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Murray AL, O'Boyle DS, Walsh BH, Murray DM. Validation of a machine learning algorithm for identifying infants at risk of hypoxic ischaemic encephalopathy in a large unseen data set. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327366. [PMID: 39251344 DOI: 10.1136/archdischild-2024-327366] [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: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVE To validate a hypoxic ischaemic encephalopathy (HIE) prediction algorithm to identify infants at risk of HIE immediately after birth using readily available clinical data. DESIGN Secondary review of electronic health record data of term deliveries from January 2017 to December 2021. SETTING A tertiary maternity hospital. PATIENTS Infants >36 weeks' gestation with the following clinical variables available: Apgar Score at 1 min and 5 min, postnatal pH, base deficit, and lactate values taken within 1 hour of birth INTERVENTIONS: Previously trained open-source logistic regression and random forest (RF) prediction algorithms were used to calculate a probability index (PI) for each infant for the occurrence of HIE. MAIN OUTCOME Validation of a machine learning algorithm to identify infants at risk of HIE in the immediate postnatal period. RESULTS 1081 had a complete data set available within 1 hour of birth: 76 (6.95%) with HIE and 1005 non-HIE. Of the 76 infants with HIE, 37 were classified as mild, 29 moderate and 10 severe. The best overall accuracy was seen with the RF model. Median (IQR) PI in the HIE group was 0.70 (0.53-0.86) vs 0.05 (0.02-0.15), (p<0.001) in the non-HIE group. The area under the receiver operating characteristics curve for prediction of HIE=0.926 (0.893-0.959, p<0.001). Using a PI cut-off to optimise sensitivity of 0.30, 936 of the 1081 (86.5%) infants were correctly classified. CONCLUSION In a large unseen data set an open-source algorithm could identify infants at risk of HIE in the immediate postnatal period. This may aid focused clinical examination, transfer to tertiary care (if necessary) and timely intervention.
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Affiliation(s)
- Anne L Murray
- Cork University Maternity Hospital, Wilton, Cork, Ireland
- INFANT Centre, Paediatric Academic Unit, Cork University Hospital, Wilton, Cork, Ireland
| | - Daragh S O'Boyle
- INFANT Centre, Paediatric Academic Unit, Cork University Hospital, Wilton, Cork, Ireland
| | - Brian H Walsh
- Cork University Maternity Hospital, Wilton, Cork, Ireland
- INFANT Centre, Paediatric Academic Unit, Cork University Hospital, Wilton, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Centre, Paediatric Academic Unit, Cork University Hospital, Wilton, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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Daboval T, Ouellet P, El Shahed A, Ly L, Ahearne C, Racinet C. Umbilical artery eucapnic pH to assess fetal well-being. Am J Obstet Gynecol 2024; 231:348.e1-348.e8. [PMID: 38580045 DOI: 10.1016/j.ajog.2024.03.042] [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: 10/16/2023] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Umbilical artery gas results help obstetricians assess fetal well-being during labor and guide screening decisions on eligibility for therapeutic hypothermia (ie, whole-body or head cooling). The accuracy of results, especially for the base deficit on arterial cord gas analysis, in predicting brain injury is questioned. A novel biomarker specifically calculated for fetal acid-base physiology and response to asphyxia-neonatal eucapnic pH as a marker of neonatal metabolic acidosis-has the potential to be an accurate predictor of hypoxic-ischemic encephalopathy. OBJECTIVE We aimed to compare false-negative rates of hypoxic-ischemic encephalopathy for umbilical artery pH, base deficit, and neonatal eucapnic pH in assessing fetal acid-base balance as a marker of fetal well-being and predicting acute brain injury. STUDY DESIGN This is a retrospective single-center cohort study of newborns ≥ 35 weeks of gestation diagnosed with hypoxic-ischemic encephalopathy. We compared false-negative rates for any grade of hypoxic-ischemic encephalopathy using unilateral paired chi-square statistical analysis based on cutoff values for umbilical artery pH ≤7.00, base deficit ≥16 mmol/L, base deficit ≥12 mmol/L and neonatal eucapnic pH ≤7.14. We performed an analysis of variance between umbilical artery pH, base deficit, and neonatal eucapnic pH for each hypoxic-ischemic encephalopathy grade. RESULTS We included 113 newborns. False-negative rate for hypoxic-ischemic encephalopathy was significantly higher for base deficit <16 mmol/L (n=78/113; 69.0%) than <12 mmol/L (n=46/113; 40.7%), pH >7.00 (n=41/113; 36.3%), or neonatal eucpanic pH >7.14 (n=35/113; 31.0%) (P<.0001). All true-positive cases were identified using only umbilical artery pH and neonatal eucapnic pH. Base deficit ≥16 or ≥12 mmol/L did not add any value in identifying newborns with hypoxic-ischemic encephalopathy when using umbilical artery pH and neonatal eucapnic pH. No association emerged between any marker and hypoxic-ischemic encephalopathy severity grading. CONCLUSION Our findings support the accuracy of neonatal eucapnic pH to assess fetal well-being during labor and to improve predictive performance for acute brain injury. Neonatal eucpanic pH, in addition to umbilical artery pH, may be a viable alternative in identifying newborns at risk for hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Thierry Daboval
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
| | - Paul Ouellet
- Department of Surgery, University of Sherbrooke, Quebec, Canada; Vitality Health Network, North West Zone, Edmundston, New Brunswick, Canada
| | - Amr El Shahed
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Linh Ly
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Caroline Ahearne
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Claude Racinet
- University Grenoble-Alpes, Grenoble, France; Register of Childhood Disabilities and Perinatal Data, Grenoble, France
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Huntingford SL, Boyd SM, McIntyre SJ, Goldsmith SC, Hunt RW, Badawi N. Long-Term Outcomes Following Hypoxic Ischemic Encephalopathy. Clin Perinatol 2024; 51:683-709. [PMID: 39095104 DOI: 10.1016/j.clp.2024.04.008] [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] [Indexed: 08/04/2024]
Abstract
Hypoxic ischemic encephalopathy (HIE) is the most common cause of neonatal encephalopathy and results in significant morbidity and mortality. Long-term outcomes of the condition encompass impairments across all developmental domains. While therapeutic hypothermia (TH) has improved outcomes for term and late preterm infants with moderate to severe HIE, trials are ongoing to investigate the use of TH for infants with mild or preterm HIE. There is no evidence that adjuvant therapies in combination with TH improve long-term outcomes. Numerous trials of various adjuvant therapies are underway in the quest to further improve outcomes for infants with HIE.
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Affiliation(s)
- Simone L Huntingford
- Department of Paediatrics, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Newborn, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Stephanie M Boyd
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, New South Wales 2145, Australia; Faculty of Medicine and Health, University of Sydney, Campderdown, New South Wales 2006, Australia
| | - Sarah J McIntyre
- CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shona C Goldsmith
- CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rod W Hunt
- Department of Paediatrics, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Newborn, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, New South Wales 2145, Australia; CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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4
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Moran P, Sullivan K, Zanelli SA, Burnsed J. Single-Center Experience with Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy in Infants with <36 Weeks' Gestation. Am J Perinatol 2024; 41:1680-1687. [PMID: 38262469 DOI: 10.1055/a-2251-6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) has improved outcomes and mortality in infants with >36 weeks' gestational age (GA) with moderate-to-severe HIE. There are limited data on the safety and efficacy of TH in preterm infants with HIE. This study describes our experience and examines the safety of TH in neonates with <36 weeks' GA. STUDY DESIGN A single-center, retrospective study of preterm neonates born at <36 weeks' GA with moderate-to-severe HIE and treated with TH, compared to a cohort of term neonates with HIE (≥37 weeks' GA), was conducted. The term cohort was matched for degree of background abnormality on electroencephalogram, sex, inborn versus outborn status, and birth year. Medical records were reviewed for pregnancy and delivery complications, need for transfusion, sedation and antiseizure medications, electroencephalography and imaging findings, and in-hospital mortality. RESULTS Forty-two neonates born at <36 weeks' GA with HIE received TH between 2005 and 2022. Data from 42 term neonates were analyzed for comparison. The average GA of the preterm cohort was 34.6 weeks and 39.3 weeks for the term cohort. Apgar scores, degree of acidosis, and need for blood product transfusions were similar between groups. Preterm infants were more likely to require inotropic support (55 vs. 29%, p = 0.026) and hydrocortisone (36 vs. 12%, p = 0.019) for hypotension. The proportion of infants without evidence of injury on magnetic resonance imaging was similar in both groups: 43 versus 50% in preterm and term infants, respectively. No significant difference was found in mortality between groups. CONCLUSION In this single-center cohort, TH in preterm infants appears to be as safe as in term infants, with no significant increase in intracranial bleeds or mortality. Preterm infants more frequently required inotropes and steroids for hypotension. Further research is needed to determine efficacy of TH in preterm infants. KEY POINTS · TH is used off-protocol in preterm infants.. · Preterm and term infants have similar mortality.. · Preterm cohort required more inotropic support..
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Affiliation(s)
- Patricia Moran
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelsey Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Santina A Zanelli
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Jennifer Burnsed
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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5
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Oliveira RF, Wagner LH, Silva ASD, Rodrigues MCCD, Lacerda GCBD. Neurological outcomes in neonates treated with therapeutic hypothermia: challenges in a developing country. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-8. [PMID: 39341210 DOI: 10.1055/s-0044-1790575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2024]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) affects 1.5 newborns per 1 thousand term live births. Therapeutic hypothermia (TH) does not prevent all adverse outcomes. The experience with TH is still limited in Latin America. In Rio de Janeiro, Hospital Universitário Pedro Ernesto treats neonates with HIE since 2017 using the servo-controlled system. OBJECTIVE To describe the frequency of epilepsy, altered neurological exam, and neurodevelopmental delay at 12 months of age in patients treated with TH in a reference hospital in Rio de Janeiro and to evaluate the possible risk associations with clinical data and data from complementary exams. METHODS We evaluated medical records from the Neonatal Intensive Care Unit hospitalization and from first evaluation recorded at 12 months of age in the High-Risk Neonate Follow-up Outpatient Sevice. RESULTS A total of 30 subjects were included in the study. We found epilepsy in 18.2% of the patients, altered neurological exam in 40.9%, and neurodevelopmental delay in 36.4%. We also found a significant relationship between altered magnetic resonance imaging scan and subsequent altered neurological exam. Our findings are in line with those of the international literature, which shows that adverse outcomes are still observed, even when TH is applied. Brazilian data shows our limited access to complementary exams. The rate of loss to follow-up was of 26.6%, probably due to the coronavirus disease 2019 (COVID-19) pandemic and to unfavorable socioeconomic conditions. More time for prospective follow-up and protocol adjustments should contribute to improve our data. CONCLUSION High incidences of epilepsy, altered neurological exams, and neurodevelopmental delay were found, despite the use of TH. A more efficient use of resources is needed, as well as measures such as early intervention.
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Affiliation(s)
- Rita Farias Oliveira
- Hospital Universitário Gaffrée e Guinle, Departamento de Pediatria, Rio de Janeiro RJ, Brazil
- Hospital Universitário Pedro Ernesto, Departamento de Pediatria, Rio de Janeiro RJ, Brazil
- Universidade Federal do Estado do Rio de Janeiro, Centro de Ciências Biológicas e da Saúde, Programa de Pós-Graduação em Neurologia, Rio de Janeiro RJ, Brazil
| | - Lucia Helena Wagner
- Hospital Universitário Pedro Ernesto, Departamento de Pediatria, Rio de Janeiro RJ, Brazil
| | - Alexandre Sousa da Silva
- Universidade Federal do Estado do Rio de Janeiro, Escola de Matemática, Departamento de Métodos Quantitativos, Rio de Janeiro RJ, Brazil
| | | | - Glenda Corrêa Borges de Lacerda
- Universidade Federal do Estado do Rio de Janeiro, Centro de Ciências Biológicas e da Saúde, Programa de Pós-Graduação em Neurologia, Rio de Janeiro RJ, Brazil
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Raghu K, Kalish BT, Tam EWY, El Shahed A, Chau V, Wilson D, Tung S, Kazazian V, Miran AA, Hahn C, Branson HM, Ly LG, Cizmeci MN. Prognostic Indicators of Reorientation of Care in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum. J Pediatr 2024; 276:114273. [PMID: 39216619 DOI: 10.1016/j.jpeds.2024.114273] [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: 05/01/2024] [Revised: 07/30/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To investigate the clinical, electrographic, and neuroimaging characteristics in neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care using standardized scoring systems. STUDY DESIGN A nested observational substudy within a prospective hypoxic-ischemic encephalopathy cohort was conducted. Group 1 comprised infants whose parents received the medical recommendation for reorientation of care, while group 2 continued to receive standard care. Encephalopathy scores were monitored daily. Amplitude-integrated and continuous-video-integrated electroencephalogram during therapeutic hypothermia were analyzed. Standardized scoring systems for cranial ultrasonography and postrewarming brain magnetic resonance imaging were deployed. RESULTS The study included 165 infants, with 35 in group 1 and 130 in Group 2. By day 3, all infants in group 1 were encephalopathic with higher Thompson scores (median 13 [IQR 10-19] vs 0 [IQR 0-3], P < .001). Electrographic background normalization within 48 hours occurred in 3% of group 1 compared with 46% of group 2 (P < .001). Sleep-wake cycling was not observed in group 1 and emerged in 63% of group 2 within the first 72 hours (P < .001). The number of antiseizure medications received was higher in group 1 (median 3 [IQR, 2-4] vs 0 [IQR, 0-1], respectively; P < .001). Group 1 had higher cranial ultrasound injury scores (median 4 [IQR 2-7] vs 1 [IQR 0-1], P < .001) within 48 hours and postrewarming brain magnetic resonance imaging injury scores (median 33 [range 20-51] vs 4 [range 0-28], P < .001). CONCLUSIONS Neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care presented with and maintained significantly more pronounced clinical manifestations, electrographic findings, and near-total brain injury as scored objectively on all modalities. TRIAL REGISTRATION Registration of the study cohort: NCT04913324.
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Affiliation(s)
- Krishna Raghu
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Brian T Kalish
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Emily W Y Tam
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Amr El Shahed
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vann Chau
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Diane Wilson
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sandra Tung
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vanna Kazazian
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Atiyeh A Miran
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cecil Hahn
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Helen M Branson
- Division of Radiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Linh G Ly
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mehmet N Cizmeci
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Reyes-Corral M, Gil-González L, González-Díaz Á, Tovar-Luzón J, Ayuso MI, Lao-Pérez M, Montaner J, de la Puerta R, Fernández-Torres R, Ybot-González P. Pretreatment with oleuropein protects the neonatal brain from hypoxia-ischemia by inhibiting apoptosis and neuroinflammation. J Cereb Blood Flow Metab 2024:271678X241270237. [PMID: 39157939 DOI: 10.1177/0271678x241270237] [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] [Indexed: 08/20/2024]
Abstract
Hypoxic-ischemic (HI) encephalopathy is a cerebrovascular injury caused by oxygen deprivation to the brain and remains a major cause of neonatal mortality and morbidity worldwide. Therapeutic hypothermia is the current standard of care but it does not provide complete neuroprotection. Our aim was to investigate the neuroprotective effect of oleuropein (Ole) in a neonatal (seven-day-old) mouse model of HI. Ole, a secoiridoid found in olive leaves, has previously shown to reduce damage against cerebral and other ischemia/reperfusion injuries. Here, we administered Ole as a pretreatment prior to HI induction at 20 or 100 mg/kg. A week after HI, Ole significantly reduced the infarct area and the histological damage as well as white matter injury, by preserving myelination, microglial activation and the astroglial reactive response. Twenty-four hours after HI, Ole reduced the overexpression of caspase-3 and the proinflammatory cytokines IL-6 and TNF-α. Moreover, using UPLC-MS/MS we found that maternal supplementation with Ole during pregnancy and/or lactation led to the accumulation of its metabolite hydroxytyrosol in the brains of the offspring. Overall, our results indicate that pretreatment with Ole confers neuroprotection and can prevent HI-induced brain damage by modulating apoptosis and neuroinflammation.
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Affiliation(s)
- Marta Reyes-Corral
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
| | - Laura Gil-González
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
| | - Ángela González-Díaz
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
| | - Javier Tovar-Luzón
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
| | - María Irene Ayuso
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
- CIBERSAM, ISCIII (Spanish Network for Research in Mental Health), Seville, Spain
| | - Miguel Lao-Pérez
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
| | - Joan Montaner
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
- Department of Neurology, Virgen Macarena University Hospital, Seville, Spain
| | - Rocío de la Puerta
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Seville, Spain
| | - Rut Fernández-Torres
- Departamento de Química Analítica, Facultad de Química, Universidad de Sevilla, Seville, Spain
| | - Patricia Ybot-González
- Institute of Biomedicine of Seville (IBiS), CSIC-US-Junta de Andalucía (SAS), Seville, Spain
- Spanish National Research Council (CSIC), Spain
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Binet L, Debillon T, Beck J, Vilotitch A, Guellec I, Ego A, Chevallier M. Effect of gestational age on cerebral lesions in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2024; 109:562-568. [PMID: 38418209 DOI: 10.1136/archdischild-2023-326131] [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: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy. DESIGN Secondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy. SETTING French neonatal intensive care units. PATIENTS Neonates with moderate or severe neonatal encephalopathy (NE) born at ≥34 weeks' GA (wGA) between September 2015 and March 2017. MAIN OUTCOME MEASURES The results of MRI performed within the first 12 days were classified in seven injured brain regions: basal ganglia and thalami, white matter (WM), cortex, posterior limb internal capsule, corpus callosum, brainstem and cerebellum. A given infant could have several brain structures affected. Risk of brain lesion according to GA was estimated by crude and adjusted ORs (aOR). RESULTS MRI was available for 626 (78.8%) of the 794 included infants with NE. WM lesions predominated in preterm compared with term infants. Compared with 39-40 wGA neonates, those born at 34-35 wGA and 37-38 wGA had greater risk of WM lesions after adjusting for perinatal factors (aOR 4.0, 95% CI (1.5 to 10.7) and ORa 2.0, 95% CI (1.1 to 3.5), respectively). CONCLUSION WM is the main brain structure affected in late-preterm and early-term infants with NE, with fewer WM lesions as GA increases. This finding could help clinicians to estimate prognosis and improve the understanding of the pathophysiology of NE. TRIAL REGISTRATION NUMBER NCT02676063, ClinicalTrials.gov.
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Affiliation(s)
- Lauren Binet
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
| | - Antoine Vilotitch
- Univversité Grenoble Alpes, Data Engineering Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Guellec
- 7 Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France
| | - Anne Ego
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004, Paris, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
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Tran HTT, Tran DM, Le HT, Hellström-Westas L, Alfvén T, Olson L. Cooling during transportation of newborns with hypoxic ischemic encephalopathy using phase change material mattresses in low-resource settings: a randomized controlled trial in Hanoi, Vietnam. BMC Pediatr 2024; 24:509. [PMID: 39118070 PMCID: PMC11308214 DOI: 10.1186/s12887-024-04987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To determine the effectiveness of phase-change-material mattress (PCM) during transportation of newborns with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN Randomized controlled trial of newborns with HIE from June 2016 to December 2019. Patients were randomized to transport with PCM or without PCM (control) when transferred to a cooling center in northern Vietnam. Primary outcome measure was mortality rate, secondary outcomes including temperature control and adverse effects. RESULT Fifty-Two patients in PCM-group and 61 in control group. Median rectal temperature upon arrival was 34.5 °C (IQR 33.5-34.8) in PCM-group and 35.1 °C (IQR 34.5-35.9) in control group (p = 0.023). Median time from birth to reach target temperature was 5.0 ± 1.4 h and 5.5 ± 1.2 h in the respective groups (p = 0.065). 81% of those transported with PCM versus 62% of infants transported without (p = 0.049) had reached target temperature within the 6-h timeframe. There was no record of overcooling (< 32 °C) in any of the groups. The was no difference in mortality rate between the two groups (33% and 34% respectively (p > 0.05)). CONCLUSION Phase-change-material can be used as a safe and effective cooling method during transportation of newborns with HIE in low-resource settings. TRIAL REGISTRATION The study was retro-prospectively registered in Clinical Trials (04/05/2022, NCT05361473).
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Affiliation(s)
- Hang T T Tran
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Vietnam National Children's Hospital, Hanoi, Vietnam.
| | - Dien M Tran
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T Le
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Mohammad K. Standardizing clinician training and patient care in the neonatal neurocritical care: A step-by-step guide. Semin Perinatol 2024; 48:151924. [PMID: 38897827 DOI: 10.1016/j.semperi.2024.151924] [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] [Indexed: 06/21/2024]
Abstract
Neonatal neurocritical care (NNCC) has emerged as an important specialty to address neurological conditions affecting newborns including a wide spectrum of brain injuries and developmental impairment. Despite the discipline's growth, variability in NNCC service delivery, patient care, and clinical training poses significant challenges and potentially adversely impacts patient outcomes. Variations in neuroprotective strategies, postnatal care, and training methodologies highlight the urgent need for a unified approach to optimize both short- and long-term neurodevelopmental outcomes for these vulnerable population. This paper presents strategic blueprints for establishing standardized NNCC clinical care and training programs focusing on collaborative effort across medical and allied health professions. By addressing these inconsistencies, the paper proposes that standardizing NNCC practices can significantly enhance the quality of care, streamline healthcare resource utilization, and improve neurodevelopmental outcome, thus paving the way for a new era of neonatal neurological care.
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Affiliation(s)
- Khorshid Mohammad
- Section of Newborn Critical Care, Department of Pediatrics, University of Calgary, Canada.
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11
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Tamez KG, Ohlin A, Wikström S, Odlind A, Olson L, Hellström-Westas L, Ågren J. Neonatal therapeutic hypothermia in a regional swedish cohort: Adherence to guidelines, transport and outcomes. Early Hum Dev 2024; 195:106077. [PMID: 39013211 DOI: 10.1016/j.earlhumdev.2024.106077] [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: 05/09/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024]
Abstract
AIM Swedish guidelines for therapeutic hypothermia (TH) after perinatal asphyxia were established in 2007, following several randomised studies that demonstrated improved outcomes. We assessed the implementation of hypothermia treatment in a mid-Swedish region with a sizeable proportion of outborn infants. METHOD A population-based TH cohort from 2007 to 2015 was scrutinised for adherence to national guidelines, interhospital transport, including the use of a cooling mattress made of phase change material for thermal management, and outcomes. RESULTS Of 136 admitted infants, 99 (73 %) were born outside the hospital. Ninety-eight percent fulfilled the criteria for postnatal depression/acidosis, and all patients had moderate-to-severe encephalopathy. Treatment was initiated within 6 h in 85 % of patients; amplitude-integrated electroencephalography/electroencephalography was recorded in 98 %, cranial ultrasound in 78 %, brain magnetic resonance imaging in 79 %, hearing tests in all, and follow-up was performed in 93 %. Although target body temperature was attained later (p < 0.01) in outborn than in inborn infants, at a mean (standard deviations) age of 6.2 (3.2) h vs 4.4 (2.6) h, 40 % of those transported using the cooling mattress were already within the therapeutic temperature range on arrival, and few were excessively cooled. The mortality rate was 23 %, and 38 % of the survivors had neurodevelopmental impairment at a median of 2.5 years. CONCLUSION The regionalisation of TH, including interhospital transport, was feasible and resulted in outcomes comparable to those of randomised controlled studies.
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Affiliation(s)
- Karla Gonzalez Tamez
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Andreas Ohlin
- Örebro University, Faculty of Medicine and Health, Department of Paediatrics, Örebro, Sweden.
| | - Sverre Wikström
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Örebro University, Faculty of Medicine and Health, Department of Paediatrics, Örebro, Sweden.
| | | | - Linus Olson
- Karolinska Institute, Department of Women's and Children's Health, Stockholm, Sweden.
| | | | - Johan Ågren
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
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12
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Kota S, Kang S, Liu YL, Liu H, Montazeri S, Vanhatalo S, Chalak LF. Prognostic value of quantitative EEG in early hours of life for neonatal encephalopathy and neurodevelopmental outcomes. Pediatr Res 2024:10.1038/s41390-024-03255-8. [PMID: 39039325 DOI: 10.1038/s41390-024-03255-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The ability to determine severity of encephalopathy is crucial for early neuroprotective therapies and for predicting neurodevelopmental outcome. The objective of this study was to assess a novel brain state of newborn (BSN) trend to distinguish newborns with presence of hypoxic ischemic encephalopathy (HIE) within hours after birth and predict neurodevelopmental outcomes at 2 years of age. METHOD This is a prospective cohort study of newborns at 36 weeks' gestation or later with and without HIE at birth. The Total Sanart Score (TSS) was calculated based on a modified Sarnat exam within 6 h of life. BSN was calculated from electroencephalogram (EEG) measurements initiated after birth. The primary outcome at 2 year of age was a diagnosis of death or disability using the Bayley Scales of Infant Development III. RESULTS BSN differentiated between normal and abnormal neurodevelopmental outcomes throughout the entire recording period from 6 h of life. Additionally, infants with lower BSN values had higher odds of neurodevelopmental impairment and HIE. BSN distinguished between normal (n = 86) and HIE (n = 46) and showed a significant correlation with the concomitant TSS. CONCLUSION BSN is a sensitive real-time marker for monitoring dynamic progression of encephalopathy and predicting neurodevelopmental impairment. IMPACT This is a prospective cohort study to investigate the ability of brain state of newborn (BSN) trend to predict neurodevelopmental outcome within the first day of life and identify severity of encephalopathy. BSN predicts neurodevelopmental outcomes at 2 years of age and the severity of encephalopathy severity. It also correlates with the Total Sarnat Score from the modified Sarnat exam. BSN could serve as a promising bedside trend aiding in accurate assessment and identification of newborns who may benefit from additional neuroprotection therapies.
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Affiliation(s)
- Srinivas Kota
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shu Kang
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Yu-Lun Liu
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Saeed Montazeri
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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13
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Schettler KF. Neuromonitoring in neonatal intensive care units-an important need towards individualized neuroprotective care. Eur J Pediatr 2024:10.1007/s00431-024-05642-z. [PMID: 38858228 DOI: 10.1007/s00431-024-05642-z] [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: 05/05/2024] [Revised: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
Neuromonitoring has been widely accepted as an important part in neonatal care. Amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are often mentioned in this context, though being only a part of the fully array of methods and examinations that could be considered neuromonitoring. Within the broad array of medical conditions that could be encountered in a neonatal patient, it is important to be aware of the indications for neuromonitoring and especially which neuromonitoring technique to use best for the individual condition. aEEG is now a widely accepted neuromonitor in neonatology with its value in hypoxic events and seizures only rarely questioned. Other methods like NIRS still have to prove themselves in the future. The SafeBoosC-III trial showed that it still remains difficult for some of these methods to prove their value for the improvement of outcome. Bute future developments such as multimodal neuromonitoring with data integration and artificial intelligence analysis could improve the value of these methods.
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14
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Proietti J, Boylan GB, Walsh BH. Regional variability in therapeutic hypothermia eligibility criteria for neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2024:10.1038/s41390-024-03184-6. [PMID: 38649726 DOI: 10.1038/s41390-024-03184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
Early induced therapeutic hypothermia represents the cornerstone treatment in neonates with probable hypoxic-ischemic encephalopathy. The selection of patients for treatment usually involves meeting criteria indicating evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. In this review, we highlight the variability that exists between some of the different regional and national eligibility guidelines. Determining the potential presence of perinatal hypoxia-ischemia may require either one, two or three signs amongst history of acute perinatal event, prolonged resuscitation at delivery, abnormal blood gases and low Apgar score, with a range of cutoff values. Clinical neurological exams often define the severity of encephalopathy differently, with varying number of domains required for determining eligibility and blurred interpretation of findings assigned to different severity grades in different systems. The role of early electrophysiological assessment is weighted differently. A clinical implication is that infants may receive different care depending on the location in which they are born. This could also impact epidemiological data, as inference of rates of moderate-severe encephalopathy based on therapeutic hypothermia rates are misleading and influenced by different eligibility methods used. We would advocate that a universally endorsed single severity staging of encephalopathy is vital for standardizing management and neonatal outcome. IMPACT: Variability exists between regional and national therapeutic hypothermia eligibility guidelines for neonates with probable hypoxic-ischemic encephalopathy. Differences are common in both criteria indicating perinatal hypoxia-ischemia and criteria defining moderate or severe encephalopathy. The role of early electrophysiological assessment is also weighted unequally. This reflects in different individual care and impacts research data. A universally endorsed single severity staging of encephalopathy would be crucial for standardizing management.
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Affiliation(s)
- Jacopo Proietti
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Engineering for Innovation Medicine, Innovation Biomedicine section, University of Verona, Verona, Italy
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland.
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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15
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Mietzsch U, Kolnik SE, Wood TR, Natarajan N, Gonzalez FF, Glass H, Mayock DE, Bonifacio SL, Van Meurs K, Comstock BA, Heagerty PJ, Wu TW, Wu YW, Juul SE. Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:308-316. [PMID: 38071538 PMCID: PMC11031347 DOI: 10.1136/archdischild-2023-326102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/09/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). DESIGN Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. SETTING Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). INTERVENTIONS Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME MEASURES Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months. RESULTS Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. CONCLUSION Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22-36 months in infants with moderate or severe HIE.
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Affiliation(s)
- Ulrike Mietzsch
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah E Kolnik
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas Ragnar Wood
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Niranjana Natarajan
- Child Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Neurology, Division of Child Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Fernando F Gonzalez
- Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
- Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Hannah Glass
- Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
- Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
- Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Dennis E Mayock
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sonia L Bonifacio
- Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Pediatrics, Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital School, Palo Alto, California, USA
| | - Krisa Van Meurs
- Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Pediatrics, Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital School, Palo Alto, California, USA
| | - Bryan A Comstock
- Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Patrick J Heagerty
- Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tai-Wei Wu
- Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Pediatrics, Children's Hospital Los Angeles Division of Neonatology, Los Angeles, California, USA
| | - Yvonne W Wu
- Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
- Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Sandra E Juul
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
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16
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Langeslag JF, Onland W, Groenendaal F, de Vries LS, van Kaam AH, de Haan TR. Association Between Seizures and Neurodevelopmental Outcome at Two and Five Years in Asphyxiated Newborns With Therapeutic Hypothermia. Pediatr Neurol 2024; 153:152-158. [PMID: 38387280 DOI: 10.1016/j.pediatrneurol.2024.01.023] [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: 06/25/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To investigate the association between the presence and severity of seizures in asphyxiated newborns and their neurodevelopmental outcome at ages two and five years. METHODS Retrospective data analysis from a prospectively collected multicenter cohort of 186 term-born asphyxiated newborns undergoing therapeutic hypothermia (TH) in 11 centers in the Netherlands and Belgium. Seizures were diagnosed by amplitude-integrated electroencephalography (EEG) and raw EEG signal reading up to 48 hours after rewarming. Neurodevelopmental outcome was assessed by standardized testing at age two and five years. Primary outcome was death or long-term neurodevelopmental impairment (NDI) including cerebral palsy. Associations were calculated using univariate and multivariate logistic regression analyses adjusting for Thompson score and a validated brain magnetic resonance imaging (MRI) score. RESULTS Seventy infants (38%) had seizures during TH or rewarming, and 44 (63%) of these needed two or more antiseizure medications (ASMs). Overall mortality was 21%. Follow-up data from 147 survivors were available for 137 infants (93%) at two and for 94 of 116 infants (81%) at five years. NDI was present in 26% at two and five years. Univariate analyses showed a significant association between seizures and death or NDI, but this was no longer significant after adjusting for Thompson and MRI score in the multivariate analysis; this was also true for severe seizures (need for two or more ASMs) or seizures starting during rewarming. CONCLUSION The presence or severity of seizures in newborns undergoing TH for hypoxic-ischemic encephalopathy was not independently associated with death or NDI up to age five years after adjusting for several confounders.
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Affiliation(s)
- Juliette F Langeslag
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Brain Center, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Brain Center, Utrecht, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Timo R de Haan
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.
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17
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Pressler R, Boylan G, Dempsey E, Klotz KA, Krauwinkel W, Will E, Morita D, Floricel F, Elshoff J, van den Anker J. Pharmacokinetics and safety of brivaracetam in neonates with repeated electroencephalographic seizures: A multicenter, open-label, single-arm study. Epilepsia Open 2024; 9:522-533. [PMID: 38049197 PMCID: PMC10984296 DOI: 10.1002/epi4.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE To evaluate the pharmacokinetics (PK), safety, and tolerability of brivaracetam (BRV) in neonates with repeated electroencephalographic seizures not controlled with previous antiseizure medications (ASMs). METHODS Phase 2/3, multicenter, open-label, single-arm study (N01349/NCT03325439) in neonates with repeated electroencephalographic seizures (lasting ≥10 s) confirmed by video-electroencephalography, and inadequate seizure control with at least one ASM. A screening period (up to 36 h) was followed by a 48-h evaluation period during which patients received 0.5 mg/kg BRV twice daily (b.i.d) intravenously (IV). Patients who benefitted from BRV (investigator's opinion) could continue 0.5 mg/kg b.i.d (IV or oral solution) in an extension period. Outcomes included plasma concentrations of BRV following the first dose (primary), and incidence of treatment-emergent adverse events (TEAEs). RESULTS Six patients (median [range] postnatal age: 1.5 [1.0, 6.0] days) received ≥1 dose of BRV. All six patients completed the evaluation period; two entered and completed the extension period. Overall (evaluation and extension periods), three patients received one dose of 0.5 mg/kg BRV and three received more than one dose. The median (range) duration of exposure to BRV (IV and oral solution) was 1.5 (1.0, 29.0) days (n = 6). At 0.5-1, 2-4, and 8-12 h following IV BRV administration, the GeoMean (GeoCV) plasma concentrations of BRV were 0.53 mg/L (15.40% [n = 5]), 0.50 mg/L (28.20% [n = 6]), and 0.34 mg/L (13.20% [n = 5]), respectively. Individual and population BRV PK profiles were estimated, and individual PK parameters were calculated using Bayesian feedback. The observed concentrations were consistent with the predicted PK. Three patients experienced four TEAEs, none of which were considered related to BRV. SIGNIFICANCE BRV plasma concentrations in neonates were consistent with data in older children receiving BRV oral solution, and with data from adults receiving a nominal IV dose of 25 mg b.i.d. BRV was well tolerated, with no drug-related TEAEs reported. PLAIN LANGUAGE SUMMARY Few drugs are available to treat seizures in newborn babies. Brivaracetam is approved to treat focal-onset seizures in children and adults in Europe (patients 2 years of age and older) and the United States (patients 1 month of age or older). In this study, six newborns with repeated seizures were treated with intravenous brivaracetam. The study doctors took samples of blood from the newborns and measured the levels of brivaracetam. The concentrations of brivaracetam in the newborns' blood plasma were consistent with data from studies in older children and in adults. No brivaracetam-related medical problems were reported.
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Affiliation(s)
- Ronit Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital and Clinical NeuroscienceUCL‐GOS Institute of Child HealthLondonUK
| | - Geraldine Boylan
- INFANT Research Centre and Department of Paediatrics and Child HealthCorkIreland
| | - Eugene Dempsey
- INFANT Research Centre and Department of Paediatrics and Child HealthCorkIreland
| | - Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical CenterUniversity of FreiburgFreiburgGermany
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Garcia-Alix A, Arnaez J, Arca G, Martinez-Biarge M. Hypoxic-ischaemic encephalopathy code: A systematic review for resource-limited settings. An Pediatr (Barc) 2024; 100:275-286. [PMID: 38614864 DOI: 10.1016/j.anpede.2024.04.001] [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: 01/11/2024] [Accepted: 02/28/2024] [Indexed: 04/15/2024] Open
Abstract
It is estimated that 96% of infants with hypoxic-ischaemic encephalopathy (HIE) are born in resource-limited settings with no capacity to provide the standard of care that has been established for nearly 15 years in high-resource countries, which includes therapeutic hypothermia (TH), continuous electroencephalographic monitoring and magnetic resonance imaging (MRI) in addition to close vital signs and haemodynamic monitoring. This situation does not seem to be changing; however, even with these limitations, currently available knowledge can help improve the care of HIE patients in resource-limited settings. The purpose of this systematic review was to provide, under the term "HIE Code", evidence-based recommendations for feasible care practices to optimise the care of infants with HIE and potentially help reduce the risks associated with comorbidity and improve neurodevelopmental outcomes. The content of the HIE code was grouped under 9 headings: (1) prevention of HIE, (2) resuscitation, (3) first 6h post birth, (4) identification and grading of encephalopathy, (5) seizure management, (6) other therapeutic interventions, (7) multiple organ dysfunction, (8) diagnostic tests and (9) family care.
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Affiliation(s)
- Alfredo Garcia-Alix
- Neurología Neonatal, NeNe Foundation, Madrid, Spain; Neonatología, Ibero-American Society of Neonatology (SIBEN), New Jersey, USA.
| | - Juan Arnaez
- Neurología Neonatal, NeNe Foundation, Madrid, Spain; Neonatología, Ibero-American Society of Neonatology (SIBEN), New Jersey, USA; Unidad Neonatal, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Gemma Arca
- Neurología Neonatal, NeNe Foundation, Madrid, Spain; Departamento de Neonatología, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Miriam Martinez-Biarge
- Department of Paediatrics, Imperial College Healthcare NHS Trust, Londres, United Kingdom
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19
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Liu Y, Liu NX. Correlation Study on the Prognostic Value of miR-21 and S-100B Protein Levels in Neonatal Hypoxic-Ischemic Encephalopathy Undergoing Hypothermia Therapy. Int J Neurosci 2024:1-12. [PMID: 38512134 DOI: 10.1080/00207454.2024.2334375] [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: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the variations in serum levels of microRNA-21 (miR-21) and S-100B protein in neonates with hypoxic-ischemic encephalopathy (HIE) after receiving hypothermia therapy and explore the correlation of these biomarkers with the neurodevelopmental prognosis of the infants. METHODS This retrospective analysis included 90 neonatal HIE patients diagnosed and treated between January 2019 and December 2022. Real-time quantitative PCR and enzyme-linked immunosorbent assay (ELISA) methods were used to measure miR-21 and S-100B protein levels. Neurodevelopmental assessments were conducted at one year, and follow-up was performed using the Bayley Scales of Infant and Toddler Development third edition. Statistical analysis was carried out using SPSS software, with t-tests for continuous variables, chi-square tests for categorical data, Pearson correlation coefficient for correlation analysis, and multivariate regression analysis to adjust for confounding factors. RESULTS After hypothermia therapy, the observation group showed a significant decrease in miR-21 and S-100B protein levels (P < 0.001), and neurodevelopmental scores were significantly higher than the control group (P < 0.05). Correlation analysis indicated a negative correlation between miR-21 and neurodevelopmental scores (r=-0.62, P < 0.001), as well as a negative correlation between S-100B protein levels (r=-0.76, P < 0.001). Multivariate regression analysis demonstrated that miR-21 levels and S-100B protein levels maintained independent negative correlations with neurodevelopmental scores (P < 0.001). CONCLUSION Hypothermia therapy significantly reduces serum levels of miR-21 and S-100B protein in neonatal HIE patients and may be associated with better prognosis. miR-21 and S-100B serve as prognostic biomarkers, aiding in predicting and improving the treatment outcomes and long-term prognosis of neonatal HIE.
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Affiliation(s)
- Yan Liu
- Department of Newborn Pediatrics, Hengshui people's Hospital, Hengshui 053000, Hebei, China
| | - Nuo-Xuan Liu
- Department of Clincal, Hebei North University, Zhangjiakou 050031, Hebei, China
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20
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Ristovska S. Respiratory Distress Syndrome (RDS) in Newborns with Hypoxic-Ischemic Encephalopathy (HIE). Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024; 45:19-30. [PMID: 38575384 DOI: 10.2478/prilozi-2024-0003] [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] [Indexed: 04/06/2024]
Abstract
Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns between January 2021 and July 2022 at the University Clinic for Gynecology and Obstetrics, Skopje. Up to date criteria for HIE/RDS for term and for preterm infants as well for the severity of HIE/RDS were used in a comprehensive analysis of cranial ultrasonography, neurological status, neonatal infections, Apgar score, bradycardia and hypotension, X-ray of the lungs, FiO2, acid-base status, assisted ventilation and use of surfactant. Three groups were created: HIE with RDS (42 babies), HIE without RDS (30 babies) and RDS without HIE in 38 neonates. All newborns with severe (third) degree of HIE died. Intracranial bleeding was found in 35.7% in the first group and 30% in the second group, and in the third group in 53.3%. The need for surfactant in the HIE group with RDS is 59.5%, and in the RDS group without HIE 84.2%. DIC associated with sepsis was found in 13.1-50% in those groups. In newborns with HIE and bradycardia, the probability of having RDS was on average 3.2 times higher than in those without bradycardia. The application of the surfactant significantly improved the pH, pO2, pCO2, BE and chest X-ray in children with RDS. An Apgar score less than 6 at the fifth minute increases the risk of RDS by 3 times. The metabolic acidosis in the first 24 hours increases the risk of death by 23.6 times. The combination of HIE/ RDS significantly worsens the disease outcome. The use of scoring systems improved the early detection of high risk babies and initiation of early treatment increased the chances for survival without disabilities.
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Affiliation(s)
- Sanja Ristovska
- PJU University Clinic for Gynecology and Obstetrics, Faculty of Medicine, University of "St. Cyril and Methodius", Skopje, RN Macedonia
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Farag MM, Khedr AAEHAER, Attia MH, Ghazal HAER. Role of Near-Infrared Spectroscopy in Monitoring the Clinical Course of Asphyxiated Neonates Treated with Hypothermia. Am J Perinatol 2024; 41:429-438. [PMID: 34965589 DOI: 10.1055/s-0041-1740513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. STUDY DESIGN Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. RESULTS Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. CONCLUSION NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. KEY POINTS · Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.. · Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.. · Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia..
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Affiliation(s)
| | | | - MennattAllah Hassan Attia
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Varga Z, Andorka C, Pataki M, Meder U, Szakmar E, Szabo AJ, Szabo M, Jermendy A. Higher parental education was associated with good cognitive outcomes in infants with hypoxic-ischaemic encephalopathy. Acta Paediatr 2024; 113:417-425. [PMID: 38108642 DOI: 10.1111/apa.17058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
AIM Predicting neurodevelopmental outcomes in hypoxic-ischaemic encephalopathy (HIE) remains imprecise, despite advanced imaging and neurophysiological tests. We explored the predictive value of socio-economic status (SES). METHODS The cohort comprised 93 infants (59% male) with HIE, who had received therapeutic hypothermia. Patients underwent magnetic resonance imaging, and brain injuries were quantified using the Barkovich scoring system. Family SES was self-reported using a questionnaire. Adverse outcomes were defined as mild to severely delayed development with a score of ≤85 in any domain at 2 years of age, based on the Bayley Scales of Infant Development, Second Edition. Data are presented as odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS Multiple regression modelling revealed that higher parental education was strongly associated with good cognitive development, when adjusted for gestational age, serum lactate and brain injuries (OR 2.20, 95% CI 1.16-4.36). The effect size of parental education (β = 0.786) was higher than one score for any brain injury using the Barkovich scoring system (β = -0.356). The literacy environment had a significant effect on cognitive development in the 21 infants who had brain injuries (OR 40, 95% CI 3.70-1352). CONCLUSION Parental education and the literacy environment influenced cognitive outcomes in patients with HIE.
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Affiliation(s)
- Zsuzsanna Varga
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Csilla Andorka
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Margit Pataki
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Unoke Meder
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Eniko Szakmar
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Attila J Szabo
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Miklos Szabo
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Department of Pediatrics, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
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Hart AR, Kieran M, Matthews E, Mandefield L, Williams T, Johnson K, English S, Evans D, Cutsey L, Goodden J. Preliminary results on validity and reliability from two prospective cohort studies on a new Neonatal Coma Score. Arch Dis Child Fetal Neonatal Ed 2024; 109:173-181. [PMID: 37652673 DOI: 10.1136/archdischild-2023-325765] [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: 04/29/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To collect data on content/face validity and interobserver agreement for a Neonatal Coma Score (NCS) in well full-term neonates and on construct validity in unwell and preterm babies, specifically how the NCS changed with gestational age and illness. DESIGN Prospective cohort studies. SETTING Two UK tertiary neonatal units (Sheffield and Leeds). PATIENTS 151 well full-term (≥37 weeks gestational age) newborn babies recruited between January and February 2020 in Sheffield and April and May 2021 in Leeds; 101 sick preterm and full-term babies admitted to Sheffield neonatal unit between January 2021 and May 2022. INTERVENTION A new NCS. MAIN OUTCOME MEASURES Determination of normal values in well babies born ≥37 weeks gestational age; data on how the NCS changes with gestational age and illness. RESULTS Face validity was demonstrated during development of the NCS. The median NCS of well, full-term newborn babies was 15 and the intraclass correlation coefficient was 0.78 (95% CI 0.70 to 0.84). In the 'well' preterm population, 95% <28 weeks had a score ≥11; 28-31 weeks ≥11; 32-36 weeks ≥13 and 37-44 weeks 14-15. The NCS dropped during periods of deterioration, demonstrating evidence of construct validity. Criterion validity was not assessed. CONCLUSIONS The NCS has good intraobserver agreement in well full-term babies, with a normal NCS 14-15. The NCS in preterm neonates depended on gestational age, and deterioration from baseline was associated with illness. Further work is needed to determine normal scores each gestational age, reliability at lower levels, how early the NCS identifies deterioration and comparison with other assessment tools to demonstrate criterion validity.
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Affiliation(s)
- Anthony Richard Hart
- Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, Division of Health and Social Care Research, London, UK
| | - Martha Kieran
- Medical School, The University of Sheffield, Sheffield, UK
| | | | - Laura Mandefield
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Tamanna Williams
- Deparment of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kathryn Johnson
- Department of Neonatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sharon English
- Department of Neonatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Denise Evans
- Neonatal Education, Yorkshire and Humber Neonatal Operational Delivery Network, Sheffield, UK
| | - Lisa Cutsey
- Department of Paediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Goodden
- Department of Paediatric Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Arad N, Meledin I, Hazan I, Noyman I, Marks KA, Abramsky R, Shany E. The Association of Therapeutic Hypothermia With Seizure Burden in Neonates With Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2024; 151:143-148. [PMID: 38157720 DOI: 10.1016/j.pediatrneurol.2023.12.005] [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: 07/22/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To compare seizure burden between newborn infants treated with therapeutic hypothermia (TH) and those that were not and to compare the need for antiseizure medications (ASM) in a cohort of infants who were diagnosed with neonatal hypoxic-ischemic encephalopathy (HIE). METHODS This was a retrospective cohort study on infants born after 35 weeks' gestation, diagnosed with moderate to severe HIE, monitored with amplitude-integrated electroencephalography (aEEG) and eligible for TH. Infants born before the implementation of TH in 2008 were compared with infants born thereafter who received TH. Seizure burden was assessed from aEEG as total time in minutes of seizures activity per hour of recording. Other clinical and demographic data were retrieved from a prospective local database of infants with HIE. RESULTS Overall, 149 of 207 infants were included in the study: 112 exposed to TH and 37 not exposed. Cooled infants had a lower seizure burden overall (0.4 vs 2.3 min/h, P < 0.001) and were also less likely to be treated with ASM (74% vs 100%, P < 0.001). In multivariable regression models, not exposed to TH, having a depressed aEEG background, and having higher Apgar scores were associated with higher seizure burden (incidence rate ratio: 4.78 for noncooled infants, P < 0.001); also, not exposed to TH was associated with a higher likelihood of multidrug ASM (odds ratio: 4.83, P < 0.001). CONCLUSIONS TH in infants with moderate to severe HIE is associated with significant reduction of seizure burden and ASM therapy.
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Affiliation(s)
- Noa Arad
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Irina Meledin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology, Cheryl and Haim Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel
| | - Itai Hazan
- Clinical Research Center, Soroka Medical Center, Beer-Sheva, Israel
| | - Iris Noyman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Pediatric Neurology Unit, Cheryl and Haim Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel
| | - Kyla A Marks
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology, Cheryl and Haim Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel
| | - Ramy Abramsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology, Cheryl and Haim Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology, Cheryl and Haim Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel.
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Toptan HH, Tezel KG, Tezel O, Ataç Ö, Vardar G, Gülcan Kersin S, Özek E. Inflammatory and Hematologic Liver and Platelet (HALP) Scores in Hypothermia-Treated Hypoxic-Ischemic Encephalopathy (HIE). CHILDREN (BASEL, SWITZERLAND) 2024; 11:72. [PMID: 38255385 PMCID: PMC10814453 DOI: 10.3390/children11010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study examined systemic inflammatory indices and "Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) scores" in neonates with hypoxic-ischemic encephalopathy (HIE). METHODS A total of 43 neonates with moderate-to-severe HIE at 36 weeks' gestation were assessed. Systemic inflammatory markers were measured before HT commenced within 0-6 h after birth and between 60 and 72 h during and after therapy or before adjusting for hypothermia. RESULTS Platelet counts, hemoglobin levels, and platelet indices in the HIE group were significantly lower at both time points (p = 0.001). Both the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) decreased in the HIE group after hypothermia therapy (p = 0.001). Seizures, PVL, and kidney injuries were associated with higher HALP scores. The AUCs of NLR, PLR, MLR, SII, SIRI, and platelet, neutrophil, monocyte, and lymphocyte Index (PIV) showed significant sensitivity and specified HIE, with area under the curve (AUC) values of 0.654, 0.751, 0.766, 0.700, 0.722, and 0.749, respectively. CONCLUSIONS A significant difference in systemic inflammatory markers was found between the HIE and control groups after hypothermia treatment, with significant reductions in the MLR and NLR. These markers, particularly MLR, were significant predictors of adverse clinical outcomes including seizures, PVL, and kidney damage.
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Affiliation(s)
- Handan Hakyemez Toptan
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
| | - Kübra Gökçe Tezel
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
| | - Oğuzhan Tezel
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
| | - Ömer Ataç
- Department of Public Health, International School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Gonca Vardar
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
| | - Sinem Gülcan Kersin
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
| | - Eren Özek
- Department of Pediatrics, Division of Neonatology, School of Medicine, Marmara University, Istanbul 34722, Turkey; (K.G.T.); (O.T.); (G.V.); (S.G.K.); (E.Ö.)
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Okulu E, Hirfanoglu IM, Satar M, Erdeve O, Koc E, Ozlu F, Gokce M, Armangil D, Tunc G, Demirel N, Unal S, Ozdemir R, Deveci MF, Akar M, Demirel MK, Çetinkaya M, Buker HSC, Karagöl BS, Yaprak D, Akcan AB, Anik A, Narter F, Arayici S, Yildirim E, Akin IM, Sahin O, Ozdemir OEB, Ovali F, Akin MA, Celik Y, Orman A, Uslu S, Ozkan H, Koksal N, Tastekin A, Gunduz M, Arisoy AE, Gurpinar R, Ors R, Altunhan H, Kececi R, Yildizdas HY, Terek D, Ates M, Kader S, Mutlu M, Çelik K, Yucesoy E, Mert MK, Gulasi S, Kucuktasci K, Arman D, Hekimoglu B, Gultekin ND, Celik HT, Kahvecioglu D, Akyildiz C, Taşkın E, Ciftdemir NA, Uygun SS, Kaya TB, Akdag A, Yilmaz A. An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy. PLoS One 2023; 18:e0295759. [PMID: 38096201 PMCID: PMC10721008 DOI: 10.1371/journal.pone.0295759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HİE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.
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Affiliation(s)
- Emel Okulu
- Ankara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Ibrahim Murat Hirfanoglu
- Gazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Mehmet Satar
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
| | - Omer Erdeve
- Ankara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Esin Koc
- Gazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Ferda Ozlu
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
- Department of Neonatology, Seyhan State Hospital, Adana, Türkiye
| | - Mahmut Gokce
- Department of Neonatology, Seyhan State Hospital, Adana, Türkiye
| | - Didem Armangil
- Department of Pediatrics, Neonatal Intensive Care Unit, Koru Hospital, Ankara, Türkiye
| | - Gaffari Tunc
- Cumhuriyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Sivas, Türkiye
| | - Nihal Demirel
- Yildirim Beyazit University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
- Department of Neonatology, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Türkiye
| | - Sezin Unal
- Department of Neonatology, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Türkiye
| | - Ramazan Ozdemir
- Inonu University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Malatya, Türkiye
| | - Mehmet Fatih Deveci
- Inonu University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Malatya, Türkiye
| | - Melek Akar
- Department of Neonatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir Türkiye
| | - Melike Kefeli Demirel
- Department of Neonatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir Türkiye
| | - Merih Çetinkaya
- Department of Neonatology, University of Health Sciences, Basaksehir Çam and Sakura City Hospital, Istanbul, Türkiye
| | - Halime Sema Can Buker
- Department of Neonatology, University of Health Sciences, Basaksehir Çam and Sakura City Hospital, Istanbul, Türkiye
| | - Belma Saygılı Karagöl
- Gulhane Faculty of Medicine, Department of Pediatrics, Division of Neonatology, University of Health Sciences, Ankara, Türkiye
| | - Deniz Yaprak
- Gulhane Faculty of Medicine, Department of Pediatrics, Division of Neonatology, University of Health Sciences, Ankara, Türkiye
| | - Abdullah Barıs Akcan
- Adnan Menderes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Aydin, Türkiye
| | - Ayse Anik
- Adnan Menderes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Aydin, Türkiye
| | - Fatma Narter
- Department of Neonatology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
| | - Sema Arayici
- Department of Neonatology, Eskisehir State Hospital, Eskisehir, Türkiye
| | - Egemen Yildirim
- Department of Neonatology, Eskisehir State Hospital, Eskisehir, Türkiye
| | - Ilke Mungan Akin
- Department of Neonatology, University of Health Sciences, Umraniye Training and Research Hospital Istanbul, Istanbul, Türkiye
| | - Ozlem Sahin
- Department of Neonatology, University of Health Sciences, Umraniye Training and Research Hospital Istanbul, Istanbul, Türkiye
| | - Ozgul Emel Bulut Ozdemir
- Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Fahri Ovali
- Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Mustafa Ali Akin
- Ondokuz Mayis University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Samsun, Türkiye
| | - Yalcin Celik
- Mersin University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Mersin, Türkiye
| | - Aysen Orman
- Mersin University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Mersin, Türkiye
| | - Sinan Uslu
- Department of Neonatology, University of Health Sciences, Sisli Etfal Hamidiye Training and Research Hospital, Istanbul, Türkiye
| | - Hilal Ozkan
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Türkiye
| | - Nilgun Koksal
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Türkiye
| | - Ayhan Tastekin
- Medipol University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Mehmet Gunduz
- Medipol University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
| | - Ayse Engin Arisoy
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kocaeli, Türkiye
| | - Resat Gurpinar
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kocaeli, Türkiye
| | - Rahmi Ors
- Department of Pediatrics, Neonatal Intensive Care Unit, Ozel Medova Hospital, Konya, Türkiye
| | - Huseyin Altunhan
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Ramazan Kececi
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Hacer Yapicioglu Yildizdas
- Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana, Türkiye
| | - Demet Terek
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Mehmet Ates
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Sebnem Kader
- Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Trabzon, Türkiye
| | - Mehmet Mutlu
- Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Trabzon, Türkiye
| | - Kıymet Çelik
- Akdeniz University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Antalya, Türkiye
| | - Ebru Yucesoy
- Harran University Faculty of Medicine, Department of Pediatrics Division of Neonatology, Sanliurfa, Türkiye
| | | | - Selvi Gulasi
- Department of Neonatology, University of Health Sciences, Adana, Türkiye
| | - Kazım Kucuktasci
- Adana City Training and Research Hospital, Department of Pediatrics, Neonatal Intensive Care Unit, Ozel Saglik Hospital, Denizli, Türkiye
| | - Didem Arman
- Department of Neonatology, Istanbul Training and Research Hospital, Istanbul, Türkiye
| | - Berna Hekimoglu
- Department of Neonatology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Türkiye
| | - Nazlı Dilay Gultekin
- Department of Neonatology, Van Regional Training and Research Hospital, Van, Türkiye
| | - Hasan Tolga Celik
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
| | - Dilek Kahvecioglu
- Department of Neonatology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Can Akyildiz
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Izmir, Türkiye
| | - Erdal Taşkın
- Fırat University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Elazıg, Türkiye
| | - Nukhet Aladag Ciftdemir
- Trakya University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Edirne, Türkiye
| | - Saime Sundus Uygun
- Necmettin Erbakan University Selcuk Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Konya, Türkiye
| | - Tugba Barsan Kaya
- Osmangazi University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Eskisehir, Türkiye
| | - Arzu Akdag
- Department of Neonatology, University of Health Sciences, Yuksek Ihtisas Teaching Hospital, Bursa, Türkiye
| | - Aslan Yilmaz
- Cerrahpasa University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Türkiye
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Birkenmaier A, Adams M, Kleber M, Schwendener Scholl K, Rathke V, Hagmann C, Brotschi B, Grass B. Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register. Ther Hypothermia Temp Manag 2023; 13:175-183. [PMID: 36811496 DOI: 10.1089/ther.2022.0055] [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] [Indexed: 02/24/2023] Open
Abstract
The Swiss National Asphyxia and Cooling Register was implemented in 2011. This study assessed quality indicators of the cooling process and (short-term) outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) longitudinally over time in Switzerland. This is a multicenter national retrospective cohort study of prospectively collected register data. Quality indicators were defined for longitudinal comparison (2011-2014 vs. 2015-2018) of processes of TH and (short-term) outcomes of neonates with moderate-to-severe HIE. Five hundred seventy neonates receiving TH in 10 Swiss cooling centers were included (2011-2018). Four hundred forty-nine (449/570; 78.8%) neonates with moderate-to-severe HIE received TH according to the Swiss National Asphyxia and Cooling Register Protocol. Quality indicators of processes of TH improved in 2015-2018 (compared with 2011-2014): less passive cooling (p = 0.013), shorter time to reach target temperature (p = 0.002), and less over- or undercooling (p < 0.001). In 2015-2018, adherence to performing a cranial magnetic resonance imaging after rewarming improved (p < 0.001), whereas less cranial ultrasounds were performed on admission (p = 0.012). With regard to quality indicators of short-term outcomes, persistent pulmonary hypertension of the neonate was reduced (p = 0.003), and there was a trend toward less coagulopathy (p = 0.063) in 2015-2018. There was no statistically significant change in the remaining processes and outcomes. The Swiss National Asphyxia and Cooling Register is well implemented with good overall adherence to the treatment protocol. Management of TH improved longitudinally. Continuous reevaluation of register data is desirable for quality assessment, benchmarking, and maintaining international evidence-based quality standards.
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Affiliation(s)
- André Birkenmaier
- University of Zurich, Faculty of Medicine, Department of Neonatology and Pediatric Intensive Care, Children's Hospital St. Gallen, Neonatal and Pediatric Intensive Care Unit, St. Gallen, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Kleber
- Clinic of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Verena Rathke
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beate Grass
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Abstract
BACKGROUND The Neonatal Task Force of the International Liaison Committee on Resuscitation (ILCOR) makes practice recommendations for the care of newborn infants in the delivery room (DR). ILCOR recommends that all infants who are gasping, apnoeic, or bradycardic (heart rate < 100 per minute) should be given positive pressure ventilation (PPV) with a manual ventilation device (T-piece, self-inflating bag, or flow-inflating bag) via an interface. The most commonly used interface is a face mask that encircles the infant's nose and mouth. However, gas leak and airway obstruction are common during face mask PPV. Nasal interfaces (single and binasal prongs (long or short), or nasal masks) and laryngeal mask airways (LMAs) may also be used to deliver PPV to newborns in the DR, and may be more effective than face masks. OBJECTIVES To determine whether newborn infants receiving PPV in the delivery room with a nasal interface compared to a face mask, laryngeal mask airway (LMA), or another type of nasal interface have reduced mortality and morbidity. To assess whether safety and efficacy of the nasal interface differs according to gestational age or ventilation device. SEARCH METHODS Searches were conducted in September 2022 in CENTRAL, MEDLINE, Embase, Epistemonikos, and two trial registries. We searched conference abstracts and checked the reference lists of included trials and related systematic reviews identified through the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCT's that compared the use of nasal interfaces to other interfaces (face masks, LMAs, or one nasal interface to another) to deliver PPV to newborn infants in the DR. DATA COLLECTION AND ANALYSIS Each review author independently evaluated the search results against the selection criteria, screened retrieved records, extracted data, and appraised the risk of bias. If they were study authors, they did not participate in the selection, risk of bias assessment, or data extraction related to the study. In such instances, the study was independently assessed by other review authors. We contacted trial investigators to obtain additional information. We completed data analysis according to the standards of Cochrane Neonatal, using risk ratio (RR) and 95% confidence Intervals (CI) to measure the effect of the different interfaces. We used fixed-effect models and the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included five trials, in which 1406 infants participated. They were conducted in 13 neonatal centres across Europe and Australia. Each of these trials compared a nasal interface to a face mask for the delivery of respiratory support to newborn infants in the DR. Potential sources of bias were a lack of blinding to treatment allocation of the caregivers and investigators in all trials. The evidence suggests that resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on reducing death before discharge (typical risk ratio (RR) 0.72, 95% CI 0.47 to 1.13; 3 studies, 1124 infants; low-certainty evidence). Resuscitation with a nasal interface may reduce the rate of intubation in the DR, but the evidence is very uncertain (RR 0.68, 95% CI 0.54 to 0.85; 5 studies, 1406 infants; very low-certainty evidence). The evidence is very uncertain for the rate of intubation within 24 hours of birth (RR 0.97, 95% CI 0.85 to 1.09; 3 studies, 749 infants; very low-certainty evidence), endotracheal intubation outside the DR during hospitalisation (RR 1.15, 95% CI 0.93 to 1.42; 1 study, 144 infants; very low-certainty evidence) and cranial ultrasound abnormalities (intraventricular haemorrhage (IVH) grade ≥ 3, or periventricular leukomalacia; RR 0.94, 95% CI 0.55 to 1.61; 3 studies, 749 infants; very low-certainty evidence). Resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on the incidence of air leaks (RR 1.09, 95% CI 0.85 to 1.09; 2 studies, 507 infants; low-certainty evidence), or the need for supplemental oxygen at 36 weeks' corrected gestational age (RR 1.06, 95% CI 0.8 to 1.40; 2 studies, 507 infants; low-certainty evidence). We identified one ongoing study, which compares a nasal mask to a face mask to deliver PPV to infants in the DR. We did not identify any completed trials that compared nasal interfaces to LMAs or one nasal interface to another. AUTHORS' CONCLUSIONS Nasal interfaces were found to offer comparable efficacy to face masks (low- to very low-certainty evidence), supporting resuscitation guidelines that state that nasal interfaces are a comparable alternative to face masks for providing respiratory support in the DR. Resuscitation with a nasal interface may reduce the rate of intubation in the DR when compared with a face mask. However, the evidence is very uncertain. This uncertainty is attributed to the use of a new ventilation system in the nasal interface group in two of the five trials. As such, it is not possible to differentiate separate, specific effects related to the ventilation device or to the interface in these studies.
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Affiliation(s)
- Caitriona M Ni Chathasaigh
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
| | - Colm Pf O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Lisa K McCarthy
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Alongi S, Lambicchi L, Moltrasio F, Botto VA, Bernasconi DP, Cuttin MS, Paterlini G, Malguzzi S, Locatelli A. Placental pathology in perinatal asphyxia: a case-control study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1186362. [PMID: 37790677 PMCID: PMC10545088 DOI: 10.3389/fcdhc.2023.1186362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/23/2023] [Indexed: 10/05/2023]
Abstract
Introduction Placentas of term infants with birth asphyxia are reported to have more lesion such as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM) and chorioamnionitis with fetal response (FIR) than those of term infants without birth asphyxia. We compared the placental pathology of asphyxiated newborns, including those who developed hypoxic-ischemic encephalopathy (HIE), with non-asphyxiated controls. Methods We conducted a retrospective case-control study of placentas from neonates with a gestational age ≥ 35 weeks, a birthweight ≥ 1,800 g, and no malformations. Cases were asphyxiated newborns (defined as those with an umbilical artery pH ≤ 7.0 or base excess ≤ -12 mMol, 10-minute Apgar score ≤ 5, or the need for resuscitation lasting >10 min) from a previous cohort, with (n=32) and without (n=173) diagnosis of HIE. Controls were non-asphyxiated newborns from low-risk l (n= 50) or high-risk (n= 68) pregnancies. Placentas were analyzed according to the Amsterdam Placental Workshop Group Consensus Statement 2014. Results Cases had a higher prevalence of nulliparity, BMI>25, thick meconium, abnormal fetal heart monitoring, and acute intrapartum events than controls (p<0.001). MVM and FVM were more frequent among non-asphyxiated than asphyxiated newborns (p<0.001). There was no significant difference in inflammatory lesions or abnormal umbilical insertion site. Histologic meconium-associated changes (MAC) were observed in asphyxiated newborns only (p= 0.039). Discussion Our results confirm the role of antepartum and intrapartum risk factors in neonatal asphyxia and HIE. No association between neonatal asphyxia and placental lesions was found, except for in the case of MAC. The association between clinical and placental data is crucial to understanding and possibly preventing perinatal asphyxia in subsequent pregnancies.
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Affiliation(s)
- Silvia Alongi
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy
| | - Laura Lambicchi
- Department of Obstetrics and Gynecology, Fondazione MONZA e BRIANZA per il BAMBINO e la sua MAMMA (MBBM), San Gerardo Hospital, Monza, MB, Italy
| | - Francesca Moltrasio
- Department of Pathology, Desio Hospital, Azienda Socio Sanitaria Territoriale (ASST) Brianza, Desio, MB, Italy
| | | | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre – B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
| | - Maria Serena Cuttin
- Department of Pathology, Vimercate Hospital, Azienda Socio Sanitaria Territoriale (ASST) Brianza, Vimercate, MB, Italy
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Fondazione MONZA e BRIANZA per il BAMBINO e la sua MAMMA (MBBM), San Gerardo Hospital, Monza, MB, Italy
| | - Silvia Malguzzi
- Neonatal Intensive Care Unit, Fondazione MONZA e BRIANZA per il BAMBINO e la sua MAMMA (MBBM), San Gerardo Hospital, Monza, MB, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
- Obstetrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Gerardo dei Tintori, Monza, Italy
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30
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Malan R, Van der Linde J, Kritzinger A, Graham MA, Krüger E. Evolution of Feeding and Developmental Outcomes in Infants With Moderate Hypoxic-Ischemic Encephalopathy: A Pilot Study. Neonatal Netw 2023; 42:264-275. [PMID: 37657810 DOI: 10.1891/nn-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 09/03/2023]
Abstract
The purpose of the study was to describe the evolution of outcomes among full-term infants with moderate hypoxic-ischemic encephalopathy (HIE); from their early swallowing and feeding abilities during hospitalization, to their later developmental outcomes at 6 and 12 months. Four participants with moderate HIE were recruited. Early feeding and swallowing were assessed using the Neonatal Feeding Assessment Scale and video fluoroscopic swallow studies. Developmental assessments were conducted at 6 and 12 months using the Rossetti Infant-Toddler Language Scale and Vineland-3 Scale. All participants displayed atypical outcomes throughout the study, including oropharyngeal dysphagia initially during hospitalization. All participants were discharged on oral feeds but some breastfeeding difficulties persisted. Variable but pervasive developmental delays were found among all participants at 6 and 12 months. This study emphasizes the need for consistent early intervention from the neonatal period onward, for all infants with moderate HIE. Future studies should use larger cohorts, longer follow-up, and correlational designs.
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31
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Celik Y, Özgür A, Sungur MA, Yıldırım N, Teke S. Is Selective Head Cooling Combined with Whole-Body Cooling the Most Effective Hypothermia Method for Neonatal Hypoxic-Ischemic Encephalopathy? Ther Hypothermia Temp Manag 2023; 13:70-76. [PMID: 36251965 DOI: 10.1089/ther.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
This study aimed to compare combined hypothermia (CH) to the 2 classical therapeutic hypothermia (TH) methods selective head cooling (SHC) and whole-body cooling (WBC). This retrospective cohort study included neonates who underwent CH, SHC, and WBC between 2012 and 2020. Mean rectal temperature was maintained at 33.5 ± 0.5°C by cooling the head and the body in the CH group, at 34.5 ± 0.5°C by cooling the head in the SHC group, and at 33.5 ± 0.5°C by cooling the body in the WBC group. The groups were compared in terms of side effects, magnetic resonance imaging (MRI) scores, and status at discharge. The study included 60 neonates in the CH group, 112 in the WBC group, and 27 in the SHC group. There was no significant difference in side effects between the groups (p > 0.05). There was no significant difference in brain MRI scores between the groups (p > 0.05); however, gray matter, white matter, and total MRI scores in the CH group were lower than in the WBC group. Duration of hospitalization was shorter in the CH group than in the other two groups (p = 0.022). CH was not associated with more side effects than the two classical TH methods. In addition, some of these findings suggest that CH might result in better clinical outcome than the two classical TH methods.
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Affiliation(s)
- Yalcin Celik
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Anıl Özgür
- Department of Radiology, School of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Düzce University, Düzce, Turkey
| | - Nazım Yıldırım
- Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Selçuk Teke
- Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
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32
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Tsuda K, Shibasaki J, Takeuchi A, Mukai T, Sugiyama Y, Isayama T, Ioroi T, Takahashi A, Yutaka N, Iwata O. Prolonged requirements for mechanical ventilation and tube feeding support predicted 18-month outcomes for neonatal encephalopathy. Acta Paediatr 2023; 112:734-741. [PMID: 36708079 DOI: 10.1111/apa.16687] [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: 09/07/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
AIM We evaluated the predictive ability of prolonged requirements for mechanical ventilation or tube feeding support for 18-month composite outcomes in infants with hypoxic-ischaemic encephalopathy treated with hypothermia. METHODS This retrospective, nationwide, observational study focused on newborn infants registered in Japan's Baby Cooling Registry between 1 January 2012 and 31 December 2016. The adverse outcomes were defined as death or survival with cerebral palsy, visual or auditory impairment or the requirement for mechanical ventilation or tube feeding at 18 months of age. RESULTS Adverse outcomes occurred in 165 (28%) of the 591 children in the final cohort. These were predicted by prolonged dependence on mechanical ventilation or tube feeding for more than seven and more than 14 days. The respective values were positive predictive value 0.34 (95% CI 0.33-0.34) and 0.60 (95% CI 0.56-0.62), negative predictive value 0.97 (95% CI 0.91-0.99) and 0.93 (95% CI 0.90-0.95) and area under the curve 0.59 (95% CI 0.54-0.64) and 0.81 (95% CI 0.77-0.85). CONCLUSION Prolonged dependence on mechanical ventilation or tube feeding for more than 14 days may be useful in predicting 18-month outcomes in newborn infants who have received therapeutic hypothermia.
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Affiliation(s)
- Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takeo Mukai
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Perinatal Medical Center, Himeji Red Cross Hospital, Hyogo, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Aoki H, Shibasaki J, Tsuda K, Yamamoto K, Takeuchi A, Sugiyama Y, Isayama T, Mukai T, Ioroi T, Yutaka N, Takahashi A, Tokuhisa T, Nabetani M, Iwata O. Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy. Pediatr Res 2023; 93:1057-1063. [PMID: 35908094 DOI: 10.1038/s41390-022-02212-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND To explore the predictive value of the Thompson score during the first 4 days of life for estimating short-term adverse outcomes in neonatal encephalopathy. METHODS This observational study evaluated infants with neonatal encephalopathy (≥36 weeks of gestation) registered in a multicenter cohort of cooled infants in Japan. The Thompson score was evaluated at 0-24, 24-48, 48-72, and 72-90 h of age. Adverse outcomes included death, survival with respiratory impairment (requiring tracheostomy), or survival with feeding impairment (requiring gavage feeding) at discharge. RESULTS Of the 632 infants, 21 (3.3%) died, 59 (9.3%) survived with respiratory impairment, and 113 (17.9%) survived with feeding impairment. The Thompson score throughout the first 4 days accurately predicted death, respiratory impairment, or feeding impairment. The 72-90 h score showed the highest accuracy. A cutoff of ≥15 had a sensitivity of 0.85 and specificity of 0.92 for death or respiratory impairment, while a cutoff of ≥14 had a sensitivity of 0.71 and a specificity of 0.92 for death, respiratory or feeding impairment. CONCLUSION A high Thompson score during the first 4 days of life, especially at 72-90 h could thus be useful for estimating the need for prolonged life support. IMPACT The Thompson score on days 1-4 of age was useful in predicting death and respiratory or feeding impairments. The 72-90 h Thompson score showed the highest predictive capability. Owing to the rarity of withdrawal of life-sustaining treatment in Japan, 43% of infants with persistent severe encephalopathy with a Thompson score of ≥15 at 72-90 h of age could regain spontaneous breathing, be extubated, and survive without tracheostomy. Meanwhile, approximately 50% of infants who survived without tracheostomy required gavage feeding. Our results could provide useful information for clinical decision making regarding infants with persistent severe encephalopathy.
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Affiliation(s)
- Hirosato Aoki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takeo Mukai
- Center for Advanced Medical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Perinatal Medical Center, Himeji Red Cross Hospital, Hyogo, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Takuya Tokuhisa
- Department of Neonatology, Perinatal Medical Center, Imakiire General Hospital, Kagoshima, Japan
| | - Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Pinto CR, Duarte JV, Marques C, Vicente IN, Paiva C, Éloi J, Pereira DJ, Correia BR, Castelo-Branco M, Oliveira G. The role of early functional neuroimaging in predicting neurodevelopmental outcomes in neonatal encephalopathy. Eur J Pediatr 2023; 182:1191-1200. [PMID: 36607412 PMCID: PMC10023620 DOI: 10.1007/s00431-022-04778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
Reliably assessing the early neurodevelopmental outcomes in infants with neonatal encephalopathy (NE) is of utmost importance to advise parents and implement early and personalized interventions. We aimed to evaluate the accuracy of neuroimaging modalities, including functional magnetic resonance imaging (fMRI) in predicting neurodevelopmental outcomes in NE. Eighteen newborns with NE due to presumed perinatal asphyxia (PA) were included in the study, 16 of whom underwent therapeutic hypothermia. Structural magnetic resonance imaging (MRI), and fMRI during passive visual, auditory, and sensorimotor stimulation were acquired between the 10th and 14th day of age. Clinical follow-up protocol included visual and auditory evoked potentials and a detailed neurodevelopmental evaluation at 12 and 18 months of age. Infants were divided according to sensory and neurodevelopmental outcome: severe, moderate disability, or normal. Structural MRI findings were the best predictor of severe disability with an AUC close to 1.0. There were no good predictors to discriminate between moderate disability versus normal outcome. Nevertheless, structural MRI measures showed a significant correlation with the scores of neurodevelopmental assessments. During sensorimotor stimulation, the fMRI signal in the right hemisphere had an AUC of 0.9 to predict absence of cerebral palsy (CP). fMRI measures during auditory and visual stimulation did not predict sensorineural hearing loss or cerebral visual impairment. CONCLUSION In addition to structural MRI, fMRI with sensorimotor stimulation may open the gate to improve the knowledge of neurodevelopmental/motor prognosis if proven in a larger cohort of newborns with NE. WHAT IS KNOWN • Establishing an early, accurate neurodevelopmental prognosis in neonatal encephalopathy remains challenging. • Although structural MRI has a central role in neonatal encephalopathy, advanced MRI modalities are gradually being explored to optimize neurodevelopmental outcome knowledge. WHAT IS NEW • Newborns who later developed cerebral palsy had a trend towards lower fMRI measures in the right sensorimotor area during sensorimotor stimulation. • These preliminary fMRI results may improve future early delineation of motor prognosis in neonatal encephalopathy.
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Affiliation(s)
- Carla R Pinto
- Pediatric Intensive Care Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Avenida Afonso Romão, Coimbra, 3000-602, Portugal.
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
| | - João V Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carla Marques
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês N Vicente
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Paiva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Éloi
- Otorhinolaryngology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela J Pereira
- Neuroradiology Unit, Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bárbara R Correia
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Quantitative Methods, Information and Management Systems Department, Coimbra Business School, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Guiomar Oliveira
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Chen X, Chen H, Jiang D. Maternal and Fetal Risk Factors for Neonatal Hypoxic-Ischemic Encephalopathy: A Retrospective Study. Int J Gen Med 2023; 16:537-545. [PMID: 36818762 PMCID: PMC9936872 DOI: 10.2147/ijgm.s394202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Background Neonatal hypoxic-ischemic encephalopathy (HIE) leads to different degree of neurological sequelae. The incidence of HIE is relatively high, and the risk factors associated with HIE are still controversial. It is necessary to identify the risk factors associated with HIE. Methods A total of 258 neonates (110 HIE patients and 148 controls) were enrolled in this study. The characteristics of pregnant women and fetuses during pregnancy and delivery were compared between HIE patients and controls, and the risk factors of HIE were analyzed. Results The proportions of premature infants, low-birth-weight infants and the levels of 1-minute Apgar score, 5-minute Apgar score in HIE group were significantly lower than those in control group, while the proportion of amniotic fluid contamination in the HIE group was significantly higher than those of the controls. When HIE was taken as the end point of 1-minute Apgar score, and 5-minute Apgar score, the cut-off value of 1-minute Apgar score was 3, and 5-minute Apgar score was 7 by receiver operating characteristic (ROC) curve analysis. The results of multivariate logistic regression analysis showed that low birth weight (<2.5 kg) (OR 1.780, 95% CI: 0.124-25.463, P=0.016), amniotic fluid contamination (OR 3.223, 95% CI: 1.049-9.901, P=0.041), low 1-minute Apgar score (≤3) (OR 92.425, 95% CI: 15.522-550.343, P<0.001), and low 5-minute Apgar score (≤7) (OR 12.641, 95% CI: 2.894-55.227, P=0.001) may increase risk of HIE. In addition, amniotic fluid contamination, low 1-minute Apgar score (≤3), and low 5-minute Apgar score (≤7) may increase risk of HIE among newborns born to women without previous childbearing history, but not in newborns born to women with previous childbearing history. Conclusion Low birth weight (<2.5 kg), amniotic fluid contamination, low 1-minute Apgar score (≤3), and 5-minute Apgar score (≤7) may increase risk of HIE.
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Affiliation(s)
- Xuexin Chen
- Department of Neonatology, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Correspondence: Xuexin Chen, Department of Neonatology, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, People’s Republic of China, Tel +86 753-2131-230, Email
| | - Hongxiang Chen
- Department of Neonatology, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Dongchang Jiang
- Department of Neonatology, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
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36
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Palliyalil S, Bashir RA, Zein H, Murthy P, Flores-Sarnat L, Sarnat HB, Mohammad K. The Utility of Simulation-Based Training in Teaching Frontline Providers Modified Sarnat Encephalopathy Examination: A Randomized Controlled Pilot Trial. Pediatr Neurol 2023; 139:70-75. [PMID: 36543025 DOI: 10.1016/j.pediatrneurol.2022.11.009] [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: 05/23/2022] [Revised: 08/24/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited training in targeted neurological examination makes it challenging for frontline providers to identify newborns with perinatal asphyxia eligible for therapeutic hypothermia. This training is important in the era of telemedicine, where the experts can remotely guide further care of these newborns. METHODS This randomized controlled pilot study was conducted in a South Indian tertiary hospital. Neonatal nurses, who had no previous hands-on experience in MSEE, were trained in modified Sarnat staging by a didactic teaching session using online teaching module. The nurses were then randomized into two groups for hands-on demonstration by the same trainer (low-fidelity mannequin versus a healthy term newly born infant). After the training period, MSEEs of a normal newborn were performed independently by nurses and were video recorded and assessed by three blinded neonatologists with expertise in neonatal neurology. A follow-up examination was performed by the same nurses after three months to assess skill retention. RESULTS The 10 global ratings of the components of the MSEE were comparable among both groups in both initial and follow-up assessments. The overall diagnostic value was comparable between the simulation and traditional groups (93.75%, 94.11%, respectively). Follow-up examination after three months showed better skill retention in the simulation group (84%) compared with the traditional group (66.7%). CONCLUSIONS Online-based and low-fidelity mannequin training was equally effective as the traditional method of teaching MSEE in term neonates.
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Affiliation(s)
- Sajla Palliyalil
- Department of Pediatrics & Neonatology, Renai Medicity, Kochi, Kerala
| | | | - Hussein Zein
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Laura Flores-Sarnat
- Section of Neurology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Harvey B Sarnat
- Section of Neurology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Thiim KR, Garvey AA, Singh E, Walsh B, Inder TE, El-Dib M. Brain Injury in Infants Evaluated for, But Not Treated with, Therapeutic Hypothermia. J Pediatr 2023; 253:304-309. [PMID: 36179889 DOI: 10.1016/j.jpeds.2022.09.027] [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: 06/01/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
Defining neonatal encephalopathy clinically to qualify for therapeutic hypothermia is challenging. This study examines magnetic resonance imaging outcomes of 39 infants who were evaluated and not cooled using criteria inclusive of mild encephalopathy. Infants evaluated for therapeutic hypothermia are at risk for brain injury and may benefit from neuroimaging and follow-up.
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Affiliation(s)
- Kirsten R Thiim
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aisling A Garvey
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Harvard Medical School, Boston, MA
| | - Elizabeth Singh
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brian Walsh
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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38
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Foglia EE, Davis PG, Guinsburg R, Kapadia V, Liley HG, Rüdiger M, Schmölzer GM, Strand ML, Wyckoff MH, Wyllie J, Weiner GM. Recommended Guideline for Uniform Reporting of Neonatal Resuscitation: The Neonatal Utstein Style. Pediatrics 2023; 151:190463. [PMID: 36632729 DOI: 10.1542/peds.2022-059631] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical research on neonatal resuscitation has accelerated over recent decades. However, an important methodologic limitation is that there are no standardized definitions or reporting guidelines for neonatal resuscitation clinical studies. To address this, the International Liaison Committee on Resuscitation Neonatal Life Support Task Force established a working group to develop the first Utstein-style reporting guideline for neonatal resuscitation. The working group modeled this approach on previous Utstein-style guidelines for other populations. This reporting guideline focuses on resuscitation of newborns immediately after birth for respiratory failure, bradycardia, severe bradycardia, or cardiac arrest. We identified 7 relevant domains: setting, patient, antepartum, birth/preresuscitation, resuscitation process, postresuscitation process, and outcomes. Within each domain, relevant data elements were identified as core versus supplemental. Core data elements should be collected and reported for all neonatal resuscitation studies, while supplemental data elements may be collected and reported using standard definitions when possible. The Neonatal Utstein template includes both core and supplemental elements across the 7 domains, and the associated Data Table provides detailed information and reporting standards for each data element. The Neonatal Utstein reporting guideline is anticipated to assist investigators engaged in neonatal resuscitation research by standardizing data definitions. The guideline will facilitate data pooling in meta-analyses, enhancing the strength of neonatal resuscitation treatment recommendations and subsequent guidelines.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter G Davis
- Newborn Research Center, the Royal Women's Hospital and the University of Melbourne, Victoria, Australia
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health.,Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Medizinische Fakultät TU Dresden, Dresden, Germany
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marya L Strand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Longitudinal perturbations of plasma nuclear magnetic resonance profiles in neonatal encephalopathy. Pediatr Res 2023:10.1038/s41390-023-02464-x. [PMID: 36639516 DOI: 10.1038/s41390-023-02464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Neonatal encephalopathy (NE) is a major cause of mortality and severe neurological disability in the neonatal period and beyond. We hypothesized that the degree of brain injury is reflected in the molecular composition of peripheral blood samples. METHODS A sub-cohort of 28 newborns included in the HYPOTOP trial was studied. Brain injury was assessed by magnetic resonance imaging (MRI) once per patient and neurodevelopment at 24 months of age was evaluated using the Bayley III Scales of Infant and Toddler Development. The nuclear magnetic resonance (NMR) profile of 60 plasma samples collected before, during, and after cooling was recorded. RESULTS In total, 249 molecular features were quantitated in plasma samples from newborns and postnatal age showed to affect detected NMR profiles. Lactate, beta-hydroxybutyrate, pyruvate, and three triglyceride biomarkers showed the ability to discern between different degrees of brain injury according to MRI scores. The prediction performance of lactate was superior as compared to other clinical and biochemical parameters. CONCLUSIONS This is the first longitudinal study of an ample compound panel recorded by NMR spectroscopy in plasma from NE infants. The serial determination of lactate confirms its solid position as reliable candidate biomarker for predicting the severity of brain injury. IMPACT The use of nuclear magnetic resonance (NMR) spectroscopy enables the simultaneous quantitation of 249 compounds in a small volume (i.e., 100 μL) of plasma. Longitudinal perturbations of plasma NMR profiles were linked to magnetic resonance imaging (MRI) outcomes of infants with neonatal encephalopathy (NE). Lactate, beta-hydroxybutyrate, pyruvate, and three triglyceride biomarkers showed the ability to discern between different degrees of brain injury according to MRI scores. Lactate is a minimally invasive candidate biomarker for early staging of MRI brain injury in NE infants that might be readily implemented in clinical guidelines for NE outcome prediction.
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40
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Heys M, Kesler E, Sassoon Y, Wilson E, Fitzgerald F, Gannon H, Hull‐Bailey T, Chimhini G, Khan N, Cortina‐Borja M, Nkhoma D, Chiyaka T, Stevenson A, Crehan C, Chiume ME, Chimhuya S. Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The Neotree. Learn Health Syst 2023; 7:e10310. [PMID: 36654803 PMCID: PMC9835040 DOI: 10.1002/lrh2.10310] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Improving peri- and postnatal facility-based care in low-resource settings (LRS) could save over 6000 babies' lives per day. Most of the annual 2.4 million neonatal deaths and 2 million stillbirths occur in healthcare facilities in LRS and are preventable through the implementation of cost-effective, simple, evidence-based interventions. However, their implementation is challenging in healthcare systems where one in four babies admitted to neonatal units die. In high-resource settings healthcare systems strengthening is increasingly delivered via learning healthcare systems to optimise care quality, but this approach is rare in LRS. Methods Since 2014 we have worked in Bangladesh, Malawi, Zimbabwe, and the UK to co-develop and pilot the Neotree system: an android application with accompanying data visualisation, linkage, and export. Its low-cost hardware and state-of-the-art software are used to support healthcare professionals to improve postnatal care at the bedside and to provide insights into population health trends. Here we summarise the formative conceptualisation, development, and preliminary implementation experience of the Neotree. Results Data thus far from ~18 000 babies, 400 healthcare professionals in four hospitals (two in Zimbabwe, two in Malawi) show high acceptability, feasibility, usability, and improvements in healthcare professionals' ability to deliver newborn care. The data also highlight gaps in knowledge in newborn care and quality improvement. Implementation has been resilient and informative during external crises, for example, coronavirus disease 2019 (COVID-19) pandemic. We have demonstrated evidence of improvements in clinical care and use of data for Quality Improvement (QI) projects. Conclusion Human-centred digital development of a QI system for newborn care has demonstrated the potential of a sustainable learning healthcare system to improve newborn care and outcomes in LRS. Pilot implementation evaluation is ongoing in three of the four aforementioned hospitals (two in Zimbabwe and one in Malawi) and a larger scale clinical cost effectiveness trial is planned.
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Affiliation(s)
- Michelle Heys
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Erin Kesler
- Children's Hospital of Philadelphia General, Thoracic, and Fetal Surgery Newborn Intensive Care UnitPhiladelphiaUSA
| | | | - Emma Wilson
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Felicity Fitzgerald
- Infection, Immunity and Inflammation Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Hannah Gannon
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Tim Hull‐Bailey
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Gwendoline Chimhini
- Department of Primary Healthcare SciencesUniversity of ZimbabweHarareZimbabwe
| | - Nushrat Khan
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Mario Cortina‐Borja
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - Alex Stevenson
- Department of Primary Healthcare SciencesUniversity of ZimbabweHarareZimbabwe
- Mbuya Nehanda Maternity HospitalHarareZimbabwe
| | - Caroline Crehan
- Population, Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Simbarashe Chimhuya
- Department of Primary Healthcare SciencesUniversity of ZimbabweHarareZimbabwe
- Maternity DivisionSally Mugabe Central HospitalHarareZimbabwe
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41
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Gannon H, Chimhini G, Cortina-Borja M, Chiyaka T, Mangiza M, Fitzgerald F, Heys M, Neal SR, Chimhuya S. Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000911. [PMID: 36962805 PMCID: PMC10021203 DOI: 10.1371/journal.pgph.0000911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/04/2022] [Indexed: 06/18/2023]
Abstract
Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 -October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score "11-14" (OR 2.98 (1.08-8.22)) or "15-22" (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions.
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Affiliation(s)
- Hannah Gannon
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences. Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Gwendoline Chimhini
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences. Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe
- Sally Mugabe Central Hospital Neonatal Unit, Harare, Zimbabwe
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Tarisai Chiyaka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Marcia Mangiza
- Sally Mugabe Central Hospital Neonatal Unit, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Michelle Heys
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Specialist Children’s and Young People’s Services, East London NHS Foundation Trust, London, United Kingdom
| | - Samuel R. Neal
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Simbarashe Chimhuya
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences. Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe
- Sally Mugabe Central Hospital Neonatal Unit, Harare, Zimbabwe
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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - LABOR Study Group
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
- UNC Global Projects Zambia, LLC, Lusaka, Zambia
- Fakir Mohan Medical College and Hospital, Balasore, India
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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Singh A, Saluja S, Kler N, Garg P, Soni A, Thakur A. Amplitude integrated EEG: how much it helps in prognostication in neonatal encephalopathy? J Matern Fetal Neonatal Med 2022; 35:7748-7755. [PMID: 34121586 DOI: 10.1080/14767058.2021.1937104] [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: 11/28/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neonatal encephalopathy (NE) is associated with a high risk of adverse neurological outcomes. Several neurodiagnostic tests have been evaluated to predict the prognosis. Amplitude integrated Electroencephalogram (aEEG) is now being commonly used for bedside evaluation of cerebral function. There is limited data on the role of aEEG for prognostication in NE, from resource-limited settings. OBJECTIVE To evaluate the predictive ability of aEEG for abnormal neurological outcomes in neonatal encephalopathy or neonates with encephalopathy. METHODS Neonates above 35 weeks of gestation admitted to NICU in a tertiary care hospital with a diagnosis of encephalopathy were enrolled. Clinical characteristics severity of encephalopathy and seizures were recorded. Amplitude integrated recording was started at admission and continued till recovery of trace to normal or for 10 days. The primary outcome was death or abnormal neurological status at 3-6 months of age. The study was registered in the Clinical Trial Registry of India (CTRI/2013/05/003612). RESULTS The incidence of NE was 6% of total admission. Moderate and severe encephalopathy occurred in 58 and 39% of babies respectively. Hypoxic-ischemic encephalopathy was the most common cause. Clinical seizures occurred in 91% of cases. An abnormal aEEG trace was observed in 51 (76.1%) infants with NE. For adverse neurological outcomes at an age average of 4.5 months of age, aEEG had a sensitivity, specificity, NPV, and PPV of 100, 54.2, 100, and 77.5, respectively. CONCLUSIONS Clinical staging and aEEG has good predictive ability to detect an adverse neurological outcome. aEEG improves the ability to predict abnormal outcome in babies with moderate encephalopathy. Early recovery of aEEG abnormality correlates with better neurodevelopmental outcomes.KEY MESSAGESWhat's known: aEEG is a useful modality to assess neurodevelopmental outcomes however data from developing countries is lacking.What's new: aEEG monitoring in babies in neonatal encephalopathy may improve the prediction of abnormal neurological outcomes in babies with moderate encephalopathy.
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Affiliation(s)
- Anita Singh
- Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Arun Soni
- Sir Ganga Ram Hospital, New Delhi, India
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Lohmüller-Weiß S, Schiefer A, Fusch C. 38 + 6. SSW, schlappes Neugeborenes ohne Eigenatmung. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Espinoza ML, Brundler MA, Hasan SU, Mohammad K, Momin S, Al Shaikh B, Yusuf K. Placental pathology as a marker of brain injury in infants with hypoxic ischemic encephalopathy. Early Hum Dev 2022; 174:105683. [PMID: 36215816 DOI: 10.1016/j.earlhumdev.2022.105683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypoxic Ischemic Encephalopathy (HIE) can lead to devastating consequences for the affected infant. Although therapeutic cooling benefits infants with moderate and severe HIE, differentiating mild from moderate-severe HIE may be challenging. The placenta reflects the fetal intrauterine environment and may reveal underlying processes that affect brain injury. AIM To describe placental histopathology using the Amsterdam Placental Workshop Group Criteria in different grades of HIE. STUDY DESIGN Retrospective cohort. SUBJECTS Infants admitted to a tertiary care neonatal intensive care unit with a diagnosis of HIE between 2011 and 2016. OUTCOME MEASURE Maternal and neonatal clinical variables and placental histopathology using the Amsterdam Placental Workshop Group Criteria were compared between mild and moderate-severe HIE. Mann-Whitney or t-test or ꭓ2 were performed for bivariate associations as appropriate. To explain the relationship between placental pathology and severity of HIE odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using logistic regression models. RESULTS Of the 73 infants in the study, 23 had mild and 50 moderate-sever HIE. There was no difference in maternal and neonatal characteristics except for sentinel events which were higher in the moderate- severe group. On placental histopathology, acute inflammation, including fetal inflammatory reaction (FIR) were significantly higher in the moderate-severe group. After adjusting for confounders, FIR remained significantly associated with moderate-severe HIE, ORs 6.29, 95 % CI 1.5-25. CONCLUSION Our study demonstrates FIR in the placenta is associated with severity of HIE.
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Affiliation(s)
- Maria Liza Espinoza
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada
| | - Marie-Anne Brundler
- Department of Pathology & Laboratory Medicine and Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shabih U Hasan
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada
| | - Sarfaraz Momin
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada
| | - Belal Al Shaikh
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada
| | - Kamran Yusuf
- Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada.
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Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia. Pediatr Res 2022:10.1038/s41390-022-02352-w. [PMID: 36272997 DOI: 10.1038/s41390-022-02352-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To re-visit short-term outcomes and associated risk factors of newborns with hypoxic-ischemic encephalopathy (HIE) in an era where hypothermia treatment (HT) is widespread. METHODS This is a prospective population-based cohort in French neonatal intensive care units (NICU). Neonates born at or after 34 weeks of gestational age with HIE were included; main outcomes were in-hospital death and discharge with abnormal or normal MRI. Associations of early perinatal risk factors, present at birth or at admission to NICU, with these outcomes were studied. RESULTS A total of 794 newborns were included and HT was administered to 670 (84.4%); 18.3% died and 28.5% and 53.2% survived with abnormal and normal MRI, respectively. Severe neurological status, Apgar score at 5 mn ≤5, lactate at birth ≥11 mMoles/l, and glycemia ≥100 mg/dL at admission were associated with an increased risk of death (relative risk ratios (aRRR) (95% CI) 19.93 (10.00-39.70), 2.89 (1.22-1.62), 3.06 (1.60-5.83), and 2.55 (1.38-4.71), respectively). Neurological status only was associated with survival with abnormal MRI (aRRR (95% CI) 1.76 (1.15-2.68)). CONCLUSION Despite high use of HT in this cohort, 46.8% died or presented brain lesions. Early neurological and biological examinations were associated with unfavorable outcomes and these criteria could be used to target children who warrant further neuroprotective treatment. TRIAL REGISTRATION Clinical trial registry, NCT02676063, ClinicalTrials.gov. IMPACT In this population-based cohort of newborns with HIE where 84% received hypothermia, 46.8% still had an unfavorable evolution (death or survival with abnormal MRI). Risk factors for death were high lactate, low Apgar score, severe early neurological examination, and high glycaemia. While studies have established risk factors for HIE, few have focused on early perinatal factors associated with short-term prognosis. This French population-based cohort updates knowledge about early risk factors for adverse outcomes in the era of widespread cooling. In the future, criteria associated with an unfavorable evolution could be used to target children who would benefit from another neuroprotective strategy with hypothermia.
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Fadilah A, Clare Q, Hart AR. Attitudes towards the neurological examination in an unwell neonate: a mixed methods approach. BMC Pediatr 2022; 22:562. [PMID: 36151513 PMCID: PMC9502918 DOI: 10.1186/s12887-022-03616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 09/15/2022] [Indexed: 11/12/2022] Open
Abstract
Background The neurological examination of an unwell neonate can aid management, such as deciding if hypothermia treatment is warranted in hypoxic ischaemic encephalopathy or directing investigations in hypotonic neonates. Current standardised examinations are not designed for unwell or ventilated neonates, and it is unclear how confident paediatricians feel about the examination or what aspects they perform. Aim This study aimed to review the confidence of UK paediatricians on the neurological examination in unwell neonates, describe their attitudes towards it, and determine what could improve practice. Methods An explanatory sequential mixed methods approach (QUAN → QUAL) with equal weighting between stages. A survey on attitudes to the neonatal neurological examination was sent to all UK neonatal units and members of the British Paediatric Neurology Association. Volunteers were sought for semi-structured interviews. Thematic analysis was used to interpret qualitative data, which was triangulated with quantitative questionnaire data. Results One hundred ninety-three surveys were returned, 31.0% from neonatologists, 9.3% paediatric neurologist. The median range for confidence was 4 (IQR3-5). Twenty-three interviews occurred. Thematic analysis revealed three themes: “Current culture on neonatal units”, “ Practicalities of the neurological examination in unwell neonates”, and “Changing the culture”. Most interviewees did not feel confident performing or interpreting the neurological examination in unwell neonates. Many units had a culture of seeing it as low priority, did not see its relevance in the acute management of unwell neonates. A few interviewees worked in units with a positive culture towards the neurological examination who used adapted standardised examinations and provided training. 72% of questionnaire responders wanted a new standardised neurological examination designed for the unwell neonate, which should be short, utilise pictures like the Hammersmith Neonatal Neurological Examination, contain an assessment of consciousness, be developmentally appropriate and achievable in unwell, ventilated neonates, be accompanied by a schematic to aid interpretation, and for greater training and assessments of competence. Conclusions There are barriers preventing paediatricians being able to perform a neurological examination in unwell neonates, and a culture of neurophobia is common. A new standardised examination is needed, alongside aids to interpretation, training, and assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03616-4.
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Affiliation(s)
- Ala Fadilah
- Department of Paediatric and Perinatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Tapton Crescent Road, Sheffield, S10 5DD, UK
| | - Quentin Clare
- Department of Paediatric and Perinatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Tapton Crescent Road, Sheffield, S10 5DD, UK
| | - Anthony Richard Hart
- Department of Paediatric and Perinatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Tapton Crescent Road, Sheffield, S10 5DD, UK.
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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - LABOR Study Group
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
- UNC Global Projects Zambia, LLC, Lusaka, Zambia
- Fakir Mohan Medical College and Hospital, Balasore, India
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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Moderate to severe neonatal encephalopathy with suspected hypoxic-ischaemic encephalopathy in cooled term infants born in Tygerberg Academic Hospital: Characteristics of fetal monitoring and modifiable factors. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. In South Africa, in babies >2 500 g, intrapartum asphyxia is the main cause of neonatal death or stillbirth in those who were alive prior to labour. In a developing population, ~60% of neonatal encephalopathy (NE) has evidence of intrapartum hypoxic ischaemia. Therapeutic hypothermia for term babies born with NE can improve neonatal prognosis and long-term survival.
Objectives. To identify the healthcare worker- and system-related modifiable factor(s) that were associated with NE in babies of ≥36 weeks’ gestation born at Tygerberg Hospital (a secondary/tertiary referral hospital) between 1 January 2016 and 30 December 2018.
Methods. This was an observational cross-sectional study analysing data from the Tygerberg Hospital Hypoxic Ischaemic Encephalopathy database, the electronic labour ward register, the mortality database and clinical data from patient folders.
Results. A total of 118 babies were admitted for head cooling, and therefore included in the study. The hospital in-born rate for serious encephalopathy is 5.5/1 000 in singleton live-born babies (9/1 000 rate for live-born deliveries ≥36 weeks). A sentinel event was identified in 19 (16%) cases. Delay in accessing theatre was the main system-related modifiable factor (25/58 or 43% of cases delivered by emergency caesarean delivery). The average decision-to-incision time was 1 hour 40 minutes, while the average bed occupancy in the emergency maternity centre was 102%. Failure to recognise or respond to an abnormal cardiotocograph was the dominant avoidable factor related to healthcare workers in 34 cases (36.4%).
Conclusion. Babies born with severe NE place a burden on parents, healthcare staff and resources. Careful intrapartum care, including utilisation of protocols for the use of oxytocin, are imperative. It is recommended that improved access to emergency theatres and appropriately trained staff for maternity units should be a priority for healthcare planners.
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Barata L, de Hoz-Rivera M, Romero A, Martínez M, Silva L, Villa M, Campa L, Jiménez-Sánchez L, Martínez-Orgado J. Role of 5HT1A Receptors in the Neuroprotective and Behavioral Effects of Cannabidiol in Hypoxic–Ischemic Newborn Piglets. Front Pharmacol 2022; 13:925740. [PMID: 35924056 PMCID: PMC9341521 DOI: 10.3389/fphar.2022.925740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Hypoxic–ischemic (HI) insults have important deleterious consequences in newborns, including short-term morbidity with neuromotor and cognitive disturbances. Cannabidiol (CBD) has demonstrated robust neuroprotective effects and shows anxiolytic/antidepressant effects as well. These effects are thought to be related to serotonin 5-HT1A receptor (5HT1AR) activation. We hereby aimed to study the role of 5HT1AR in the neuroprotective and behavioral effects of CBD in HI newborn piglets. Methods: 1-day-old piglets submitted to 30 min of hypoxia (FiO2 10%) and bilateral carotid occlusion were then treated daily with vehicle, CBD 1 mg/kg, or CBD with the 5HT1AR antagonist WAY 100635 1 mg/kg 72 h post-HI piglets were studied using amplitude-integrated EEG to detect seizures and a neurobehavioral test to detect neuromotor impairments. In addition, behavioral performance including social interaction, playful activity, hyperlocomotion, and motionless periods was assessed. Then, brain damage was assessed using histology (Nissl and TUNEL staining) and biochemistry (proton magnetic resonance spectroscopy studies. Results: HI led to brain damage as assessed by histologic and biochemistry studies, associated with neuromotor impairment and increased seizures. These effects were not observed in HI piglets treated with CBD. These beneficial effects of CBD were not reversed by the 5HT1AR antagonist, which is in contrast with previous studies demonstrating that 5HT1AR antagonists eliminated CBD neuroprotection as assessed 6 h after HI in piglets. HI led to mood disturbances, with decreased social interaction and playfulness and increased hyperlocomotion. Mood disturbances were not observed in piglets treated with CBD, but in this case, coadministration of the 5HT1AR antagonist eliminates the beneficial effects of CBD. Conclusion: CBD prevented HI-induced mood disturbances in newborn piglets by acting on 5HT1AR. However, 5HT1AR activation seems to be necessary for CBD neuroprotection only in the first hours after HI.
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Affiliation(s)
- Lorena Barata
- Servicio de Neonatología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - María de Hoz-Rivera
- Fundación para La Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Angela Romero
- Fundación para La Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María Martínez
- Fundación para La Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura Silva
- Fundación para La Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María Villa
- Fundación para La Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Leticia Campa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spanish National Research Council (CSIC), Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Institut d'Investigacions August Pi i Sunyer (IDIBAPS), ISCIII, Madrid, Spain
| | - Laura Jiménez-Sánchez
- Centro de Investigación Biomédica, Instituto de Biotecnoloía, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de, Granada, Spain
| | - José Martínez-Orgado
- Servicio de Neonatología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- *Correspondence: José Martínez-Orgado,
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