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Lavrentev SN, Petrova AS, Serova OF, Vishnyakova P, Kondratev MV, Gryzunova AS, Zakharova NI, Zubkov VV, Silachev DN. Ultrasound Diagnosis and Near-Infrared Spectroscopy in the Study of Encephalopathy in Neonates Born under Asphyxia: Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:591. [PMID: 38790586 PMCID: PMC11119551 DOI: 10.3390/children11050591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.
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Affiliation(s)
- Simeon N. Lavrentev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Anastasia S. Petrova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Olga F. Serova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
| | - Polina Vishnyakova
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Maxim V. Kondratev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Anastasia S. Gryzunova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Nina I. Zakharova
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Victor V. Zubkov
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Denis N. Silachev
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
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Farag MM, Khedr AAEHAER, Attia MH, Ghazal HAER. Role of Near-Infrared Spectroscopy in Monitoring the Clinical Course of Asphyxiated Neonates Treated with Hypothermia. Am J Perinatol 2024; 41:429-438. [PMID: 34965589 DOI: 10.1055/s-0041-1740513] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. STUDY DESIGN Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. RESULTS Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. CONCLUSION NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. KEY POINTS · Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.. · Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.. · Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia..
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Affiliation(s)
| | | | - MennattAllah Hassan Attia
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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El-Atawi KM, Osman MF, Hassan M, Siwji ZA, Hassan AA, Abed MY, Elsayed Y. Predictive Utility of Near-Infrared Spectroscopy for the Outcomes of Hypoxic-Ischemic Encephalopathy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51162. [PMID: 38283516 PMCID: PMC10812856 DOI: 10.7759/cureus.51162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
This systematic review and meta-analysis aimed to assess the utility of near-infrared spectroscopy (NIRS) in predicting the perinatal outcomes of neonates with hypoxic-ischemic encephalopathy (HIE). We conducted a literature search on Medline via PubMed, Web of Science, Scopus, and CENTRAL Library. We included studies that utilized early NIRS monitoring to study the accuracy of NIRS in predicting the perinatal outcomes of neonates with hypoxic-ischemic encephalopathy. Nine studies that met our eligibility criteria were included. These studies were published between 2012 and 2023. In this meta-analysis, no significant differences in regional cerebral oxygen saturation (cSpO2) were found between normal and abnormal groups at 12 hours (MD = 0.21, 95% CI: -6.39 to 6.82, P = 0.95) and 24 hours (MD = -1.96, 95% CI: -6.95 to 3.03, P = 0.44). However, at 48 hours, cSpO2 was significantly lower in the normal group (MD = -4.9, 95% CI: -5.91 to -3.89, P < 0.00001). At 72 hours, our analysis revealed a significant difference with lower cSpO2 in the normal group (MD = -3.0, 95% CI: -5.5 to -0.5, P = 0.02). Regarding cerebral fractional tissue oxygen extraction (FTOE), no significant differences were observed at 12 hours (MD = 0.03, 95% CI: -0.02 to 0.09, P = 0.24). After 24 hours, the normal group exhibited lower FTOE (MD = -0.03, 95% CI: -0.04 to -0.01, P < 0.001), while after 48 hours, the normal group had higher FTOE (MD = 0.07, 95% CI: 0.04 to 0.10, P < 0.0001). Early cerebral NIRS monitoring is beneficial in predicting the outcomes of HIE in term neonates. Our analysis showed that several NIRS parameters, such as regional cSpO2 and cerebral FTOE, are significantly associated with adverse outcomes in the first 72 hours of birth.
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Affiliation(s)
- Khaled M El-Atawi
- Pediatrics/Neonatal Intensive Care Unit, Latifa Women and Children Hospital, Dubai, ARE
| | | | | | | | - Ahmed A Hassan
- Pediatric Cardiology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Maysam Y Abed
- Pediatric Cardiology, Ibn Albitar Tertiary Center for Cardiology, Baghdad, IRQ
| | - Yasser Elsayed
- Pediatrics and Neonatology, Health Sciences Centre-Winnipeg, Max Rady College of Medicine, University of Manitoba, Manitoba, CAN
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Glass HC, Numis AL, Comstock BA, Gonzalez FF, Mietzsch U, Bonifacio SL, Massey S, Thomas C, Natarajan N, Mayock DE, Sokol GM, Van Meurs KP, Ahmad KA, Maitre N, Heagerty PJ, Juul SE, Wu YW, Wusthoff CJ. Association of EEG Background and Neurodevelopmental Outcome in Neonates With Hypoxic-Ischemic Encephalopathy Receiving Hypothermia. Neurology 2023; 101:e2223-e2233. [PMID: 37816642 PMCID: PMC10727206 DOI: 10.1212/wnl.0000000000207744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Predicting neurodevelopmental outcome for neonates with hypoxic-ischemic encephalopathy (HIE) is important for clinical decision-making, care planning, and parent communication. We examined the relationship between EEG background and neurodevelopmental outcome among children enrolled in a trial of erythropoietin or placebo for neonates with HIE treated with therapeutic hypothermia. METHODS Participants had EEG recorded throughout hypothermia. EEG background was classified as normal, discontinuous, or severely abnormal (defined as burst suppression, low voltage suppressed, or status epilepticus) at 5 1-hour epochs: onset of recording, 24, 36, 48, and 72 hours after birth. The predominant background pattern during the entire continuous video EEG monitoring recording was calculated using the arithmetic mean of the 5 EEG background ratings (normal = 0; discontinuous = 1; severely abnormal = 2) as follows: "predominantly normal" (mean = 0), "normal/discontinuous" (0 < mean<1), "predominantly discontinuous" (mean = 1), "discontinuous/severely abnormal" (1 < mean<2), or "predominantly severely abnormal" (mean = 2). Primary outcome was death or neurodevelopmental impairment (NDI) defined as cerebral palsy, Gross Motor Function Classification Score ≥1, or cognitive score <90 on Bayley Scales of Infant Toddler Development, third edition at age 2 years. Neurodevelopment was also categorized into a 5-level ordinal measure: no, mild, moderate, severe NDI, or death for secondary analysis. We used generalized linear regression models with robust standard errors to assess the relative risk of death or NDI by EEG background in both unadjusted and adjusted analyses controlling for the effects of treatment group, sex, HIE severity, and study recruitment site. RESULTS Among 142 neonates, the predominant background EEG pattern was predominantly normal in 35 (25%), normal/discontinuous in 68 (48%), predominantly discontinuous in 11 (7.7%), discontinuous/severely abnormal in 16 (11%), and predominantly severely abnormal in 12 (8.5%). Increasing severity of background across monitoring epochs was associated with increasingly worse clinical outcomes. Children with severe EEG background abnormality at any time point (n = 36, 25%) were significantly more likely to die or have severe NDI at 2 years (adjusted relative risk: 7.95, 95% CI 3.49-18.12). DISCUSSION EEG background is strongly associated with NDI at age 2 years. These results can be used to assist health care providers to plan follow-up care and counsel families for decision-making related to goals of care.
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Affiliation(s)
- Hannah C Glass
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA.
| | - Adam L Numis
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Bryan A Comstock
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Fernando F Gonzalez
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Ulrike Mietzsch
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Sonia Lomeli Bonifacio
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Shavonne Massey
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Cameron Thomas
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Niranjana Natarajan
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Dennis E Mayock
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Gregory M Sokol
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Krisa P Van Meurs
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Kaashif A Ahmad
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Nathalie Maitre
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Patrick J Heagerty
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Sandra E Juul
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Yvonne W Wu
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
| | - Courtney J Wusthoff
- Departments of Neurology and Weill Institute for Neuroscience (H.C.G., A.L.N., Y.W.W.); Pediatrics (H.C.G., A.L.N., Y.W.W.), UCSF Benioff Children's Hospital; Epidemiology & Biostatistics (H.C.G.), University of California San Francisco, CA; Department Biostatistics (B.A.C., P.J.H.), University of Washington, Seattle; Department of Pediatrics (U.M., S.E.J.), Division of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital; Department of Pediatrics (K.P.V.M., S.L.B.), Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA; Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine (S.L.M.), University of Pennsylvania, Philadelphia; Department of Pediatrics (C.T.), University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; Department of Neurology (N.N.), University of Washington School of Medicine, Seattle; Department of Pediatrics (G.S.), Indiana University School of Medicine, Indianapolis, IN; Pediatrix Neonatology of San Antonio (K.A.A.), TX; Department of Pediatrics, and Emory + Children's Pediatric Institute (N.M.), Emory University, Atlanta, GA; Department of Neurology (C.J.W.), Stanford University, Palo Alto, CA
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5
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Variane GFT, Dahlen A, Noh CY, Zeng J, Yan ES, Kaneko JS, Gouveia MS, Van Meurs KP, Chock VY. Cerebral oxygen saturation in neonates: a bedside comparison between neonatal and adult NIRS sensors. Pediatr Res 2023; 94:1810-1816. [PMID: 37391490 DOI: 10.1038/s41390-023-02705-z] [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: 08/03/2022] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The majority of neonatal NIRS literature recommends target ranges for cerebral saturation (rScO2) based on data using adult sensors. Neonatal sensors are now commonly used in the neonatal intensive care unit (NICU). However, there is limited clinical data correlating these two measurements of cerebral oxygenation. METHODS A prospective observational study was conducted in two NICUs between November 2019 and May 2021. An adult sensor was placed on infants undergoing routine cerebral NIRS monitoring with a neonatal sensor. Time-synchronized rScO2 measurements from both sensors, heart rate, and systemic oxygen saturation values were collected over 6 h under varying clinical conditions and compared. RESULTS Time-series data from 44 infants demonstrated higher rScO2 measurements with neonatal sensors than with adult sensors; however, the magnitude of the difference varied depending on the absolute value of rScO2 (Adult = 0.63 × Neonatal + 18.2). While there was an approximately 10% difference when adult sensors read 85%, readings were similar when adult sensors read 55%. CONCLUSION rScO2 measured by neonatal sensors is typically higher than measured by adult sensors, but the difference is not fixed and is less at the threshold indicative of cerebral hypoxia. Assuming fixed differences between adult and neonatal sensors may lead to overdiagnosis of cerebral hypoxia. IMPACT In comparison to adult sensors, neonatal sensors rScO2 readings are consistently higher, but the magnitude of the difference varies depending on the absolute value of rScO2. Marked variability during high and low rScO2 readings was noted, with approximately 10% difference when adult sensors read 85%, but nearly similar (58.8%) readings when adult sensors read 55%. Estimating fixed differences of approximately 10% between adult and neonatal probes may lead to an inaccurate diagnosis of cerebral hypoxia and result in subsequent unnecessary interventions.
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Affiliation(s)
- Gabriel F T Variane
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil.
| | - Alex Dahlen
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Caroline Y Noh
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Jingying Zeng
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elisabeth S Yan
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Julianna S Kaneko
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Marcella S Gouveia
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Krisa P Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
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6
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Harvey-Jones K, Lange F, Verma V, Bale G, Meehan C, Avdic-Belltheus A, Hristova M, Sokolska M, Torrealdea F, Golay X, Parfentyeva V, Durduran T, Bainbridge A, Tachtsidis I, Robertson NJ, Mitra S. Early assessment of injury with optical markers in a piglet model of neonatal encephalopathy. Pediatr Res 2023; 94:1675-1683. [PMID: 37308684 PMCID: PMC10624614 DOI: 10.1038/s41390-023-02679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Opportunities for adjunct therapies with cooling in neonatal encephalopathy are imminent; however, robust biomarkers of early assessment are lacking. Using an optical platform of broadband near-infrared spectroscopy and diffuse correlation spectroscopy to directly measure mitochondrial metabolism (oxCCO), oxygenation (HbD), cerebral blood flow (CBF), we hypothesised optical indices early (1-h post insult) after hypoxia-ischaemia (HI) predicts insult severity and outcome. METHODS Nineteen newborn large white piglets underwent continuous neuromonitoring as controls or following moderate or severe HI. Optical indices were expressed as mean semblance (phase difference) and coherence (spectral similarity) between signals using wavelet analysis. Outcome markers included the lactate/N-acetyl aspartate (Lac/NAA) ratio at 6 h on proton MRS and TUNEL cell count. RESULTS CBF-HbD semblance (cerebrovascular dysfunction) correlated with BGT and white matter (WM) Lac/NAA (r2 = 0.46, p = 0.004, r2 = 0.45, p = 0.004, respectively), TUNEL cell count (r2 = 0.34, p = 0.02) and predicted both initial insult (r2 = 0.62, p = 0.002) and outcome group (r2 = 0.65 p = 0.003). oxCCO-HbD semblance (cerebral metabolic dysfunction) correlated with BGT and WM Lac/NAA (r2 = 0.34, p = 0.01 and r2 = 0.46, p = 0.002, respectively) and differentiated between outcome groups (r2 = 0.43, p = 0.01). CONCLUSION Optical markers of both cerebral metabolic and vascular dysfunction 1 h after HI predicted injury severity and subsequent outcome in a pre-clinical model. IMPACT This study highlights the possibility of using non-invasive optical biomarkers for early assessment of injury severity following neonatal encephalopathy, relating to the outcome. Continuous cot-side monitoring of these optical markers can be useful for disease stratification in the clinical population and for identifying infants who might benefit from future adjunct neuroprotective therapies beyond cooling.
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Affiliation(s)
| | - Frederic Lange
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vinita Verma
- Institute for Women's Health, University College London, London, UK
| | - Gemma Bale
- Department of Engineering and Department of Physics, University of Cambridge, Cambridge, UK
| | | | | | - Mariya Hristova
- Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Francisco Torrealdea
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Xavier Golay
- Institute of Neurology, University College London, London, UK
| | - Veronika Parfentyeva
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Alan Bainbridge
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, UK.
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7
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Sutin J, Vyas R, Feldman HA, Ferradal S, Hsiao CH, Zampolli L, Pierce LJ, Nelson CA, Morton SU, Hay S, El-Dib M, Soul JS, Lin PY, Grant PE. Association of cerebral metabolic rate following therapeutic hypothermia with 18-month neurodevelopmental outcomes after neonatal hypoxic ischemic encephalopathy. EBioMedicine 2023; 94:104673. [PMID: 37392599 PMCID: PMC10338207 DOI: 10.1016/j.ebiom.2023.104673] [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: 01/12/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Therapeutic hypothermia (TH) is standard of care for moderate to severe neonatal hypoxic ischemic encephalopathy (HIE) but many survivors still suffer lifelong disabilities and benefits of TH for mild HIE are under active debate. Development of objective diagnostics, with sensitivity to mild HIE, are needed to select, guide, and assess response to treatment. The objective of this study was to determine if cerebral oxygen metabolism (CMRO2) in the days after TH is associated with 18-month neurodevelopmental outcomes as the first step in evaluating CMRO2's potential as a diagnostic for HIE. Secondary objectives were to compare associations with clinical exams and characterise the relationship between CMRO2 and temperature during TH. METHODS This was a prospective, multicentre, observational, cohort study of neonates clinically diagnosed with HIE and treated with TH recruited from the tertiary neonatal intensive care units (NICUs) of Boston Children's Hospital, Brigham and Women's Hospital, and Beth Israel Deaconess Medical Center between December 2015 and October 2019 with follow-up to 18 months. In total, 329 neonates ≥34 weeks gestational age admitted with perinatal asphyxia and suspected HIE were identified. 179 were approached, 103 enrolled, 73 received TH, and 64 were included. CMRO2 was measured at the NICU bedside by frequency-domain near-infrared and diffuse correlation spectroscopies (FDNIRS-DCS) during the late phases of hypothermia (C), rewarming (RW) and after return to normothermia (NT). Additional variables were body temperature and clinical neonatal encephalopathy (NE) scores, as well as findings from magnetic resonance imaging (MRI) and spectroscopy (MRS). Primary outcome was the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 18 months, normed (SD) to 100 (15). FINDINGS Data quality for 58 neonates was sufficient for analysis. CMRO2 changed by 14.4% per °C (95% CI, 14.2-14.6) relative to its baseline at NT while cerebral tissue oxygen extraction fraction (cFTOE) changed by only 2.2% per °C (95% CI, 2.1-2.4) for net changes from C to NT of 91% and 8%, respectively. Follow-up data for 2 were incomplete, 33 declined and 1 died, leaving 22 participants (mean [SD] postnatal age, 19.1 [1.2] month; 11 female) with mild to moderate HIE (median [IQR] NE score, 4 [3-6]) and 21 (95%) with BSID-III scores >85 at 18 months. CMRO2 at NT was positively associated with cognitive and motor composite scores (β (SE) = 4.49 (1.55) and 2.77 (1.00) BSID-III points per 10-10 moL/dl × mm2/s, P = 0.009 and P = 0.01 respectively; linear regression); none of the other measures were associated with the neurodevelopmental outcomes. INTERPRETATION Point of care measures of CMRO2 in the NICU during C and RW showed dramatic changes and potential to assess individual response to TH. CMRO2 following TH outperformed conventional clinical evaluations (NE score, cFTOE, and MRI/MRS) at predicting cognitive and motor outcomes at 18 months for mild to moderate HIE, providing a promising objective, physiologically-based diagnostic for HIE. FUNDING This clinical study was funded by an NIH grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, United States (R01HD076258).
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Affiliation(s)
- Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Rutvi Vyas
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Henry A Feldman
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Department of Pediatrics, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Silvina Ferradal
- Department of Intelligent Systems Engineering, Indiana University Bloomington, 107 S Indiana Ave., Bloomington, IN 47405, USA
| | - Chuan-Heng Hsiao
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Lucca Zampolli
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Lara J Pierce
- Department of Psychology, York University, 198 York Blvd., North York, ON M3J 2S5, Canada
| | - Charles A Nelson
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Sarah U Morton
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Susanne Hay
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| | - Mohamed El-Dib
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Janet S Soul
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Department of Neurology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Patricia E Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
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8
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Chock VY, Van Meurs KP. Editorial: Advances in the use of neuromonitoring in newborns. Front Pediatr 2023; 11:1215991. [PMID: 37284291 PMCID: PMC10240396 DOI: 10.3389/fped.2023.1215991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
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9
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Tierradentro-García LO, Saade-Lemus S, Freeman C, Kirschen M, Huang H, Vossough A, Hwang M. Cerebral Blood Flow of the Neonatal Brain after Hypoxic-Ischemic Injury. Am J Perinatol 2023; 40:475-488. [PMID: 34225373 PMCID: PMC8974293 DOI: 10.1055/s-0041-1731278] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes. STUDY DESIGN The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE. CONCLUSION The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions. KEY POINTS · Hypoxic-ischemic injury in infants can result in adverse long-term neurologic sequelae.. · Cerebral blood flow is a useful biomarker in neonatal hypoxic-ischemic injury.. · Imaging modality, variables affecting cerebral blood flow, and patient characteristics affect cerebral blood flow assessment..
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Affiliation(s)
| | - Sandra Saade-Lemus
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, Brigham and Women’s Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colbey Freeman
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hao Huang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Martini S, Thewissen L, Austin T, da Costa CS, de Boode WP, Dempsey E, Kooi E, Pellicer A, Rhee CJ, Riera J, Wolf M, Wong F. Near-infrared spectroscopy monitoring of neonatal cerebrovascular reactivity: where are we now? Pediatr Res 2023:10.1038/s41390-023-02574-6. [PMID: 36997690 DOI: 10.1038/s41390-023-02574-6] [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: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/19/2023]
Abstract
Cerebrovascular reactivity defines the ability of the cerebral vasculature to regulate its resistance in response to both local and systemic factors to ensure an adequate cerebral blood flow to meet the metabolic demands of the brain. The increasing adoption of near-infrared spectroscopy (NIRS) for non-invasive monitoring of cerebral oxygenation and perfusion allowed investigation of the mechanisms underlying cerebrovascular reactivity in the neonatal population, confirming important associations with pathological conditions including the development of brain injury and adverse neurodevelopmental outcomes. However, the current literature on neonatal cerebrovascular reactivity is mainly still based on small, observational studies and is characterised by methodological heterogeneity; this has hindered the routine application of NIRS-based monitoring of cerebrovascular reactivity to identify infants most at risk of brain injury. This review aims (1) to provide an updated review on neonatal cerebrovascular reactivity, assessed using NIRS; (2) to identify critical points that need to be addressed with targeted research; and (3) to propose feasibility trials in order to fill the current knowledge gaps and to possibly develop a preventive or curative approach for preterm brain injury. IMPACT: NIRS monitoring has been largely applied in neonatal research to assess cerebrovascular reactivity in response to blood pressure, PaCO2 and other biochemical or metabolic factors, providing novel insights into the pathophysiological mechanisms underlying cerebral blood flow regulation. Despite these insights, the current literature shows important pitfalls that would benefit to be addressed in a series of targeted trials, proposed in the present review, in order to translate the assessment of cerebrovascular reactivity into routine monitoring in neonatal clinical practice.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOU S. Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | | | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Centre, University College Cork, Cork, Ireland
| | - Elisabeth Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Christopher J Rhee
- Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Joan Riera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Center for Biomedical Technology, Technical University, Madrid, Spain
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Flora Wong
- Monash Newborn, Monash Children's Hospital, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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11
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Hermans T, Carkeek K, Dereymaeker A, Jansen K, Naulaers G, Van Huffel S, De Vos M. Partial wavelet coherence as a robust method for assessment of neurovascular coupling in neonates with hypoxic ischemic encephalopathy. Sci Rep 2023; 13:457. [PMID: 36627381 PMCID: PMC9832127 DOI: 10.1038/s41598-022-27275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
In neonates with hypoxic ischemic encephalopathy, the computation of wavelet coherence between electroencephalogram (EEG) power and regional cerebral oxygen saturation (rSO2) is a promising method for the assessment of neurovascular coupling (NVC), which in turn is a promising marker for brain injury. However, instabilities in arterial oxygen saturation (SpO2) limit the robustness of previously proposed methods. Therefore, we propose the use of partial wavelet coherence, which can eliminate the influence of SpO2. Furthermore, we study the added value of the novel NVC biomarkers for identification of brain injury compared to traditional EEG and NIRS biomarkers. 18 neonates with HIE were monitored for 72 h and classified into three groups based on short-term MRI outcome. Partial wavelet coherence was used to quantify the coupling between C3-C4 EEG bandpower (2-16 Hz) and rSO2, eliminating confounding effects of SpO2. NVC was defined as the amount of significant coherence in a frequency range of 0.25-1 mHz. Partial wavelet coherence successfully removed confounding influences of SpO2 when studying the coupling between EEG and rSO2. Decreased NVC was related to worse MRI outcome. Furthermore, the combination of NVC and EEG spectral edge frequency (SEF) improved the identification of neonates with mild vs moderate and severe MRI outcome compared to using EEG SEF alone. Partial wavelet coherence is an effective method for removing confounding effects of SpO2, improving the robustness of automated assessment of NVC in long-term EEG-NIRS recordings. The obtained NVC biomarkers are more sensitive to MRI outcome than traditional rSO2 biomarkers and provide complementary information to EEG biomarkers.
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Affiliation(s)
- Tim Hermans
- Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium.
| | - Katherine Carkeek
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium ,grid.48769.340000 0004 0461 6320Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Anneleen Dereymaeker
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium
| | - Katrien Jansen
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Child Neurology, UZ Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- grid.5596.f0000 0001 0668 7884Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- grid.5596.f0000 0001 0668 7884Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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12
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Variane GFT, Pietrobom RFR, Noh CY, Van Meurs KP, Chock VY. Newer indications for neuromonitoring in critically ill neonates. Front Pediatr 2023; 11:1111347. [PMID: 37187586 PMCID: PMC10175818 DOI: 10.3389/fped.2023.1111347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Continuous neuromonitoring in the neonatal intensive care unit allows for bedside assessment of brain oxygenation and perfusion as well as cerebral function and seizure identification. Near-infrared spectroscopy (NIRS) reflects the balance between oxygen delivery and consumption, and use of multisite monitoring of regional oxygenation provides organ-specific assessment of perfusion. With understanding of the underlying principles of NIRS as well as the physiologic factors which impact oxygenation and perfusion of the brain, kidneys and bowel, changes in neonatal physiology can be more easily recognized by bedside providers, allowing for appropriate, targeted interventions. Amplitude-integrated electroencephalography (aEEG) allows continuous bedside evaluation of cerebral background activity patterns indicative of the level of cerebral function as well as identification of seizure activity. Normal background patterns are reassuring while abnormal background patterns indicate abnormal brain function. Combining brain monitoring information together with continuous vital sign monitoring (blood pressure, pulse oximetry, heart rate and temperature) at the bedside may be described as multi-modality monitoring and facilitates understanding of physiology. We describe 10 cases in critically ill neonates that demonstrate how comprehensive multimodal monitoring provided greater recognition of the hemodynamic status and its impact on cerebral oxygenation and cerebral function thereby informing treatment decisions. We anticipate that there are numerous other uses of NIRS as well as NIRS in conjunction with aEEG which are yet to be reported.
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Affiliation(s)
- Gabriel F. T. Variane
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Correspondence: Gabriel Variane
| | - Rafaela F. R. Pietrobom
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Caroline Y. Noh
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Valerie Y. Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
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Chock VY, Rao A, Van Meurs KP. Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy. Front Pediatr 2023; 11:1138062. [PMID: 36969281 PMCID: PMC10030520 DOI: 10.3389/fped.2023.1138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
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Bailey SM, Prakash SS, Verma S, Desai P, Kazmi S, Mally PV. Near-infrared spectroscopy in the medical management of infants. Curr Probl Pediatr Adolesc Health Care 2022; 52:101291. [PMID: 36404215 DOI: 10.1016/j.cppeds.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016.
| | - Shrawani Soorneela Prakash
- Division of Neonatology, Department of Pediatrics, NYCHHC/Lincoln Medical and Mental Health Center, Bronx, NY 10451
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Purnahamsi Desai
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Sadaf Kazmi
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
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15
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Dhillon SK, Gunn ER, Lear BA, King VJ, Lear CA, Wassink G, Davidson JO, Bennet L, Gunn AJ. Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia. Front Pediatr 2022; 10:925951. [PMID: 35903161 PMCID: PMC9314655 DOI: 10.3389/fped.2022.925951] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Perinatal hypoxia-ischemia (HI) is still a significant contributor to mortality and adverse neurodevelopmental outcomes in term and preterm infants. HI brain injury evolves over hours to days, and involves complex interactions between the endogenous protective and pathological processes. Understanding the timing of evolution of injury is vital to guide treatment. Post-HI recovery is associated with a typical neurophysiological profile, with stereotypic changes in cerebral perfusion and oxygenation. After the initial recovery, there is a delayed, prolonged reduction in cerebral perfusion related to metabolic suppression, followed by secondary deterioration with hyperperfusion and increased cerebral oxygenation, associated with altered neurovascular coupling and impaired cerebral autoregulation. These changes in cerebral perfusion are associated with the stages of evolution of injury and injury severity. Further, iatrogenic factors can also affect cerebral oxygenation during the early period of deranged metabolism, and improving clinical management may improve neuroprotection. We will review recent evidence that changes in cerebral oxygenation and metabolism after HI may be useful biomarkers of prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alistair J. Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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16
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Arriaga-Redondo M, Bravo DB, Del Hoyo AA, Arrondo AP, Martín YR, Sánchez-Luna M. Prognostic value of somatosensory-evoked potentials in the newborn with hypoxic-ischemic encephalopathy after the introduction of therapeutic hypothermia. Eur J Pediatr 2022; 181:1609-1618. [PMID: 35066625 DOI: 10.1007/s00431-021-04336-0] [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: 08/12/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED To establish the ability of somatosensory-evoked potentials (SEPs) to detect neurological damage in neonatal patients with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Retrospective study including 84 neonates ≥ 36 weeks of gestational age with HIE and TH with SEPs performed in the first 14 days of life. SEPs from the median nerve were performed after completion of TH. Either unilateral or bilateral absence of N20, or unilateral or bilateral latency ≥ 36 ms, was considered pathological. All newborns underwent a cerebral resonance imaging (MRI) at between days 7 and 14 of life and a neurodevelopmental evaluation using the Brunet-Lezine test at two years of age; a global Brunet-Lezine test score < 70 was considered unfavorable. The risk of moderate-to-severe alteration on basal ganglia-thalamic (BGT) and/or white matter areas on MRI for pathological SEPs was as follows: odds ratio 95% IC: 23.1 (6.9-76.9), sensitivity 78.6%, specificity 86.3%, positive predictive value 75.9%, and negative predictive value 88%. The BGT and internal capsule were the areas with the greatest risk of lesion with an altered SEPs: odds ratio 95% IC 93.1 (11.1-777.8). The risk of neurodevelopmental impairment for pathological SEPs was odds ratio 95% IC: 38.5 (4.4-335.3), sensitivity 91.7%, specificity 77.8% positive predictive value 52.4%, and negative predictive value 97.2%. CONCLUSION The present study demonstrates the good predictive capacity of SEPs performed in the first two weeks of life in newborns with HIE and TH to detect an increased risk of neuroimaging lesions and neurodevelopmental impairment at two years of age. WHAT IS KNOWN • Bilateral absence of the N20 cortical component of somatosensory evoked potentials has been associated with poor neurological outcome in neonates with hypoxic-ischemic encephalopathy. WHAT IS NEW • This work confirms the predictive capacity of SEPs by adding two important aspects: the value of latency when interpreting SEPs results and the absence of effect of the hypothermia method used on the results of SEPs.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain.
| | - Dorotea Blanco Bravo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
| | | | - Ana Polo Arrondo
- Neurophysiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
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17
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Variane GFT, Camargo JPV, Rodrigues DP, Magalhães M, Mimica MJ. Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care. Front Pediatr 2022; 9:755144. [PMID: 35402367 PMCID: PMC8984110 DOI: 10.3389/fped.2021.755144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Division of Neonatology, Grupo Santa Joana, São Paulo, Brazil
| | - João Paulo Vasques Camargo
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Data Science Department, OPD Team, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Department of Pathology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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18
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Variane GFT, Magalhães M, Pietrobom RFR, Netto A, Rodrigues DP, Gasperini R, Sant’Anna GM. Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil. PLoS One 2022; 17:e0262581. [PMID: 35020756 PMCID: PMC8754327 DOI: 10.1371/journal.pone.0262581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Management of high-risk newborns should involve the use of standardized protocols and training, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG, Near Infrared Spectroscopy, and neuroimaging. Brazil is a large country with disparities in health care assessment and some neonatal intensive care units (NICUs) are not well structured with trained personnel able to provide adequate neurocritical care. To reduce this existing gap, an advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) Guidelines was developed and implemented in a group of Brazilian NICUs.
Methods
A prospective, multicenter, and observational study will be conducted in all 20 Brazilian NICUs using the PBSF Guidelines as standard-of-care. All infants treated accordingly to the guidelines during Dec 2021 to Nov 2024 will be eligible. Ethical approval was obtained from participating centers. The primary objective is to describe adherence to the PBSF Guidelines and clinical outcomes, by center and over a 3-year period. Adherence will be measured by quantification of neuromonitoring, neuroimaging exams, sub-specialties consultation, and clinical case discussions and videoconference meetings. Clinical outcomes of interest are detection of seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, length of hospital stay, and referral of patients to specialized follow-up.
Discussion
The study will provide evaluation of PBSF Guidelines adherence and its impact on clinical outcomes. Thus, data from this large prospective, multicenter, and observational study will help determine whether neonatal neurocritical care via telemedicine can be effective. Ultimately, it may offer the necessary framework for larger scale implementation and development of research projects using remote neuromonitoring.
Trial registration
NCT03786497, Registered 26 December 2018, https://www.clinicaltrials.gov/ct2/show/NCT03786497?term=protecting+brains+and+saving+futures&draw=2&rank=1.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Neonatal Division, Grupo Santa Joana, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- * E-mail:
| | - Maurício Magalhães
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Neonatal Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Rafaela Fabri Rodrigues Pietrobom
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Alexandre Netto
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Gasperini
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Neonatal Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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19
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Garvey AA, Pavel AM, Murray DM, Boylan GB, Dempsey EM. Does Early Cerebral Near-Infrared Spectroscopy Monitoring Predict Outcome in Neonates with Hypoxic Ischaemic Encephalopathy? A Systematic Review of Diagnostic Test Accuracy. Neonatology 2022; 119:1-9. [PMID: 34818237 DOI: 10.1159/000518687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypoxic ischaemic encephalopathy (HIE) remains one of the top 10 contributors to the global burden of disease. Early objective biomarkers are required. Near-infrared spectroscopy (NIRS) may provide a valuable insight into cerebral perfusion and metabolism. We aimed to determine whether early NIRS monitoring (<6 h of age) can predict outcome as defined by grade of encephalopathy, brain MRI findings, and/or neurodevelopmental outcome at 1-2 years in infants with HIE. METHODS We searched PubMed, Scopus, Web of Science, Embase, and The Cochrane Library databases (July 2019). Studies of infants born ≥36+0 weeks gestation with HIE who had NIRS recording commenced before 6 h of life were included. We planned to provide a narrative of all the studies included, and if similar clinically and methodologically, the results would be pooled in a meta-analysis to determine test accuracy. RESULTS Seven studies were included with a combined total of 161 infants. Only 1 study included infants with mild HIE. A range of different oximeters and probes were utilized with varying outcome measures making comparison difficult. Although some studies showed a trend towards higher cSO2 values before 6 h in infants with adverse neurodevelopmental outcomes, in the majority, this was not significant until beyond 24 h of life. CONCLUSION Very little data currently exists to assess the use of early NIRS to predict outcome in infants with HIE. Further studies using a standardized approach are required before NIRS can be evaluated as a potential objective assessment tool for early identification of at-risk infants.
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Affiliation(s)
- Aisling A Garvey
- INFANT Research Centre, Cork, Ireland, .,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland,
| | - Andreea M Pavel
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- INFANT Research Centre, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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20
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Das Y, Leon RL, Liu H, Kota S, Liu Y, Wang X, Zhang R, Chalak LF. Wavelet-based neurovascular coupling can predict brain abnormalities in neonatal encephalopathy. Neuroimage Clin 2021; 32:102856. [PMID: 34715603 PMCID: PMC8564674 DOI: 10.1016/j.nicl.2021.102856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in neonates, but quantitative methods to predict outcomes early in their course of illness remain elusive. Real-time physiologic biomarkers of neurologic injury are needed in order to predict which neonates will benefit from therapies. Neurovascular coupling (NVC) describes the correlation of neural activity with cerebral blood flow, and the degree of impairment could predict those at risk for poor outcomes. OBJECTIVE To determine if neurovascular coupling (NVC) calculated in the first 24-hours of life based on wavelet transform coherence analysis (WTC) of near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG) can predict abnormal brain MRI in neonatal HIE. METHODS WTC analysis was performed between dynamic oscillations of simultaneously recorded aEEG and cerebral tissue oxygen saturation (SctO2) signals for the first 24 h after birth. The squared cross-wavelet coherence, R2, of the time-frequency domain described by the WTC, is a localized correlation coefficient (ranging between 0 and 1) between these two signals in the time-frequency domain. Statistical analysis was based on Monte Carlo simulation with a 95% confidence interval to identify the time-frequency areas from the WTC scalograms. Brain MRI was performed on all neonates and classified as normal or abnormal based on an accepted classification system for HIE. Wavelet metrics of % significant SctO2-aEEG coherence was compared between the normal and abnormal MRI groups. RESULT This prospective study recruited a total of 36 neonates with HIE. A total of 10 had an abnormal brain MRI while 26 had normal MRI. The analysis showed that the SctO2-aEEG coherence between the group with normal and abnormal MRI were significantly different (p = 0.0007) in a very low-frequency (VLF) range of 0.06-0.2 mHz. Using receiver operating characteristic (ROC) curves, the use of WTC-analysis of NVC had an area under the curve (AUC) of 0.808, and with a cutoff of 10% NVC. Sensitivity was 69%, specificity was 90%, positive predictive value (PPV) was 94%, and negative predictive value (NPV) was 52% for predicting brain injury on MRI. This was superior to the clinical Total Sarnat score (TSS) where AUC was 0.442 with sensitivity 61.5%, specificity 30%, PPV 75%, and NPV 31%. CONCLUSION NVC is a promising neurophysiological biomarker in neonates with HIE, and in our prospective cohort was superior to the clinical Total Sarnat score for prediction of abnormal brain MRI.
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Affiliation(s)
- Yudhajit Das
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Rachel L Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Srinivas Kota
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yulun Liu
- Department of Population and Datasciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xinlong Wang
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Rong Zhang
- Departments of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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21
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Costa FG, Hakimi N, Van Bel F. Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns. Int J Mol Sci 2021; 22:ijms22105389. [PMID: 34065460 PMCID: PMC8160954 DOI: 10.3390/ijms22105389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 02/01/2023] Open
Abstract
Abnormal patterns of cerebral perfusion/oxygenation are associated with neuronal damage. In preterm neonates, hypoxemia, hypo-/hypercapnia and lack of cerebral autoregulation are related to peri-intraventricular hemorrhages and white matter injury. Reperfusion damage after perinatal hypoxic ischemia in term neonates seems related with cerebral hyperoxygenation. Since biological tissue is transparent for near infrared (NIR) light, NIR-spectroscopy (NIRS) is a noninvasive bedside tool to monitor brain oxygenation and perfusion. This review focuses on early assessment and guiding abnormal cerebral oxygenation/perfusion patterns to possibly reduce brain injury. In term infants, early patterns of brain oxygenation helps to decide whether or not therapy (hypothermia) and add-on therapies should be considered. Further NIRS-related technical advances such as the use of (functional) NIRS allowing simultaneous estimation and integrating of heart rate, respiration rate and monitoring cerebral autoregulation will be discussed.
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Affiliation(s)
- Filipe Gonçalves Costa
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
| | - Naser Hakimi
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
- Artinis Medical Systems, B.V., 6662 PW Elst, The Netherlands
| | - Frank Van Bel
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
- Correspondence: ; Tel.: +31-887-554-545
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22
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Das Y, Wang X, Kota S, Zhang R, Liu H, Chalak LF. Neurovascular coupling (NVC) in newborns using processed EEG versus amplitude-EEG. Sci Rep 2021; 11:9426. [PMID: 33941837 PMCID: PMC8093202 DOI: 10.1038/s41598-021-88849-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
There is a critical need for development of real time physiological biomarkers for birth asphyxia that constitutes a major global public health burden. Our recent study (Scientific Reports, V10:9183, 2020) established a novel non-invasive neurovascular coupling (NVC) assessment in newborns using dynamic wavelet transform coherence (WTC) analysis irrespective of different aEEG algorithms. As an extended study, the current paper examines whether the variability in processed EEG and amplitude-EEG (aEEG) outputs would impact the determination of NVC in newborns with encephalopathy. Concurrent processed EEG tracings and regional near infrared spectroscopy (NIRS)-based cerebral tissue oxygen saturation (SctO2) readings during a period of twenty hours in their first day of life were selected and processed in this study. After bandpass-filtered in 2–15 Hz, rectified, and down-sampled at 0.21 Hz, the processed EEG tracings along with NIRS-SctO2 (0.21 Hz) were used to perform WTC analysis, followed by comparison of WTC-metrics between SctO2-processed EEG coherence and SctO2-aEEG coherence using Bland–Altman statistics. Our results demonstrated high and significant correlation (R2 = 0.96, p < 0.001) between NVC assessments by SctO2-processed EEG and SctO2-aEEG coherence, confirming that band-passed, rectified, and down-sampled processed EEG, or aEEG, can be paired with NIRS-SctO2 to assess NVC in newborns with encephalopathy. Findings indicate the feasibility of a simpler approach to NVC in neonates by using directly processed EEG, instead of aEEG.
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Affiliation(s)
- Yudhajit Das
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Xinlong Wang
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Srinivas Kota
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Departments of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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23
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Pereira CO, Dias A, Nunes Vicente I, Pinto JT, Marques C, Dinis A, Pinto C, Carvalho L. Prognostic value of near-infrared spectroscopy in hypoxic-ischaemic encephalopathy. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy. J Perinatol 2021; 41:269-277. [PMID: 33462339 DOI: 10.1038/s41372-020-00910-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/16/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the association of cerebral oxygen saturation (CrSO2) collected by near infrared spectroscopy (NIRS) during therapeutic hypothermia (TH) and rewarming with evidence of brain injury on post-rewarming MRI. STUDY DESIGN This retrospective cohort study included 49 infants, who received TH for mild to severe neonatal encephalopathy. Of those, 26 presented with brain injury assessed by a novel MRI grading system, whereas 23 had normal MRI scans. RESULTS CrSO2 increased significantly from the first to the second day of TH in infants with brain injury, whereas it remained stable in patients with normal MRI. Increasing mean CrSO2 values during rewarming was associated with brain injury (aOR 1.14; 95% CI 1.00-1.28), specifically with gray matter (GM) injury (aOR 1.23; 95% CI 1.02-1.49). The area under the ROC curve showed an excellent discrimination for GM involvement. CONCLUSION Clinically applied NIRS during TH and rewarming can assist in identifying the risk for brain injury.
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25
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Harvey-Jones K, Lange F, Tachtsidis I, Robertson NJ, Mitra S. Role of Optical Neuromonitoring in Neonatal Encephalopathy-Current State and Recent Advances. Front Pediatr 2021; 9:653676. [PMID: 33898363 PMCID: PMC8062863 DOI: 10.3389/fped.2021.653676] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Neonatal encephalopathy (NE) in term and near-term infants is a significant global health problem; the worldwide burden of disease remains high despite the introduction of therapeutic hypothermia. Assessment of injury severity and effective management in the neonatal intensive care unit (NICU) relies on multiple monitoring modalities from systemic to brain-specific. Current neuromonitoring tools provide information utilized for seizure management, injury stratification, and prognostication, whilst systemic monitoring ensures multi-organ dysfunction is recognized early and supported wherever needed. The neuromonitoring technologies currently used in NE however, have limitations in either their availability during the active treatment window or their reliability to prognosticate and stratify injury confidently in the early period following insult. There is therefore a real need for a neuromonitoring tool that provides cot side, early and continuous monitoring of brain health which can reliably stratify injury severity, monitor response to current and emerging treatments, and prognosticate outcome. The clinical use of near-infrared spectroscopy (NIRS) technology has increased in recent years. Research studies within this population have also increased, alongside the development of both instrumentation and signal processing techniques. Increasing use of commercially available cerebral oximeters in the NICU, and the introduction of advanced optical measurements using broadband NIRS (BNIRS), frequency domain NIRS (FDNIRS), and diffuse correlation spectroscopy (DCS) have widened the scope by allowing the direct monitoring of oxygen metabolism and cerebral blood flow, both key to understanding pathophysiological changes and predicting outcome in NE. This review discusses the role of optical neuromonitoring in NE and why this modality may provide the next significant piece of the puzzle toward understanding the real time state of the injured newborn brain.
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Affiliation(s)
- Kelly Harvey-Jones
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Frederic Lange
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nicola J Robertson
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom.,Edinburgh Neuroscience & Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Subhabrata Mitra
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom
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26
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Bale G, Mitra S, Tachtsidis I. Metabolic brain measurements in the newborn: Advances in optical technologies. Physiol Rep 2020; 8:e14548. [PMID: 32889790 PMCID: PMC7507543 DOI: 10.14814/phy2.14548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023] Open
Abstract
Neonatal monitoring in neonatal intensive care is pushing the technological boundaries of newborn brain monitoring in order to improve patient outcome. There is an urgent need of a cot side, real time monitoring for assessment of brain injury severity and neurodevelopmental outcome, in particular for term newborn infants with hypoxic-ischemic brain injury. This topical review discusses why brain tissue metabolic monitoring is important in this group of infants and introduces the currently used neuromonitoring techniques for metabolic monitoring in the neonatal intensive care unit (NICU). New optical techniques that can monitor changes in brain metabolism together with brain hemodynamics at the cot side are presented. Early studies from these emerging technologies have demonstrated their potential to deliver continuous information regarding cerebral physiological changes in sick newborn infants in real time. The promises of these new tools as well as their potential limitations are discussed.
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Affiliation(s)
- Gemma Bale
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Subhabrata Mitra
- Neonatology, EGA Institute for Women's HealthUniversity College LondonLondonUK
| | - Ilias Tachtsidis
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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27
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Mitra S, Bale G, Meek J, Tachtsidis I, Robertson NJ. Cerebral Near Infrared Spectroscopy Monitoring in Term Infants With Hypoxic Ischemic Encephalopathy-A Systematic Review. Front Neurol 2020; 11:393. [PMID: 32536901 PMCID: PMC7267214 DOI: 10.3389/fneur.2020.00393] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time. Objective: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE. Search Methods: A systematic search was performed in Ovid EMBASE and Medline database from inception to November 2019. The search combined three broad categories: measurement (NIRS monitoring), disease condition [hypoxic ischemic encephalopathy (HIE)] and subject category (newborn infants) using a stepwise approach as per PRISMA guidance. Selection Criteria: Only human studies published in English were included. Data Collection and Analysis: Two authors independently selected, assessed the quality, and extracted data from the studies for this review. Results: Forty-seven studies on term and near-term infants following HIE were identified. Most studies measured multi-distance NIRS based cerebral tissue saturation using monitors that are referred to as cerebral oximeters. Thirty-nine studies were published since 2010; eight studies were published before this. Fifteen studies reviewed the neurodevelopmental outcome in relation to NIRS findings. No randomized study was identified. Conclusion: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions.
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Affiliation(s)
- Subhabrata Mitra
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Gemma Bale
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Judith Meek
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nicola J. Robertson
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
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28
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Oliveira Pereira C, Dias A, Nunes Vicente I, Pinto JT, Marques C, Dinis A, Pinto C, Carvalho L. [Prognostic value of near-infrared spectroscopy in hypoxic-ischaemic encephalopathy]. An Pediatr (Barc) 2020; 94:136-143. [PMID: 32387191 DOI: 10.1016/j.anpedi.2020.01.022] [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: 09/01/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Despite treatment with hypothermia, 40% of newborns with hypoxic-ischaemic encephalopathy die or suffer moderate to severe disability. Near-infrared spectroscopy (NIRS) could be a useful, non-invasive tool to establish the prognosis. OBJECTIVES To evaluate the prognostic value of NIRS in predicting neurodevelopmental outcomes at 18 to 36 months in newborns with hypoxic-ischaemic encephalopathy, and to establish the time points and cut-off values of regional cerebral oxygen saturation that exhibit the strongest correlation to these outcomes. PATIENTS AND METHODS The study included all term newborns with hypoxic-ischaemic encephalopathy managed with hypothermia and NIRS between 2013 and 2016. We established 3 outcome categories: normal neurodevelopment, moderate disability and severe disability. RESULTS The sample comprised 28 newborns (median gestational age, 39 weeks; median birth weight, 3195g). The median regional cerebral oxygen saturation increased from 65% to 85% at 48hours post birth. Neurodevelopmental outcomes were normal in 28.6%, while 35.7% developed moderate disability and 35.7% severe disability; 3 patients died. We found a statistically significant difference between groups at 48hours (P=.005) and after hypothermia (P=.03), with higher values in patients with disability. When we compared patients in the severe disability group with the other groups, we found a statistically significant area under the ROC curve at 48hours of 0.872 (P=.001) applying a regional cerebral oxygen saturation cutoff of 83.5%. After hypothermia, regional cerebral oxygen saturation values below 66.0% (AUC, 0.794; P=.017) predicted normal development, while values above 82% (AUC, 0.881; P=.001) predicted severe disability. CONCLUSIONS NIRS seems to be a valuable tool to predict neurodevelopmental outcomes in patients with hypoxic-ischaemic encephalopathy, even after hypothermia, with higher cerebral oxygen saturation values in patients with disability.
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Affiliation(s)
- Catarina Oliveira Pereira
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Andrea Dias
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Nunes Vicente
- Centro de Desarrollo Infantil, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Teresa Pinto
- Servicio de Radiología, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Marques
- Centro de Desarrollo Infantil, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Alexandra Dinis
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Pinto
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Leonor Carvalho
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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29
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Othman MH, Bhattacharya M, Møller K, Kjeldsen S, Grand J, Kjaergaard J, Dutta A, Kondziella D. Resting-State NIRS-EEG in Unresponsive Patients with Acute Brain Injury: A Proof-of-Concept Study. Neurocrit Care 2020; 34:31-44. [PMID: 32333214 DOI: 10.1007/s12028-020-00971-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neurovascular-based imaging techniques such as functional MRI (fMRI) may reveal signs of consciousness in clinically unresponsive patients but are often subject to logistical challenges in the intensive care unit (ICU). Near-infrared spectroscopy (NIRS) is another neurovascular imaging technique but low cost, can be performed serially at the bedside, and may be combined with electroencephalography (EEG), which are important advantages compared to fMRI. Combined NIRS-EEG, however, has never been evaluated for the assessment of neurovascular coupling and consciousness in acute brain injury. METHODS We explored resting-state oscillations in eight-channel NIRS oxyhemoglobin and eight-channel EEG band-power signals to assess neurovascular coupling, the prerequisite for neurovascular-based imaging detection of consciousness, in patients with acute brain injury in the ICU (n = 9). Conscious neurological patients from step-down units and wards served as controls (n = 14). Unsupervised adaptive mixture-independent component analysis (AMICA) was used to correlate NIRS-EEG data with levels of consciousness and clinical outcome. RESULTS Neurovascular coupling between NIRS oxyhemoglobin (0.07-0.13 Hz) and EEG band-power (1-12 Hz) signals at frontal areas was sensitive and prognostic to changing consciousness levels. AMICA revealed a mixture of five models from EEG data, with the relative probabilities of these models reflecting levels of consciousness over multiple days, although the accuracy was less than 85%. However, when combined with two channels of bilateral frontal neurovascular coupling, weighted k-nearest neighbor classification of AMICA probabilities distinguished unresponsive patients from conscious controls with > 90% accuracy (positive predictive value 93%, false discovery rate 7%) and, additionally, identified patients who subsequently failed to recover consciousness with > 99% accuracy. DISCUSSION We suggest that NIRS-EEG for monitoring of acute brain injury in the ICU is worthy of further exploration. Normalization of neurovascular coupling may herald recovery of consciousness after acute brain injury.
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Affiliation(s)
- Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mahasweta Bhattacharya
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Kirsten Møller
- Department of Neuroanesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Kjeldsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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30
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Giesinger RE, El Shahed AI, Castaldo MP, Breatnach CR, Chau V, Whyte HE, El-Khuffash AF, Mertens L, McNamara PJ. Impaired Right Ventricular Performance Is Associated with Adverse Outcome after Hypoxic Ischemic Encephalopathy. Am J Respir Crit Care Med 2020; 200:1294-1305. [PMID: 31251076 DOI: 10.1164/rccm.201903-0583oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Asphyxiated neonates with hypoxic ischemic encephalopathy (HIE) are at risk of myocardial dysfunction; however, echocardiography studies are limited and little is known about the relationship between hemodynamics and brain injury.Objectives: To analyze the association between severity of myocardial dysfunction and adverse outcome as defined by the composite of death and/or abnormal magnetic resonance imaging.Methods: Neonates with HIE undergoing therapeutic hypothermia were enrolled. Participants underwent echocardiography at 24 hours, 72 hours (before rewarming), and 96 hours (after rewarming). Cerebral hemodynamics were monitored by near-infrared spectroscopy and middle cerebral artery Doppler.Measurements and Main Results: Fifty-three patients with a mean gestation and birthweight of 38.8 ± 2.0 weeks and 3.33 ± 0.6 kg, respectively, were recruited. Thirteen patients (25%) had mild encephalopathy, 27 (50%) had moderate encephalopathy, and 13 (25%) had severe encephalopathy. Eighteen patients (34%) had an adverse outcome. Severity of cardiovascular illness (P < 0.001) and severity of neurologic insult (P = 0.02) were higher in neonates with adverse outcome. Right ventricle (RV) systolic performance at 24 hours was substantially lower than published normative data in all groups. At 24 hours, lower tricuspid annular plane systolic excursion (P = 0.004) and RV fractional area change (P < 0.001), but not pulmonary hypertension, were independently associated with adverse outcome on logistic regression. High brain regional oxygen saturation (P = 0.007) and low middle cerebral artery resistive index (P = 0.04) were associated with RV dysfunction on post hoc analysis.Conclusions: RV dysfunction is associated with the risk of adverse outcome in asphyxiated patients with HIE undergoing hypothermia. Echocardiography may be a valuable diagnostic and prognostic tool in this vulnerable population.
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Affiliation(s)
| | | | | | - Colm R Breatnach
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and
| | | | - Hilary E Whyte
- Division of Neonatology and.,Department of Paediatrics and
| | - Afif F El-Khuffash
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Division of Neonatology and.,Department of Paediatrics and.,Department of Physiology, The University of Toronto, Toronto, Ontario, Canada
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31
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Montaldo P, Ivain P, Lally P, Bassett P, Pant S, Oliveira V, Mendoza J, Morales M, Swamy R, Shankaran S, Thayyil S. White matter injury after neonatal encephalopathy is associated with thalamic metabolite perturbations. EBioMedicine 2020; 52:102663. [PMID: 32062359 PMCID: PMC7016374 DOI: 10.1016/j.ebiom.2020.102663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although thalamic magnetic resonance (MR) spectroscopy (MRS) accurately predicts adverse outcomes after neonatal encephalopathy, its utility in infants without MR visible deep brain nuclei injury is not known. We examined thalamic MRS metabolite perturbations in encephalopathic infants with white matter (WM) injury with or without cortical injury and its associations with adverse outcomes. METHODS We performed a subgroup analysis of all infants recruited to the MARBLE study with isolated WM or mixed WM/cortical injury, but no visible injury to the basal ganglia/thalamus (BGT) or posterior limb of the internal capsule (PLIC). We used binary logistic regression to examine the association of MRS biomarkers with three outcomes (i) WM injury score (1 vs. 2/3); (ii) cortical injury scores (0/1 vs. 2/3); and (iii) adverse outcomes (defined as death, moderate/severe disability) at two years (yes/no). We also assessed the accuracy of MRS for predicting adverse outcome. FINDINGS Of the 107 infants included in the analysis, five had adverse outcome. Reduced thalamic N-acetylaspartate concentration [NAA] (odds ratio 0.4 (95% CI 0.18-0.93)) and elevated thalamic Lactate/NAA peak area ratio (odds ratio 3.37 (95% CI 1.45-7.82)) were significantly associated with higher WM injury scores, but not with cortical injury. Thalamic [NAA] (≤5.6 mmol/kg/wet weight) had the best accuracy for predicting adverse outcomes (sensitivity 1.00 (95% CI 0.16-1.00); specificity 0.95 (95% CI 0.84-0.99)). INTERPRETATION Thalamic NAA is reduced in encephalopathic infants without MR visible deep brain nuclei injury and may be a useful predictor of adverse outcomes. FUNDING The National Institute for Health Research (NIHR).
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Affiliation(s)
- Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK; Department of Neonatal Intensive Care, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy.
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Pete Lally
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Stuti Pant
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Vania Oliveira
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Josephine Mendoza
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria Morales
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Ravi Swamy
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
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Gacio S. Amplitude-integrated electroencephalography for neonatal seizure detection. An electrophysiological point of view. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:122-130. [PMID: 30810597 DOI: 10.1590/0004-282x20180150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
Seizures in the newborn are associated with high morbidity and mortality, making their detection and treatment critical. Seizure activity in neonates is often clinically obscured, such that detection of seizures is particularly challenging. Amplitude-integrated EEG is a technique for simplified EEG monitoring that has found an increasing clinical application in neonatal intensive care. Its main value lies in the relative simplicity of interpretation, allowing nonspecialist members of the care team to engage in real-time detection of electrographic seizures. Nevertheless, to avoiding misdiagnosing rhythmic artifacts as seizures, it is necessary to recognize the electrophysiological ictal pattern in the conventional EEG trace available in current devices. The aim of this paper is to discuss the electrophysiological basis of the differentiation of epileptic seizures and extracranial artifacts to avoid misdiagnosis with amplitude-integrated EEG devices.
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Affiliation(s)
- Sebastián Gacio
- Hospital de Niños Ricardo Gutiérrez, División de Neurología, Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Juan A. Fernández, División de Neonatología, Ciudad Autónoma de Buenos Aires, Argentina
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33
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Cerebral near-infrared spectroscopy in term newborns: reference values and hypoxic-ischemic encephalopathy. ACTA MEDICA MARTINIANA 2019. [DOI: 10.2478/acm-2019-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Non-invasive measurement of cerebral tissue oxygenation (cStO2) using near-infrared spectroscopy (NIRS) is attracting an increasing attention not only in neonatology. The vast diversity of commercially available NIRS devices makes it difficult to compare in the published clinical studies. This review provides a view on the practical use of NIRS as a tool for cStO2 measurement, its limitations and pitfalls, with a focus on brain dysfunction caused by hypoxic-ischemic encephalopathy. This syndrome of disturbed neurologic function in the earliest days after the birth in the term infants is manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, subnormal level of consciousness, and often seizures. This fascinating technology has already proven accurate and has been recommended to use during daily routine tool to evaluate the level of oxygen saturation in brain in intensive care units worldwide.
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Shany E, Taha N, Benkovich E, Novoa R, Meledin I, Mandola A, Novack V, Shelef I. Association of cerebral activity with MRI scans in infants with neonatal encephalopathy undergoing therapeutic hypothermia. Eur J Pediatr 2019; 178:851-861. [PMID: 30900074 DOI: 10.1007/s00431-019-03364-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Abstract
We aimed to correlate amplitude-integrated EEG (aEEG) in neonatal hypoxic ischemic encephalopathy (HIE) with early magnetic resonance imaging (MRI). In this retrospective study, 32 neonates over 35 weeks' gestation with moderate/severe HIE who were treated with hypothermia were included. Early MRI scans and daily aEEG background were categorized to mild/normal, moderate, and severely abnormal. Time to sleep cycling was noted on aEEG. Mantel-Haenszel test for trends was used to explore associations between aEEG and MRI and outcome. LOESS regression was used for exploring the association of cycling with MRI scores. MRI was normal/mildly abnormal in 20 (63%) infants; in 9 (28%), moderately abnormal; and in 3 (9%), severely abnormal. Twenty-seven (84%) infants s urvived. MRI severity score was significantly associated with aEEG background score on the third and fourth days of life (p < 0.01). An increase in the MRI severity score was noted if sleep cycling appeared after the fifth day of life.Conclusions: Depressed aEEG at the third and fourth days of life and appearance of cycling beyond the fifth day of life are associated with cerebral MRI abnormalities and may be associated with increased risk of abnormal outcome. What is known: • Since therapeutic hypothermia has been shown to change long-term outcome, amplitude-integrated EEG in infants with hypoxic ischemic neonatal encephalopathy soon after birth have a limited predictive power for long-term outcome in treated infants. • Brain MRI after therapeutic hypothermia in the above infants has a significant predictive value for long-term outcome What is new: • Background amplitude-integrated EEG activity depression at the age of 3 and 4 days and delay of appearance of cycling activity are associated with worse MRI scores and may be predictive of worse long-term outcome.
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Affiliation(s)
- Eilon Shany
- Neonatology Department, Soroka Medical Center, Rager Ave 151, 84101, Be'er Sheva, Israel. .,Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
| | - Nasrin Taha
- Pediatrics Division, Soroka Medical Center, Be'er Sheva, Israel
| | - Ela Benkovich
- Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Radiology Department, Soroka Medical Center, Be'er Sheva, Israel
| | - Rosa Novoa
- Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Radiology Department, Soroka Medical Center, Be'er Sheva, Israel
| | - Irina Meledin
- Neonatology Department, Soroka Medical Center, Rager Ave 151, 84101, Be'er Sheva, Israel.,Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Amarilla Mandola
- Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Pediatrics Division, Soroka Medical Center, Be'er Sheva, Israel
| | - Victor Novack
- Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Clinical Research Center, Soroka Medical Center, Be'er Sheva, Israel
| | - Ilan Shelef
- Faculty of Health sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Radiology Department, Soroka Medical Center, Be'er Sheva, Israel
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Han Y, Fu N, Chen W, Liang J, Cui Y, Zhang Y, Qin J. Prognostic Value of Electroencephalography in Hypothermia-Treated Neonates With Hypoxic-Ischemic Encephalopathy: A Meta-Analysis. Pediatr Neurol 2019; 93:3-10. [PMID: 30691779 DOI: 10.1016/j.pediatrneurol.2018.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/05/2018] [Accepted: 12/24/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Electroencephalography (EEG) background activity is associated with neurological outcome in neonates with hypoxic-ischemic encephalopathy. There is uncertainty about the prognostic value of EEG background activity after hypothermia was introduced. METHODS Searches were made on Pubmed, Embase, and the Cochrane Library, from inception to March 1, 2018. Pooled sensitivities and specificities were calculated to assess the diagnostic power of burst suppression, low voltage, and flat trace background activities in the prediction of an adverse neurological outcome in the follow-up period in hypothermia-treated neonates with hypoxic-ischemic encephalopathy. I2 was used to assess heterogeneity, and meta-regression was done to explore the source of heterogeneity. RESULTS Eighteen studies with 940 neonates were included. Pooled sensitivities and specificities in predicting the combination of death and neurodevelopmental impairment were burst suppression (sensitivity 0.87 [95% confidence interval (CI) 0.79 to 0.93], specificity 0.60 [95% CI 0.44 to 0.74]), low voltage (sensitivity 0.84 [0.75 to 0.90], specificity 0.80 [0.58 to 0.92]), and flat trace (sensitivity 0.85 [0.75 to 0.92], specificity 0.94 [0.77 to 0.99]). Subgroup analysis revealed the sensitivities of background patterns obtained after 24 hours of life were higher than those within age 24 hours, whereas the specificities were just the reverse. Flat trace performed best on sensitivity 0.93 (0.60 to 0.99) and specificity 0.90 (0.64 to 0.98) in predicting death. Burst suppression demonstrated the highest sensitivity 0.87 (0.58 to 0.97) and flat trace performed best on specificity 0.85 (0.60 to 0.96) in predicting neurodevelopmental impairment. CONCLUSIONS EEG background activity is predictive of long-term neurological outcome in hypothermia-treated neonates with hypoxic-ischemic encephalopathy. Burst suppression, low voltage, and flat trace are potential predictors of death or neurodevelopmental impairment.
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Affiliation(s)
- Ye Han
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Na Fu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Wenjie Chen
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jingjing Liang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Yanan Cui
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Ying Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
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Arriaga-Redondo M, Arnaez J, Benavente-Fernández I, Lubián-López S, Hortigüela M, Vega-Del-Val C, Garcia-Alix A. Lack of Variability in Cerebral Oximetry Tendency in Infants with Severe Hypoxic-Ischemic Encephalopathy Under Hypothermia. Ther Hypothermia Temp Manag 2019; 9:243-250. [PMID: 30676288 DOI: 10.1089/ther.2018.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Cerebral oximetry using near-infrared spectroscopy (NIRS) provides continuous, noninvasive assessment of the degree of hemoglobin saturation of the brain tissue. Previous studies suggest that high values of regional cerebral tissue oxygen saturation (rScO2) during the first days in neonates with significant hypoxic-ischemic encephalopathy (HIE) are correlated with an adverse neurological outcome. However, the results are not consistent among the studies. To examine the correlation of rScO2 values and their variability over time with HIE severity, amplitude integrated electroencephalography (aEEG) background and seizure activity, neuron-specific enolase levels in cerebrospinal fluid, magnetic resonance imaging (MRI) findings, and neurological outcome. Retrospective study that included all consecutive infants with moderate-to-severe HIE born at ≥35 weeks gestational age admitted between January 2011 and December 2014. NIRS monitoring was initiated at admission and maintained during therapeutic hypothermia up to 12 hours after rewarming. To analyze rScO2, different periods (0-6, 6-24, 24-48, 48-72, and 72-100 hours of life) and three ranges (<55%, 55-90%, >90%) were considered. Variability in each patient was considered ≤5% when changes in rScO2 values in all periods were ≤5%. Twenty-three newborns were included. Infants who suffered from severe HIE, seizures, abnormal aEEG background, altered MRI or death, and abnormal outcome had rScO2 values >90% and with less variability (≤5%). rScO2 values >90% and a lack of variability over time in infants with HIE during cooling provide useful information about the severity of neurological status.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Division, Gregorio Marañón Hospital, Madrid, Spain.,Fundación NeNe, Madrid, Spain
| | - Juan Arnaez
- Fundación NeNe, Madrid, Spain.,Neonatology Division, Burgos University Hospital, Burgos, Spain
| | | | - Simón Lubián-López
- Fundación NeNe, Madrid, Spain.,Neonatology Division, Puerta del Mar University Hospital, Cádiz, Spain
| | | | | | - Alfredo Garcia-Alix
- Fundación NeNe, Madrid, Spain.,Institut de Recerca Pediatrica Sant Joan de Dèu, Sant Joan de Dèu Hospital, Passeig Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Raras (CIBERER), Madrid, Spain
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Variane GFT, Chock VY, Netto A, Pietrobom RFR, Van Meurs KP. Simultaneous Near-Infrared Spectroscopy (NIRS) and Amplitude-Integrated Electroencephalography (aEEG): Dual Use of Brain Monitoring Techniques Improves Our Understanding of Physiology. Front Pediatr 2019; 7:560. [PMID: 32039117 PMCID: PMC6985148 DOI: 10.3389/fped.2019.00560] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/23/2019] [Indexed: 01/10/2023] Open
Abstract
Continuous brain monitoring tools are increasingly being used in the neonatal intensive care unit (NICU) to assess brain function and cerebral oxygenation in neonates at high risk for brain injury. Near infrared spectroscopy (NIRS) is useful in critically ill neonates as a trend monitor to evaluate the balance between tissue oxygen delivery and consumption, providing cerebral and somatic oximetry values, and allowing earlier identification of abnormalities in hemodynamics and cerebral perfusion. Amplitude-integrated electroencephalography (aEEG) is a method for continuous monitoring of cerebral function at the bedside. Simultaneous use of both monitoring modalities may improve the understanding of alterations in hemodynamics and risk of cerebral injury. Several studies have described correlations between aEEG and NIRS monitoring, especially in infants with hypoxic-ischemic encephalopathy (HIE), but few describe the combined use of both monitoring techniques in a wider range of clinical scenarios. We review the use of NIRS and aEEG in neonates and describe four cases where abnormal NIRS values were immediately followed by changes in brain activity as seen on aEEG allowing the impact of a hemodynamic disturbance on the brain to be correlated with the changes in the aEEG background pattern. These four clinical scenarios demonstrate how simultaneous neuromonitoring with aEEG and NIRS provides important clinical information. We speculate that routine use of these combined monitoring modalities may become the future standard for neonatal neuromonitoring.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Grupo Santa Joana, Division of Neonatology, São Paulo, Brazil.,Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Alexandre Netto
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Rafaela Fabri Rodrigues Pietrobom
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil.,Neonatal Unit, Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, São Paulo, Brazil
| | - Krisa Page Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
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Weeke LC, Toet MC, de Vries LS. Amplitude-Integrated EEG and Its Potential Role in Augmenting Management Within the NICU. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Boylan GB, Kharoshankaya L, Mathieson SR. Diagnosis of seizures and encephalopathy using conventional EEG and amplitude integrated EEG. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:363-400. [PMID: 31324321 DOI: 10.1016/b978-0-444-64029-1.00018-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Seizures are more common in the neonatal period than at any other time of life, partly due to the relative hyperexcitability of the neonatal brain. Brain monitoring of sick neonates in the NICU using either conventional electroencephalography or amplitude integrated EEG is essential to accurately detect seizures. Treatment of seizures is important, as evidence increasingly indicates that seizures damage the brain in addition to that caused by the underlying etiology. Prompt treatment has been shown to reduce seizure burden with the potential to ameliorate seizure-mediated damage. Neonatal encephalopathy most commonly caused by a hypoxia-ischemia results in an alteration of mental status and problems such as seizures, hypotonia, apnea, and feeding difficulties. Confirmation of encephalopathy with EEG monitoring can act as an important adjunct to other investigations and the clinical examination, particularly when considering treatment strategies such as therapeutic hypothermia. Brain monitoring also provides useful early prognostic indicators to clinicians. Recent use of machine learning in algorithms to continuously monitor the neonatal EEG, detect seizures, and grade encephalopathy offers the exciting prospect of real-time decision support in the NICU in the very near future.
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Affiliation(s)
- Geraldine B Boylan
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
| | - Liudmila Kharoshankaya
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sean R Mathieson
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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Chock VY, Variane GFT, Netto A, Van Meurs KP. NIRS improves hemodynamic monitoring and detection of risk for cerebral injury: cases in the neonatal intensive care nursery. J Matern Fetal Neonatal Med 2018; 33:1802-1810. [PMID: 30244630 DOI: 10.1080/14767058.2018.1528223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Near-infrared spectroscopy (NIRS) monitoring provides a noninvasive, bedside measure of cerebral and somatic oxygenation in neonates at risk for hemodynamic instability and brain injury. This technology has been increasingly utilized in the neonatal intensive care unit, however, clinicians perceive a lack of evidence for the added value of NIRS monitoring. We present six clinical scenarios illustrating the value of NIRS monitoring for the diagnosis and management of critically ill newborns.
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Affiliation(s)
- Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gabriel F T Variane
- Department of Pediatrics, Division of Neonatology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil.,Division of Neonatology, Grupo Santa Joana, Sao Paulo, Brazil
| | - Alexandre Netto
- Department of Pediatrics, Division of Neonatology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | - Krisa P Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Chock VY, Frymoyer A, Yeh CG, Van Meurs KP. Renal Saturation and Acute Kidney Injury in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia. J Pediatr 2018; 200:232-239.e1. [PMID: 29866591 DOI: 10.1016/j.jpeds.2018.04.076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 04/26/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the range of renal near-infrared spectroscopy (NIRS) measures in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE) and to determine the association between renal NIRS measures and the development of acute kidney injury (AKI). STUDY DESIGN A retrospective chart review was conducted of neonates with moderate to severe HIE who received therapeutic hypothermia at a tertiary care center from 2014 to 2016. Neonates had routine continuous NIRS monitoring of cerebral and renal saturation (Rsat) as part of their clinical care for 72 hours of cooling and until 24 hours after rewarming. The outcome of AKI was defined by an abnormal rate of decline of serum creatinine over the first 5 days of life. Mixed effects models determined the association between renal NIRS measures and AKI over time. RESULTS Of 38 neonates with HIE undergoing cooling, 15 (39%) developed AKI. Rsat was lower than cerebral saturation during cooling (P < .01), but Rsat increased over time after rewarming, while renal oxygen extraction levels decreased (P < .0001). Neonates with AKI had higher Rsat levels (P < .01) compared with those without AKI after 24 hours of life. Using receiver operating characteristic curves, Rsat >75% by 24-48 hours predicted AKI with a sensitivity of 79% and specificity of 82% (area under the receiver operating characteristic curve = 0.76). CONCLUSIONS Throughout cooling, neonates with AKI had higher Rsat measures than those without AKI. These differences may reflect lower oxygen extraction by the injured kidney. NIRS monitoring of Rsat may identify neonates with HIE at risk of developing AKI.
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Affiliation(s)
- Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA.
| | - Adam Frymoyer
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Christine G Yeh
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Krisa P Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
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Jinnai W, Nakamura S, Koyano K, Yamato S, Wakabayashi T, Htun Y, Nakao Y, Iwase T, Nakamura M, Yasuda S, Ueno M, Miki T, Kusaka T. Relationship between prolonged neural suppression and cerebral hemodynamic dysfunction during hypothermia in asphyxiated piglets. Brain Dev 2018; 40:649-661. [PMID: 29789202 DOI: 10.1016/j.braindev.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 02/09/2018] [Accepted: 04/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Hypothermia (HT) improves the outcome of neonatal hypoxic-ischemic encephalopathy. Here, we investigated changes during HT in cortical electrical activity using amplitude-integrated electroencephalography (aEEG) and in cerebral blood volume (CBV) and cerebral hemoglobin oxygen saturation using near-infrared time-resolved spectroscopy (TRS) and compared the results with those obtained during normothermia (NT) after a hypoxic-ischemic (HI) insult in a piglet model of asphyxia. We previously reported that a greater increase in CBV can indicate greater pressure-passive cerebral perfusion due to more severe brain injury and correlates with prolonged neural suppression during NT. We hypothesized that when energy metabolism is suppressed during HT, the cerebral hemodynamics of brains with severe injury would be suppressed to a greater extent, resulting in a greater decrease in CBV during HT that would correlate with prolonged neural suppression after insult. METHODS Twenty-six piglets were divided into four groups: control with NT (C-NT, n = 3), control with HT (C-HT, n = 3), HI insult with NT (HI-NT, n = 10), and HI insult with HT (HI-HT, n = 10). TRS and aEEG were performed in all groups until 24 h after the insult. Piglets in the HI-HT group were maintained in a hypothermic state for 24 h after the insult. RESULTS There was a positive linear correlation between changes in CBV at 1, 3, 6, and 12 h after the insult and low-amplitude aEEG (<5 µV) duration after insult in the HI-NT group, but a negative linear correlation between these two parameters at 6 and 12 h after the insult in the HI-HT group. The aEEG background score and low-amplitude EEG duration after the insult did not differ between these two groups. DISCUSSION AND CONCLUSION A longer low-amplitude EEG duration after insult was associated with a greater CBV decrease during HT in the HI-HT group, suggesting that brains with more severe neural suppression could be more prone to HT-induced suppression of cerebral metabolism and circulation.
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Affiliation(s)
- Wataru Jinnai
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan; Division of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kosuke Koyano
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Yamato
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan; Division of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | | | - Yinmon Htun
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuhiro Nakao
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Iwase
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Makoto Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Saneyuki Yasuda
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masaki Ueno
- Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takanori Miki
- Department of Anatomy and Neurobiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives. J Perinatol 2018; 38:431-443. [PMID: 29472709 DOI: 10.1038/s41372-018-0075-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022]
Abstract
Near infrared spectroscopy (NIRS) provides a non-invasive, continuous monitoring of regional tissue oxygenation. NIRS assessment of neonatal splanchnic oxygenation (SrSO2) has gained increasing interest over the last decade, as local hypoxia and ischemia underlie the most feared gut complications in neonates. Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants. Even so, while splanchnic NIRS monitoring looks promising for investigating gut physiopathology in research settings, further studies are needed to evaluate its feasibility as a routine monitoring tool in neonatal care and to investigate its potential role in clinical decision making. After a brief introduction to NIRS technical principles, this review aims to provide a complete overview of current neonatal applications for splanchnic NIRS monitoring, to discuss its possible limitations and to suggest future directions for research and clinical applications.
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Noninvasive continuous cardiac output and cerebral perfusion monitoring in term infants with neonatal encephalopathy: assessment of feasibility and reliability. Pediatr Res 2017; 82:789-795. [PMID: 28665923 DOI: 10.1038/pr.2017.154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/18/2017] [Indexed: 11/08/2022]
Abstract
BackgroundNoninvasive hemodynamic monitoring of infants with neonatal encephalopathy (NE) undergoing therapeutic hypothermia (TH) would be a potentially useful clinical tool. We aimed to assess the feasibility and reliability of noninvasive cardiac output monitoring (NICOM) and near-infrared spectroscopy (NIRS) in this cohort.MethodsNICOM and NIRS were commenced to measure cardiac output (CO), systemic vascular resistance (SVR), blood pressure (BP), and cerebral regional oxygen saturations (SctO2) during TH and rewarming. NICOM measures of CO were also compared with simultaneous echocardiography-derived CO (echo-CO).ResultsTwenty infants with a median gestation of 40 weeks were enrolled. There was a strong correlation between NICOM- and echo-CO (r2=0.79, P<0.001). NICOM-CO was systematically lower than echo-CO with a bias of 27% (limits of agreement 3-51%). NICOM illustrated lower CO during TH, which increased during rewarming. SctO2 increased over the first 30 h of TH and stayed high for the remainder of the study. There was a rise in SVR over the first 30 h of TH and a decrease during rewarming (all P<0.05).ConclusionsNoninvasive hemodynamic assessment of infants with NE is feasible and illustrates potentially important changes. Larger studies are needed to assess the clinical applicability of those methods in this cohort.
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Jain SV, Pagano L, Gillam-Krakauer M, Slaughter JC, Pruthi S, Engelhardt B. Cerebral regional oxygen saturation trends in infants with hypoxic-ischemic encephalopathy. Early Hum Dev 2017; 113:55-61. [PMID: 28772198 DOI: 10.1016/j.earlhumdev.2017.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurological outcomes in neonatal hypoxic-ischemic encephalopathy (HIE) continue to be sub-optimal despite therapeutic hypothermia (TH). Cerebral near-infrared spectroscopy provides real-time regional oxygen saturation (CrSO2) that may be a marker of adverse MRI findings and neurodevelopmental outcomes. AIM The aim of this study was to examine the value of CrSO2 monitoring in infants with HIE undergoing TH. STUDY DESIGN AND SUBJECTS In this prospective study, CrSO2 was continuously recorded in 21 infants with HIE admitted for TH. OUTCOME MEASURES Brain MRI signal abnormalities at 2weeks were scored in individual brain region and classified as none/mild, moderate and severe. 13 infants completed Bayley Scales of Infant Development (BSID) testing at 18-24months. RESULTS Between 24 and 36h of life, there was a significant increase in odds of having moderate-severe brain MRI abnormalities with higher absolute CrSO2 values. Per 10% increase in absolute CrSO2, the odds ratio for moderate-severe brain MRI abnormalities was greatest at 30h (OR 3.78; confidence intervals (CI): 1.23-11.6, p=0.011). CrSO2 increased more rapidly in infants with greater injury seen on MRI (0.20/h for MRI scores 0/1, by 0.48/h for MRI score 2, and by 0.68/h for MRI score 3, p=0.05). At 30h, absolute CrSO2 correlated significantly with abnormal MRI findings in basal ganglia (92% vs. 78%, p=0.001), white matter (88% vs. 76%, p=0.01), posterior limb of internal capsule (92% vs. 78%, p=0.001), and brain stem (94% vs. 80%, p=0.03) but not with cortical injury (86% vs. 80%, p=0.17). Higher CrSO2 beyond 24h correlated with greater odds of worse BSID scores. CONCLUSIONS Increasing CrSO2 is associated with moderate-severe brain injury as assessed by MRI. Higher absolute CrSO2 values during TH correlates with subcortical injury on MRI and poor neurodevelopmental outcomes in infants with HIE undergoing TH. CrSO2 can inform providers seeking early identification of patients at risk of worse injury who may benefit from further intervention.
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Affiliation(s)
- Siddharth V Jain
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.
| | - Lindsay Pagano
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - Maria Gillam-Krakauer
- Division of Neonatology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University, Nashville, TN, United States
| | - Sumit Pruthi
- Division of Pediatric Neuroradiology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - Barbara Engelhardt
- Division of Neonatology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
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Chiarelli AM, Zappasodi F, Di Pompeo F, Merla A. Simultaneous functional near-infrared spectroscopy and electroencephalography for monitoring of human brain activity and oxygenation: a review. NEUROPHOTONICS 2017; 4:041411. [PMID: 28840162 PMCID: PMC5566595 DOI: 10.1117/1.nph.4.4.041411] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 05/24/2023]
Abstract
Multimodal monitoring has become particularly common in the study of human brain function. In this context, combined, synchronous measurements of functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) are getting increased interest. Because of the absence of electro-optical interference, it is quite simple to integrate these two noninvasive recording procedures of brain activity. fNIRS and EEG are both scalp-located procedures. fNIRS estimates brain hemodynamic fluctuations relying on spectroscopic measurements, whereas EEG captures the macroscopic temporal dynamics of brain electrical activity through passive voltages evaluations. The "orthogonal" neurophysiological information provided by the two technologies and the increasing interest in the neurovascular coupling phenomenon further encourage their integration. This review provides, together with an introduction regarding the principles and future directions of the two technologies, an evaluation of major clinical and nonclinical applications of this flexible, low-cost combination of neuroimaging modalities. fNIRS-EEG systems exploit the ability of the two technologies to be conducted in an environment or experimental setting and/or on subjects that are generally not suited for other neuroimaging modalities, such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography. fNIRS-EEG brain monitoring settles itself as a useful multimodal tool for brain electrical and hemodynamic activity investigation.
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Affiliation(s)
- Antonio M. Chiarelli
- University of Illinois at Urbana Champaign, Beckman Institute, Urbana, Illinois, United States
| | - Filippo Zappasodi
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Francesco Di Pompeo
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Arcangelo Merla
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
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Koyama Y, Mizutani T, Marushima A, Sonobe A, Shimojo N, Kawano S. Cerebral Tissue Oxygenation Index Using Near-infrared Spectroscopy during Extracorporeal Cardio-pulmonary Resuscitation Predicted Good Neurological Recovery in a Patient with Acute Severe Anemia. Intern Med 2017; 56:2451-2453. [PMID: 28824052 PMCID: PMC5643173 DOI: 10.2169/internalmedicine.7826-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the clinical course of a patient who had a good neurological outcome despite severe anemia, high serum lactate levels, and a long period of time from cardiac arrest (CA) to extracorporeal cardio-pulmonary resuscitation (ECPR) establishment. During the period of resuscitation, the tissue oxygenation index (TOI) values were measured continuously by a near-infrared spectroscopy monitoring device and were kept within the normal range. The TOI seems to reflect cerebral perfusion and the balance between the oxygen supply and demand in the brain during ECPR, thereby predicting the neurological outcome. Continuous TOI monitoring is useful for predicting the neurological outcome during ECPR.
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Affiliation(s)
- Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
| | - Taro Mizutani
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
| | - Aiki Marushima
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
| | - Aiko Sonobe
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
| | - Satoru Kawano
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Japan
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Predictive value of amplitude-integrated EEG (aEEG) after rescue hypothermic neuroprotection for hypoxic ischemic encephalopathy: a meta-analysis. J Perinatol 2017; 37:684-689. [PMID: 28252661 DOI: 10.1038/jp.2017.14] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Amplitude-integrated electroencephalography (aEEG) is a useful bedside tool in predicting the neurodevelopmental outcome after neonatal encephalopathy; however, the prognostic accuracy may be altered by rescue hypothermic neuroprotection. The objective of this study is to examine the prognostic accuracy of aEEG for predicting long-term neurodevelopmental outcomes in term newborn infants undergoing therapeutic hypothermia for neonatal encephalopathy. STUDY DESIGN We examined all studies (Medline, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library; 2000 to 2014) comparing aEEG (6, 24, 48 or 72 h) in term encephalopathic babies undergoing therapeutic hypothermia, with neurodevelopmental outcome at 1 year or more. We extracted individual patient data from the eligible studies to calculate prognostic indices with exact confidence intervals (CIs). We considered continuous normal voltage as normal aEEG pattern and discontinuous normal voltage, burst suppression, flat trace and persistently low voltage as abnormal, and defined adverse outcome as death or moderate/severe disability at 1 year. RESULTS We reviewed a total of 70 articles, 17 of which met the inclusion criteria. Eight studies were excluded and 9 studies (N=520) were included in the meta-analysis. The pooled sensitivity and specificity for an abnormal trace at 6 h of age to predict adverse outcome were 96% (95% CI 91 to 98%) and 39% (95% CI 32 to 46%). The diagnostic odds ratio of an abnormal trace was highest at 48 h (66.9 (95% CI 19.7, 227.2)). CONCLUSIONS A persistantly abnormal aEEG at 48 h or more is associated with an adverse neurodevelopmal outcome. The positive prognostic value of 6 h aEEG is poor and good outcome may occur despite abnormal aEEG. Conversely, a normal 6 h aEEG has a good negative predictive value although do not exclude adverse outcomes.
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Hudson BF, Oostendorp LJM, Candy B, Vickerstaff V, Jones L, Lakhanpaul M, Bluebond-Langner M, Stone P. The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review. Palliat Med 2017; 31:419-436. [PMID: 27609607 PMCID: PMC5405809 DOI: 10.1177/0269216316663856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. AIM To explore how children and young people (aged 0-25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. RESULTS A total of 215 studies - 152 qualitative, 54 quantitative and 9 mixed methods - were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants' perceptions of potential burdens. CONCLUSION All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment.
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Affiliation(s)
- Briony F Hudson
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Linda JM Oostendorp
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
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Goeral K, Urlesberger B, Giordano V, Kasprian G, Wagner M, Schmidt L, Berger A, Klebermass-Schrehof K, Olischar M. Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalopathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy. Neonatology 2017; 112:193-202. [PMID: 28704822 DOI: 10.1159/000468976] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few data have been published on the combined use of amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy (NIRS) for outcome prediction in neonates cooled for hypoxic-ischemic encephalopathy (HIE). OBJECTIVE Our aim was to evaluate the predictive values and the most powerful predictive combinations of single aEEG and NIRS parameters and the respective cut-off values with regard to short-term outcomes in HIE II. METHODS aEEG and NIRS were prospectively studied at the Medical University of Vienna in the first 102 h of life with regard to magnetic resonance imaging (MRI). Thirty-two neonates diagnosed with HIE II treated with hypothermia were investigated. The measurement period was divided into 6-h epochs. According to MRI, 2 outcome groups were defined and predictive values of aEEG parameters, regional cerebral oxygen saturation (rScO2), and the additional value of both methods combined were studied. Receiver operating curves (ROC) were obtained and area under the curve (AUC) values were calculated. ROC were then used to detect the optimal cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values. RESULTS At all time epochs, combined parameter scores were more predictive than single parameter scores. The highest AUC were observed between 18 and 60 h of cooling for the aEEG summation score (0.72-0.84) and for (background pattern + seizures) × rScO2 (0.79-0.85). At 42-60 h sensitivity was similar between those 2 scores (87.5-90.0%), but the addition of NIRS to aEEG led to an increase in specificity (from 52.4-59.1% to 72.7-90.5%). CONCLUSIONS In HIE II, aEEG and NIRS are important predictors of short-term outcome. The combination of both methods improves prognostication. The highest predictive abilities were observed between 18 and 60 h of cooling.
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Affiliation(s)
- Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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