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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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Hayakawa K, Tanda K, Nishimoto M, Nishimura A, Kinoshita D, Sano Y. Apparent diffusion coefficient values can predict neuromotor outcome in term neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr 2024; 113:191-198. [PMID: 37874257 DOI: 10.1111/apa.17011] [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: 07/08/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM To determine the apparent diffusion coefficient (ADC) in brain structures during the first 2 weeks of life and its relation with neurological outcome for hypoxic-ischaemic encephalopathy (HIE) in term neonates. METHODS We retrospectively evaluated 56 term-born neonates. The ADC values were measured for 11 brain regions. The clinical outcomes at least 2 years of age were defined as normal outcome, mild disability and severe disability. The area under curves (AUCs) by ROC analysis were performed to predict the neurodevelopmental outcomes. The clinical outcomes were compared between favourable outcome and adverse outcome and also between normal outcome and unfavourable outcome. RESULTS Thirty-four patients were judged as normal outcome, 10 as mild disability and 12 as severe disability. When the clinical outcomes were compared between favourable outcome and adverse outcome, the AUC on the 1st week was highest value at the thalamus. When the clinical outcomes were compared between normal outcome and unfavourable outcome, the AUC on the 1st week was highest at the thalamus. CONCLUSION The ADC values in the thalamus in the 1st week can predict the neurological outcome. The ADC values in centrum semiovale on the 2nd week can be used to predict neurodevelopmental outcomes.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masakazu Nishimoto
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuko Sano
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Brain injury following mild hypoxic-ischemic encephalopathy in neonates-Ten-year experience in a tertiary perinatal center. J Perinatol 2022; 42:1630-1636. [PMID: 35953534 DOI: 10.1038/s41372-022-01486-3] [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: 03/19/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We aimed to evaluate abnormal magnetic resonance imaging (MRI) findings in neonates with mild hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN This was a single-center, retrospective study of mild HIE conducted from 2011 to 2020. Almost all neonates with mild HIE received management targeted to a temperature of 36 ± 0.5°C for 72 h and underwent MRI (135 of 145). We evaluated medical records and assessed amplitude-integrated electroencephalography (aEEG). RESULT All participants survived until discharge. Abnormal MRI findings were present in 23/135 (17%) neonates. The normal versus abnormal MRI-finding groups had similar characteristics, except discontinuous aEEG patterns (p = 0.002) and inotropic drugs (p = 0.035). Regression analyses showed discontinuous aEEG patterns (odds ratio = 19.3, 95% confidence interval=1.88-197, p = 0.013) being associated with higher odds of abnormal MRI findings. CONCLUSION Our study suggests that a discontinuous aEEG pattern is associated with abnormal MRI findings and can be used to discuss the definition of mild HIE.
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Vega-Del-Val C, Arnaez J, Caserío S, Gutiérrez EP, Castañón L, Benito M, Garcia-Alix A. Adherence to hypothermia guidelines in newborns with hypoxic-ischemic encephalopathy. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:30-39. [PMID: 35729059 DOI: 10.1016/j.anpede.2021.07.007] [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: 06/03/2021] [Accepted: 07/16/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION We do not have population data in Spain on the application of therapeutic hypothermia (TH). The objective was to examine adherence to management standards during TH of infants with hypoxic-ischemic encephalopathy (HIE). METHOD Multicenter observational cohort study from the beginning of TH (year 2010) in 5 hospitals in a Spanish region, until year 2019. RESULTS 133 patients were recruited, 72% diagnosed with moderate HIE and the rest of them with severe HIE. In 84% of infants, passive hypothermia was started at birth. Active TH was started at a median age of 5 h of life (IQR 3.3; 6.3), although the central targeted temperature (33-34 °C) was reached at a median age of 3.5 h (IQR 1; 6). Those born extramural, initiated active TH 3.3 h on average later than those born intramural, but without differences in the age at which the targeted temperature was reached. Sedoanalgesia was used in 97%. 100% were monitored with amplitude-integrated EEG and 59% with cerebral oxymetry. MRI was performed in 94% with moderate HIE vs. 65% with severe; P < .001. Neuron-specific enolase in cerebrospinal fluid was determined in 42%. The average duration of rewarming was median 10 h (IQR 8; 12), with no differences depending on the degree of HIE (P = .57). CONCLUSIONS The implementation of TH successfully met the standards. However, aspects of care that could be improved were detected. Auditing newborn care with HIE is crucial to achieving programs with a high quality of care in each region.
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Affiliation(s)
| | - Juan Arnaez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Burgos, Burgos, Spain; Neurología Neonatal, Fundación NeNe, Madrid, Spain.
| | - Sonia Caserío
- Departamento de Pediatría (Neonatología), Hospital Universitario Río Hortega, Valladolid, Spain
| | - Elena Pilar Gutiérrez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Leticia Castañón
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de León, León, Spain
| | - Marta Benito
- Departamento de Pediatría (Neonatología), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Hayakawa K, Tanda K, Nishimura A, Koshino S, Kizaki Z, Ohno K. Diffusion restriction in the corticospinal tract and the corpus callosum of term neonates with hypoxic-ischemic encephalopathy. Pediatr Radiol 2022; 52:1356-1369. [PMID: 35294621 DOI: 10.1007/s00247-022-05331-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/21/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diffusion-weighted imaging performed shortly after brain injury has been shown to facilitate visualization of acute corticospinal tract injury known as "pre-Wallerian degeneration." OBJECTIVE The aim of this study was to determine whether diffusion restriction in the corticospinal tract and corpus callosum occurs within the first 2 weeks after birth in neonates with neonatal hypoxic-ischemic encephalopathy. MATERIALS AND METHODS We enrolled a consecutive series of 66 infants diagnosed with hypoxic-ischemic encephalopathy who underwent MRI. We evaluated diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values to assess the presence of restricted diffusion in the corticospinal tract and corpus callosum. Next, we compared ADC values in the corticospinal tract and in the splenium and genu of the corpus callosum of infants with abnormal pattern on MRI with those of control infants, who showed a normal pattern on MRI. We attempted to follow all infants with hypoxic-ischemic encephalopathy until 18 months of age and assess them using a standardized neurologic examination. RESULTS After exclusions, we recruited 25 infants with abnormal MRI and 20 with normal MRI (controls). Among these 45 neonates, pre-Wallerian degeneration was visualized in the corticospinal tract in 10 neonates and in the corpus callosum in 12. The ADC values in the corticospinal tract in the first week were significantly lower than they were in the second week. Infants with pre-Wallerian degeneration in the corticospinal tract showed an unfavorable outcome. CONCLUSION Pre-Wallerian degeneration was visualized in the corticospinal tract and corpus callosum and was associated with extensive brain injury caused by hypoxic-ischemic encephalopathy. The changes in signal were observed to evolve over time within the first 2 weeks. The clinical outcome of infants having pre-Wallerian degeneration in the corticospinal tract was unfavorable.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan.
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Sachiko Koshino
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan
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Tsuda K, Shibasaki J, Isayama T, Takeuchi A, Mukai T, Ioroi T, Takahashi A, Sano H, Yutaka N, Iwata S, Nabetani M, Sobajima H, Hosono S, Tamura M, Iwata O. Body temperature, heart rate and long-term outcome of cooled infants: an observational study. Pediatr Res 2022; 91:921-928. [PMID: 33846554 DOI: 10.1038/s41390-021-01502-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Therapeutic hypothermia is a standard of care for neonatal encephalopathy; however, approximately one in two newborn infants fails to respond to this treatment. Recent studies have suggested potential relationships between body temperature, heart rate and the outcome of cooled infants. METHODS The clinical data of 756 infants registered to the Baby Cooling Registry of Japan between January 2012 and December 2016 were analysed to assess the relationship between body temperature, heart rate and adverse outcomes (death or severe impairment at 18 months corrected age). RESULTS A lower body temperature at admission was associated with adverse outcomes in the univariate analysis (P < 0.001), the significance of which was lost when adjusted for the severity of encephalopathy and other covariates. A higher body temperature during cooling and higher heart rate before and during cooling were associated with adverse outcomes in both univariate (all P < 0.001) and multivariate (P = 0.012, P < 0.001 and P < 0.001, respectively) analyses. CONCLUSIONS Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling, whereas causal relationships between slightly higher temperatures during cooling and adverse outcomes need to be elucidated in future studies. IMPACT In a large cohort of encephalopathic newborn infants, dual roles of body temperature to the outcome were shown; adverse outcomes were associated with a lower body temperature at admission and higher body temperature during cooling. A higher heart rate before and during cooling were associated with adverse outcomes. Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling. The exact mechanism underlying the relationship between slightly higher body temperature during cooling and adverse outcomes remains unknown, which needs to be elucidated in future studies.
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Affiliation(s)
- Kennosuke Tsuda
- Department of Pediatrics, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.,Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takeo Mukai
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Perinatal Medical Center, Himeji Red Cross Hospital, Hyogo, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroyuki Sano
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Hisanori Sobajima
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigeharu Hosono
- Division of Neonatology, Department of Perinatal and Neonatal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
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Hayakawa K, Tanda K, Nishimura A, Kinoshita D, Kizaki Z, Ohno K. Diffusion Restriction in the Optic Radiation of Term Neonates With Hypoxic-Ischemic Encephalopathy Demonstrated by Magnetic Resonance Imaging (MRI). J Child Neurol 2021; 36:950-957. [PMID: 34547931 DOI: 10.1177/08830738211015019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There has been no previous report of diffusion restriction in the optic radiation of term neonates with hypoxic-ischemic encephalopathy. Here, using diffusion-weighted magnetic resonance imaging (MRI), we assessed diffusion restriction in the optic radiation within the first 2 weeks of life and estimated signal changes and the apparent diffusion coefficient in the optic radiation and lateral geniculate body using T1-weighted MRI. MATERIALS AND METHODS Forty-five term neonates with hypoxic-ischemic encephalopathy underwent MRI twice during the first 2 weeks of life. Diffusion-weighted imaging and apparent diffusion coefficient were used to evaluate the presence of diffusion restriction in the optic radiation and lateral geniculate body. Apparent diffusion coefficient and T1 signal changes in the optic radiation and lateral geniculate body were also compared with those in 11 control neonates showing a normal pattern on MRI. RESULTS Diffusion restriction in the optic radiation was observed in 29% (13/45) of the hypoxic-ischemic encephalopathy neonates at a median age of 3.5 days (range: 1-9 days). The apparent diffusion coefficient in the optic radiation of affected neonates was significantly reduced in comparison with the controls. In all neonates with optic radiation involvement, increased T1 signal intensity was observed in the optic radiation in the second week, and was also evident in in lateral geniculate body in 8 of those neonates. CONCLUSION Diffusion restriction in the optic radiation is not rare among term neonates with hypoxic-ischemic encephalopathy, being visualized by diffusion-weighted imaging in the first week of life and also high-intensity T1 signal changes in the second week. This diffusion restriction in the optic radiation might be due to transsynaptic neuronal degeneration.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Radiology, Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Radiology, Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto, Japan
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Vega-Del-Val C, Arnaez J, Caserío S, Gutiérrez EP, Castañón L, Benito M, Garcia-Alix A. [Adherence to hypothermia guidelines in newborns with hypoxic-ischemic encephalopathy]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00245-9. [PMID: 34535415 DOI: 10.1016/j.anpedi.2021.07.008] [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: 06/03/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We do not have population data in Spain on the application of therapeutic hypothermia (TH). The objective was to examine adherence to management standards during TH of infants with hypoxic-ischemic encephalopathy (HIE). METHOD Multicenter observational cohort study from the beginning of TH (year 2010) in 5 hospitals in a Spanish region, until year 2019. RESULTS 133 patients were recruited, 72% diagnosed with moderate HIE and the rest of them with severe HIE. In 84% of infants, passive hypothermia was started at birth. Active TH was started at a median age of 5hours of life (IQR: 3.3-6.3), although the central targeted temperature (33-34°C) was reached at a median age of 3.5hours (IQR: 1-6). Those born extramural, initiated active TH 3.3hours on average later than those born intramural, but without differences in the age at which the targeted temperature was reached. Sedoanalgesia was used in 97%. The 100% were monitored with amplitude-integrated EEG and 59% with cerebral oxymetry. MRI was performed in 94% with moderate HIE vs. 65% with severe; P<.001. Neuron-specific enolase in cerebrospinal fluid was determined in 42%. The average duration of rewarming was median 10hours (IQR: 8-12), with no differences depending on the degree of HIE (P=.57). CONCLUSIONS The implementation of TH successfully met the standards. However, aspects of care that could be improved were detected. Auditing newborn care with HIE is crucial to achieving programs with a high quality of care in each region.
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Affiliation(s)
- Cristina Vega-Del-Val
- Unidad de Neonatología, Complejo Asistencial Universitario de Burgos, Burgos, España
| | - Juan Arnaez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Burgos, Burgos, España; Neurología Neonatal, Fundación NeNe, Madrid, España.
| | - Sonia Caserío
- Departamento de Pediatría (Neonatología), Hospital Universitario Río Hortega, Valladolid, España
| | - Elena Pilar Gutiérrez
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Leticia Castañón
- Departamento de Pediatría (Neonatología), Complejo Asistencial Universitario de León, León, España
| | - Marta Benito
- Departamento de Pediatría (Neonatología), Hospital Clínico Universitario de Valladolid, Valladolid, España
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Hayakawa K, Tanda K, Nishimura A, Kinoshita D, Nishimoto M, Kizaki Z, Ohno K. Morphological changes in the pons and cerebellum during the first two weeks in term infants with pontine and cerebellar injury and profound neonatal asphyxia. Acta Radiol 2021; 63:1110-1117. [PMID: 34259022 DOI: 10.1177/02841851211030777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The morphological changes in the pons and cerebellum of neonates experiencing profound asphyxia in the early period of life remain to be clarified. PURPOSE To assess the changes in the size of the pons and cerebellum during the first two weeks of life in term neonates with pontine and cerebellar injury caused by hypoxic-ischemic encephalopathy in comparison with a control group. MATERIAL AND METHODS Two groups were investigated: a group with pontine/cerebellar injury (PCI) (n = 10) demonstrated by magnetic resonance imaging (MRI) diffusion-weighted imaging; and a control group without PCI - focal-multifocal white matter injury and a normal pattern (n = 24). The anteroposterior diameter (APD) and height of the pons and cerebellar vermis, and the transverse width of the cerebellum were measured twice in the first and second weeks of life. Differences between the groups were analyzed statistically using paired and unpaired Student's t-test at a significance level of P < 0.05. RESULTS In the PCI group, the pontine APD and cerebellar vermian height were significantly decreased in the second week. An increase of pons and cerebellar size was evident during the first two weeks of life in the control groups. CONCLUSION Infants with PCI and profound asphyxia show rapid decreases in pontine APD and cerebellar vermian height within the first two weeks of life.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masakazu Nishimoto
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Hayakawa K, Tanda K, Koshino S, Nishimura A, Kizaki Z, Ohno K. Pontine and cerebellar injury in neonatal hypoxic-ischemic encephalopathy: MRI features and clinical outcomes. Acta Radiol 2020; 61:1398-1405. [PMID: 31979976 DOI: 10.1177/0284185119900442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perinatal hypoxic-ischemic encephalopathy (HIE) is a major cause of death and disability in infants. Magnetic resonance imaging (MRI) is valuable for predicting the outcome in high-risk neonates. The relationship of pontine and cerebellar injury to outcome has not been explored sufficiently. PURPOSE To characterize MRI features of pontine and cerebellar injury and to assess the clinical outcomes of these neonates. MATERIAL AND METHODS The retrospective study included 59 term neonates (25 girls) examined by MRI using 1.5-T scanner in the first two weeks of life between 2008 and 2017. Involvement of the pons and cerebellum was judged as a high signal intensity on diffusion-weighted image (DWI) and a restricted diffusion on an apparent diffusion coefficient (ADC) map. RESULTS Pontine involvement was observed in the dorsal portion of pons in eight neonates and cerebellar involvement was observed in dentate nucleus (n = 8), cerebellar vermis (n = 3), and hemisphere (n = 1) in 11 neonates. Combined pontine and cerebellar involvement was observed in eight neonates and only cerebellar involvement in three. The pontine and cerebellar injuries were always associated with very severe brain injury including a basal ganglia/thalamus injury pattern and a total brain injury pattern. In terms of clinical outcome, all but four lost to follow-up, had severe cerebral palsy. CONCLUSION Pontine and cerebellar involvement occurred in the dorsal portion of pons and mostly dentate nucleus and was always associated with a more severe brain injury pattern as well as being predictive of major disability.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Sachiko Koshino
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Karpuz D, Çelik Y, Duman D, Durak F, Bozlu G, Giray D, Kara B, Hallıoğlu Kılınç O. Hipoksik iskemik ensefalopatili infantlarda tam kan sayımı parametreleri ve ekokardiyografi bulgularının prognostik değeri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.645596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Nonomura M, Harada S, Asada Y, Matsumura H, Iwami H, Tanaka Y, Ichiba H. Combination therapy with erythropoietin, magnesium sulfate and hypothermia for hypoxic-ischemic encephalopathy: an open-label pilot study to assess the safety and feasibility. BMC Pediatr 2019; 19:13. [PMID: 30621649 PMCID: PMC6325796 DOI: 10.1186/s12887-018-1389-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although therapeutic hypothermia improves the outcome of neonatal hypoxic-ischemic encephalopathy (HIE), its efficacy is still limited. This preliminary study evaluates the safety and feasibility of the combination therapy with erythropoietin (Epo), magnesium sulfate and hypothermia in neonates with HIE. METHODS A combination therapy with Epo (300 U/kg every other day for 2 weeks), magnesium sulfate (250 mg/kg for 3 days) and hypothermia was started within 6 h of birth in neonates who met the institutional criteria for hypothermia therapy. All patients received continuous infusion of dopamine. Vital signs and adverse events were recorded during the therapy. Short-term and long-term developmental outcomes were also evaluated. RESULTS Nine patients were included in the study. The mean age at first intervention was 3.9 h (SD, 0.5). Death, serious adverse events or changes in vital signs likely due to intervention were not observed during hospital care. All nine patients completed the therapy. At the time of hospital discharge, eight patients had established oral feeding and did not require ventilation support. Two patients had abnormal MRI findings. At 18 months of age, eight patients received a follow-up evaluation, and three of them showed signs of severe neurodevelopmental disability. CONCLUSION The combination therapy with 300 U/kg Epo every other day for 2 weeks, 250 mg/kg magnesium sulphate for 3 days and therapeutic hypothermia is feasible in newborn patients with HIE. TRIAL REGISTRATION ISRCTN33604417 retrospectively registered on 14 September 2018.
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Affiliation(s)
- Miho Nonomura
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Sayaka Harada
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yuki Asada
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hisako Matsumura
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hiroko Iwami
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yuko Tanaka
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hiroyuki Ichiba
- Department of Neonatology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nakajima J, Tsutsumi N, Nara S, Ishii H, Suganami Y, Sunohara D, Kawashima H. Correlations of Enzyme Levels at Birth in Stressed Neonates with Short-Term Outcomes. Fetal Pediatr Pathol 2018; 37:157-165. [PMID: 29737915 DOI: 10.1080/15513815.2018.1458928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Multi-organ injury causes leakage of several intracellular enzymes into the circulation. We evaluated the correlation between the serum-leaked intracellular enzyme levels at the beginning of treatment and the outcome in perinatally stressed neonates. MATERIALS AND METHODS We retrospectively studied neonates whose 1 minute Apgar score was < 7. We collected initial venous blood sample data, including aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) levels, and correlated these with patient short-term outcomes. RESULTS Of 60 neonates, nine patients were treated with therapeutic hypothermia, and 32 needed mechanical ventilation. The therapeutic hypothermia group showed significantly larger base deficit, and higher lactate, AST, ALT, LDH, and CK (all p < 0.01). The duration of mechanical ventilation significantly correlated with AST, ALT, LDH, and CK levels (all p < 0.01). CONCLUSION Initial enzyme levels are useful for predicting the duration of mechanical ventilation in stressed neonates.
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Affiliation(s)
- Junya Nakajima
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan.,b Kameda Medical Center , Department of Neonatology , Higashi-cho, Kamogawa City , Chiba , Japan
| | - Norito Tsutsumi
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
| | - Shonosuke Nara
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
| | - Hiroki Ishii
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
| | - Yusuke Suganami
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
| | - Daisuke Sunohara
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
| | - Hisashi Kawashima
- a Tokyo Medical University , Department of Pediatrics , Nishi-shinjuku, Shinjuku-ku , Tokyo , Japan
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Kobayashi A, Usuda T, Wada M, Kaneko T, Kojima K, Saitoh A. Thyroid function in asphyxiated newborns who received hypothermia therapy. Pediatr Int 2018; 60:433-437. [PMID: 29460458 DOI: 10.1111/ped.13534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/17/2018] [Accepted: 02/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid function in asphyxiated newborns who received hypothermia therapy and its relation to neurological outcome are not well described. METHODS We performed a prospective study to measure thyroid function in 12 asphyxiated newborns who received hypothermia therapy. We measured serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) on admission, at 24, 72, and 96 h after birth, and at discharge (range, 17-54 days). The 12 newborns were divided into two groups based on the presence of brain injury on head magnetic resonance imaging (six in the abnormal imaging group and six in the normal imaging group), and thyroid function was compared between the two groups. RESULTS Serum TSH was within the normal range in the 12 newborns. Serum FT3 and FT4 remained low at 24, 72, and 96 h after birth, and returned to normal range at discharge in the 12 newborns. There was no significant difference in serum TSH between the two groups, but serum FT3 at 96 h after birth, and serum FT4 at 72 and 96 h after birth, were significantly lower in the abnormal imaging group than in the normal imaging group (P = 0.02; P = 0.03; and P = 0.01, respectively). CONCLUSIONS Asphyxiated newborns have transient low thyroid hormone levels at 24-96 h after birth. Serum FT3 and FT4 between 72 and 96 h after birth may predict brain injury in asphyxiated newborns.
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Affiliation(s)
- Akira Kobayashi
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.,Department of Neonatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Touhei Usuda
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masaki Wada
- Department of Neonatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan
| | - Takayuki Kaneko
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kinuko Kojima
- Department of Neonatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Nabetani M, Shintaku H, Hamazaki T. Future perspectives of cell therapy for neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2018; 83:356-363. [PMID: 29016557 DOI: 10.1038/pr.2017.260] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/05/2017] [Indexed: 12/24/2022]
Abstract
Neonatal ischemic brain injury causes permanent motor-deficit cerebral palsy. Hypoxic-ischemic encephalopathy (HIE) is a very serious condition that can result in death and disability. In 1997, we reported that irreversible neuronal cell damage is induced by the elevation of intracellular Ca ion concentration that has occurred in sequence after excess accumulation of the excitatory neurotransmitter glutamate during ischemia. We also reported that hypothermia was effective in treating ischemic brain damage in rats by suppressing energy loss and raising intracellular Ca ion concentration. Following the 2010 revised International Liaison Committee on Resuscitation guideline, our group developed the Guideline for the treatment of Hypothermia in Japan, and we started online case registry in January 2012. However, therapeutic hypothermia must be initiated within the first 6 h after birth. By contrast, cell therapy may have a much longer therapeutic time window because it might reduce apoptosis/oxidative stress and enhance the regenerative process. In 2014, we administered autologous umbilical cord blood stem cell (UCBC) therapy for neonatal HIE, for the first time in Japan. We enrolled five full-term newborns with moderate-to-severe HIE. Our autologous UCBC therapy is leading to new protocols for the prevention of ischemic brain damage.
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Affiliation(s)
- Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.,Department of Pediatrics, Faculty of Medicine, Osaka City University 1-4-3 Asahi-cho, Abeno-ku, Osaka, Japan
| | - Haruo Shintaku
- Department of Pediatrics, Faculty of Medicine, Osaka City University 1-4-3 Asahi-cho, Abeno-ku, Osaka, Japan
| | - Takashi Hamazaki
- Department of Pediatrics, Faculty of Medicine, Osaka City University 1-4-3 Asahi-cho, Abeno-ku, Osaka, Japan
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. [Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain]. An Pediatr (Barc) 2017; 89:12-23. [PMID: 28764944 DOI: 10.1016/j.anpedi.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres.
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Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, España; Fundación NeNe, Madrid, España.
| | - Alfredo García-Alix
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Universitat de Barcelona, Barcelona, España; Fundación NeNe, Madrid, España
| | - Gemma Arca
- Unidad de Neonatología, Hospital Universitario Clínic (Sede Maternitat), Barcelona, España; Fundación NeNe, Madrid, España
| | - Eva Valverde
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España; Fundación NeNe, Madrid, España
| | - Sonia Caserío
- Unidad de Neonatología, Hospital Universitario Río Hortega, Valladolid, España; Fundación NeNe, Madrid, España
| | - M Teresa Moral
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España; Fundación NeNe, Madrid, España
| | - Isabel Benavente-Fernández
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
| | - Simón Lubián-López
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
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Nakajima J, Sunohara D, Kawashima H. A case of pulmonary artery sling where onset Was induced by therapeutic hypothermia. Pediatr Pulmonol 2017; 52:E7-E10. [PMID: 27505140 DOI: 10.1002/ppul.23538] [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: 04/18/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/06/2022]
Abstract
A neonate with severe neonatal asphyxia was treated with therapeutic hypothermia. He developed hypothermia-induced respiratory deterioration, after which congenital tracheal stenosis and pulmonary artery sling were diagnosed. Even low-grade hypothermia is likely to induce bronchial narrowing in neonates, especially in neonates with congenital respiratory tract anomalies. Congenital tracheal stenosis represents a potential pitfall in differential diagnosis and should be carefully ruled out in cases of bronchial narrowing episode induced by therapeutic hypothermia. Pediatr Pulmonol. 2017;52:E7-E10. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Junya Nakajima
- Department of Pediatrics, Tokyo Medical University, Tokyo, Japan
| | - Daisuke Sunohara
- Department of Pediatrics, Tokyo Medical University, Tokyo, Japan
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Yokoi K, Kobayashi S, Muramatsu K, Suzuki S, Gotou H. The question of whether or not to perform therapeutic hypothermia: A case of neonatal spinal cord injury. J Neonatal Perinatal Med 2017; 10:195-198. [PMID: 28409761 DOI: 10.3233/npm-171695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neonatal spinal cord injury is an extremely rare perinatal complication that often occurs concurrently with hypoxic ischemic encephalopathy (HIE), further complicating diagnosis of spinal cord injury. Although therapeutic hypothermia for moderate to severe HIE is widely recommended in Japan, it is difficult to determine whether it satisfies the neurological findings-related entry criteria in some patients.We describe a female infant with neonatal spinal cord injury after forceps delivery, who underwent therapeutic hypothermia upon diagnosis of HIE. The Apgar scores were 5 at 1 min, 6 at 5 min, and not recorded at 10 min. Blood gas analysis of her umbilical artery was not performed. Since respiratory failure, hypotonia and the absence of primitive reflexes were found at 2 hours after birth, she was initially diagnosed with moderate HIE and underwent a therapeutic hypothermia. Magnetic resonance imaging after therapeutic hypothermia revealed the spinal cord was narrowed from the lower medulla oblongata to the upper cervical cord. Thus she was diagnosed with an upper spinal cord injury at that time.Some patients with neonatal spinal cord injuries satisfy the criteria for therapeutic hypothermia. When neonates with asphyxia present with prolonged respiratory failure and hypotonia, spinal cord injury should be considered in the differential diagnosis. Thus, an early MRI is vital for the diagnosis of spinal cord injury.
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Celik Y, Atıcı A, Gulası S, Okuyaz C, Makharoblıdze K, Sungur MA. Comparison of selective head cooling versus whole-body cooling. Pediatr Int 2016; 58:27-33. [PMID: 26189647 DOI: 10.1111/ped.12747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/11/2015] [Accepted: 06/09/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study compared selective head cooling (SHC) and whole-body cooling (WBC) in newborns with hypoxic-ischemic encephalopathy (HIE). METHODS We conducted a prospective randomized small-scale pilot study in newborns with HIE, born after >35 weeks of gestation. The patients were randomly assigned to receive SHC or WBC. RESULTS The SHC group consisted of 17 patients, and the WBC group, 12 patients. There was no significant difference in adverse effects related to cooling therapy between the two groups. During the 12 month study period, seven patients in the SHC group and four in the WBC group died, but the difference was not significant (P = 0.667). Among the patients alive at 12 months after treatment, six in the SHC group and four in the WBC group had severe disabilities; the difference was not significant (P = 0.671). When the composite outcome of death or severe disability was evaluated, the difference between the SHC group (77%, n = 13) and the WBC group (67%, n = 8) was not significant (P = 0.562). Moreover, the number of survivors without disability at 12 months after treatment did not differ significantly between the SHC group (n = 3) and the WBC group (n = 4; P = 0.614). CONCLUSIONS There were no significant differences in adverse effects, 12 month neuromotor development, or mortality rate between SHC and WBC in newborns with HIE, born after >35 weeks of gestation.
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Affiliation(s)
- Yalcın Celik
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Aytug Atıcı
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Selvi Gulası
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Khatuna Makharoblıdze
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, School of Medicine, Mersin University, Mersin, Turkey
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Nakamura S, Koyano K, Jinnai W, Hamano S, Yasuda S, Konishi Y, Kuboi T, Kanenishi K, Nishida T, Kusaka T. Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy. Brain Dev 2015; 37:925-32. [PMID: 25975705 DOI: 10.1016/j.braindev.2015.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/26/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) usually results in a poor clinical outcome even when treated with hypothermic therapy (HT). Early postnatal changes in cerebral blood oxygenation and hemodynamics may be critical determinants of brain injury and the efficacy of HT. OBJECTIVES We measured cerebral hemoglobin oxygen saturation (ScO2) and cerebral blood volume (CBV) by near-infrared time-resolved spectroscopy (TRS) in HT-treated and non-HT-treated neonatal HIE patients to assess the influence of these parameters on clinical outcome. METHODS We retrospectively compared ScO2, CBV, and clinical outcomes of 11 neonates with HIE: 5 were treated by HT (HT-treated; 33.5°C±0.5°C for 72h starting approximately 6h after delivery) and 6 were not (non-HT-treated). Both CBV and ScO2 were measured by TRS at 6, 24, 48, and 72h after birth. Magnetic resonance imaging (MRI) was performed 1-2weeks after birth to assess brain injury. RESULTS Five neonates had adverse outcomes (3 HT-treated, 2 non-HT-treated). Of these, 1 died within 3days of birth and 4 had abnormal MRI findings, including basal ganglia, white matter, and/or thalamic lesions. The other 6 neonates had normal MRI findings (favorable outcome). At 6h after birth, CBV was significantly higher in neonates with adverse outcomes compared with those with a favorable outcome. At 24h after birth, ScO2 was significantly higher in neonates with adverse outcomes. Furthermore, we found that combined CBV at 24h after birth plus ScO2 had the best predictive ability for neurological outcome: sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. CONCLUSION Early postnatal CBV and ScO2 elevations were predictive of a poor outcome in HIE. Therefore, measuring combined CBV plus ScO2 at 24h after birth can allow more precise prediction of neurological outcome. Control of postnatal CBV and ScO2 is critical for effective HIE treatment.
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Affiliation(s)
- Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kosuke Koyano
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Wataru Jinnai
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Hamano
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Saneyuki Yasuda
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yukihiko Konishi
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Toru Kuboi
- Department of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Kenji Kanenishi
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tomoko Nishida
- Department of Education for Children with Special Needs, Faculty of Education, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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Çelik Y, Atıcı A, Gülaşı S, Makharoblıdze K, Eskandari G, Sungur MA, Akbayır S. The effects of selective head cooling versus whole-body cooling on some neural and inflammatory biomarkers: a randomized controlled pilot study. Ital J Pediatr 2015; 41:79. [PMID: 26472263 PMCID: PMC4608056 DOI: 10.1186/s13052-015-0188-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023] Open
Abstract
Background Therapeutic hypothermia (TH) has become standard care in newborns with moderate to severe hypoxic ischemic encephalopathy (HIE), and the 2 most commonly used methods are selective head cooling (SHC) and whole body cooling (WBC). This study aimed to determine if the effects of the 2 methods on some neural and inflammatory biomarkers differ. Materials and methods This prospective randomized pilot study included newborns delivered after >36 weeks of gestation. SHC or WBC was administered randomly to newborns with moderate to severe HIE that were prescribed TH. The serum interleukin (IL)-1β, IL-6, neuron-specific enolase (NSE), brain-specific creatine kinase (CK-BB), tumor necrosis factor-alpha (TNF-α), and protein S100 levels, the urine S100B level, and the urine lactate/creatinine (L/C) ratio were evaluated 6 and 72 h after birth. The Bayley Scales of Infant and Toddler Development-III was administered at month 12 for assessment of neurodevelopmental findings. Results The SHC group included 14 newborns, the WBC group included 10, the mild HIE group included 7, and the control group included 9. All the biomarker levels in the SHC and WBC groups at 6 and 72 h were similar, and all the changes in the biomarker levels between 6 and 72 h were similar in both groups. The serum IL-6 and protein S100 levels at 6 h in the SHC and WBC groups were significantly higher than in the control group. The urine L/C ratio at 6 h in the SHC and WBC groups was significantly higher than in the mild HIE and control groups. The IL-6 level and L/C ratio at 6 and 72 h in the patients that had died or had disability at month 12 were significantly higher than in the patients without disability at month 12. Conclusion The effects of SHC and WBC on the biomarkers evaluated did not differ. The urine L/C ratio might be useful for differentiating newborns with moderate and severe HIE from those with mild HIE. Furthermore, the serum IL-6 level and the L/C ratio might be useful for predicting disability and mortality in newborns with HIE.
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Affiliation(s)
- Yalçın Çelik
- Mersin University School of Medicine, Department of Neonatology Care Unit, 33343, Mersin, Turkey.
| | - Aytuğ Atıcı
- Mersin University Faculty of Medicine, Department of Neonatology, 33343, Mersin, Turkey.
| | - Selvi Gülaşı
- Mersin University School of Medicine, Department of Neonatology, 33343, Mersin, Turkey.
| | - Khatuna Makharoblıdze
- Mersin University Faculty of Medicine, Department of Pediatric Neurology, 33343, Mersin, Turkey.
| | - Gülçin Eskandari
- Mersin University Faculty of Medicine, Department of Biochemistry, 33343, Mersin, Turkey.
| | - Mehmet Ali Sungur
- Mersin University Faculty of Medicine, Department of Biostatistics, 33343, Mersin, Turkey.
| | - Serin Akbayır
- Mersin University Faculty of Medicine, Department of Biochemistry, 33343, Mersin, Turkey.
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Çelik Y, Atıcı A, Beydağı H, Reşitoğlu B, Yılmaz N, Ün İ, Polat A, Bağdatoğlu C, Dağtekin A, Sungur MA, Tiftik N. The effects of fibroblast growth factor-2 and pluripotent astrocytic stem cells on cognitive function in a rat model of neonatal hypoxic-ischemic brain injury. J Matern Fetal Neonatal Med 2015; 29:2199-204. [PMID: 26365220 DOI: 10.3109/14767058.2015.1080683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to determine the effect of pluripotent astrocytic stem cells (PASCs) and fibroblast growth factor-2 (FGF-2) on cognitive function in neonatal rats with hypoxic-ischemic brain injury (HIBI). METHODS The study was performed on 7-d-old rats that were randomly divided into four groups. All rats, except those in the sham group, were kept in a hypoxic chamber containing 8% oxygen for 2 h after the ligation of the right carotid artery. Next, 5 d after HIBI was induced, PASCs were administered to the motor cortex, and FGF-2 was administered intraperitoneally to group AF; PASCs were administered to the motor cortex, and salt solution buffered with phosphate was administered intraperitoneally to group A; and fresh cell culture solution (medium) was administered to group M. Immunofluorescence was used to localize the administered PASCs in the brains of rats from groups A and AF. The Morris water maze tank (MWM) test was performed to assess the rats' cognitive functions at week 12. The rats that were administered PASCs were observed for the development of neoplasms and autopsies were performed after 30 months. RESULTS PASCs migrated to damaged brain regions surrounding the hippocampus in groups A and AF. The mean platform finding time (PFT) significantly decreased over time in each group on day 1-4 of MWM testing (p < 0.001). On day 2-4, the mean PFT was shortest in group S followed by group AF. In group A, the PFT was significantly longer than in group S on day 3-4 (p = 0.01 and 0.007, respectively). On day 5 of the MWM test, the time spent in the eastern quadrant (which previously contained the platform) was longest in group S followed by groups AF, A, and M; however, the differences between groups were not significant (p = 0.51). After 30 months, none of the rats in groups A or AF had benign or malignant neoplasms. CONCLUSIONS Following the administration of PASCs in rats with experimentally induced HIBI, PASCs migrated to the injured brain regions; however, treatment with PASCs did not have a positive effect on cognitive function. The administration of FGF-2 together with PASCs resulted in positive cognitive results, although not at the level of significance.
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Affiliation(s)
- Yalçın Çelik
- a Department of Neonatal Intensive Care Unit , Mersin University School of Medicine , Mersin , Turkey
| | - Aytuğ Atıcı
- b Department of Neonatal Intensive Care Unit, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Hüseyin Beydağı
- c Department of Physiology, Faculty of Medicine , Mersin University Mersin , Turkey
| | - Bora Reşitoğlu
- c Department of Physiology, Faculty of Medicine , Mersin University Mersin , Turkey
| | - Necat Yılmaz
- d Department of Histology-Embryology, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - İsmail Ün
- e Department of Pharmacology, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Ayşe Polat
- f Department of Pathology, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Celal Bağdatoğlu
- g Department of Neurosurgery, Faculty of Medicine , Mersin University , Mersin , Turkey , and
| | - Ahmet Dağtekin
- g Department of Neurosurgery, Faculty of Medicine , Mersin University , Mersin , Turkey , and
| | - Mehmet Ali Sungur
- h Department of Biostatistics, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Nalan Tiftik
- e Department of Pharmacology, Faculty of Medicine , Mersin University , Mersin , Turkey
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Iwata O, Takenouchi T, Iwata S, Nabetani M, Mukai T, Shibasaki J, Tsuda K, Tokuhisa T, Sobajima H, Tamura M. The baby cooling project of Japan to implement evidence-based neonatal cooling. Ther Hypothermia Temp Manag 2015; 4:173-9. [PMID: 25260150 DOI: 10.1089/ther.2014.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Therapeutic hypothermia was first recommended as a standard of care by international guidelines in 2010. However, at that time, the number of centers capable of providing standard cooling was limited even in Japan. The aim of this project was to implement a nationwide network of evidence-based cooling within 3 years. A taskforce was formed in June 2010 to undergo the primary nationwide practice survey, design of action plans, and the appraisal of interventions by involving all registered level-II/III neonatal intensive care units in Japan. Based on findings from the primary survey, aggressive action plans were introduced that focused on the formulation of clinical recommendations, facilitation of educational events, and opening of an online case registry. Findings from the follow-up survey (January 2013) were compared with the results from the primary survey (June 2010). Four workshops and three consensus meetings were held to formulate clinical recommendations, which were followed by the publication of practical textbooks, large-scale education seminars, and implementation of a case registry. A follow-up survey covering 253 units (response rate: 89.1%) showed that cooling centers increased from 89 to 135. Twelve prefectures had no cooling centers in 2010, whereas all 47 prefectures had at least one in 2013. In cooling centers, adherence to the standard cooling protocols and the use of servo-controlled cooling devices improved from 20.7% to 94.7% and from 79.8% to 98.5%, respectively. A rapid improvement in the national provision of evidence-based cooling was achieved. International consensus guidelines coupled with domestic interventions might be effective in changing empirical approaches to evidence-based practice.
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Affiliation(s)
- Osuke Iwata
- 1 Department of Pediatrics & Child Health, Centre for Developmental & Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
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Atıcı A, Çelik Y, Gülaşı S, Turhan AH, Okuyaz Ç, Sungur MA. Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: short term results. Turk Arch Pediatr 2015; 50:27-36. [PMID: 26078694 DOI: 10.5152/tpa.2015.2167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022]
Abstract
AIM In this study, it was aimed to investigate which method was superior by applying selective head cooling or whole body cooling therapy in newborns diagnosed with moderate or severe hypoxic ischemic encephalopathy. MATERIALS AND METHOD Newborns above the 35th gestational age diagnosed with moderate or severe hypoxic ischemic encephalopathy were included in the study and selective head cooling or whole body cooling therapy was performed randomly. The newborns who were treated by both methods were compared in terms of adverse effects in the early stage and in terms of short-term results. Ethics committee approval was obtained for the study (06.01.2010/35). RESULTS Fifty three babies diagnosed with hypoxic ischemic encephalopathy were studied. Selective head cooling was applied to 17 babies and whole body cooling was applied to 12 babies. There was no significant difference in terms of adverse effects related to cooling therapy between the two groups. When the short-term results were examined, it was found that the hospitalization time was 34 (7-65) days in the selective head cooling group and 18 (7-57) days in the whole body cooling group and there was no significant difference between the two groups (p=0.097). Four patients in the selective head cooling group and two patients in the whole body cooling group were discharged with tracheostomy because of the need for prolonged mechanical ventilation and there was no difference between the groups in terms of discharge with tracheostomy (p=0.528). Five patients in the selective head cooling group and three patients in the whole body cooling group were discharged with a gastrostomy tube because they could not be fed orally and there was no difference between the groups in terms of discharge with a gastrostomy tube (p=0.586). One patient who was applied selective head cooling and one patient who was applied whole body cooling died during hospitalization and there was no difference between the groups in terms of mortality (p=0.665). CONCLUSIONS There is no difference between the methods of selective head cooling and whole body cooling in terms of adverse effects and short-term results.
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Affiliation(s)
- Aytuğ Atıcı
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yalçın Çelik
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Selvi Gülaşı
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ali Haydar Turhan
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Çetin Okuyaz
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, Turkey
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Rewarming from therapeutic hypothermia induces cortical neuron apoptosis in a swine model of neonatal hypoxic-ischemic encephalopathy. J Cereb Blood Flow Metab 2015; 35:781-93. [PMID: 25564240 PMCID: PMC4420851 DOI: 10.1038/jcbfm.2014.245] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 11/08/2022]
Abstract
The consequences of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy are poorly understood. Adverse effects from suboptimal rewarming could diminish neuroprotection from hypothermia. Therefore, we tested whether rewarming is associated with apoptosis. Piglets underwent hypoxia-asphyxia followed by normothermic or hypothermic recovery at 2 hours. Hypothermic groups were divided into those with no rewarming, rewarming at 0.5 °C/hour, or rewarming at 4 °C/hour. Neurodegeneration at 29 hours was assessed by hematoxylin and eosin staining, TUNEL assay, and immunoblotting for cleaved caspase-3. Rewarmed piglets had more apoptosis in motor cortex than did those that remained hypothermic after hypoxia-asphyxia. Apoptosis in piriform cortex was greater in hypoxic-asphyxic, rewarmed piglets than in naive/sham piglets. Caspase-3 inhibitor suppressed apoptosis with rewarming. Rapidly rewarmed piglets had more caspase-3 cleavage in cerebral cortex than did piglets that remained hypothermic or piglets that were rewarmed slowly. We conclude that rewarming from therapeutic hypothermia can adversely affect the newborn brain by inducing apoptosis through caspase mechanisms.
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Drew KL, Romanovsky AA, Stephen TKL, Tupone D, Williams RH. Future approaches to therapeutic hypothermia: a symposium report. Temperature (Austin) 2015; 2:168-71. [PMID: 27227020 PMCID: PMC4843898 DOI: 10.4161/23328940.2014.976512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 12/22/2022] Open
Key Words
- A1AR
- AGS, arctic ground squirrel
- CE, capillary electrophoresis
- EEG,electroencephalogram
- FSCV, Fast scan cyclic voltammetry
- HPLC, high performance liquid chromatography
- ICV, intracerebroventricular
- TRPM8
- Tb, core body temperature
- adenosine
- capillary electrophoresis
- hibernation
- nNOS, neuronal nitric oxide synthase; NTS, nucleus tractus solitarii; TH, therapeutic hypothermia; TRP, transient receptor potential [channel(s)]; TRPM8, TRP melastatin-8
- nNOS/NK1
- targeted temperature management
- therapeutic hypothermia
- torpor
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Affiliation(s)
- Kelly L Drew
- Institute of Arctic Biology; University of Alaska Fairbanks; Fairbanks, AK, USA
| | - Andrej A Romanovsky
- Systemic Inflammation Laboratory (Fever Lab); Trauma Research, St. Joseph's Hospital and Medical Center; Phoenix, AZ, USA
| | - Terilyn KL Stephen
- Department of Chemistry and Biochemistry; University of Alaska Fairbanks; Fairbanks, AK, USA
| | - Domenico Tupone
- Department of Neurological Surgery; Oregon Health & Science University; Portland, OR, USA
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Tokuhisa T, Ibara S, Minakami H, Maede Y, Ishihara C, Matsui T. Outcome of infants with hypoxic ischemic encephalopathy treated with brain hypothermia. J Obstet Gynaecol Res 2014; 41:229-37. [DOI: 10.1111/jog.12520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Takuya Tokuhisa
- Department of Neonatology; Perinatal Medical Center, Kagoshima City Hospital; Kagoshima Japan
| | - Satoshi Ibara
- Department of Neonatology; Perinatal Medical Center, Kagoshima City Hospital; Kagoshima Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yoshinobu Maede
- Department of Neonatology; Perinatal Medical Center, Kagoshima City Hospital; Kagoshima Japan
| | - Chie Ishihara
- Department of Neonatology; Perinatal Medical Center, Kagoshima City Hospital; Kagoshima Japan
| | - Takako Matsui
- Department of Neonatology; Perinatal Medical Center, Kagoshima City Hospital; Kagoshima Japan
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Kuboi T, Kusaka T, Okazaki K, Kaku U, Kakinuma R, Kondo M, Nishida A. Subcutaneous fat necrosis after selective head cooling in an infant. Pediatr Int 2013; 55:e23-4. [PMID: 23679178 DOI: 10.1111/j.1442-200x.2012.03730.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/19/2012] [Accepted: 07/25/2012] [Indexed: 11/30/2022]
Abstract
Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Selective head cooling was provided for 72 h after birth. SCFN developed on the patient's cheeks and back at the age of 21 days. Thus, SCFN may be caused by selective head cooling, similarly to whole-body cooling.
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Affiliation(s)
- Toru Kuboi
- Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Kato T, Okumura A, Tsuji T, Hayashi S, Kito M, Natsume J. Punctate white matter lesions in a late preterm-born infant with hypoxic ischaemic encephalopathy: chronological change in magnetic resonance imaging. Dev Med Child Neurol 2012; 54:862. [PMID: 22369473 DOI: 10.1111/j.1469-8749.2012.04235.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan.
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