge; cerebral palsy; general cognitive ability; quality of life of the child, and adverse events related to treatment. CONCLUSION We developed a core outcome set for the treatment of NE. This will allow future trials to measure and report the same outcomes and ensure results can be compared. Future work should identify how best to measure the COS. IMPACT We have identified seven outcomes that should be measured and reported in all studies for the treatment of neonatal encephalopathy. Previously, a core outcome set for neonatal encephalopathy treatments did not exist. This will help to reduce heterogeneity in outcomes reported in clinical trials and other studies, and help researchers identify the best treatments for neonatal encephalopathy.
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Affiliation(s)
- Fiona A Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland.
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
- School of Medicine, University of Limerick, Limerick, Ireland.
| | - Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Malcolm R Battin
- Department of Newborn Services, Auckland District Health Board, Auckland, New Zealand
| | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, US
| | - Linda Biesty
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Elaine Finucane
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Patricia Healy
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, US
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Eleanor J Molloy
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
- Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Matthew J Parkes
- Centre for Statistics in Medicine; Nuffield Dept of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxfordshire, UK
| | - Farhana Tabassum
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Council of International Neonatal Nurses, Sydney, NSW, Australia
| | - James W H Webbe
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
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Teoh LJ, Kellett S, Patel DE, Cortina-Borja M, Solebo AL, Rahi JS. Evaluating the Quantity and Quality of Health Economic Literature in Blinding Childhood Disorders: A Systematic Literature Review. PHARMACOECONOMICS 2024; 42:275-299. [PMID: 37971639 PMCID: PMC7615631 DOI: 10.1007/s40273-023-01311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Evidence on the socioeconomic burden associated with childhood visual impairment, severe visual impairment and blindness (VI/SVI/BL) is needed to inform economic evaluations of existing and emerging interventions aimed at protecting or improving vision. This study aimed to evaluate the quantity and quality of literature on resource use and/or costs associated with childhood VI/SVI/BL disorders. METHODS PubMed, Web of Science (Ovid), the National Health Service (NHS) Economic Evaluation Database and grey literature were searched in November 2020. The PubMed search was rerun in February 2022. Original articles reporting unique estimates of resource use or cost data on conditions resulting in bilateral VI/SVI/BL were eligible for data extraction. Quality assessment (QA) was undertaken using the Drummond checklist adapted for cost-of-illness (COI) studies. RESULTS We identified 31 eligible articles, 27 from the peer-reviewed literature and four from the grey literature. Two reported on resource use, and 29 reported on costs. Cerebral visual impairment and optic nerve disorders were not examined in any included studies, whereas retinopathy of prematurity was the most frequently examined condition. The quality of studies varied, with economic evaluations having higher mean QA scores (82%) compared to COI studies (77%). Deficiencies in reporting were seen, particularly in the clinical definitions of conditions in economic evaluations and a lack of discounting and sensitivity analyses in COI studies. CONCLUSIONS There is sparse literature on resource use or costs associated with childhood visual impairment disorders. The first step in addressing this important evidence gap is to ensure core visual impairment outcomes are measured in future randomised control trials of interventions as well as cohort studies and are reported as a discrete health outcome.
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Affiliation(s)
- Lucinda J Teoh
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK.
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Salomey Kellett
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Dipesh E Patel
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Moorfields NIHR Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
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49
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Hemmingsen D, Moster D, Engdahl B, Klingenberg C. Hearing impairment after asphyxia and neonatal encephalopathy: a Norwegian population-based study. Eur J Pediatr 2024; 183:1163-1172. [PMID: 37991501 PMCID: PMC10950958 DOI: 10.1007/s00431-023-05321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
The purpose of this study is to evaluate the association between perinatal asphyxia, neonatal encephalopathy, and childhood hearing impairment. This is a population-based study including all Norwegian infants born ≥ 36 weeks gestation between 1999 and 2014 and alive at 2 years (n = 866,232). Data was linked from five national health registries with follow-up through 2019. Perinatal asphyxia was defined as need for neonatal intensive care unit (NICU) admission and an Apgar 5-min score of 4-6 (moderate) or 0-3 (severe). We coined infants with seizures and an Apgar 5-min score < 7 as neonatal encephalopathy with seizures. Infants who received therapeutic hypothermia were considered to have moderate-severe hypoxic-ischemic encephalopathy (HIE). The reference group for comparisons were non-admitted infants with Apgar 5-min score ≥ 7. We used logistic regression models and present data as adjusted odds ratios (aORs) with 95% confidence intervals (CI). The aOR for hearing impairment was increased in all infants admitted to NICU: moderate asphyxia aOR 2.2 (95% CI 1.7-2.9), severe asphyxia aOR 5.2 (95% CI 3.6-7.5), neonatal encephalopathy with seizures aOR 7.0 (95% CI 2.6-19.0), and moderate-severe HIE aOR 10.7 (95% CI 5.3-22.0). However, non-admitted infants with Apgar 5-min scores < 7 did not have increased OR of hearing impairment. The aOR for hearing impairment for individual Apgar 5-min scores in NICU infants increased with decreasing Apgar scores and was 13.6 (95% CI 5.9-31.3) when the score was 0. Conclusions: An Apgar 5-min score < 7 in combination with NICU admission is an independent risk factor for hearing impairment. Children with moderate-severe HIE had the highest risk for hearing impairment. What is Known: • Perinatal asphyxia and neonatal encephalopathy are associated with an increased risk of hearing impairment. • The strength of the association, and how other co-morbidities affect the risk of hearing impairment, is poorly defined. What is New: • Among neonates admitted to a neonatal intensive care unit (NICU), decreased Apgar 5-min scores, and increased severity of neonatal encephalopathy, were associated with a gradual rise in risk of hearing impairment. • Neonates with an Apgar 5-min score 7, but without NICU admission, did not have an increased risk of hearing impairment.
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Affiliation(s)
- Dagny Hemmingsen
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, N-9038, Tromsø, Norway.
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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50
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Tang L, Kebaya LMN, Altamimi T, Kowalczyk A, Musabi M, Roychaudhuri S, Vahidi H, Meyerink P, de Ribaupierre S, Bhattacharya S, de Moraes LTAR, St Lawrence K, Duerden EG. Altered resting-state functional connectivity in newborns with hypoxic ischemic encephalopathy assessed using high-density functional near-infrared spectroscopy. Sci Rep 2024; 14:3176. [PMID: 38326455 PMCID: PMC10850364 DOI: 10.1038/s41598-024-53256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) results from a lack of oxygen to the brain during the perinatal period. HIE can lead to mortality and various acute and long-term morbidities. Improved bedside monitoring methods are needed to identify biomarkers of brain health. Functional near-infrared spectroscopy (fNIRS) can assess resting-state functional connectivity (RSFC) at the bedside. We acquired resting-state fNIRS data from 21 neonates with HIE (postmenstrual age [PMA] = 39.96), in 19 neonates the scans were acquired post-therapeutic hypothermia (TH), and from 20 term-born healthy newborns (PMA = 39.93). Twelve HIE neonates also underwent resting-state functional magnetic resonance imaging (fMRI) post-TH. RSFC was calculated as correlation coefficients amongst the time courses for fNIRS and fMRI data, respectively. The fNIRS and fMRI RSFC maps were comparable. RSFC patterns were then measured with graph theory metrics and compared between HIE infants and healthy controls. HIE newborns showed significantly increased clustering coefficients, network efficiency and modularity compared to controls. Using a support vector machine algorithm, RSFC features demonstrated good performance in classifying the HIE and healthy newborns in separate groups. Our results indicate the utility of fNIRS-connectivity patterns as potential biomarkers for HIE and fNIRS as a new bedside tool for newborns with HIE.
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Affiliation(s)
- Lingkai Tang
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada
| | - Lilian M N Kebaya
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Paediatrics, Division of Neonatal-Perinatal Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Talal Altamimi
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra Kowalczyk
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Melab Musabi
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sriya Roychaudhuri
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Homa Vahidi
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paige Meyerink
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
- Clinical Neurological Sciences, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Soume Bhattacharya
- Neonatal-Perinatal Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Keith St Lawrence
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada
- Medical Biophysics, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emma G Duerden
- Biomedical Engineering, Faculty of Engineering, Western University, London, ON, Canada.
- Neuroscience, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada.
- Applied Psychology, Faculty of Education, Western University, 1137 Western Rd, London, ON, N6G 1G7, Canada.
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