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Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, Pryde P, Wolf HT, Crowther CA. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2024; 5:CD004661. [PMID: 38726883 PMCID: PMC11082932 DOI: 10.1002/14651858.cd004661.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND Magnesium sulphate is a common therapy in perinatal care. Its benefits when given to women at risk of preterm birth for fetal neuroprotection (prevention of cerebral palsy for children) were shown in a 2009 Cochrane review. Internationally, use of magnesium sulphate for preterm cerebral palsy prevention is now recommended practice. As new randomised controlled trials (RCTs) and longer-term follow-up of prior RCTs have since been conducted, this review updates the previously published version. OBJECTIVES To assess the effectiveness and safety of magnesium sulphate as a fetal neuroprotective agent when given to women considered to be at risk of preterm birth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 17 March 2023, as well as reference lists of retrieved studies. SELECTION CRITERIA We included RCTs and cluster-RCTs of women at risk of preterm birth that assessed prenatal magnesium sulphate for fetal neuroprotection compared with placebo or no treatment. All methods of administration (intravenous, intramuscular, and oral) were eligible. We did not include studies where magnesium sulphate was used with the primary aim of preterm labour tocolysis, or the prevention and/or treatment of eclampsia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion, extracted data, and assessed risk of bias and trustworthiness. Dichotomous data were presented as summary risk ratios (RR) with 95% confidence intervals (CI), and continuous data were presented as mean differences with 95% CI. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included six RCTs (5917 women and their 6759 fetuses alive at randomisation). All RCTs were conducted in high-income countries. The RCTs compared magnesium sulphate with placebo in women at risk of preterm birth at less than 34 weeks' gestation; however, treatment regimens and inclusion/exclusion criteria varied. Though the RCTs were at an overall low risk of bias, the certainty of evidence ranged from high to very low, due to concerns regarding study limitations, imprecision, and inconsistency. Primary outcomes for infants/children: Up to two years' corrected age, magnesium sulphate compared with placebo reduced cerebral palsy (RR 0.71, 95% CI 0.57 to 0.89; 6 RCTs, 6107 children; number needed to treat for additional beneficial outcome (NNTB) 60, 95% CI 41 to 158) and death or cerebral palsy (RR 0.87, 95% CI 0.77 to 0.98; 6 RCTs, 6481 children; NNTB 56, 95% CI 32 to 363) (both high-certainty evidence). Magnesium sulphate probably resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.96, 95% CI 0.82 to 1.13; 6 RCTs, 6759 children); major neurodevelopmental disability (RR 1.09, 95% CI 0.83 to 1.44; 1 RCT, 987 children); or death or major neurodevelopmental disability (RR 0.95, 95% CI 0.85 to 1.07; 3 RCTs, 4279 children) (all moderate-certainty evidence). At early school age, magnesium sulphate may have resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.82, 95% CI 0.66 to 1.02; 2 RCTs, 1758 children); cerebral palsy (RR 0.99, 95% CI 0.69 to 1.41; 2 RCTs, 1038 children); death or cerebral palsy (RR 0.90, 95% CI 0.67 to 1.20; 1 RCT, 503 children); and death or major neurodevelopmental disability (RR 0.81, 95% CI 0.59 to 1.12; 1 RCT, 503 children) (all low-certainty evidence). Magnesium sulphate may also have resulted in little to no difference in major neurodevelopmental disability, but the evidence is very uncertain (average RR 0.92, 95% CI 0.53 to 1.62; 2 RCTs, 940 children; very low-certainty evidence). Secondary outcomes for infants/children: Magnesium sulphate probably reduced severe intraventricular haemorrhage (grade 3 or 4) (RR 0.76, 95% CI 0.60 to 0.98; 5 RCTs, 5885 infants; NNTB 92, 95% CI 55 to 1102; moderate-certainty evidence) and may have resulted in little to no difference in chronic lung disease/bronchopulmonary dysplasia (average RR 0.92, 95% CI 0.77 to 1.10; 5 RCTs, 6689 infants; low-certainty evidence). Primary outcomes for women: Magnesium sulphate may have resulted in little or no difference in severe maternal outcomes potentially related to treatment (death, cardiac arrest, respiratory arrest) (RR 0.32, 95% CI 0.01 to 7.92; 4 RCTs, 5300 women; low-certainty evidence). However, magnesium sulphate probably increased maternal adverse effects severe enough to stop treatment (average RR 3.21, 95% CI 1.88 to 5.48; 3 RCTs, 4736 women; moderate-certainty evidence). Secondary outcomes for women: Magnesium sulphate probably resulted in little to no difference in caesarean section (RR 0.96, 95% CI 0.91 to 1.02; 5 RCTs, 5861 women) and postpartum haemorrhage (RR 0.94, 95% CI 0.80 to 1.09; 2 RCTs, 2495 women) (both moderate-certainty evidence). Breastfeeding at hospital discharge and women's views of treatment were not reported. AUTHORS' CONCLUSIONS The currently available evidence indicates that magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus, compared with placebo, reduces cerebral palsy, and death or cerebral palsy, in children up to two years' corrected age, and probably reduces severe intraventricular haemorrhage for infants. Magnesium sulphate may result in little to no difference in outcomes in children at school age. While magnesium sulphate may result in little to no difference in severe maternal outcomes (death, cardiac arrest, respiratory arrest), it probably increases maternal adverse effects severe enough to stop treatment. Further research is needed on the longer-term benefits and harms for children, into adolescence and adulthood. Additional studies to determine variation in effects by characteristics of women treated and magnesium sulphate regimens used, along with the generalisability of findings to low- and middle-income countries, should be considered.
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Affiliation(s)
- Emily S Shepherd
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lex W Doyle
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Stéphane Marret
- INSERM Unit 1245, Team 4, Rouen School of Medicine, Normandy University, Rouen, France
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
| | - Dwight J Rouse
- Women & Infants Hospital of Rhode Island, The Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter Pryde
- Department of Anesthesiology, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Hanne T Wolf
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
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Kobayashi M, Hirata S, Fujimaki T. Neuroprotective Effects of Artificial Cerebrospinal Fluid: Analysis of Brainstem Auditory-Evoked Potential Monitoring During Microvascular Decompression in 117 Consecutive Patients. Neurosurgery 2023; 94:00006123-990000000-00994. [PMID: 38084994 PMCID: PMC10990391 DOI: 10.1227/neu.0000000000002793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To study the efficacy of irrigation with artificial cerebrospinal fluid (aCSF) for protection of cranial nerves during surgery; the time required for recovery of brainstem auditory-evoked potentials (BAEPs) that would reflect cochlear function was analyzed in comparison with that for saline irrigation. METHODS This retrospective study included 117 consecutive patients (95 women, mean age 51.5 ± 11.4 year) who underwent microvascular decompression for hemifacial spasm. During surgery, BAEPs were monitored to avoid damage to the auditory pathways. When a delayed latency of >1 ms or a decrease in amplitude of >50% was detected in BAEP wave V, surgical maneuvers were halted, and the operative field was irrigated with saline or aCSF. Saline was used for irrigation in 58 patients and aCSF in the other 59. The time required for BAEP recovery at the first halt in each patient was analyzed, and the results were compared between the groups. RESULTS Surgical procedures were interrupted because of BAEP latency delays or decreases in amplitude in 51 of the patients in the saline group and 54 in the aCSF group. In both groups, the latencies and amplitudes recovered significantly with time and both recovered earlier after aCSF irrigation than after saline irrigation. Hearing outcome was not significantly different between 2 groups. CONCLUSION aCSF is effective for protection of cochlear nerve and promotes recovery from transient dysfunction during surgery. The protective effect may be attributed to multiple factors including conditioned pH, electrolyte composition, glucose, and microelements, such as magnesium and phosphate.
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Affiliation(s)
| | - Sachiko Hirata
- Department of Neurosurgery, Saitama Medical University, Saitama, Japan
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Chen Z, Zhu C, Huang L, Qi Y, Guo X, Xie L, Li H. Serum Magnesium Level as a Biomarker to Predict the Risk of Labor Epidural Anesthesia Associated Fever. Int J Gen Med 2023; 16:5131-5138. [PMID: 37954654 PMCID: PMC10637208 DOI: 10.2147/ijgm.s431731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Objective Excessive pain will have adverse effects on the mother and fetus. Labor epidural analgesia greatly reduces the pain, which is widely carried out abroad. Labor epidural anesthesia-associated fever (LEAF) is the biggest problem for labor epidural anesthesia. This study aimed to evaluate the clinical value of serum magnesium levels to predict the LEAF. Methods Overall 528 singleton term-pregnant women who underwent labor epidural anesthesia in Fujian Provincial Maternity and Children's Health Hospital, affiliated hospital of Fujian Medical University from January 2019 to June 2019, were analyzed retrospectively. The serum magnesium level was detected using venous blood samples. The relationship between the serum magnesium level and LEAF was interpreted, and the optimal cut-off values of the serum magnesium level to predict LEAF were calculated. Results Overall, 65 (12.30%) participants had LEAF. And a higher rate of the bulging membrane, gestational hypertension, neonatal intensive care unit (NICU) admission, and the different mode of delivery was significantly associated with LEAF. Also, the serum magnesium level demonstrated higher significantly in presence of LEAF than absence (P<0.05). What is more, it indicated that the area under the receiver operating characteristic curve (AUC) for the serum magnesium level was 0.825, and an optimal cut-off of the serum magnesium level was 0.855 mg/dl. Furthermore, it demonstrated that the serum magnesium level had the highest OR (OR= 7.49; 95% CI (4.58-14.35)) (P<0.001). The bulging membrane is an independent risk factor presence of LEAF (OR = 1.55; 95% CI (1.01-2.43)) (P=0.038). Conclusion This study demonstrated that the baseline of serum magnesium can provide a suitable biomarker to predict LEAF. It can help to provide a useful target for LEAF treatment and enhance surveillance before fever.
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Affiliation(s)
- Zhiwei Chen
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chuling Zhu
- Department of Women’s health Department, QuanZhou Women and Children’s Hospital, Quanzhou, People’s Republic of China
| | - Lingna Huang
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yuanjie Qi
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xiaoyao Guo
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Li Xie
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Hua Li
- Department of Gynecologic, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
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Orzeł A, Unrug-Bielawska K, Filipecka-Tyczka D, Berbeka K, Zeber-Lubecka N, Zielińska M, Kajdy A. Molecular Pathways of Altered Brain Development in Fetuses Exposed to Hypoxia. Int J Mol Sci 2023; 24:10401. [PMID: 37373548 DOI: 10.3390/ijms241210401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Perinatal hypoxia is a major cause of neurodevelopmental impairment and subsequent motor and cognitive dysfunctions; it is associated with fetal growth restriction and uteroplacental dysfunction during pregnancy. This review aims to present the current knowledge on brain development resulting from perinatal asphyxia, including the causes, symptoms, and means of predicting the degree of brain damage. Furthermore, this review discusses the specificity of brain development in the growth-restricted fetus and how it is replicated and studied in animal models. Finally, this review aims at identifying the least understood and missing molecular pathways of abnormal brain development, especially with respect to potential treatment intervention.
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Affiliation(s)
- Anna Orzeł
- Centre of Postgraduate Medical Education, I-st Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland
| | - Katarzyna Unrug-Bielawska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 00-001 Warsaw, Poland
| | - Dagmara Filipecka-Tyczka
- Centre of Postgraduate Medical Education, I-st Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland
| | - Krzysztof Berbeka
- Centre of Postgraduate Medical Education, I-st Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland
| | - Natalia Zeber-Lubecka
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, 00-001 Warsaw, Poland
- Centre of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Clinical Oncology, 01-813 Warsaw, Poland
| | - Małgorzata Zielińska
- Centre of Postgraduate Medical Education, I-st Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland
| | - Anna Kajdy
- Centre of Postgraduate Medical Education, I-st Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland
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Inomata S, Yoshida T, Nagaoka M, Yasuda I, Aoki A, Tamura K, Kawasaki Y, Makimoto M, Matsumura K, Adachi Y. Effects of long‐term antenatal magnesium sulfate administration on the bone mineralization of preterm infants. J Obstet Gynaecol Res 2022; 48:3119-3127. [DOI: 10.1111/jog.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Satomi Inomata
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Mitsuhide Nagaoka
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Ippei Yasuda
- Department of Obstetrics and Gynecology University of Toyama Toyama Japan
| | - Aiko Aoki
- Department of Obstetrics and Gynecology University of Toyama Toyama Japan
| | - Kentaro Tamura
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Yukako Kawasaki
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Masami Makimoto
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine University of Toyama Toyama Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine University of Toyama Toyama Japan
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Peraçoli JC, Silva PB, Neves HM, Borges VTM, Abbade JF, Costa RAA, Batista FRG, Peraçoli MTS, Romão-Veiga M. Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with imminent eclampsia. Pregnancy Hypertens 2022; 29:46-53. [PMID: 35728369 DOI: 10.1016/j.preghy.2022.06.002] [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: 02/15/2022] [Revised: 05/30/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compared the modulatory effect of two intravenous magnesium sulfate (MgSO4) regimens on the systemic inflammatory response in pregnant women diagnosed with imminent eclampsia. STUDY DESIGN In a single-blind cross-sectional study, 33 women were allocated according to the Zuspan (n = 16) and Sibai (n = 17) MgSO4 regimens, and treated for 24 h. Blood samples were collected pre-administration of the loading dose, at 24 h of the maintenance dose of MgSO4, and at 48 h, when patients were without treatment. Plasma was used to determine interleukin (IL)-1 beta (IL-1β), IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), heat shock protein (Hsp70), and heme oxygenase-1 (HO-1) by ELISA. RESULTS The treatment with the Zuspan's regimen didn't change plasma concentrations of TNF-α, IL-10, and Hsp70 in the three-time points studied. However, it decreased IL-1β at 24 h and 48 h and IL-6 at 48 h, and increased HO-1 concentration at 48 h. On the other hand, compared to the pre-treatment period, Sibai's regimen induced a significant decrease in TNF-α, IL-1β, IL-6, and Hsp70, while increased HO-1 levels both at 24 h and 48 h and, IL-10 concentration at 48 h. CONCLUSIONS Sibai's regimen determined an early and efficient immunoregulatory effect on systemic inflammatory response in preeclampsia, suggesting that the maintenance dose of two grams of MgSO4 was better than one gram in the treatment of imminent eclampsia.
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Affiliation(s)
- José C Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Patricia B Silva
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Haroldo M Neves
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Vera T M Borges
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Joelcio F Abbade
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Roberto A A Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Fernanda R G Batista
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Maria T S Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil; Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Mariana Romão-Veiga
- Department of Gynecology and Obstetrics, Botucatu Medical School and Department of Chemistry and Biological Sciences, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, SP, Brazil.
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Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Sénat MV, Schmitz T, Sentilhes L. [Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of Anesthesiology and Intensive Care (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021:S2468-7189(21)00246-4. [PMID: 34772654 DOI: 10.1016/j.gofs.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
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Chollat C, Bertrand E, Petit-Ledo A, de Vansay C, Voisin C, Dabaj I, Gillibert A, Marret S. Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center. J Pediatr 2021; 237:183-189.e6. [PMID: 34144033 DOI: 10.1016/j.jpeds.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the prevalence of cerebral palsy (CP) at age 2 years in infants born before 33 weeks of gestation and to analyze the fetal neuroprotective effect of the antenatal administration of magnesium sulfate (MgSO4) treatment on CP. STUDY DESIGN Preterm infants born before 33 weeks of gestation and discharged from the Rouen University Hospital's Neonatal Intensive Care Unit between 2007 and 2015 were included. At age 2 years, pediatricians of the perinatal network of Eure and Seine-Maritime counties administered standardized questionnaires analyzing motor, cognitive, and behavioral items, derived from the Denver and Amiel-Tison scales. A routine protocol based on MgSO4 infusion was introduced in 2010. The primary outcome measure was the occurrence of CP according to the Surveillance of Cerebral Palsy in Europe network definition. RESULTS A total of 1759 very preterm infants were included, among whom 138 (7.8%) died and 148 (9.1%) were lost to follow-up. Assuming that those lost to follow-up had no CP, at 2 years, 55 of 1621 infants (3.4%; 95% CI, 2.6%-4.4%) had CP. After statistical adjustment for birth term and antenatal corticosteroid use, a significant decrease in CP was observed after implementation of a protocol of MgSO4 administration in mothers before imminent preterm birth at <33 weeks of gestation (aOR, 0.53; 95% CI, 0.29-0.98; P = .04). CONCLUSIONS The prevalence of CP at 2 years after very preterm birth was low. The implementation of a neuroprotective protocol with MgSO4 was associated with reduced CP occurrence; however, several relevant limitations must be considered for interpretation.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Neonatal Intensive Care Unit, Port-Royal, Paris Center University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Emmanuelle Bertrand
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Alice Petit-Ledo
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Caroline Voisin
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Ivana Dabaj
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Stéphane Marret
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France.
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9
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Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Camilleri C, Sénat MV, Schmitz T, Sentilhes L. Guidelines for the management of women with severe pre-eclampsia. Anaesth Crit Care Pain Med 2021; 40:100901. [PMID: 34602381 DOI: 10.1016/j.accpm.2021.100901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide national guidelines for the management of women with severe pre-eclampsia. DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The last SFAR and CNGOF guidelines on the management of women with severe pre-eclampsia were published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology. RESULTS The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1+/-), 9 have a moderate level of evidence (GRADE 2+/-), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe pre-eclampsia.
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Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Céline Camilleri
- "Grossesse et Santé, Contre la Prééclampsie" Association, Paris, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
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10
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Samir A, Nasef N, Fathy K, El-Gilany AH, Yahia S. Effect of cerebrolysin on neurodevelopmental outcome of high risk preterm infants: A randomized controlled trial. J Neonatal Perinatal Med 2021; 15:37-45. [PMID: 33935111 DOI: 10.3233/npm-200659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A significant proportion of preterm infants experience developmental delay despite receiving a post discharge early interventional care. Cerebrolysin is a peptide mixture which acts similar to endogenous neurotrophic factors through promoting neurogenesis and enhancing neuronal plasticity. OBJECTIVE To compare the effect of Cerebrolysin plus routine intervention program versus routine intervention program alone on the outcome of preterm infants at high risk for neurodevelopmental delay. METHODS In a randomized controlled trial, high-risk preterm infants < 32 weeks' gestation who have abnormal neurological assessment at two months corrected post-natal age were randomized at 6 months corrected post natal age to receive either early intervention program or early intervention program plus Cerebrolysin injection of 0.1 mL/kg body weight every week for 3 months as an adjuvant therapy. The primary outcome was the rate of failure of the gross motor assessment at 12 months of corrected age and secondary outcomes included fine motor, language, and personal social development at 12 months corrected post-natal age as assessed by Denver Developmental Screening Test II. RESULTS Cerebrolysin group had a significant lower number of infants diagnosed with failed gross motor development compared to infants in the routine intervention group [10 (33%) versus 21 (70%), p = 0.009]. Cerebrolysin group had a significant lower number of infants diagnosed with failed fine motor, language and personal social development compared to infants in the routine intervention group. CONCLUSION Cerebrolysin, as an adjuvant therapy to routine early interventional care, may improve gross motor development of high-risk preterm infants at 12 months corrected post-natal age.
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Affiliation(s)
- A Samir
- Mansoura University Children's Hospital, Mansoura, Egypt
| | - N Nasef
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - K Fathy
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - A-H El-Gilany
- Department of Public Health, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - S Yahia
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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11
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Effect of Neuroprotective Magnesium Sulfate Treatment on Brain Transcription Response to Hypoxia Ischemia in Neonate Mice. Int J Mol Sci 2021; 22:ijms22084253. [PMID: 33923910 PMCID: PMC8074012 DOI: 10.3390/ijms22084253] [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: 04/02/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
MgSO4 is widely used in the prevention of preterm neurological disabilities but its modes of action remain poorly established. We used a co-hybridization approach using the transcriptome in 5-day old mice treated with a single dose of MgSO4 (600 mg/kg), and/or exposed to hypoxia-ischemia (HI). The transcription of hundreds of genes was altered in all the groups. MgSO4 mainly produced repressions culminating 6 h after injection. Bio-statistical analysis revealed the repression of synaptogenesis and axonal development. The putative targets of MgSO4 were Mnk1 and Frm1. A behavioral study of adults did not detect lasting effects of neonatal MgSO4 and precluded NMDA-receptor-mediated side effects. The effects of MgSO4 plus HI exceeded the sum of the effects of separate treatments. MgSO4 prior to HI reduced inflammation and the innate immune response probably as a result of cytokine inhibition (Ccl2, Ifng, interleukins). Conversely, MgSO4 had little effect on HI-induced transcription by RNA-polymerase II. De novo MgSO4-HI affected mitochondrial function through the repression of genes of oxidative phosphorylation and many NAD-dehydrogenases. It also likely reduced protein translation by the repression of many ribosomal proteins, essentially located in synapses. All these effects appeared under the putative regulatory MgSO4 induction of the mTORC2 Rictor coding gene. Lasting effects through Sirt1 and Frm1 could account for this epigenetic footprint.
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12
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Abstract
Cerebral palsy (CP), defined as a group of nonprogressive disorders of movement and posture, is the most common cause of severe neurodisability in children. The prevalence of CP is the same across the globe, affecting approximately 17 million people worldwide. Cerebral Palsy is an umbrella term used to describe the disease due to its inherent heterogeneity. For instance, CP has multiple (1) causes; (2) clinical types; (3) patterns of neuropathology on brain imaging and (4) it's associated with several developmental pathologies such as intellectual disability, autism, epilepsy, and visual impairment. Understanding its physiopathology is crucial to developing protective strategies. Despite its importance, there is still insufficient progress in the areas of CP prediction, early diagnosis, treatment, and prevention. Herein we describe the current risk factors and biomarkers used for the diagnosis and prediction of CP. With the advancement in biomarker discovery, we predict that our understanding of the etiopathophysiology of CP will also increase, lending to more opportunities for developing novel treatments and prognosis.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States.
| | - Sun Kwon Kim
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States
| | - Kyung Joon Oh
- Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States; Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States
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13
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Mitchell NA, Grimbly C, Rosolowsky ET, O'Reilly M, Yaskina M, Cheung PY, Schmölzer GM. Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants. Front Pediatr 2020; 8:34. [PMID: 32117839 PMCID: PMC7026247 DOI: 10.3389/fped.2020.00034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: To determine the incidence and risk factors associated with neonatal hypoglycemia in the premature population <33 weeks' gestation. Methods: This was a secondary retrospective analysis from previous infants enrolled in randomized controlled trials. A total of 255 infants <33 weeks' gestation were born during the study period. Eight infants were excluded due to missing glucose or maternal data and 175 infants were analyzed. Main outcome measures: Primary outcome was hypoglycemia (blood glucose <2.6mmol/L) determined via glucose oxidase method on arterial or venous blood gas. Birth weight subgroups: small for gestational age (SGA, birth weight <10%ile for gestational age) and large for gestational age (LGA, birth weight >90%ile for gestational age). Maternal hypertension was systolic blood pressure >140mmHg. Results: 175 infants <33 weeks' gestational age (89 male, 84 female) were analyzed. Hypoglycemia occurred in 59 infants (33.7%). Maternal hypertension (OR 3.07, 95% CI 1.51-6.30, p = 0.002) was the sole risk factor for neonatal hypoglycemia. Protective factors for hypoglycemia included labor at time of delivery (OR 4.51, 95% CI 2.29-9.18, p <0.0001) and antenatal magnesium sulfate (OR 2.53, 95% CI 1.23-5.50, p = 0.01). There were no significant differences between hypoglycemic and euglycemic infants in sex, gestational age, LGA infants, antenatal steroids, vaginal birth, or maternal diabetes. SGA infants were excluded from analysis due to sample size. Conclusions: Premature infants <33 weeks' gestation have increased risk of hypoglycemia. Maternal hypertension increases hypoglycemia risk. Antenatal magnesium sulfate administration or labor at time of delivery decrease hypoglycemia risk.
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Affiliation(s)
- Nikki A Mitchell
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.,Medical School, University of Alberta, Edmonton, AB, Canada
| | - Chelsey Grimbly
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Elizabeth T Rosolowsky
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Megan O'Reilly
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.,Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.,Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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14
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Austin T. The development of neonatal neurointensive care. Pediatr Res 2019:10.1038/s41390-019-0729-5. [PMID: 31852010 DOI: 10.1038/s41390-019-0729-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023]
Abstract
Brain injury remains one of the major unsolved problems in neonatal care, with survivors at high risk of lifelong neurodisability. It is unlikely that a single intervention can ameliorate neonatal brain injury, given the complex interaction between pathological processes, developmental trajectory, genetic susceptibility, and environmental influences. However, a coordinated, interdisciplinary approach to understand the root cause enables early detection, and diagnosis with enhanced clinical care offering the best chance of improving outcomes and facilitate new lines of neuroprotective treatments. Adult neurointensive care has existed as a speciality in its own right for over 20 years; however, it is only recently that large prospective studies have demonstrated the benefit of this model of care. The 'Neuro-intensive Care Nursery' model originated at the University of California San Francisco in 2008, and since then a growing number of units worldwide have adopted this approach. As well as providing consistent coordinated care for infants from a multidisciplinary team, it provides opportunities for specialist education and training in neonatal neurology, neuromonitoring, neuroimaging and nursing. This review outlines the origins of brain-oriented care of the neonate and the development of the Neuro-NICU (neonatal intensive care unit) and discusses some of the challenges and opportunities in expanding this model of care.
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Affiliation(s)
- Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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15
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Alpay Savasan Z, Yilmaz A, Ugur Z, Aydas B, Bahado-Singh RO, Graham SF. Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study. Metabolites 2019; 9:metabo9020027. [PMID: 30717353 PMCID: PMC6409919 DOI: 10.3390/metabo9020027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/17/2022] Open
Abstract
Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Ali Yilmaz
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Zafer Ugur
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Buket Aydas
- Departments of Mathematics and Computer Sciences, Albion College, 611 E. Porter St., Albion, MI 49224, USA.
| | - Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
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