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Troncoso G, Agudelo-Pérez S, Maldonado NT, Becerra MP. Relationship of passive hypothermia during transport with the incidence of early multiorgan compromise in newborns with perinatal asphyxia. Early Hum Dev 2023; 187:105902. [PMID: 38029558 DOI: 10.1016/j.earlhumdev.2023.105902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Gloria Troncoso
- Fundación Cardioinfantil, Instituto de Cardiología, Colombia.
| | - Sergio Agudelo-Pérez
- Department of Pediatrics, School of Medicine, Universidad de La Sabana, Neonatal Unit, Fundación Cardioinfantil - LaCardio, Colombia.
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2
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Kieffer H, Carlton K, Adams S, Jozwik J, Cabacungan E, Cohen SS. Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU. J Perinat Med 2023; 51:956-961. [PMID: 36976872 DOI: 10.1515/jpm-2022-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 03/04/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Therapeutic hypothermia (TH) is now standard of care for the neuroprotection of patients with moderate to severe hypoxic-ischemic encephalopathy (HIE). TH misuse results in increased medical complication rates and high health care resource utilization. Quality improvement (QI) methodology can address drift from clinical guidelines. Assessment of sustainability of any intervention over time is an integral part of the QI methodology. METHODS Our prior QI intervention improved medical documentation using an electronic medical record-smart phrase (EMR-SP) and demonstrated special cause variation. This study serves as Epoch 3 and investigates the sustainability of our QI methods to decrease TH misuse. RESULTS A total of 64 patients met the diagnostic criteria for HIE. Over the study period, 50 patients were treated with TH, and 33 cases (66%) used TH appropriately. The number of appropriate TH cases between cases of misuse increased to an average of 9 in Epoch 3 from 1.9 in Epoch 2. Of the 50 cases, 34 (68%) had EMR-SP documentation included. Length of stay and TH complication rates did not vary between cases of TH misuse and appropriate TH use. CONCLUSIONS Our study confirmed a sustained decrease in TH misuse, despite inconsistent use of EMR-SP. We speculate that culture change involving increased awareness of guidelines through education may have contributed more to a lasting change.
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Affiliation(s)
| | - Katherine Carlton
- Medical College of Wisconsin Affiliated Hospitals, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samuel Adams
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jenna Jozwik
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erwin Cabacungan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan S Cohen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Chen Y, Zeng H, Liu H. MiR-21 participates in the neuroprotection of diazoxide against hypoxic-ischemia encephalopathy by targeting PDCD4. Brain Inj 2022; 36:876-885. [PMID: 35695083 DOI: 10.1080/02699052.2022.2087906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of neonatal death and permanent neurological disability. Here, we designed to quest therapeutic effects of diazoxide (DZ) on HIE and its mechanism. METHODS The cell model of HIE was established. CCK8 and flow cytometry were applied to test cell viability and apoptosis. RT-qPCR and western blotting was evaluated to the expression of miR-21, PDCD4, PI3K, and p-AKT/AKT. Commercial kits were employed to detect SOD, MDA, LDH. DCFH-DA was used to measure intracellular ROS. ELISA was performed to estimate IL-1β, IL-6 and TNF-α. Dual-luciferase reporter gene and RIP assay were applied to confirm the binding relationships between miR-21 and PDCD4. RESULTS In H19-7 cells and PC12 cells stimulated by OGD, with low cell viability, high apoptosis, miR-21 high expression and PDCD4 low expression. However, the functions were all reversed by DZ administration. Furthermore, miR-21 inhibitor could abolish the beneficial effects of DZ on OGD-induced cells. Besides, miR-21 could interact with PDCD4. In addition, PDCD4 involved with the regulation of DZ to OGD-induced cells via PI3K/AKT pathway. CONCLUSION DZ enhanced miR-21 level and inhibited PDCD4 level via PI3K/AKT pathway to resisted HIE.
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Affiliation(s)
- Yuxia Chen
- Department of Neurosurgery, Longhua District Central Hospital, Shenzhen, P.R. China
| | - Hao Zeng
- Department of Neonatology, Longhua District Central Hospital, Shenzhen, P.R. China
| | - Huayan Liu
- Department of Neonatology, Longhua District Central Hospital, Shenzhen, P.R. China
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Shipley L, Mistry A, Sharkey D. Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:6-12. [PMID: 34045283 DOI: 10.1136/archdischild-2020-320966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes. DESIGN Retrospective cohort study using National Neonatal Research Database and propensity score-matching. SETTING UK neonatal units. PATIENTS Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011-2016. INTERVENTIONS Birth in non-CC compared with CC. MAIN OUTCOME MEASURES Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer. RESULTS 5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth. CONCLUSIONS Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.
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Affiliation(s)
- Lara Shipley
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aarti Mistry
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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Matsuda VDV, Tejada MB, Motta-Teixeira LC, Ikebara JM, Cardoso DS, Machado-Nils AV, Lee VY, Diccini I, Arruda BP, Martins PP, Dias NMM, Tessarotto RP, Raeisossadati R, Bruno M, Takase LF, Kihara AH, Nogueira MI, Xavier GF, Takada SH. Impact of neonatal anoxia and hypothermic treatment on development and memory of rats. Exp Neurol 2021; 340:113691. [PMID: 33713657 DOI: 10.1016/j.expneurol.2021.113691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/18/2021] [Accepted: 03/07/2021] [Indexed: 01/02/2023]
Abstract
Therapeutic hypothermia (TH) is well established as a standard treatment for term and near-term infants. However, therapeutic effects of hypothermia following neonatal anoxia in very premature babies remains inconclusive. The present rodent model of preterm neonatal anoxia has been shown to alter developmental milestones and hippocampal neurogenesis, and to disrupt spatial learning and memory in adulthood. These effects seem to be reduced by post-insult hypothermia. Epigenetic-related mechanisms have been postulated as valuable tools for developing new therapies. Dentate gyrus neurogenesis is regulated by epigenetic factors. This study evaluated whether TH effects in a rodent model of preterm oxygen deprivation are based on epigenetic alterations. The effects of TH on both developmental features (somatic growth, maturation of physical characteristics and early neurological reflexes) and performance of behavioral tasks at adulthood (spatial reference and working memory, and fear conditioning) were investigated in association with the possible involvement of the epigenetic operator Enhancer of zeste homolog 2 (Ezh2), possibly related to long-lasting effects on hippocampal neurogenesis. Results showed that TH reduced both anoxia-induced hippocampal neurodegeneration and anoxia-induced impairments on risk assessment behavior, acquisition of spatial memory, and extinction of auditory and contextual fear conditioning. In contrast, TH did not prevent developmental alterations caused by neonatal anoxia and did not restore hippocampal neurogenesis or cause changes in EZH2 levels. In conclusion, despite the beneficial effects of TH in hippocampal neurodegeneration and in reversing disruption of performance of behavioral tasks following oxygen deprivation in prematurity, these effects seem not related to developmental alterations and hippocampal neurogenesis and, apparently, is not caused by Ezh2-mediated epigenetic alteration.
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Affiliation(s)
- Victor Daniel Vasquez Matsuda
- Neuroscience and Behaviour Laboratory, Department of Physiology, Institute of Biosciences, Universidade de São Paulo, São Paulo, SP, Brazil; Neuroscience Laboratory, Department of Anatomy, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Martin Bustelo Tejada
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, the Netherlands; Experimental Neuropathology Laboratory, Institute of Cellular Biology and Neuroscience "Prof. E. De Robertis" (IBCN), Faculty of Medicine, University of Buenos Aires, CONICET, Buenos Aires, Argentina; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Biomedical Sciences Institute, Faculty of Medical Sciences, Catholic University of Cuyo, San Juan, Argentina; Neurogenetics Laboratory, Universidade Federal do ABC, São Bernardo do Campo, SP, Brazil
| | - Lívia Clemente Motta-Teixeira
- Neuroscience and Behaviour Laboratory, Department of Physiology, Institute of Biosciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliane Midori Ikebara
- Neurogenetics Laboratory, Universidade Federal do ABC, São Bernardo do Campo, SP, Brazil
| | | | - Aline Vilar Machado-Nils
- Neuroscience and Behaviour Laboratory, Department of Physiology, Institute of Biosciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vitor Yonamine Lee
- Neuroscience Laboratory, Department of Anatomy, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabelle Diccini
- Neuroscience Laboratory, Department of Anatomy, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Petrucelli Arruda
- Neuroscience Laboratory, Department of Anatomy, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil; Neurogenetics Laboratory, Universidade Federal do ABC, São Bernardo do Campo, SP, Brazil
| | | | | | | | - Reza Raeisossadati
- Neurogenetics Laboratory, Universidade Federal do ABC, São Bernardo do Campo, SP, Brazil
| | - Martin Bruno
- Biomedical Sciences Institute, Faculty of Medical Sciences, Catholic University of Cuyo, San Juan, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Luiz Fernando Takase
- Department of Morphology and Pathology, Biological Sciences and Health Center, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Maria Inês Nogueira
- Neuroscience Laboratory, Department of Anatomy, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Fernando Xavier
- Neuroscience and Behaviour Laboratory, Department of Physiology, Institute of Biosciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia Honda Takada
- Neurogenetics Laboratory, Universidade Federal do ABC, São Bernardo do Campo, SP, Brazil.
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Abstract
Primary function of cardiovascular system is to meet body's metabolic demands. The aim of inotrope therapy is to minimise adverse impact of cardiovascular compromise. Current use of inotropes is primarily guided by the pathophysiology of cardiovascular compromise and anticipated actions of inotropes. Lack of significant reduction in morbidity and mortality associated with cardiovascular compromise despite inotrope use, highlights major gaps in our understanding of circulatory targets, thresholds and choices of inotrope therapy. Thus far, prevention of cardiovascular compromise remains the most effective strategy to optimize outcomes. Studies of alternative design are needed for further advancement in cardiovascular therapy in neonates.
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Affiliation(s)
- Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital, Lookout Road, New Lambton Heights, New South Wales 2305, Australia; University of Newcastle, Newcastle, Australia.
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, Lookout Road, New Lambton Heights, New South Wales 2305, Australia; University of Newcastle, Newcastle, Australia
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Bustelo M, Barkhuizen M, van den Hove DLA, Steinbusch HWM, Bruno MA, Loidl CF, Gavilanes AWD. Clinical Implications of Epigenetic Dysregulation in Perinatal Hypoxic-Ischemic Brain Damage. Front Neurol 2020; 11:483. [PMID: 32582011 PMCID: PMC7296108 DOI: 10.3389/fneur.2020.00483] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Placental and fetal hypoxia caused by perinatal hypoxic-ischemic events are major causes of stillbirth, neonatal morbidity, and long-term neurological sequelae among surviving neonates. Brain hypoxia and associated pathological processes such as excitotoxicity, apoptosis, necrosis, and inflammation, are associated with lasting disruptions in epigenetic control of gene expression contributing to neurological dysfunction. Recent studies have pointed to DNA (de)methylation, histone modifications, and non-coding RNAs as crucial components of hypoxic-ischemic encephalopathy (HIE). The understanding of epigenetic dysregulation in HIE is essential in the development of new clinical interventions for perinatal HIE. Here, we summarize our current understanding of epigenetic mechanisms underlying the molecular pathology of HI brain damage and its clinical implications in terms of new diagnostic, prognostic, and therapeutic tools.
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Affiliation(s)
- Martín Bustelo
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands.,Instituto de Ciencias Biomédicas, Facultad de Ciencias Médicas, Universidad Católica de Cuyo, San Juan, Argentina.,Laboratorio de Neuropatología Experimental, Facultad de Medicina, Instituto de Biología Celular y Neurociencias "Prof. E. De Robertis" (IBCN), Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Melinda Barkhuizen
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
| | - Daniel L A van den Hove
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands.,Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Harry Wilhelm M Steinbusch
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands
| | - Martín A Bruno
- Instituto de Ciencias Biomédicas, Facultad de Ciencias Médicas, Universidad Católica de Cuyo, San Juan, Argentina
| | - C Fabián Loidl
- Instituto de Ciencias Biomédicas, Facultad de Ciencias Médicas, Universidad Católica de Cuyo, San Juan, Argentina.,Laboratorio de Neuropatología Experimental, Facultad de Medicina, Instituto de Biología Celular y Neurociencias "Prof. E. De Robertis" (IBCN), Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Antonio W Danilo Gavilanes
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.,Facultad de Ciencias Médicas, Instituto de Investigación e Innovación de Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
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8
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Bhagat I, Sarkar S. Multiple Organ Dysfunction During Therapeutic Cooling of Asphyxiated Infants. Neoreviews 2019; 20:e653-e660. [PMID: 31676739 DOI: 10.1542/neo.20-11-e653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The main purpose of therapeutic cooling is neuroprotection of asphyxiated infants with significant hypoxic-ischemic encephalopathy. However, to improve the overall outcome, it is necessary to properly manage the full range of multiple organ system complications found in asphyxiated infants undergoing therapeutic cooling. Every physiologic process in an asphyxiated infant can potentially be affected by the cooling treatment. The purpose of this review is to discuss the effect of cooling on neonatal physiology in the current recommended cooling range and the management thereof.
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Affiliation(s)
- Indira Bhagat
- Division of Neonatal-Perinatal Medicine, Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Subrata Sarkar
- Division of Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, MI
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9
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Coleman SR, Chen M, Patel S, Yan H, Kaye AD, Zebrower M, Gayle JA, Liu H, Urman RD. Enhanced Recovery Pathways for Cardiac Surgery. Curr Pain Headache Rep 2019; 23:28. [DOI: 10.1007/s11916-019-0764-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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10
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Fazel Bakhsheshi M, Keenliside L, Lee TY. A novel selective cooling system for the brain: feasibility study in rabbits vs piglets. Intensive Care Med Exp 2018; 6:45. [PMID: 30387029 PMCID: PMC6212374 DOI: 10.1186/s40635-018-0211-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/21/2018] [Indexed: 01/09/2023] Open
Abstract
Background Selective brain cooling (SBC) methods could alleviate the complications associated with systemic hypothermia. The authors (MFB, LK, and T-YL) have developed a simple and an effective nasopharyngeal SBC method using a vortex tube. The primary focus of the study is to evaluate the effectiveness of this approach on rabbits and compare it with our previous published finding on piglets, which are mammals without and with a carotid rete, respectively. Methods Experiments were conducted on six rabbits. Body temperature was measured continuously using an esophageal temperature probe while brain temperature was measured with an implanted thermometer. Two successive experiments were performed on each animal. In the first experiment, brain cooling was initiated by blowing room temperature air from the hospital medical air outlet, at a flow rate of 14–15 L/min into both nostrils for 60 min. The second series of measurements and brain cooling was performed in the same manner as the first one but blowing cold air (− 7 °C) at the same flow rate. Results One hour post cooling with room temperature air at a flow rate of 14–15 L/min, the brain temperature was 34.2 ± 1.2 °C which resulted in mean brain cooling rates of 3.7 ± 0.9 °C/h. Brain temperature could be reduced more rapidly at mean rates of 5.2 ± 1.9 °C/h, while the body temperature as measured by the esophageal temperature probe was maintained above 36 °C during cooling and maintaining period. Conclusions We have demonstrated that using the vortex tube allows initial rapid and SBC in rabbits. Moreover, comparing results between piglets and rabbits demonstrates clearly that the lack of a carotid rete does not prevent specific cooling of the brain by means of the nasopharyngeal method.
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Affiliation(s)
- Mohammad Fazel Bakhsheshi
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada. .,Imaging Research Laboratories, Robarts Research Institute, 100 Perth Drive, P.O. Box 5015, London, Ontario, N6A 5k8, Canada.
| | - Lynn Keenliside
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, 100 Perth Drive, P.O. Box 5015, London, Ontario, N6A 5k8, Canada.,Departments of Medical Imaging and Biophysics, The University of Western Ontario, London, Ontario, Canada
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Chiang MC, Jong YJ, Lin CH. Therapeutic hypothermia for neonates with hypoxic ischemic encephalopathy. Pediatr Neonatol 2017; 58:475-483. [PMID: 28416250 DOI: 10.1016/j.pedneo.2016.11.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023] Open
Abstract
Therapeutic hypothermia (TH) is a recommended regimen for newborn infants who are at or near term with evolving moderate-to-severe hypoxic ischemic encephalopathy (HIE). The Task Force of the Taiwan Child Neurology Society and the Taiwan Society of Neonatology held a joint meeting in 2015 to establish recommendations for using TH on newborn patients with HIE. Based on current evidence and experts' experiences, this review article summarizes the key points and recommendations regarding TH for newborns with HIE, including: (1) selection criteria for TH; (2) choices of method and equipment for TH; (3) TH prior to and during transport; (4) methods for temperature maintenance, monitoring, and rewarming; (5) systemic care of patients during TH, including the care of respiratory and cardiovascular systems, management of fluids, electrolytes, and nutrition, as well as sedation and drug metabolism; (6) monitoring and management of seizures; (7) neuroimaging, prognostic factors, and outcomes; and (8) adjuvant therapy for TH.
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Affiliation(s)
- Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yuh-Jyh Jong
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan.
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12
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Abstract
"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in "Golden hour" of preterm and term neonatal care.
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Affiliation(s)
- Deepak Sharma
- National Institute of Medical Science, Jaipur, Rajasthan India
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13
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Zou R, Mu DZ. [Prevention and treatment of energy failure in neonates with hypoxic-ischemic encephalopathy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:915-920. [PMID: 27655554 PMCID: PMC7389965 DOI: 10.7499/j.issn.1008-8830.2016.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
Hypoxic-ischemic encephalopathy (HIE) in neonates is the brain injury caused by perinatal asphyxia or hypoxia and is a major cause of death in neonates and nervous system dysfunction in infants and young children. Although to a certain degree, mild hypothermia therapy reduces the mortality of infants with moderate to severe HIE, it cannot achieve the expected improvements in nervous system dysfunction. Hence, it is of vital importance to search for effective therapeutic methods for HIE. The search for more therapies and better preventive measures based on the pathogenesis of HIE has resulted in much research. As an important link in the course of HIE, energy failure greatly affects the development and progression of HIE. This article reviews the research advances in the treatment and prevention of energy failure in the course of HIE.
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Affiliation(s)
- Rong Zou
- Department of Pediatrics, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China.
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Arriaga Redondo M, Rodriguez Sánchez de la Blanca A, Lowy Benoliel A, Navarro Patiño N, Villar Castro S, Blanco Bravo D, Sánchez-Luna M. Stridor in neonates with hypoxic-ischaemic encephalopathy subject to selective cerebral or whole body hypothermia. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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[Stridor in neonates with hypoxic-ischaemic encephalopathy subject to selective cerebral or whole body hypothermia]. An Pediatr (Barc) 2015; 85:128-33. [PMID: 26625966 DOI: 10.1016/j.anpedi.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hypothermia treatment has improved the prognosis of asphyxiated neonates. Widely used, it has demonstrated to be safe without severe side effects. The aim of this article is to review the incidence of stridor amongst asphyxiated newborns treated with hypothermia in our unit. METHODS Retrospective chart review of our patients. RESULTS Stridor was presented in 7/75 (9.3%) of patients during hypothermia. Three received whole body hypothermia, 3 selective cerebral, and in one case both techniques were used. All cases required increased respiratory support. CONCLUSIONS Different mechanisms may be responsible for the appearance of stridor in patients with hypoxic-ischaemic encephalopathy (HIE). In our series the incidence of stridor was similar for the two hypothermia devices. To better understand these possible side effects of hypothermia, further prospective studies (which should include laryngoscopy) are needed.
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Silveira RC, Procianoy RS. Hypothermia therapy for newborns with hypoxic ischemic encephalopathy. J Pediatr (Rio J) 2015; 91:S78-83. [PMID: 26354871 DOI: 10.1016/j.jped.2015.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Therapeutic hypothermia reduces cerebral injury and improves the neurological outcome secondary to hypoxic ischemic encephalopathy in newborns. It has been indicated for asphyxiated full-term or near-term newborn infants with clinical signs of hypoxic-ischemic encephalopathy (HIE). SOURCES A search was performed for articles on therapeutic hypothermia in newborns with perinatal asphyxia in PubMed; the authors chose those considered most significant. SUMMARY OF THE FINDINGS There are two therapeutic hypothermia methods: selective head cooling and total body cooling. The target body temperature is 34.5 °C for selective head cooling and 33.5 °C for total body cooling. Temperatures lower than 32 °C are less neuroprotective, and temperatures below 30 °C are very dangerous, with severe complications. Therapeutic hypothermia must start within the first 6h after birth, as studies have shown that this represents the therapeutic window for the hypoxic-ischemic event. Therapy must be maintained for 72 h, with very strict control of the newborn's body temperature. It has been shown that therapeutic hypothermia is effective in reducing neurologic impairment, especially in full-term or near-term newborns with moderate hypoxic-ischemic encephalopathy. CONCLUSION Therapeutic hypothermia is a neuroprotective technique indicated for newborn infants with perinatal asphyxia and hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Rita C Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Renato S Procianoy
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Hypothermia therapy for newborns with hypoxic ischemic encephalopathy. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Although cooling therapy has been the standard of care for neonatal encephalopathy (NE) in high-income countries for more than half a decade, it is still not widely used in low- and middle-income countries (LMIC), which bear 99% of the encephalopathy burden; neither is it listed as a priority research area in global health. Here we explore the major roadblocks that prevent the use of cooling in LMIC, including differences in population comorbidities, suboptimal intensive care, and the lack of affordable servo-controlled cooling devices. The emerging data from LMIC suggest that the incidence of coexisting perinatal infections in NE is no different to that in high-income countries, and that cooling can be effectively provided without tertiary intensive care and ventilatory support; however, the data on safety and efficacy of cooling are limited. Without adequately powered clinical trials, the creeping and uncertain introduction of cooling therapy in LMIC will be plagued by residual safety concerns, and any therapeutic benefit will be even more difficult to translate into widespread clinical use.
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Brain Cooling With Ventilation of Cold Air Over Respiratory Tract in Newborn Piglets: An Experimental and Numerical Study. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2015; 3:1500108. [PMID: 27170888 PMCID: PMC4848075 DOI: 10.1109/jtehm.2015.2424214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/30/2015] [Accepted: 03/28/2015] [Indexed: 11/20/2022]
Abstract
We investigate thermal effects of pulmonary cooling which was induced by cold air through an endotracheal tube via a ventilator on newborn piglets. A mathematical model was initially employed to compare the thermal impact of two different gas mixtures, O2-medical air (1:2) and O2-Xe (1:2), across the respiratory tract and within the brain. Following mathematical simulations, we examined the theoretical predictions with O2-medical air condition on nine anesthetized piglets which were randomized to two treatment groups: 1) control group (\documentclass[12pt]{minimal}
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\end{document}). Numerical and experimental results using O2-medical air mixture show that brain temperature fell from 38.5 °C and 38.3 °C ± 0.3 °C to 35.7 °C ± 0.9 °C and 36.5 °C ± 0.6 °C during 3 h cooling which corresponded to a mean cooling rate of 0.9 °C/h ± 0.2 °C/h and 0.6 °C/h ± 0.1 °C/h, respectively. According to the numerical results, decreasing the metabolic rate and increasing air velocity are helpful to maximize the cooling effect. We demonstrated that pulmonary cooling by cooling of inhalation gases immediately before they enter the trachea can slowly reduce brain and core body temperature of newborn piglets. Numerical simulations show no significant differences between two different inhaled conditions, i.e., O2-medical air (1:2) and O2-Xe (1:2) with respect to cooling rate.
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Wang D, McMillan H, Bariciak E. Subdural haemorrhage and severe coagulopathy resulting in transtentorial uncal herniation in a neonate undergoing therapeutic hypothermia. BMJ Case Rep 2014; 2014:bcr-2013-203080. [PMID: 25100805 DOI: 10.1136/bcr-2013-203080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Therapeutic hypothermia has been shown to be efficacious for improving long-term neurodevelopmental outcomes following perinatal asphyxia. Thus, cooling protocols have been adopted at most tertiary neonatal centres. We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischaemic encephalopathy following a difficult forceps delivery. She abruptly deteriorated, exhibiting signs of transtentorial uncal herniation and severe disseminated intravascular coagulopathy. CT of the head confirmed a life-threatening subdural haematoma and a concealed skull fracture. Hypothermia has been shown to impair haemostasis in vivo and thus may potentially exacerbate occult haemorrhages in a clinical setting. Newborns that require instrument-assisted delivery are a particularly high-risk group for occult head injuries and should undergo careful clinical assessment for fractures and intracranial haemorrhage prior to initiation of therapeutic hypothermia.
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Affiliation(s)
- Dianna Wang
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Hugh McMillan
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Erika Bariciak
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Heart Rate and Arterial Pressure Changes during Whole-Body Deep Hypothermia. ISRN PEDIATRICS 2013; 2013:140213. [PMID: 23691350 PMCID: PMC3649319 DOI: 10.1155/2013/140213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022]
Abstract
Whole-body deep hypothermia (DH) could be a new therapeutic strategy for asphyxiated newborn. This retrospective study describes how DH modified the heart rate and arterial blood pressure if compared to mild hypothermia (MH). Fourteen in DH and 17 in MH were cooled within the first six hours of life and for the following 72 hours. Hypothermia criteria were gestational age ≥36 weeks; birth weight ≥1800 g; clinical signs of moderate/severe hypoxic-ischemic encephalopathy. Rewarming was obtained in the following 6-12 hours (0.5°C/h) after cooling. Heart rates were the same between the two groups; there was statistically significant difference at the beginning of hypothermia and during rewarming. Three babies in the DH group and 2 in the MH group showed HR < 80 bpm and QTc > 520 ms. Infant submitted to deep hypothermia had not bradycardia or Qtc elongation before cooling and after rewarming. Blood pressure was significantly lower in DH compared to MH during the cooling, and peculiar was the hypotension during rewarming in DH group. Conclusion. The deeper hypothermia is a safe and feasible, only if it is performed by a well-trained team. DH should only be associated with a clinical trial and prospective randomized trials to validate its use.
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Chang M. Therapeutic Hypothermia for Newborns with Hypoxic Ischemic Encephalopathy. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Meayoung Chang
- Department of Pediatrics, Graduate School of Medicine, Chungnam National University, Daejeon, Korea
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