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Lee KS, Massaro A, Wintermark P, Soul J, Natarajan G, Dizon MLV, Mietzsch U, Mohammad K, Wu TW, Chandel A, Shenberger J, DiGeronimo R, Peeples ES, Hamrick S, Cardona VQ, Rao R. Practice Variations for Therapeutic Hypothermia in Neonates with Hypoxic-ischemic Encephalopathy: An International Survey. J Pediatr 2024; 274:114181. [PMID: 38950817 DOI: 10.1016/j.jpeds.2024.114181] [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: 02/12/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To evaluate variations in management of therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) among international clinical sites and to identify areas for harmonization. STUDY DESIGN An electronic survey was sent to Children's Hospitals Neonatal Consortium site sponsors, Canadian Neonatal Network site investigators, members of the Newborn Brain Society, and American Academy of Pediatrics Neonatology chiefs. RESULTS One hundred five sites responded, with most from high-income regions (n = 95). Groupings were adapted from the United Nations regional groups: US (n = 52 sites); Canada (n = 20); Western Europe and other states excluding Canada and US Group (WEOG, n = 18); and non-WEOG (central and eastern Europe, Asia, Africa, Latin America, and Caribbean, n = 15). Regional variations were seen in the eligibility criteria for TH, such as the minimum gestational age, grading of HIE severity, use of electroencephalography, and the frequency of providing TH for mild HIE. Active TH during transport varied among regions and was less likely in smaller volume sites. Amplitude-integrated electroencephalogram and/or continuous electroencephalogram to determine eligibility for TH was used by most sites in WEOG and non-WEOG but infrequently by the US and Canada Groups. For sedation during TH, morphine was most frequently used as first choice but there was relatively high (33%) use of dexmedetomidine in the US Group. Timing of brain magnetic resonance imaging and neurodevelopmental follow-up were variable. Neurodevelopmental follow occurred earlier and more frequently, although for a shorter duration, in the non-WEOG. CONCLUSIONS We found significant variations in practices for TH for HIE across regions internationally. Future guidelines should incorporate resource availability in a global perspective.
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Affiliation(s)
- Kyong-Soon Lee
- Division of Neonatology, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Canada.
| | - An Massaro
- Division of Neonatology, Children's National Hospital, Department of Pediatrics, The George Washington School of Medicine, Washington, DC
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Janet Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Girija Natarajan
- Children's Hospital of Michigan/Wayne State University, Detroit, MI
| | - Maria L V Dizon
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Newborn Critical Care, University of Calgary, Cumming School of Medicine, Alberta Children's Hospital, Calgary, Canada
| | - Tai-Wei Wu
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Amit Chandel
- Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | | | - Robert DiGeronimo
- Division of Neonatology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Eric S Peeples
- Division of Neonatology, Department of Pediatrics, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE
| | - Shannon Hamrick
- Emory University and Children's Healthcare of Atlanta, Atlanta GA
| | | | - Rakesh Rao
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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2
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Bruns N, Feddahi N, Hojeij R, Rossi R, Dohna-Schwake C, Stein A, Kobus S, Stang A, Kowall B, Felderhoff-Müser U. Short-term outcomes of asphyxiated neonates depending on requirement for transfer in the first 24 h of life. Resuscitation 2024; 202:110309. [PMID: 39002696 DOI: 10.1016/j.resuscitation.2024.110309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
IMPORTANCE In neonates with birth asphyxia (BA) and hypoxic-ischemic encephalopathy, therapeutic hypothermia (TH), initiated within six hours, is the only safe and established neuroprotective measure to prevent secondary brain injury. Infants born outside of TH centers have delayed access to cooling. OBJECTIVE To compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)). DESIGN Nationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes. SETTING All discharges from German hospitals from 2016 to 2021. PARTICIPANTS Full term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life. EXPOSURES Postnatal transfer to a pediatric department within 24 h of admission to an external hospital. MAIN OUTCOMES In-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2. RESULTS Of 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41-4.89), 2.99 (2.65-3.38), and 1.76 (1.52-2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29-2.17)) and seizures (1.26 (1.07-1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64-1.02)) in TNs. CONCLUSION AND RELEVANCE This comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Nadia Feddahi
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rayan Hojeij
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Rossi
- Department of Pediatrics, Vivantes Klinikum Neukoelln, Berlin, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Susann Kobus
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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3
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Gray MM, Riley T, Greene ND, Mastroianni R, McLean C, Umoren RA, Tiwari A, Mahankali A, Billimoria ZC. Neonatal Transport Safety Metrics and Adverse Event Reporting: A Systematic Review. Air Med J 2023; 42:283-295. [PMID: 37356892 DOI: 10.1016/j.amj.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Neonatal transports are an essential component of regionalized medical systems. Neonates who are unstable after birth require transport to a higher level of care by neonatal transport teams. Data on adverse events on neonatal transports are limited. The aim of this study was to identify, evaluate, and summarize the findings of all relevant studies on adverse events on neonatal transports. METHODS We identified 38 studies reporting adverse events on neonatal transports from January 1, 2000, to December 31, 2019. The adverse events were distributed into 5 categories: vital sign abnormalities, laboratory value abnormalities, equipment challenges, system challenges, cardiopulmonary resuscitation, and transport-related mortality. RESULTS Most of the evidence surrounds vital sign abnormalities during transport (n = 28 studies), with hypothermia as the most frequently reported abnormal vital sign. Fourteen studies addressed laboratory abnormalities, 12 reported on events related to equipment issues, and 4 reported on system issues that lead to adverse events on transport. Of the 38 included studies, 12 included mortality related to transport as an outcome, and 4 reported on cardiopulmonary resuscitation during transport. There were significant variations in samples, definitions of adverse events, and research quality. CONCLUSION Adverse events during neonatal transport have been illuminated in various ways, with vital sign abnormalities most commonly explored in the literature. However, considerable variation in studies limits a clear understanding of the relative frequencies of each type of adverse event. The transport safety field would benefit from more efforts to standardize adverse event definitions, collect safety data prospectively, and pool data across larger care systems.
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Affiliation(s)
- Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Nancy D Greene
- Bill & Melinda Gates Medical Research Institute, Cambridge, MA
| | - Rossella Mastroianni
- Division of Neonatology, University of Washington School of Medicine, Seattle, WA
| | - Courtney McLean
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| | - Rachel A Umoren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Aditi Tiwari
- Oregon Health & Sciences University, Portland, OR
| | | | - Zeenia C Billimoria
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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4
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Kumar P, Hair P, Cunnion K, Krishna N, Bass T. Classical complement pathway inhibition reduces brain damage in a hypoxic ischemic encephalopathy animal model. PLoS One 2021; 16:e0257960. [PMID: 34591905 PMCID: PMC8483388 DOI: 10.1371/journal.pone.0257960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
Perinatal hypoxic ischemic encephalopathy (HIE) remains a major contributor of infant death and long-term disability worldwide. The role played by the complement system in this ischemia-reperfusion injury remains poorly understood. In order to better understand the role of complement activation and other modifiable mechanisms of injury in HIE, we tested the dual-targeting anti-inflammatory peptide, RLS-0071 in an animal model of HIE. Using the well-established HIE rat pup model we measured the effects of RLS-0071 during the acute stages of the brain injury and on long-term neurocognitive outcomes. Rat pups subject to hypoxia-ischemia insult received one of 4 interventions including normothermia, hypothermia and RLS-0071 with and without hypothermia. We measured histopathological effects, brain C1q levels and neuroimaging at day 1 and 21 after the injury. A subset of animals was followed into adolescence and evaluated for neurocognitive function. On histological evaluation, RLS-0071 showed neuronal protection in combination with hypothermia (P = 0.048) in addition to reducing C1q levels in the brain at 1hr (P = 0.01) and at 8 hr in combination with hypothermia (P = 0.005). MRI neuroimaging demonstrated that RLS-0071 in combination with hypothermia reduced lesion volume at 24 hours (P<0.05) as well as decreased T2 signal at day 21 in combination with hypothermia (P<0.01). RLS-0071 alone or in combination with hypothermia improved both short-term and long-term memory. These findings suggest that modulation by RLS-0071 can potentially decrease brain damage resulting from HIE.
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Affiliation(s)
- Parvathi Kumar
- ReAlta Life Sciences, Norfolk, VA, United States of America
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA, United States of America
- * E-mail:
| | - Pamela Hair
- ReAlta Life Sciences, Norfolk, VA, United States of America
| | - Kenji Cunnion
- ReAlta Life Sciences, Norfolk, VA, United States of America
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA, United States of America
- Eastern Virginia Medical School, Norfolk, VA, United States of America
| | - Neel Krishna
- ReAlta Life Sciences, Norfolk, VA, United States of America
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA, United States of America
- Eastern Virginia Medical School, Norfolk, VA, United States of America
| | - Thomas Bass
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA, United States of America
- Eastern Virginia Medical School, Norfolk, VA, United States of America
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5
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Casey S, Goasdoue K, Miller SM, Brennan GP, Cowin G, O'Mahony AG, Burke C, Hallberg B, Boylan GB, Sullivan AM, Henshall DC, O'Keeffe GW, Mooney C, Bjorkman T, Murray DM. Temporally Altered miRNA Expression in a Piglet Model of Hypoxic Ischemic Brain Injury. Mol Neurobiol 2020; 57:4322-4344. [PMID: 32720074 PMCID: PMC7383124 DOI: 10.1007/s12035-020-02018-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
Abstract
Hypoxic ischemic encephalopathy (HIE) is the most frequent cause of acquired infant brain injury. Early, clinically relevant biomarkers are required to allow timely application of therapeutic interventions. We previously reported early alterations in several microRNAs (miRNA) in umbilical cord blood at birth in infants with HIE. However, the exact timing of these alterations is unknown. Here, we report serial changes in six circulating, cross-species/bridging biomarkers in a clinically relevant porcine model of neonatal HIE with functional analysis. Six miRNAs—miR-374a, miR-181b, miR-181a, miR-151a, miR-148a and miR-128—were significantly and rapidly upregulated 1-h post-HI. Changes in miR-374a, miR-181b and miR-181a appeared specific to moderate-severe HI. Histopathological injury and five miRNAs displayed positive correlations and were predictive of MRS Lac/Cr ratios. Bioinformatic analysis identified that components of the bone morphogenic protein (BMP) family may be targets of miR-181a. Inhibition of miR-181a increased neurite length in both SH-SY5Y cells at 1 DIV (days in vitro) and in primary cultures of rat neuronal midbrain at 3 DIV. In agreement, inhibition of miR-181a increased expression of BMPR2 in differentiating SH-SY5Y cells. These miRNAs may therefore act as early biomarkers of HIE, thereby allowing for rapid diagnosis and timely therapeutic intervention and may regulate expression of signalling pathways vital to neuronal survival.
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Affiliation(s)
- Sophie Casey
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. .,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. .,Department of Anatomy and Neuroscience, University College Cork, Room 2.33, Western Gateway Building, Cork, Ireland.
| | - Kate Goasdoue
- Perinatal Research Centre, UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Stephanie M Miller
- Perinatal Research Centre, UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Gary P Brennan
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gary Cowin
- National Imaging Facility, Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Adam G O'Mahony
- Department of Anatomy and Neuroscience, University College Cork, Room 2.33, Western Gateway Building, Cork, Ireland
| | - Christopher Burke
- Department of Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Boubou Hallberg
- Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Aideen M Sullivan
- Department of Anatomy and Neuroscience, University College Cork, Room 2.33, Western Gateway Building, Cork, Ireland
| | - David C Henshall
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Room 2.33, Western Gateway Building, Cork, Ireland
| | - Catherine Mooney
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Computer Science, University College Dublin, Dublin, Ireland
| | - Tracey Bjorkman
- Perinatal Research Centre, UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Deirdre M Murray
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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6
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Bolbocean C, Shevell M. The impact of high intensity care around birth on long-term neurodevelopmental outcomes. HEALTH ECONOMICS REVIEW 2020; 10:22. [PMID: 32642972 PMCID: PMC7346442 DOI: 10.1186/s13561-020-00279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND An equitable and affordable healthcare system requires a constant search for the optimal way to deliver increasingly expensive neonatal care. Therefore, evaluating the impact of hospital intensity around birth on long-term health outcomes is necessary if we are to assess the value of high intensity neonatal care against its costs. METHODS This study exploits uneven geographical distribution of high intensity birth hospitals across Canada to generate comparisons across similar Cerebral Palsy (CP) related births treated at hospitals with different intensities. We employ a rich dataset from the Canadian Multi-Regional CP Registry (CCPR) and instrumental variables related to the mother's location of residence around birth. RESULTS We find that differences in hospitals' intensities are not associated with differences in clinically relevant, long-term CP health outcomes. CONCLUSIONS Our results suggest that existing matching mechanism of births to hospitals within large metropolitan areas could be improved by early detection of high risk births and subsequent referral of these births to high intensity birthing centers. Substantial hospitalization costs might be averted to Canadian healthcare system ($16 million with a 95% CI of $6,131,184 - $24,103,478) if CP related births were assigned to low intensity hospitals and subsequently transferred if necessary to high intensity hospitals.
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Affiliation(s)
- Corneliu Bolbocean
- Department of Preventive Medicine, University of Tennessee Health Science Centre, 66 N. Pauline Street, Memphis, TN, 38163, USA.
- The Centre for Addiction and Mental Health, Toronto, Ontario, 33 Russell St, Toronto, ON, M5S 2S1, Canada.
| | - Michael Shevell
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, QC, H3G 2M1, Canada
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7
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Xu EH, Claveau M, Yoon EW, Barrington KJ, Mohammad K, Shah PS, Wintermark P. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury. J Neonatal Perinatal Med 2020; 13:449-458. [PMID: 32310192 DOI: 10.3233/npm-190368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Birth asphyxia in term neonates remains a serious condition that causes significant mortality and long-term neurodevelopmental sequelae despite hypothermia treatment. The objective of this study was to review therapeutic hypothermia practices in a large population of neonates with hypoxic-ischemic encephalopathy (HIE) across Canada and to identify determinants of adverse outcome. METHODS Our retrospective observational cohort study examined neonates≥36 weeks, admitted to the Canadian Neonatal Network NICUs between 2010 and 2014, diagnosed with HIE, and treated with hypothermia. Adverse outcome was defined as death and/or brain injury. Maternal, birth, and postnatal characteristics were compared between neonates with adverse outcome and those without. The association between the variables which were significantly different (p < 0.05) between the two groups and adverse outcome were further tested, while adjusting for gestational age, birth weight, gender, and initial severity of encephalopathy. RESULTS A total of 2187 neonates were admitted for HIE; 52% were treated with hypothermia and 40% developed adverse outcome. Initial severity of encephalopathy (moderate, p = 0.006; severe, p < 0.0001), hypotension treated with inotropes (p = 0.001), and renal failure (p = 0.007) were significantly associated with an increased risk of death and/or brain injury. CONCLUSIONS In asphyxiated neonates treated with hypothermia, not only their initial severity of encephalopathy on admission, but also their cardiac and renal complications during the first days after birth were significantly associated with risk of death and/or brain injury. Careful monitoring and cautious management of these complications is warranted.
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Affiliation(s)
- E H Xu
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - M Claveau
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - E W Yoon
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K J Barrington
- Department of Pediatrics, Division of Neonate Medicine, University of Montreal, Montreal, Québec, Canada
| | - K Mohammad
- Department of Pediatrics, Division of Neonatology, University of Calgary, Calgary, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - P Wintermark
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
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8
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Wilson LA, Fell DB, Hawken S, Wong CA, Murphy MSQ, Little J, Potter BK, Walker M, Lacaze-Masmonteil T, Juul S, Chakraborty P, Wilson K. Association between newborn screening analytes and hypoxic ischemic encephalopathy. Sci Rep 2019; 9:15704. [PMID: 31673070 PMCID: PMC6823438 DOI: 10.1038/s41598-019-51919-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/10/2019] [Indexed: 01/04/2023] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) is a major cause of neonatal mortality and morbidity. Our study sought to examine whether patterns of newborn screening analytes differed between infants with and without neonatal HIE in order to identify opportunities for potential use of these analytes for diagnosis in routine clinical practice. We linked a population-based newborn screening registry with health databases to identify cases of HIE among term infants (≥37 weeks' gestation) in Ontario from 2010-2015. Correlations between HIE and screening analytes were examined using multivariable logistic regression models containing clinical factors and individual screening analytes (acyl-carnitines, amino acids, fetal-to-adult hemoglobin ratio, endocrine markers, and enzymes). Among 731,841 term infants, 3,010 were diagnosed with HIE during the neonatal period. Multivariable models indicated that clinical variables alone or in combination with hemoglobin values were not associated with HIE diagnosis. Although the model was improved after adding acyl-carnitines and amino acids, the ability of the model to identify infants with HIE was moderate. Our findings indicate that analytes associated with catabolic stress were altered in infants with HIE; however, future research is required to determine whether amino acid and acyl-carnitine profiles could hold clinical utility in the early diagnosis or clinical management of HIE. In particular, further research should examine whether cord blood analyses can be used to identify HIE within a clinically useful timeframe or to guide treatment and predict long-term health outcomes.
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Affiliation(s)
- Lindsay A Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Ontario, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa Ontario, Canada
- ICES, University of Ottawa, Ottawa Ontario, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada
- ICES, University of Ottawa, Ottawa Ontario, Canada
| | | | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada
- ICES, University of Ottawa, Ottawa Ontario, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa Ontario, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - Sandra Juul
- Department of Pediatrics, University of Washington, Seattle Washington, USA
| | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa Ontario, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Ontario, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada.
- ICES, University of Ottawa, Ottawa Ontario, Canada.
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9
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Guillot M, Philippe M, Miller E, Davila J, Barrowman NJ, Harrison MA, Ben Fadel N, Redpath S, Lemyre B. Influence of timing of initiation of therapeutic hypothermia on brain MRI and neurodevelopment at 18 months in infants with HIE: a retrospective cohort study. BMJ Paediatr Open 2019; 3:e000442. [PMID: 31206080 PMCID: PMC6542433 DOI: 10.1136/bmjpo-2019-000442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/08/2019] [Accepted: 03/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the influence of timing of initiation of therapeutic hypothermia (TH) on brain injury on MRI and on neurodevelopmental outcomes at 18 months. DESIGN Retrospective cohort study. SETTING Tertiary neonatal intensive care unit in Ontario, Canada. PATIENTS Ninety-one patients with hypoxic ischaemic encephalopathy (HIE) were included, 54 in the early TH group and 37 in the late TH group. INTERVENTION Whole-body hypothermia administered for 72 hours, initiated either before 3 hours of life (early TH) or between 3 and 6 hours of life (late TH). MAIN OUTCOME MEASURES Brain injury on MRI after TH (assessed by two neuroradiologists), and neurodevelopmental outcomes at 18 months old. RESULTS TH was initiated at a median time of 1.4 hours (early TH) and 4.4 hours (late TH). Sixty-four neonates (early TH=36, late TH=28) survived and completed neurodevelopmental assessment at 18 months. Neonates in the early TH group received more extensive resuscitation than neonates in the late TH group (p=0.0008). No difference was observed between the two groups in the pattern or severity of brain injury on MRI, or in the neurodevelopmental outcomes at 18 months. The non-survivors (n=16) had lower Apgar scores at 10 min, more extensive resuscitation, suffered from more severe HIE and had significantly more abnormal cerebral function monitoring. CONCLUSION In this retrospective cohort study, TH initiated early was associated neither with a difference in brain injury on MRI nor better neurodevelopmental outcomes at 18 months.
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Affiliation(s)
- Mireille Guillot
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Marissa Philippe
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Elka Miller
- Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jorge Davila
- Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nicholas James Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mary-Ann Harrison
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nadya Ben Fadel
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stephanie Redpath
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cooling in neonatal hypoxic-ischemic encephalopathy: practices and opinions on minimum standards in the state of California. J Perinatol 2018; 38:54-58. [PMID: 29048405 DOI: 10.1038/jp.2017.153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/06/2017] [Accepted: 08/11/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although hospitals increasingly offer therapeutic hypothermia (TH), there is variable implementation of related services. We assessed current practices and opinions regarding what services should be required of centers providing TH in California. STUDY DESIGN We surveyed neonatal intensive care unit physicians statewide regarding practices and opinions about services related to TH. RESULTS Of the 50 participating centers (47% response rate), 66% offer TH. Most TH centers reported using: an evidence-based protocol (92%), neurology consultation (92%), amplitude-integrated electroencephalography (aEEG) or EEG (88%), magnetic resonance imagings (MRIs) interpreted by pediatric neuroradiologists (71%) and developmental follow-up (93%). TH centers reported treating a median of 11 patients annually (interquartile range (IQR) 4 to 24). Respondents considered it 'critical' that TH centers offer: aEEG monitoring (70%), MRI (69%), occupational and physical therapy (67%) and developmental follow-up (94%). Over 70% thought TH centers should treat a minimum volume annually (median=10, IQR 5 to 12). CONCLUSION Physicians across practice settings in California endorsed minimum standards for TH centers to promote quality of care.
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Sebetseba KN, Ramdin T, Ballot D. The Use of Therapeutic Hypothermia in Neonates with Perinatal Asphyxia at Charlotte Maxeke Johannesburg Academic Hospital: A Retrospective Review. Ther Hypothermia Temp Manag 2017; 10:135-140. [PMID: 29182481 DOI: 10.1089/ther.2017.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Therapeutic hypothermia (TH) has become the standard of care to reduce neurological damage following perinatal asphyxia. Current recommendations call for implementation of a standard, evidence-based protocol for the provision of TH. This is particularly challenging in resource-limited settings. This is a retrospective, descriptive study to determine whether neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) are receiving TH according to the unit protocol in place. The study included all neonates with a birth weight greater than 1800 g admitted to the CMJAH neonatal unit from January 1, 2013, to June 30, 2017, before 24 hours of life. Neonates were assessed as to whether they met the criteria for TH according to the protocol, and reasons for not providing TH to those who qualified were investigated. The total number of neonates enrolled for the study was 485. Three hundred patients met the criteria for TH. 185/300 appropriately received TH. One hundred fifteen patients were not cooled, despite meeting TH criteria. Reasons for this included severe clinical conditions (73/115) and a lack of equipment (26/115). Of the remaining 185 patients who did not meet TH criteria, 21 patients inappropriately received TH. A total of 206 neonates received TH. TH at CMJAH is largely being practiced as per protocol. Still, more resources are needed, not only to optimize the number of patients who have access to this treatment modality but also in terms of imaging and support strategies.
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Affiliation(s)
- Khutso N Sebetseba
- Department of Pediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanusha Ramdin
- Department of Pediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Daynia Ballot
- Department of Pediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
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Luton A, Hernandez J, Patterson CR, Nielsen-Farrell J, Thompson A, Kaiser JR. Preventing Pressure Injuries in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: An Interprofessional Quality Improvement Project. Adv Neonatal Care 2017; 17:237-244. [PMID: 28141600 DOI: 10.1097/anc.0000000000000383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) can be caused by multiple factors including pressure, shear, friction, moisture/incontinence, device-related pressure, immobility, inactivity, and nutritional deficits. Along with immobility, medical device-related (MDR) HAPIs are a primary cause of pressure injury in neonates, as the clinical practice setting has become increasingly technologically advanced. It is estimated that up to 50% of HAPIs are MDR in pediatric patients. Neonates are at particular risk for HAPI because of their specific anatomical, physiological, and developmental vulnerabilities. A specific example of confluent factors that may increase risk for HAPI is the application of therapeutic hypothermia (TH) and continuous electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy (HIE). INTERVENTIONS An interprofessional team collaborated to expand upon existing evidence-based standards of care to address the needs of this specific population within the neonatal intensive care unit (NICU). Interventions centered on revision of current protocols, with efforts to optimize product selection, hardwire assessment practices, and refine documentation of patient care and outcomes. METHODS The team primarily utilized plan-do-study-act (PDSA) cycles to test and refine specific methods and strategies to reduce HAPIs. Tested solutions were adopted, adapted, or abandoned. RESULTS A sustained zero HAPI rate in the HIE population resulted. The team continues to collect, report, and utilize near-miss data to continue to refine the process as new risks are identified. IMPLICATIONS FOR PRACTICE Recognizing the unique skin protection needs of special populations within the NICU, such as those undergoing TH, is crucial. When evidence-based standards of care fail to adequately meet such needs, a collaborative approach to identifying, testing, and implementing population-specific solutions is essential. IMPLICATIONS FOR RESEARCH A paucity of literature regarding the unique skin protection needs for babies undergoing TH exists. Work should be done to better describe the influence of TH on skin integrity, with the goal of identifying population-specific protective measures.
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Affiliation(s)
- Alexandra Luton
- Newborn Center, Texas Children's Hospital, Houston (Ms Luton); CMHH Quality & Safety, Children's Memorial Hermann Hospital, Houston, Texas (Ms Hernandez); Neurodiagnostic Technology School, Medical Education and Training Campus, Fort Sam Houston, Texas (Mr Patterson); MoonPenny Consulting, Delaware, Ohio (Ms Nielsen-Farrell); Neurophysiology Department, Texas Children's Hospital, Houston (Ms Thompson); and Departments of Pediatrics (Section of Neonatology) and Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX (Dr Kaiser)
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. [Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain]. An Pediatr (Barc) 2017; 89:12-23. [PMID: 28764944 DOI: 10.1016/j.anpedi.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres.
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Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, España; Fundación NeNe, Madrid, España.
| | - Alfredo García-Alix
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Universitat de Barcelona, Barcelona, España; Fundación NeNe, Madrid, España
| | - Gemma Arca
- Unidad de Neonatología, Hospital Universitario Clínic (Sede Maternitat), Barcelona, España; Fundación NeNe, Madrid, España
| | - Eva Valverde
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España; Fundación NeNe, Madrid, España
| | - Sonia Caserío
- Unidad de Neonatología, Hospital Universitario Río Hortega, Valladolid, España; Fundación NeNe, Madrid, España
| | - M Teresa Moral
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España; Fundación NeNe, Madrid, España
| | - Isabel Benavente-Fernández
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
| | - Simón Lubián-López
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
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Sellam A, Lode N, Ayachi A, Jourdain G, Dauger S, Jones P. Passive hypothermia (≥35 - <36°C) during transport of newborns with hypoxic-ischaemic encephalopathy. PLoS One 2017; 12:e0170100. [PMID: 28278217 PMCID: PMC5344310 DOI: 10.1371/journal.pone.0170100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypothermia initiated in the first six hours of life in term infants with hypoxic ischemic encephalopathy reduces the risk of death and severe neurological sequelae. Our study's principal objective was to evaluate transport predictors potentially influencing arrival in NICU (Neonatal Intensive Care Unit) at a temperature ≥35-<36°C. METHODOLOGY/PRINCIPAL FINDINGS A multi-centric, prospective cohort study was conducted during 18 months by the three Neonatal Transport Teams and 13 NICUs. Newborns were selected for inclusion according to biological and clinical criteria before transport using passive hypothermia using a target temperature of ≥35-<36°C. Data on 120 of 126 inclusions were available for analysis. Thirty-three percent of the children arrived in NICU with the target temperature of ≥35-<36°C. The mean temperature for the whole group of infants on arrival in NICU was 35.4°C (34.3-36.5). The median age of all infants on arrival in NICU was 3h03min [2h25min-3h56min]. Three infants arrived in NICU with a temperature of <33°C and eleven with a temperature ≥37°C. Adrenaline during resuscitation was associated with a lower mean temperature on arrival in NICU. CONCLUSIONS/SIGNIFICANCE Our strategy using ≥35-<36°C passive hypothermia combined with short transport times had little effect on temperature after the arrival of Neonatal Transport Team although did reduce numbers of infants arriving in NICU in deep hypothermia. For those infants where hypothermia was discontinued in NICU our strategy facilitated re-warming. Re-adjustment to a lower target temperature to ≥34.5-<35.5°C may reduce the proportion of infants with high/normothermic temperatures.
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Affiliation(s)
- Aurélie Sellam
- SMUR Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Noëlla Lode
- SMUR Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Azzedine Ayachi
- SMUR Pédiatrique, AP-HP, Hôpital André Gregoire, Montreuil-sous-Bois, France
| | | | - Stéphane Dauger
- Réanimation Pédiatrique (PICU), Hôpital Robert Debré, Paris, France
| | - Peter Jones
- SMUR Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
- Réanimation Pédiatrique (PICU), Hôpital Robert Debré, Paris, France
- Portex Unit, Critical Care Group – Portex Unit, Institute of Child Health, University College London, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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16
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Mehta S, Joshi A, Bajuk B, Badawi N, McIntyre S, Lui K. Eligibility criteria for therapeutic hypothermia: From trials to clinical practice. J Paediatr Child Health 2017; 53:295-300. [PMID: 27701803 DOI: 10.1111/jpc.13378] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 06/17/2016] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
Abstract
AIM Whole body therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy was introduced into clinical practice in New South Wales (NSW) and Australian Capital Territory in 2007. State-wide policy adopting the eligibility criteria and practice based on trial-designs was published in 2009. METHODS The study was conducted by retrospectively reviewing medical records of all TH infants born between 2007 and 2011 in NSW and Australian Capital Territory to examine if eligibility criteria (assessed against evidence-based policy directives) were met. RESULTS A total of 207 infants received TH, 104 (50%) did not meet the eligibility criteria defined in NSW policy directive. Over the 5-year period, the proportion of infants meeting the eligibility criteria did not change. Seventy percent of infants (73 out of 104) not meeting eligibility criteria did not fulfil the criteria for 'evidence of asphyxia', although half of them met 'moderate or severe encephalopathy criterion'. Adverse events (hypotension, coagulopathy and arrhythmia), were more common in the 'criteria met' group than the 'criteria not met' group (89 vs. 71%, P = 0.001). Similar proportions of infants had TH discontinued before 72 h (criteria met: 32 (31%) vs. criteria not met: 27(26%)). Most frequent reason for early cessation was 'palliation' (19/32, 59%) in criteria met and 'clinical improvement' (16/27, 59%) in criteria not met group. CONCLUSIONS Many TH infants were treated based on clinician judgement, though not meeting the trial-design policy criteria. Early TH cessation (<72 h) was common. Future studies are warranted on long-term neurodevelopmental outcomes for all infants receiving TH particularly those with early cessation of therapy.
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Affiliation(s)
- Shailender Mehta
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neonatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Anjali Joshi
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Department of Neonatology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, University of Notre Dame, Sydney, New South Wales, Australia
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
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Programa multicéntrico para la atención integral del recién nacido con agresión hipóxico-isquémica perinatal (ARAHIP). An Pediatr (Barc) 2015; 82:172-82. [DOI: 10.1016/j.anpedi.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/25/2014] [Accepted: 05/08/2014] [Indexed: 11/24/2022] Open
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Arnáez J, Vega C, García-Alix A, Gutiérrez E, Caserío S, Jiménez M, Castañón L, Esteban I, Hortelano M, Hernández N, Serrano M, Prada T, Diego P, Barbadillo F. Multicenter programme for the integrated care of newborns with perinatal hypoxic-ischaemic insult (ARAHIP). An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2014.05.004] [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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Sarafidis K, Soubasi V, Diamanti E, Mitsakis K, Drossou-Agakidou V. Therapeutic hypothermia in asphyxiated neonates with hypoxic-ischemic encephalopathy: A single-center experience from its first application in Greece. Hippokratia 2014; 18:226-230. [PMID: 25694756 PMCID: PMC4309142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Therapeutic hypothermia has become an established therapy in asphyxiated neonates with evidence of moderate/severe hypoxic-ischemic encephalopathy. Herein, we describe our recent experience with total body cooling in asphyxiated neonates, which is the first relevant report in Greece. PATIENTS AND METHODS The medical records of all asphyxiated newborns treated with therapeutic hypothermia in our center between September 2010 and October 2013 were retrospectively reviewed. We recorded data related to neonatal-perinatal characteristics, whole body cooling and outcome. RESULTS Twelve asphyxiated neonates [median gestational age 38 weeks (36-40)] received whole body cooling (rectal temperature 33.5 ± 0.5 (o)C for 72 hours) during the study period for moderate (n=3) and severe (n=9) hypoxic-ischemic encephalopathy. Cooling was passive in 4 and active in 8 (66.7%) cases. Therapeutic hypothermia was initiated at the median age of 5 hours (0.5-11) after birth. Seven neonates survived (58.3%) to hospital discharge. On follow-up (7-35 months), neurodevelopment outcome was normal in 1 case, while 3, 1 and 2 subjects had mild, moderate and severe impairment, respectively. CONCLUSIONS Our initial experience with whole body cooling supports its beneficial effect in asphyxiated neonates. This treatment should be offered in all centers involved in the care of such neonates using either simple means (passive cooling) or automated cooling devices. Hippokratia 2014; 18 (3): 226-230.
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Affiliation(s)
- K Sarafidis
- 1 Department of Neonatology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - V Soubasi
- 1 Department of Neonatology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - E Diamanti
- 1 Department of Neonatology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - K Mitsakis
- 1 Department of Neonatology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - V Drossou-Agakidou
- 1 Department of Neonatology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Jia F, Du L, Hao Y, Liu S, Li N, Jiang H. Thioperamide treats neonatal hypoxic-ischemic encephalopathy by postsynaptic H1 receptors. Neural Regen Res 2013; 8:1814-22. [PMID: 25206478 PMCID: PMC4145950 DOI: 10.3969/j.issn.1673-5374.2013.19.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/25/2013] [Indexed: 11/22/2022] Open
Abstract
Thioperamide, a selective histamine H3 receptor antagonist, can increase histamine content in the brain, improve brain edema, and exert a neuroprotective effect. This study aimed to examine the mechanism of action of thioperamide during brain edema in a rat model of neonatal hypoxic-ischemic encephalopathy. Our results showed that thioperamide significantly decreased brain water content and malondialdehyde levels, while significantly increased histamine levels and superoxide dismutase activity in the hippocampus. This evidence demonstrates that thioperamide could prevent oxidative damage and attenuate brain edema following neonatal hypoxic-ischemic encephalolopathy. We further observed that changes in the above indexes occurred after combined treatment of thioperamide with the H1 receptor antagonist, pyrilamine, and the H2 receptor antagonist, tidine. Experimental findings indicated that pyrilamine reversed the effects of thioperamide; however, cimetidine had no significant influence on the effects of thioperamide. Our present findings suggest that thioperamide can increase brain histamine content and attenuate brain edema and oxidative damage by acting in combination with postsynaptic H1 receptors in a rat model of neonatal ic-ischemic encephalopathy.
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Affiliation(s)
- Feiyong Jia
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Lin Du
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Yunpeng Hao
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Shicheng Liu
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Ning Li
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Huiyi Jiang
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China,
Corresponding author: Huiyi Jiang, Attending physician, Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China, . (N20110714001)
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Noninvasive Monitoring during Interhospital Transport of Newborn Infants. Crit Care Res Pract 2013; 2013:632474. [PMID: 23509618 PMCID: PMC3595700 DOI: 10.1155/2013/632474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/04/2013] [Accepted: 01/08/2013] [Indexed: 11/17/2022] Open
Abstract
The main indications for interhospital neonatal transports are radiographic studies (e.g., magnet resonance imaging) and surgical interventions. Specialized neonatal transport teams need to be skilled in patient care, communication, and equipment management and extensively trained in resuscitation, stabilization, and transport of critically ill infants. However, there is increasing evidence that clinical assessment of heart rate, color, or chest wall movements is imprecise and can be misleading even in experienced hands. The aim of the paper was to review the current evidence on clinical monitoring equipment during interhospital neonatal transport.
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