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Emami Kazemabad MJ, Asgari Toni S, Tizro N, Dadkhah PA, Amani H, Akhavan Rezayat S, Sheikh Z, Mohammadi M, Alijanzadeh D, Alimohammadi F, Shahrokhi M, Erabi G, Noroozi M, Karimi MA, Honari S, Deravi N. Pharmacotherapeutic potential of pomegranate in age-related neurological disorders. Front Aging Neurosci 2022; 14:955735. [PMID: 36118710 PMCID: PMC9476556 DOI: 10.3389/fnagi.2022.955735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Age-related neurological disorders [AND] include neurodegenerative diseases [NDDs] such as Alzheimer's disease [AD] and Parkinson's disease [PD], which are the most prevalent types of dementia in the elderly. It also includes other illnesses such as migraine and epilepsy. ANDs are multifactorial, but aging is their major risk factor. The most frequent and vital pathological features of AND are oxidative stress, inflammation, and accumulation of misfolded proteins. As AND brain damage is a significant public health burden and its incidence is increasing, much has been done to overcome it. Pomegranate (Punica granatum L.) is one of the polyphenol-rich fruits that is widely mentioned in medical folklore. Pomegranate is commonly used to treat common disorders such as diarrhea, abdominal pain, wound healing, bleeding, dysentery, acidosis, microbial infections, infectious and noninfectious respiratory diseases, and neurological disorders. In the current review article, we aimed to summarize the data on the pharmacotherapeutic potentials of pomegranate in ANDs.
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Affiliation(s)
| | - Sara Asgari Toni
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Tizro
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Parisa Alsadat Dadkhah
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Amani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Akhavan Rezayat
- Student Research Committee, Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Zahra Sheikh
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Mohammadi
- Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Dorsa Alijanzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoosh Alimohammadi
- Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gisou Erabi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Masoud Noroozi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Mohammad Amin Karimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Honari
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Verzeletti A, Leide A, De Ferrari F. Perinatal asphyxia and medical professional liability: A case series. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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3
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Frasch MG, Szynkaruk M, Prout AP, Nygard K, Cao M, Veldhuizen R, Hammond R, Richardson BS. Decreased neuroinflammation correlates to higher vagus nerve activity fluctuations in near-term ovine fetuses: a case for the afferent cholinergic anti-inflammatory pathway? J Neuroinflammation 2016; 13:103. [PMID: 27165310 PMCID: PMC4894374 DOI: 10.1186/s12974-016-0567-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/02/2016] [Indexed: 12/18/2022] Open
Abstract
Background Neuroinflammation in utero may contribute to brain injury resulting in life-long neurological disabilities. The pivotal role of the efferent cholinergic anti-inflammatory pathway (CAP) in controlling inflammation, e.g., by inhibiting the HMGB1 release, via the macrophages’ α7 nicotinic acetylcholine receptor (α7nAChR) has been described in adults, but its importance in the fetus is unknown. Moreover, it is unknown whether CAP may also exert anti-inflammatory effects on the brain via the anatomically predominant afferent component of the vagus nerve. Methods We measured microglial activation in the ovine fetal brain near term 24 h after the umbilical cord occlusions mimicking human labor versus controls (no occlusions) by quantifying HMGB1 nucleus-to-cytosol translocation in the Iba1+ and α7nAChR+ microglia. Based on multiple clinical studies in adults and our own work in fetal autonomic nervous system, we gauged the degree of CAP activity in vivo using heart rate variability measure RMSSD that reflects fluctuations in vagus nerve activity. Results RMSSD correlated to corresponding plasma IL-1β levels at R = 0.57 (p = 0.02, n = 17) and to white matter microglia cell counts at R = −0.89 (p = 0.03). The insult increased the HMGB1 translocation in α7nAChR+ microglia in a brain region-dependent manner (p < 0.001). In parallel, RMSSD at 1 h post insult correlated with cytosolic HMGB1 of thalamic microglia (R = −0.94, p = 0.005), and RMSSD at pH nadir correlated with microglial α7nAChR in the white matter (R = 0.83, p = 0.04). Overall, higher RMSSD values correlated with lower HMGB1 translocation and higher α7nAChR intensity per area in a brain region-specific manner. Conclusions Afferent fetal CAP may translate increased vagal cholinergic signaling into suppression of cerebral inflammation in response to near-term hypoxic acidemia as might occur during labor. Our findings suggest a new control mechanism of fetal neuroinflammation via the vagus nerve, providing novel possibilities for its non-invasive monitoring in utero and for targeted treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0567-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M G Frasch
- Department of Obstetrics and Gynaecology, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. .,Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. .,Animal Reproduction Research Centre (CRRA), Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada. .,Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada. .,Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA, 98195, USA.
| | - M Szynkaruk
- Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - A P Prout
- Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - K Nygard
- Microscopy Imaging@Biotron, University of Western Ontario, London, ON, Canada
| | - M Cao
- Department of Obstetrics and Gynaecology, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - R Veldhuizen
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - R Hammond
- Department of Pathology, University of Western Ontario, London, ON, Canada
| | - B S Richardson
- Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
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Dhas BN, Samuel PS, Manigandan C. Use of computer access technology as an alternative to writing for a pre-school child with athetoid cerebral palsy--a case report. Occup Ther Health Care 2014; 28:318-32. [PMID: 24555722 DOI: 10.3109/07380577.2013.874063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to demonstrate the use of an outcome-driven model of decision-making in the implementation of computer access technology (CAT) for a pre-school child with athetoid cerebral palsy. The child did not have the fine motor skills required to hold a pencil but had the cognitive abilities to learn to write; therefore, we explored the use of a CAT device to enable written communication. Case study methodology was used to describe the selection process, child-level outcomes, and clinical challenges faced by the therapist in the use of a consortium model that was designed for an outcome-driven model of decision-making. The critical role of an occupational therapist in this process using a family-centered approach is discussed.
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Affiliation(s)
- Brightlin Nithis Dhas
- 1Department of Occupational Therapy, Rumailah Hospital, Hamad Medical Corporation , Doha , Qatar
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The electroencephalogram of the full-term newborn: Review of normal features and hypoxic-ischemic encephalopathy patterns. Neurophysiol Clin 2013; 43:267-87. [DOI: 10.1016/j.neucli.2013.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/21/2022] Open
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6
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Keihani-Doust Z, Saeedi M, Esmaeilni T, Habibi M, Nazari SSH. Two-year follow-up study on neurodevelopmental outcomes after term intrapartum asphyxia using age and stages questionnaire. J Child Neurol 2013; 28:1555-61. [PMID: 23112249 DOI: 10.1177/0883073812461564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Birth asphyxia is one of the multiple causes of neonatal encephalopathy. The objective of this study was to evaluate neurodevelopmental outcomes of newborn term infants with definitive asphyxia. Thirty infants met study criteria for asphyxia. The 5-year incidence of asphyxia was estimated to be 5.5 in 1000. According to the Age and Stage Questionnaire, 10.5% of 6-month-old infants, 14.3% of 12- and 18-month-old infants, and 5.3% of 24-month-old infants had neurodevelopmental delay in gross motor function in the absence of cerebral palsy. In 7.3% of 18-month-old infants, neurodevelopmental delay in problem-solving ability was observed. Higher values of Apgar score and bicarbonate levels were associated with higher Age and Stage Questionnaire total score. Delivery type, maternal age, gravidity of mother, and existence of mother disease during pregnancy were also associated with lower Age and Stage Questionnaire total score in different stages of life.
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Affiliation(s)
- Zarrin Keihani-Doust
- 1Department of Pediatrics, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kyriakopoulos P, Oskoui M, Dagenais L, Shevell MI. Term neonatal encephalopathy antecedent cerebral palsy: a retrospective population-based study. Eur J Paediatr Neurol 2013. [PMID: 23195237 DOI: 10.1016/j.ejpn.2012.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the clinical profile of term-born cerebral palsy children with or without antecedent moderate to severe neonatal encephalopathy. We hypothesized that antecedent neonatal encephalopathy is associated with a spastic quadriparesis cerebral palsy clinical profile, a higher severity of functional motor impairment, and a greater number of associated comorbidities. METHODS Using the Quebec Cerebral Palsy Registry, neurologic subtype, Gross Motor Function Classification System stratification, and comorbidities were compared in children with cerebral palsy with and without antecedent neonatal encephalopathy. Differences between groups were evaluated using chi square analysis for categorical variables and student t test for continuous variables. RESULTS We identified 132 children with cerebral palsy born full term over a 4 year-interval (1999-2002 inclusive) within the Quebec Cerebral Palsy Registry, of which 44 (33%) had an antecedent neonatal encephalopathy. Spastic quadriplegia subtype of cerebral palsy and Gross Motor Function Classification System Level III-V (non-independent ambulation) were significantly associated with antecedent neonatal encephalopathy. The mean number of comorbidities experienced was not different in the two groups. Of five documented comorbidities, only severe communication difficulties were found to be associated (p < 0.05) with antecedent neonatal encephalopathy. CONCLUSION A pattern of increased neuromotor impairment, functional gross motor severity and possible communication difficulties was found in the 33% of children with cerebral palsy born at term and with a history of neonatal encephalopathy.
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Affiliation(s)
- Paulina Kyriakopoulos
- Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
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Abstract
Epileptic seizures are more frequent in the neonate than at any other time. The incidence of neonatal seizures (NNS) is estimated to be between 1.5 and 5.5/1000 living births, its onset being during the first week in 80% of cases. Mortality rate remains very high (20-45%). Not all paroxysmal manifestations are epileptic, and differential diagnosis remains an important challenge. Neonates may present with different types of seizures: clonic, tonic, myoclonic (axial, focal, erratic), epileptic spasms, and subtle seizures, including autonomic signs or automatisms. The main etiology is hypoxic-ischemic encephalopathy (40-45%) with a very early onset, and variable semiology including all seizure types. An EEG is necessary to recognize the seizures, and interictal tracing may help in assessing prognosis. Ischemic stroke is associated with seizures of early onset, being focal or unilateral. Interictal EEG is asymmetrical, with focal or unilateral patterns. Other etiologies less often linked to epileptic seizures must be looked for such as brain infection, metabolic disorders, chromosomal abnormalities, inborn errors of metabolism, brain malformations, and vitamin B6 dependency. Neonatal epilepsy syndromes may have favorable (benign familial neonatal seizures) or poor (early infantile encephalopathy with epilepsy, early myoclonic encephalopathy, and migrating partial seizures in infancy) prognosis.
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Wachtel EV, Hendricks-Muñoz KD. Current management of the infant who presents with neonatal encephalopathy. Curr Probl Pediatr Adolesc Health Care 2011; 41:132-53. [PMID: 21458747 DOI: 10.1016/j.cppeds.2010.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neonatal encephalopathy after perinatal hypoxic-ischemic insult is a major contributor to global child mortality and morbidity. Brain injury in term infants in response to hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy as well as predict their outcome. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Therapeutic hypothermia is the most promising neuroprotective intervention to date for infants with moderate to severe neonatal encephalopathy after perinatal asphyxia and has currently been incorporated in many neonatal intensive care units in developed countries. However, only 1 in 6 babies with encephalopathy will benefit from hypothermia therapy; many infants still develop significant adverse outcomes. To enhance the outcome, specific diagnostic predictors are needed to identify patients likely to benefit from hypothermia treatment. Studies are needed to determine the efficacy of combined therapeutic strategies with hypothermia therapy to achieve maximal neuroprotective effect. This review focuses on important concepts in the pathophysiology, diagnosis, and management of infants with neonatal encephalopathy due to perinatal asphyxia, including an overview of recently introduced novel therapies.
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Affiliation(s)
- Elena V Wachtel
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY, USA
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Garfinkle J, Shevell MI. Predictors of outcome in term infants with neonatal seizures subsequent to intrapartum asphyxia. J Child Neurol 2011; 26:453-9. [PMID: 21270469 DOI: 10.1177/0883073810382907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to define potential clinical prognostic factors for term infants with neonatal seizures subsequent to intrapartum asphyxia. The authors completed a retrospective analysis of 62 term infants with clinical neonatal seizures subsequent to intrapartum asphyxia. Logistic regression analysis was applied to determine the independent prognostic indicators of an adverse outcome. A total of 23 (37%) infants had a normal outcome, 34 (55%) survived with 1 or more neurodevelopmental impairments (23 cerebral palsy, 28 global developmental delay, 15 epilepsy, with 18 combination of two, and 9 all three), and 5 (8%) died. Six variables were associated with an adverse outcome, but only the presence of meconium aspiration, a low (≤ 3) 1-minute Apgar score, seizure type other than focal clonic, and moderately severely abnormal electroencephalography (EEG) background findings were independently associated with an adverse outcome. Signs of acute distress are predictors of adverse outcome, alongside seizure semiology and moderate to severe EEG background abnormalities.
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Affiliation(s)
- Jarred Garfinkle
- Departments of Neurology/Neurosurgery & Pediatrics, McGill University, and Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec Canada
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Électroencéphalogramme du nouveau-né à terme. Aspects normaux et encéphalopathie hypoxo-ischémique. Neurophysiol Clin 2011; 41:1-18. [DOI: 10.1016/j.neucli.2010.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 11/26/2010] [Accepted: 12/12/2010] [Indexed: 11/22/2022] Open
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Pinchefsky E, Al-Macki N, Shevell M. Term intra-partum asphyxia: an analysis of acute non-specific supportive criteria and non-CNS organ injury. Eur J Paediatr Neurol 2010; 14:313-9. [PMID: 19811936 DOI: 10.1016/j.ejpn.2009.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the frequencies and relationships of non-specific non-essential diagnostic criteria and non-CNS organ system injury in term intra-partum asphyxia. METHODS All children with term intra-partum asphyxia encountered in a single pediatric neurology practice with at least two years follow-up and an abnormal neurologic outcome were identified. RESULTS A total of 40 children (28 males, 12 females) were identified. Twenty-four had moderate NE and sixteen severe NE. The mean number of non-specific non-essential diagnostic criteria (out of a possible 7) was 4.75+/-1.39 SD. Sixty percent had five or more criteria and all criteria were present in only 10% of newborns. The mean number of non-CNS organ systems affected was 2.88+/-1.96 SD (out of a possible 6). Ten percent of our sample showed no evident non-CNS organ injury acutely. CONCLUSION Most asphyxiated neonates failed to consistently satisfy all elements of present consensus statements.
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Affiliation(s)
- Elana Pinchefsky
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Al-Macki N, Miller SP, Hall N, Shevell M. The spectrum of abnormal neurologic outcomes subsequent to term intrapartum asphyxia. Pediatr Neurol 2009; 41:399-405. [PMID: 19931160 DOI: 10.1016/j.pediatrneurol.2009.06.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to describe the spectrum of possible abnormal neurologic outcomes in term infants with intrapartum asphyxia and to identify those clinical factors associated with the later occurrence of cerebral palsy. All children with term intrapartum asphyxia encountered in a single pediatric neurologic practice with at least 2 years of follow-up and an abnormal neurologic outcome were identified. Abnormal outcomes were grouped into those with or without cerebral palsy. A total of 40 children (28 male, 12 female) met study criteria. Of these, 23 developed cerebral palsy; the remaining 17 children developed an abnormal neurologic outcome that did not include cerebral palsy. A more severe grade of neonatal encephalopathy, a higher number of neonatal seizures, the neonatal use of phenytoin, diffuse abnormalities on imaging, and abnormal findings on neurologic examination at neonatal discharge were all significantly (P<0.05) associated with an abnormal outcome that included cerebral palsy. Abnormal neurologic outcomes other than cerebral palsy subsequent to term intrapartum asphyxia may occur. It appears that a more severe grade of apparent initial clinical injury is more likely to result in an outcome featuring cerebral palsy.
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Affiliation(s)
- Nabil Al-Macki
- Department of Neurology and Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec H3H 1P3, Canada
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Orozco-Gregorio H, Mota-Rojas D, Alonso-Spilsbury M, Olmos-Hernandez A, Ramirez-Necoechea R, Velazquez-Armenta EY, Nava-Ocampo AA, Hernandez-Gonzalez R, Trujillo-Ortega ME, Villanueva-Garcia D. Short-Term Neurophysiologic Consequences of Intrapartum Asphyxia in Piglets Born by Spontaneous Parturition. Int J Neurosci 2009; 118:1299-315. [DOI: 10.1080/00207450701872846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pin TW, Eldridge B, Galea MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Eur J Paediatr Neurol 2009; 13:224-34. [PMID: 18585940 DOI: 10.1016/j.ejpn.2008.05.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/05/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND/AIMS Post-asphyxia neonatal encephalopathy (NE) is one of the main causes of disabilities in term-born infants. This review attempted to investigate the developmental outcomes of term-born infants with post-asphyxia NE. METHOD An electronic search on various databases identified 13 empirical studies against the selection criteria modified from the consensus statement from the International Cerebral Palsy Task Force. RESULTS The overall quality of methodology of these studies was average. The random effect meta-estimate of the proportion of infants having adverse developmental outcomes such as death, cognitive impairment, sensory-motor impairments was 47% (95% CI 36-57%). Significant heterogeneity (I(2)=87.7%, p<0.00001) between studies indicated variations in number of subjects in studies and their characteristics. For those studies using the Sarnat grading of NE, the proportion of infants with adverse outcomes was nil in stage 1 (mild) NE, 32% in stage 2 (moderate) and almost 100% in stage 3 (severe) NE. CONCLUSIONS At present, researchers are using very loose diagnostic criteria of perinatal asphyxia and post-asphyxia NE, making the study samples heterogeneous. Clinicians and researchers are urged to make use of the recent consensus statement regarding diagnostic criteria for intrapartum asphyxia and to identify these high-risk infants for early intervention.
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Affiliation(s)
- Tamis W Pin
- The University of Melbourne, Victoria, Australia.
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Philopoulos D. [D. Philopoulos answers C. Racinet with regard to his article: is cerebral palsy preventable?]. ACTA ACUST UNITED AC 2008; 36:494-8. [PMID: 18462979 DOI: 10.1016/j.gyobfe.2008.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Drougia A, Giapros V, Krallis N, Theocharis P, Nikaki A, Tzoufi M, Andronikou S. Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review. Early Hum Dev 2007; 83:541-7. [PMID: 17188824 DOI: 10.1016/j.earlhumdev.2006.10.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece. DESIGN AND PATIENTS All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used). RESULTS CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16). CONCLUSION Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.
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Affiliation(s)
- A Drougia
- Neonatal Intensive Care Unit (NICU), University Hospital of Ioannina, Greece
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Kaminska A, Mourdie J, Barnerias C, Bahi-Buisson N, Plouin P, Huon C. [Management of neonatal seizures]. Arch Pediatr 2007; 14:1137-51. [PMID: 17570648 DOI: 10.1016/j.arcped.2007.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 04/18/2007] [Accepted: 05/09/2007] [Indexed: 11/25/2022]
Abstract
The aim of this review is to focus on the nosological classification of neonatal "convulsions", to precise the underlying aetiologies and the prognosis, and to propose diagnostic and therapeutical approach. Seizures may be epileptic or not, they may be occasional, part of an epilepsy syndrome or associated to a metabolic disease. Electroencephalography plays a central role; it enables to confirm the epileptic nature of the ictal events, it allows to evaluate the prognosis and to guide the treatment decision, and sometimes may help in the etiological diagnosis. Work up should include cerebral imaging (MRI) completed by other exams according to the diagnostic hypothesis. It is essential to go as far as possible in the etiological work-up not to attribute convulsions to an occasional event as HIE in which criteria remain very strict, when convulsions could be due to genetic origin or to maternal pathology. Treatment decision should comprise different ways: treatment of the underlying cause, of the eventual associated pathologies, maintenance of vital functions and antiepileptic treatment. Phenobarbitone remains the first line drug in occasional seizures, and second line drugs for which further studies are needed both for immediate and long-term secondary effects. Besides occasional seizures epilepsy syndromes and metabolic diseases remain exceptional. Nevertheless recognition of these conditions allows to establish the prognosis and to start immediately with an appropriate and specific medication depending on the epilepsy syndrome and can contribute to a prenatal diagnosis. It is important to recognize the inborn errors of metabolism because emergency appropriate treatment is required. Prognosis which is generally bad is essentially related to the underlying aetiology and probably to the duration of the active period of seizures.
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Affiliation(s)
- A Kaminska
- Service d'explorations fonctionnelles neurologiques, APHP, groupe hospitalier Cochin-Saint-Vincent-de-Paul, 74, avenue Denfert-Rochereau, 75014 Paris, France.
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Abstract
Cerebral palsy (CP) is one of the most common conditions we follow in our pediatric neurology offices. This review will hopefully convince you that the care of children with CP extends far beyond the diagnosis. The review addresses issues surrounding diagnosis, coimpairments, prognosis, and family-centeredness of care. It will also deal with routine office follow-up to prevent or identify complications, management of spasticity and other morbidities, alternative and complementary therapies, and finally transition.
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Affiliation(s)
- Ellen Wood
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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Morgan MA, Hankins GDV, Zinberg S, Schulkin J. Neonatal encephalopathy and cerebral palsy revisited: the current state of knowledge and the impact of american college of obstetricians and gynecologists task force report. J Perinatol 2005; 25:519-25. [PMID: 15908986 DOI: 10.1038/sj.jp.7211339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To re-assess obstetrician-gynecologists' knowledge of neonatal encephalopathy and cerebral palsy after publication of the ACOG/AAP Task Force report. STUDY DESIGN A questionnaire investigating knowledge of neonatal encephalopathy and cerebral palsy was mailed to 1060 members of ACOG, 337 of whom participated in a similar study in 2001. RESULTS There was a strong association between familiarity with ACOG documentation and knowledge of neonatal encephalopathy (NE) and cerebral palsy (CP) (p<0.001). As with obstetricians surveyed in 2001, knowledge gaps remain. Performance was better on practices questions than knowledge questions. About one-third (34.2%) of the physicians said their knowledge of neonatal encephalopathy was poor or deficient; the majority (76%) rated their residency training as inadequate to marginal. CONCLUSION The results indicate better knowledge of neonatal encephalopathy and cerebral palsy among physicians more familiar with the Task Force report. There is a clear need for emphasis on these topics during training and continuing medical education.
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Affiliation(s)
- Maria A Morgan
- American College of Obstetricians and Gynecologists, Washington, DC 20024, USA
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Loren DJ, Seeram NP, Schulman RN, Holtzman DM. Maternal dietary supplementation with pomegranate juice is neuroprotective in an animal model of neonatal hypoxic-ischemic brain injury. Pediatr Res 2005; 57:858-64. [PMID: 15774834 DOI: 10.1203/01.pdr.0000157722.07810.15] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neonatal hypoxic-ischemic brain injury remains a significant cause of morbidity and mortality and lacks effective therapies for prevention and treatment. Recently, interest in the biology of polyphenol compounds has led to the discovery that dietary supplementation with foods rich in polyphenols (e.g. blueberries, green tea extract) provides neuroprotection in adult animal models of ischemia and Alzheimer's disease. We sought to determine whether protection of the neonatal brain against a hypoxic-ischemic insult could be attained through supplementation of the maternal diet with pomegranate juice, notable for its high polyphenol content. Mouse dams were provided ad libitum access to drinking water with pomegranate juice, at one of three doses, as well as plain water, sugar water, and vitamin C water controls during the last third of pregnancy and throughout the duration of litter suckling. At postnatal day 7, pups underwent unilateral carotid ligation followed by exposure to 8% oxygen for 45 min. Brain injury was assessed histologically after 1 wk (percentage of tissue area loss) and biochemically after 24 h (caspase-3 activity). Dietary supplementation with pomegranate juice resulted in markedly decreased brain tissue loss (>60%) in all three brain regions assessed, with the highest pomegranate juice dose having greatest significance (p < or = 0.0001). Pomegranate juice also diminished caspase-3 activation by 84% in the hippocampus and 64% in the cortex. Ellagic acid, a polyphenolic component in pomegranate juice, was detected in plasma from treated but not control pups. These results demonstrate that maternal dietary supplementation with pomegranate juice is neuroprotective for the neonatal brain.
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Affiliation(s)
- David J Loren
- Division of Neonatology, University of Washington, Seattle, WA 98195, USA
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