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Janowska J, Gargas J, Zajdel K, Wieteska M, Lipinski K, Ziemka-Nalecz M, Frontczak-Baniewicz M, Sypecka J. Oligodendrocyte progenitor cells' fate after neonatal asphyxia-Puzzling implications for the development of hypoxic-ischemic encephalopathy. Brain Pathol 2024; 34:e13255. [PMID: 38504469 DOI: 10.1111/bpa.13255] [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: 09/14/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
Premature birth or complications during labor can cause temporary disruption of cerebral blood flow, often followed by long-term disturbances in brain development called hypoxic-ischemic (HI) encephalopathy. Diffuse damage to the white matter is the most frequently detected pathology in this condition. We hypothesized that oligodendrocyte progenitor cell (OPC) differentiation disturbed by mild neonatal asphyxia may affect the viability, maturation, and physiological functioning of oligodendrocytes. To address this issue, we studied the effect of temporal HI in the in vivo model in P7 rats with magnetic resonance imaging (MRI), microscopy techniques and biochemical analyses. Moreover, we recreated the injury in vitro performing the procedure of oxygen-glucose deprivation on rat neonatal OPCs to determine its effect on cell viability, proliferation, and differentiation. In the in vivo model, MRI evaluation revealed changes in the volume of different brain regions, as well as changes in the directional diffusivity of water in brain tissue that may suggest pathological changes to myelinated neuronal fibers. Hypomyelination was observed in the cortex, striatum, and CA3 region of the hippocampus. Severe changes to myelin ultrastructure were observed, including delamination of myelin sheets. Interestingly, shortly after the injury, an increase in oligodendrocyte proliferation was observed, followed by an overproduction of myelin proteins 4 weeks after HI. Results verified with the in vitro model indicate, that in the first days after damage, OPCs do not show reduced viability, intensively proliferate, and overexpress myelin proteins and oligodendrocyte-specific transcription factors. In conclusion, despite the increase in oligodendrocyte proliferation and myelin protein expression after HI, the production of functional myelin sheaths in brain tissue is impaired. Presented study provides a detailed description of oligodendrocyte pathophysiology developed in an effect of HI injury, resulting in an altered CNS myelination. The described models may serve as useful tools for searching and testing effective of effective myelination-supporting therapies for HI injuries.
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Affiliation(s)
- Justyna Janowska
- Department of NeuroRepair, Mossakowski Medical Research Institute PAS, Warsaw, Poland
| | - Justyna Gargas
- Department of NeuroRepair, Mossakowski Medical Research Institute PAS, Warsaw, Poland
| | - Karolina Zajdel
- NOMATEN Center of Excellence, National Center for Nuclear Research, Otwock, Poland
- Electron Microscopy Research Unit, Mossakowski Medical Research Institute PAS, Warsaw, Poland
| | - Michal Wieteska
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Institute PAS, Warsaw, Poland
| | - Kamil Lipinski
- Division of Nuclear and Medical Electronics, Warsaw University of Technology, Warsaw, Poland
| | | | | | - Joanna Sypecka
- Department of NeuroRepair, Mossakowski Medical Research Institute PAS, Warsaw, Poland
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Razif NAM, D’Arcy A, Waicus S, Agostinis A, Scheepers R, Buttle Y, Pepper A, Hughes A, Fouda B, Matreja P, MacInnis E, O’Dea M, Isweisi E, Stewart P, Branagan A, Roche EF, Meehan J, Molloy EJ. Neonatal encephalopathy multiorgan scoring systems: systematic review. Front Pediatr 2024; 12:1427516. [PMID: 39416861 PMCID: PMC11481038 DOI: 10.3389/fped.2024.1427516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/11/2024] [Indexed: 10/19/2024] Open
Abstract
Introduction Neonatal encephalopathy (NE) is a condition with multifactorial etiology that causes multiorgan injury to neonates. The severity of multiorgan dysfunction (MOD) in NE varies, with therapeutic hypothermia (TH) as the standard of care. The aim is to identify current approaches used to assess and determine an optimum scoring system for MOD in NE. Methods The systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was conducted using PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL for studies of scoring systems for MOD in NE. Results The search yielded 628 articles of which 12 studies were included for data extraction and analysis. Five studies found a positive correlation between the severity of NE and MOD. There was significant heterogeneity across the scoring systems, including the eligibility criteria for participants, the methods assessing specific organ systems, the length of follow-up, and adverse outcomes. The neurological, hepatic, cardiovascular, respiratory, hematological, and renal systems were included in most studies while the gastrointestinal system was only in three studies. The definitions for hepatic, renal, and respiratory systems dysfunction were most consistent while the cardiovascular system varied the most. Discussion A NE multiorgan scoring system should ideally include the renal, hepatic, respiratory, neurological, hematological, and cardiovascular systems. Despite the heterogeneity between the studies, these provide potential candidates for the standardization of MOD scoring systems in NE. Validation is needed for the parameters with adequate length of follow-up beyond the neonatal period. Additionally, the evaluation of MOD may be affected by TH considering its multiorgan effects.
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Affiliation(s)
| | - Aidan D’Arcy
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Sarah Waicus
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Alyssa Agostinis
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Rachelle Scheepers
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Yvonne Buttle
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Aidan Pepper
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Aisling Hughes
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Basem Fouda
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Panya Matreja
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Emily MacInnis
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mary O’Dea
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- TrinityTranslational Medicine Institute (TTMI), St James Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Pediatrics, Coombe Hospital, Dublin, Ireland
- Neonatology, Children's Health Ireland, Dublin, Ireland
| | - Eman Isweisi
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Philip Stewart
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- TrinityTranslational Medicine Institute (TTMI), St James Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Aoife Branagan
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- TrinityTranslational Medicine Institute (TTMI), St James Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Pediatrics, Coombe Hospital, Dublin, Ireland
| | - Edna F. Roche
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Judith Meehan
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- TrinityTranslational Medicine Institute (TTMI), St James Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Pediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- TrinityTranslational Medicine Institute (TTMI), St James Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Pediatrics, Coombe Hospital, Dublin, Ireland
- Neonatology, Children's Health Ireland, Dublin, Ireland
- Neurodisability, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
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3
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Quirke F, Biesty L, Battin M, Bloomfield FH, Daly M, Finucane E, Healy P, Hurley T, Kirkham JJ, Molloy E, Haas DM, Meher S, Ní Bhraonáin E, Walker K, Webbe J, Devane D. Neonatal encephalopathy: a systematic review of reported treatment outcomes. BMJ Paediatr Open 2024; 8:e002510. [PMID: 39322607 PMCID: PMC11425948 DOI: 10.1136/bmjpo-2024-002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/04/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Neonatal encephalopathy (NE) is a multi-organ condition potentially leading to death or long-term neurodisability. Therapeutic hypothermia is the standard treatment for NE; however, long-term impairments remain common. Studies of new treatments for NE often measure and report different outcomes. Core outcome sets (COSs), a minimum set of outcomes to be measured and reported in all studies for a condition, address this problem. This paper aimed to identify outcomes reported (primary, secondary, adverse events and other reported outcomes) in (1) randomised trials and (2) systematic reviews of randomised trials of interventions for the treatment of NE in the process of developing a COS for interventions for the treatment of NE. METHODS We completed a systematic search for outcomes used to evaluate treatments for NE using MEDLINE, Embase, Cochrane CENTRAL, the Cochrane Database of Systematic Reviews and the WHO International Clinical Trials Registry Platform. Two reviewers screened all included articles independently. Outcomes were extracted verbatim, similar outcomes were grouped and outcome domains were developed. RESULTS 386 outcomes were reported in 116 papers, from 85 studies. Outcomes were categorised into 18 domains. No outcome was reported by all studies, a single study reported 11 outcomes and it was not explicitly stated that outcomes had input from parents. DISCUSSION Heterogeneity in reported outcomes means that synthesis of studies evaluating new treatments for NE remains difficult. A COS, that includes parental/family input, is needed to ensure consistency in measuring and reporting outcomes, and to enable comparison of randomised trials.
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Affiliation(s)
- Fiona Quirke
- Neonatal Encephalopathy PhD Training Network, Health Research Board, Dublin, Ireland
- Health Research Board -Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
| | - Linda Biesty
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | | | | | - Mandy Daly
- Advocacy and Policymaking Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Elaine Finucane
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
| | - Tim Hurley
- Neonatal Encephalopathy PhD Training Network, Health Research Board, Dublin, Ireland
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, Manchester University, Manchester, UK
| | - Eleanor Molloy
- Paediatrics, Trinity College Dublin, Dublin, Ireland
- Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Bloomington, Indiana, USA
| | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - James Webbe
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Declan Devane
- Health Research Board -Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
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Nwankwo O, Adiele DK, Ekwochi U, Idoko CA, Obidike EK. Evaluation of Myocardial Injury Using Serum Cardiac Troponin-I in Asphyxiated Neonates at Enugu State University Teaching Hospital, Enugu, South-East Nigeria. Niger J Clin Pract 2024; 27:792-799. [PMID: 38943306 DOI: 10.4103/njcp.njcp_169_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. STUDY AIM To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). METHODS The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. RESULTS The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). CONCLUSION serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.
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Affiliation(s)
- O Nwankwo
- Department of Paediatrics, College of Medicine, Enugu State University Teaching Hospital (ESUTH), Park Lane, Enugu, Enugu State, Nigeria
| | - D K Adiele
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
| | - U Ekwochi
- Department of Paediatrics, College of Medicine, Enugu State University Teaching Hospital (ESUTH), Park Lane, Enugu, Enugu State, Nigeria
| | - C A Idoko
- Department of Community Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
| | - E K Obidike
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
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Bitar L, Stonestreet BS, Lim YP, Qiu J, Chen X, Mir IN, Chalak LF. Association between decreased cord blood inter-alpha inhibitor levels and neonatal encephalopathy at birth. Early Hum Dev 2024; 193:106036. [PMID: 38733833 DOI: 10.1016/j.earlhumdev.2024.106036] [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: 03/29/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Inter-alpha inhibitor proteins (IAIPs) are structurally related proteins found in the systemic circulation with immunomodulatory anti-inflammatory properties. Reduced levels are found in inflammatory related conditions including sepsis and necrotizing enterocolitis, and in neonatal rodents after exposure to hypoxia ischemia. In the current study, cord blood IAIP levels were measured in neonates with and without exposure to hypoxic-ischemic encephalopathy (HIE). METHODS This is a prospective cohort study including infants born ≥36 weeks over a one-year period. Term pregnancies were divided into two groups: a "reference control" (uncomplicated term deliveries), and "moderate to severe HIE" (qualifying for therapeutic hypothermia). IAIPs were quantified using a sensitive ELISA on the cord blood samples. RESULTS The study included 57 newborns: Reference control group (n = 13) and moderate/severe HIE group (n = 44). Measurement of IAIP cord blood concentrations in moderate to severe HIE group [278.2 (138.0, 366.0) μg/ml] revealed significantly lower IAIP concentrations compared with the control group [418.6 (384.5, 445.0) μg/ml] (p = 0.002). CONCLUSIONS These findings suggest a potential role for IAIPs as indicators of neonates at risk for HIE. IAIP levels could have diagnostic implications in the management of HIE. Future research is required to explore the relationship between HIE and IAIPs as biomarkers for disease severity. CATEGORY OF STUDY Translational.
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Affiliation(s)
- Lynn Bitar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Barbara S Stonestreet
- The Alpert Medical School of Brown University, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - Yow-Pin Lim
- ProThera Biologics, Inc., Providence, RI, United States of America; The Alpert Medical School of Brown University, Department of Pathology and Laboratory Medicine, Providence, RI, United States of America
| | - Joseph Qiu
- ProThera Biologics, Inc., Providence, RI, United States of America
| | - Xiaodi Chen
- The Alpert Medical School of Brown University, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - Imran N Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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DeSantis E, Talekar K, Dougherty M, Carola D, Solarin K, McElwee D, Adeniyi-Jones S, Aghai ZH. Acute Kidney Injury and Abnormalities on Brain Magnetic Resonance Imaging or Death in Infants with Hypoxic-Ischemic Encephalopathy: A Case-Control Study. Am J Perinatol 2024; 41:e2489-e2494. [PMID: 37541310 DOI: 10.1055/s-0043-1771502] [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: 08/06/2023]
Abstract
OBJECTIVE This study aimed to analyze the association between acute kidney injury (AKI) and abnormalities on brain magnetic resonance imaging (MRI) or death in neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN This is a retrospective case-control analysis of 380 neonates born at ≥35 weeks' gestation treated with therapeutic hypothermia for HIE. Death or abnormal brain MRI using the basal ganglia watershed scoring system was compared between neonates with and without AKI. RESULTS A total of 51 (13.4%) neonates had AKI. Infants with AKI had higher rates of the composite of death or abnormal brain MRI (74.5 vs. 38.3%; p < 0.001). Rate of death (21.6 vs. 5.5%; p < 0.001) and severe abnormalities on MRI or death (43.1 vs. 19.1%; p < 0.001) were also higher in neonates with AKI. CONCLUSION AKI is strongly associated with abnormalities on brain MRI or death in neonates with HIE. Identification of AKI in this patient population may be helpful in guiding clinical management and predicting potential neurodevelopmental impairment. KEY POINTS · Neonates with HIE are at increased risk for AKI.. · AKI is associated with hypoxic-ischemic injury on brain MRI or death among neonates with HIE.. · Identification of AKI in infants with HIE may help predict neurodevelopmental impairment..
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Affiliation(s)
- Eliza DeSantis
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Kiran Talekar
- Department of Radiology, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Margaret Dougherty
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - David Carola
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Kolawole Solarin
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Dorothy McElwee
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Susan Adeniyi-Jones
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
| | - Zubair H Aghai
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University Hospital/Nemours, Philadelphia, Pennsylvania
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Jayakumar S, Burton VJ, Perin J, Asafu-Adjaye D, Cristofalo E, Northington F, Chavez-Valdez R, Leppert M, Allen M, Gerner G. Factors affecting early childhood growth in hypoxic-ischemic encephalopathy treated with hypothermia. J Perinatol 2024; 44:532-538. [PMID: 38326606 PMCID: PMC11180224 DOI: 10.1038/s41372-024-01890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION There is an extensive body of research regarding neurological outcomes following neonatal hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH), with limited data on growth outcomes. We examined perinatal characteristics associated with postnatal growth in this population. METHODS Convenience cohort of 66 infants with HIE who underwent TH and participated in follow-up at 24 months of age were included. Regression modeling including perinatal anthropomorphics, markers of HIE, and systemic injury was used to evaluate growth at 24 months. RESULTS Birth head circumference was associated with weight (p = 0.036). MRI severity, pH at admission and birth head circumference were associated with height (p = 0.043, p = 0.015 and p = 0.043 respectively). MRI severity and length of intubation were associated with head circumference (p = 0.038 and p < 0.001 respectively). CONCLUSION There was a significant association between specific early factors and growth at 24 months among infants with HIE treated with TH.
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Affiliation(s)
- Srishti Jayakumar
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA.
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Vera Joanna Burton
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniella Asafu-Adjaye
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Frances Northington
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raul Chavez-Valdez
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Leppert
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilee Allen
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gwendolyn Gerner
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, Baltimore, MD, USA
- Neurosciences Intensive Care Nursery, Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Mukunya D, Oguttu F, Nambozo B, Nantale R, Makoko BT, Napyo A, Tumuhamye J, Wani S, Auma P, Atim K, Nahurira D, Okello D, Wamulugwa J, Ssegawa L, Wandabwa J, Kiguli S, Chebet M, Musaba MW. Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study. BMC Nephrol 2024; 25:116. [PMID: 38549078 PMCID: PMC10976667 DOI: 10.1186/s12882-024-03552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. METHODS We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m2. RESULTS The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m2, mean 85.8 ± SD 15.9. Nearly one third of the children (45/144) had normal eGFR (> 90 ml/Min/1.73m2), two thirds (97/144) had a mild decrease of eGFR (60-89 ml/Min/1.73m2), and only two children had a moderate decrease of eGFR (< 60 ml/Min/1.73m2). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)]. CONCLUSION We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
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Affiliation(s)
- David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Faith Oguttu
- Department of Community and Public Health, Busitema University, Mbale, Uganda.
| | - Brendah Nambozo
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Obstetrics and Gynecology, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellency for Maternal and Child Health, Mbale, Uganda
| | - Brian Tonny Makoko
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | | | - Solomon Wani
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Prossy Auma
- Mbale Regional Referral Hospital, Mbale, Uganda
| | - Ketty Atim
- Mbale Regional Referral Hospital, Mbale, Uganda
| | - Doreck Nahurira
- Department of Obstetrics and Gynecology, Busitema University, Mbale, Uganda
| | - Dedan Okello
- Department of Paediatrics and Child Health, Busitema University, Mbale, Uganda
| | | | - Lawrence Ssegawa
- Department of Research, Sanyu Africa Research Institute, Mbale, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynecology, Busitema University, Mbale, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Martin Chebet
- Department of Paediatrics and Child Health, Busitema University, Mbale, Uganda
- Department of Research, Sanyu Africa Research Institute, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellency for Maternal and Child Health, Mbale, Uganda
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9
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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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10
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Geisinger R, Rios DR, McNamara PJ, Levy PT. Asphyxia, Therapeutic Hypothermia, and Pulmonary Hypertension. Clin Perinatol 2024; 51:127-149. [PMID: 38325938 DOI: 10.1016/j.clp.2023.11.007] [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: 02/09/2024]
Abstract
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to disease, and explores the impact of the initial insult and subsequent therapeutic hypothermia on aPH.
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Affiliation(s)
- Regan Geisinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Danielle R Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 436, Boston, MA 02115, USA.
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11
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Mukunya D, Musaba MW, Nambozo B, Oguttu F, Makoko BT, Napyo A, Nantale R, Wani S, Tumuhamye J, Auma P, Atim K, Wamulugwa J, Nahurira D, Okello D, Ssegawa L, Wandabwa J, Kiguli S, Chebet M. Elevated blood pressure among children born to women with obstructed labour in Eastern Uganda: a cohort study. Clin Hypertens 2024; 30:4. [PMID: 38297357 PMCID: PMC10832100 DOI: 10.1186/s40885-023-00261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/24/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Globally, high systolic blood pressure accounts for 10.8 million deaths annually. The deaths are disproportionately higher among black people. The reasons for this disparity are poorly understood, but could include a high burden of perinatal insults such as birth asphyxia. Therefore, we aimed to assess the incidence of elevated blood pressure and to explore associated factors among children born to women with obstructed labour. METHODS We followed up children born to women with obstructed labour aged 25 to 44 months at Mbale regional referral hospital that had participated in the sodium bicarbonate trial ( Trial registration number PACTR201805003364421) between October 2021 and April 2022. Our primary outcome was elevated blood pressure defined as blood pressure (either systolic or diastolic or both) ≥ the 90th percentile for age, height, and sex in the reference population based on the clinical practice guideline for screening and management of high blood pressure in children and adolescents. We used logistic regression to estimate odds ratios between selected exposures and elevated blood pressure. RESULTS The incidence of elevated blood pressure was (39/140, 27.9%: 95% (CI: 20.6-36.1)). Participants aged three years and above had twice the odds of elevated blood pressure as those aged less than three years (Adjusted odds ratio (AOR) 2.46: 95% CI (1.01-5.97). Female participants had 2.81 times the odds of elevated blood pressure as their male counterparts (AOR 2.81 95% CI (1.16-6.82). Participants with reduced estimated glomerular filtration rate had 2.85 times the odds of having elevated blood pressure as those with normal estimated glomerular filtration rate (AOR 2.85 95% CI (1.00-8.13). We found no association between arterial cord lactate, stunting, wealth index, exclusive breastfeeding, food diversity and elevated blood pressure. CONCLUSION Our findings show a high incidence of elevated blood pressure among children. We encourage routine checking for elevated blood pressure in the pediatric population particularly those with known risk factors.
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Affiliation(s)
- David Mukunya
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
- Department of Research, Nikao Medical Center, P.O. Box 10005, Kampala, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Busitema University, P.O. Box 1460, Mbale, Uganda
- Busitema University Centre of Excellency for Maternal Reproductive and Child Health, Mbale, Uganda
| | - Brendah Nambozo
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda.
| | - Faith Oguttu
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Brian Tonny Makoko
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
- Busitema University Centre of Excellency for Maternal Reproductive and Child Health, Mbale, Uganda
| | - Solomon Wani
- Department of Community and Public Health, Busitema University, P.O. Box 1460, Mbale, Uganda
| | | | - Prossy Auma
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, P.O. Box 921, Mbale, Uganda
| | - Ketty Atim
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, P.O. Box 921, Mbale, Uganda
| | - Joan Wamulugwa
- Department of Pediatrics, Mbale Regional Referral Hospital, P.O. Box 921, Mbale, Uganda
| | - Doreck Nahurira
- Department of Obstetrics and Gynecology, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Dedan Okello
- Department of Pediatrics and Child Health, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Lawrence Ssegawa
- Department of Research, Sanyu Africa Research Institute, P.O. Box 2190, Mbale, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynecology, Busitema University, P.O. Box 1460, Mbale, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Martin Chebet
- Department of Pediatrics and Child Health, Busitema University, P.O. Box 1460, Mbale, Uganda
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12
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Hu XL, Hou C, Wang H, Li H, Pan T, Ni JC, Ding YY, Si XY, Li XC, Xu QQ. Myocardial Work for Dynamic Monitoring of Myocardial Injury in Neonatal Asphyxia. Pediatr Cardiol 2023:10.1007/s00246-023-03357-w. [PMID: 38123832 DOI: 10.1007/s00246-023-03357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
To assess the value of parameters of myocardial work for dynamic monitoring of myocardial injury after neonatal asphyxia. Fifty-three neonates with asphyxia admitted within 24 h after delivery were divided into a mild asphyxia group (n = 40) and severe asphyxia group (n = 13). Echocardiography was performed within 24 h post-birth, within 72 h post-birth (48 h after first echo), and during recovery. The left ventricular ejection fraction on M-mode echocardiography and by Simpson's biplane method (LVEF and Bi-EF, respectively), stroke volume (SV), cardiac output (CO), cardiac index (CI), global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), and other parameters were measured. Echocardiographic indicators were compared between groups and over time. GWI was significantly increased at 72 h in the mild asphyxia group (P < 0.05) but showed no significant change over time in the severe asphyxia group (P > 0.05). While GCW increased significantly over time in both groups (P < 0.05), it increased earlier in the mild asphyxia group. Time and grouping factors had independent effects on GWI and GCW (P > 0.05). The characteristics of differences in GWI and GCW between the two groups were different from those for LVEF, Bi-EF, SV, CO, CI, and GLS and their change characteristics with improvement from treatment. GWI and GCW changed significantly during recovery from neonatal asphyxia, and their change characteristics differed between mild and severe asphyxia cases. Myocardial work parameters can be used as valuable supplements to traditional indicators of left ventricular function to dynamically monitor the recovery from myocardial injury after neonatal asphyxia.
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Affiliation(s)
- Xin-Lu Hu
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Cui Hou
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Hui Wang
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Hong Li
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Pan
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun-Cheng Ni
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Yue-Yue Ding
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Xue-Ying Si
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Xiao-Chen Li
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China
| | - Qiu-Qin Xu
- Department of Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China.
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13
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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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14
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Gaston-Breton R, Maïza Letrou A, Hamoudi R, Stonestreet BS, Mabondzo A. Brain organoids for hypoxic-ischemic studies: from bench to bedside. Cell Mol Life Sci 2023; 80:318. [PMID: 37804439 PMCID: PMC10560197 DOI: 10.1007/s00018-023-04951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023]
Abstract
Our current knowledge regarding the development of the human brain mostly derives from experimental studies on non-human primates, sheep, and rodents. However, these studies may not completely simulate all the features of human brain development as a result of species differences and variations in pre- and postnatal brain maturation. Therefore, it is important to supplement the in vivo animal models to increase the possibility that preclinical studies have appropriate relevance for potential future human trials. Three-dimensional brain organoid culture technology could complement in vivo animal studies to enhance the translatability of the preclinical animal studies and the understanding of brain-related disorders. In this review, we focus on the development of a model of hypoxic-ischemic (HI) brain injury using human brain organoids to complement the translation from animal experiments to human pathophysiology. We also discuss how the development of these tools provides potential opportunities to study fundamental aspects of the pathophysiology of HI-related brain injury including differences in the responses between males and females.
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Affiliation(s)
- Romane Gaston-Breton
- Université Paris Saclay, CEA, INRAE, Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Etude de l'Unité Neurovasculaire & Innovation Thérapeutique, 91191, Gif-sur-Yvette Cedex, France
| | - Auriane Maïza Letrou
- Université Paris Saclay, CEA, INRAE, Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Etude de l'Unité Neurovasculaire & Innovation Thérapeutique, 91191, Gif-sur-Yvette Cedex, France
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, P. O. 27272, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, P. O. 27272, Sharjah, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London, UK
- ASPIRE Precision Medicine Research Institute Abu Dhabi, University of Sharjah, Sharjah, United Arab Emirates
| | - Barbara S Stonestreet
- Departments of Molecular Biology, Cell Biology and Biochemistry and Department of Pediatrics, Women & Infants Hospital of Rhode Island, The Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA
| | - Aloïse Mabondzo
- Université Paris Saclay, CEA, INRAE, Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Etude de l'Unité Neurovasculaire & Innovation Thérapeutique, 91191, Gif-sur-Yvette Cedex, France.
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15
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Momin S, Thomas S, Zein H, Scott JN, Leijser LM, Vayalthrikovil S, Yusuf K, Paul R, Howlett A, Mohammad K. Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic-Ischemic Encephalopathy. Ther Hypothermia Temp Manag 2023; 13:141-148. [PMID: 36961391 DOI: 10.1089/ther.2022.0048] [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: 03/25/2023] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).
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Affiliation(s)
- Sarfaraz Momin
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Sumesh Thomas
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Hussein Zein
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - James N Scott
- Department of Diagnostic Imaging, Division of Neuroradiology, University of Calgary, Calgary, Canada
| | - Lara M Leijser
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Sakeer Vayalthrikovil
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Renee Paul
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Alexandra Howlett
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
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Lugli L, Garetti E, Goffredo BM, Candia F, Crestani S, Spada C, Guidotti I, Bedetti L, Miselli F, Della Casa EM, Roversi MF, Simeoli R, Cairoli S, Merazzi D, Lago P, Iughetti L, Berardi A. Continuous Fentanyl Infusion in Newborns with Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia: Background, Aims, and Study Protocol for Time-Concentration Profiles. Biomedicines 2023; 11:2395. [PMID: 37760835 PMCID: PMC10525845 DOI: 10.3390/biomedicines11092395] [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: 08/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Therapeutic hypothermia (TH) is the standard of care for newborns with moderate to severe hypoxic-ischemic encephalopathy (HIE). Discomfort and pain during treatment are common and may affect the therapeutic efficacy of TH. Opioid sedation and analgesia (SA) are generally used in clinical practice, and fentanyl is one of the most frequently administered drugs. However, although fentanyl's pharmacokinetics (PKs) may be altered by hypothermic treatment, the PK behavior of this opioid drug in cooled newborns with HIE has been poorly investigated. The aim of this phase 1 study protocol (Trial ID: FentanylTH; EUDRACT number: 2020-000836-23) is to evaluate the fentanyl time-concentration profiles of full-term newborns with HIE who have been treated with TH. Newborns undergoing TH receive a standard fentanyl regimen (2 mcg/Kg of fentanyl as a loading dose, followed by a continuous infusion-1 mcg/kg/h-during the 72 h of TH and subsequent rewarming). Fentanyl plasma concentrations before bolus administration, at the end of the loading dose, and 24-48-72-96 h after infusion are measured. The median, maximum, and minimum plasma concentrations, together with drug clearance, are determined. This study will explore the fentanyl time-concentration profiles of cooled, full-term newborns with HIE, thereby helping to optimize the fentanyl SA dosing regimen during TH.
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Affiliation(s)
- Licia Lugli
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Elisabetta Garetti
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Bianca Maria Goffredo
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, Scientific Institute for hospitalization and care (IRCCS), 00100 Rome, Italy; (B.M.G.); (R.S.); (S.C.)
| | - Francesco Candia
- Pediatrics Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (S.C.); (L.I.)
| | - Sara Crestani
- Pediatrics Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (S.C.); (L.I.)
| | - Caterina Spada
- Neonatal Unit, Women’s and Children’s Department, Bufalini Hospital of Cesena, 47521 Cesena, Italy;
| | - Isotta Guidotti
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Francesca Miselli
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Elisa Muttini Della Casa
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Maria Federica Roversi
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
| | - Raffaele Simeoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, Scientific Institute for hospitalization and care (IRCCS), 00100 Rome, Italy; (B.M.G.); (R.S.); (S.C.)
| | - Sara Cairoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, Scientific Institute for hospitalization and care (IRCCS), 00100 Rome, Italy; (B.M.G.); (R.S.); (S.C.)
| | - Daniele Merazzi
- Neonatal Unit, Women’s and Children’s Department, Valduce Hospital, 22100 Como, Italy;
| | - Paola Lago
- Neonatal Intensive Care Unit, Women’s and Children’s Department, Ca’ Foncello Hospital, 31100 Treviso, Italy;
| | - Lorenzo Iughetti
- Pediatrics Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (S.C.); (L.I.)
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, 41100 Modena, Italy; (E.G.); (I.G.); (L.B.); (E.M.D.C.); (M.F.R.); (A.B.)
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17
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Mukunya D, Oguttu F, Nambozo B, Nantale R, Makoko TB, Napyo A, Tumuhamye J, Wani S, Auma P, Atim K, Okello D, Wamulugwa J, Ssegawa L, Wandabwa J, Kiguli S, Chebet M, Musaba MW, Nahurira D. Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study. RESEARCH SQUARE 2023:rs.3.rs-3121633. [PMID: 37503197 PMCID: PMC10371083 DOI: 10.21203/rs.3.rs-3121633/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for development of chronic kidney disease in infancy. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. Methods We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used estimated glomerular filtration rate (eGFR) by the Schwartz formula to calculate eGFR (0.413*height)/ serum creatinine as a measure of renal function. eGFR less than 90 ml/min/1.73m2 was classified as decreased renal function. Results The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR values ranged from 55 to 163ml/min/1.72m2, mean 85.8 ± SD 15.9. One third (31.3%) 45/144 had normal eGFR (> 90 ml/Min/1.72m2), two thirds (67.4%) 97/144 had a mild decrease of eGFR (60-89 ml/Min/1.72m2), and only 2/144 (1.4%) had a moderate decrease of eGFR. Overall incidence of reduced eGFR was 68.8% (99/144). Conclusion We observed a high incidence of impaired renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
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Affiliation(s)
| | | | | | | | | | | | - Josephine Tumuhamye
- Busitema University Centre of Excellency for Maternal Reproductive and Child Health
| | | | | | | | | | | | | | | | - Sarah Kiguli
- Makerere University Hospital, Makerere University Kampala
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Andelius TCK, Bøgh N, Pedersen MV, Omann C, Andersen M, Andersen HB, Hjortdal VE, Pedersen M, Rasmussen MB, Kyng KJ, Henriksen TB. Early changes in cerebral metabolism after perinatal hypoxia-ischemia: a study in normothermic and hypothermic piglets. Front Pediatr 2023; 11:1167396. [PMID: 37325341 PMCID: PMC10264796 DOI: 10.3389/fped.2023.1167396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Hypoxic ischemic encephalopathy (HIE) after a perinatal insult is a dynamic process that evolves over time. Therapeutic hypothermia (TH) is standard treatment for severe to moderate HIE. There is a lack of evidence on the temporal change and interrelation of the underlying mechanisms that constitute HIE under normal and hypothermic conditions. We aimed to describe early changes in intracerebral metabolism after a hypoxic-ischemic insult in piglets treated with and without TH and in controls. Methods Three devices were installed into the left hemisphere of 24 piglets: a probe measuring intracranial pressure, a probe measuring blood flow and oxygen tension, and a microdialysis catheter measuring lactate, glucose, glycerol, and pyruvate. After a standardized hypoxic ischemic insult, the piglets were randomized to either TH or normothermia. Results Glycerol, a marker of cell lysis, increased immediately after the insult in both groups. There was a secondary increase in glycerol in normothermic piglets but not in piglets treated with TH. Intracerebral pressure, blood flow, oxygen tension, and extracellular lactate remained stable during the secondary increase in glycerol. Conclusion This exploratory study depicted the development of the pathophysiological mechanisms in the hours following a perinatal hypoxic-ischemic insult with and without TH and controls.
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Affiliation(s)
- Ted C. K. Andelius
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Nikolaj Bøgh
- The MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Mette V. Pedersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Andersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hannah B. Andersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | - Martin B. Rasmussen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kasper J. Kyng
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Tine B. Henriksen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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19
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Giesinger RE, El-Khuffash AF, McNamara PJ. Arterial pressure is not reflective of right ventricular function in neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia. J Perinatol 2023; 43:162-167. [PMID: 36460796 DOI: 10.1038/s41372-022-01567-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
AIM to evaluate the correlation of recovery of arterial pressure with physiological recovery among patients with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. METHODS At 24 h postnatal age, we compared 53 neonates of whom 22 (41%) were inotrope-treated to those untreated with cardiovascular medications. RESULTS Inotrope-treated patients had persistent severe right ventricular (RV) dysfunction and evidence of abnormal brain tissue oxygen delivery, despite recovered arterial pressure. CONCLUSION Arterial pressure is not reflective of RV function and the need for inotropic agents may be reflective of abnormal brain tissue oxygen delivery.
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Affiliation(s)
- R E Giesinger
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- The Hospital for Sick Children, Toronto, ON, Canada
| | - A F El-Khuffash
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P J McNamara
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
- The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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20
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Balog V, Vatai B, Kovacs K, Szabo AJ, Szabo M, Jermendy A. Time series analysis of non-invasive hemodynamic monitoring data in neonates with hypoxic-ischemic encephalopathy. Front Pediatr 2023; 11:1112959. [PMID: 37033181 PMCID: PMC10076839 DOI: 10.3389/fped.2023.1112959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 04/11/2023] Open
Abstract
Background and aims Hemodynamic instability is common in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Rewarming is a critical period and non-invasive circulatory monitoring may help guide cardiovascular supportive therapy. The aim of the study was to provide a comprehensive analysis of cardiac function parameters during TH and its relation to neurodevelopmental outcome. Methods In a prospective, observational study, 26 neonates with moderate-severe HIE were enrolled, born between 2016 and 2019. A hemodynamic monitor based on electrical velocimetry (ICON, Osypka Medical GmbH, Berlin, Germany) was used. Heart rate (HR), stroke volume (SV), cardiac output (CO) data were recorded continuously throughout TH and rewarming. Neurological outcome was assessed at 2 years of age using the Bayley Scales of Infant Development II. edition. Favorable outcome was defined as >70 points on both the psychomotor and mental scales. Time-series analysis was used and features of cardiac function were described to perform logistic regression modeling for outcome prediction. Results Fourteen (54%) patients had favorable and 12 (46%) had adverse outcome. Data collection started from median [IQR] of 11.8 [7.0; 24.3] hours (h) of life and lasted until 84.0. [81.8; 87.0] h. During TH, the mean HR of the favorable outcome group was significantly lower than that of the adverse outcome group (86 ± 13/min vs. 104 ± 18/min, p = 0.01). During rewarming HR increased similarly in both groups. SV was unaffected by rewarming, and showed a slowly increasing trend. SV of the favorable outcome group was significantly higher compared to the adverse outcome group (1.55 ± 0.23 ml/kg vs. 1.29 ± 0.30 ml/kg, p = 0.035). In line with this, CO was similar in both groups (136 ± 27 ml/kg/min vs. 134 ± 36 ml/kg/min), and a significant 25% increase in CO was observed during rewarming. Based on multiple regression modeling, HR during TH was independently associated with neurological outcome (p = 0.023). Conclusion Based on continuous hemodynamic monitoring, patients with adverse outcome have lower SV and higher HR to achieve similar CO to patients with favorable outcome during TH. HR during hypothermia is independently associated with the neurodevelopmental outcome.
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Affiliation(s)
- Vera Balog
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Barbara Vatai
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Kata Kovacs
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Attila J. Szabo
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
- ELKH-SE Pediatric and Nephrology Research Group, Budapest, Hungary
| | - Miklos Szabo
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Correspondence: Agnes Jermendy
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21
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Patterns of acute kidney and hepatic injury and association with adverse outcomes in infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy. J Perinatol 2022; 42:1361-1367. [PMID: 35428814 DOI: 10.1038/s41372-022-01394-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe patterns of renal and hepatic injury in infants with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN Retrospective cohort of infants receiving therapeutic hypothermia for HIE was classified into groups based on organ injury: neither acute kidney injury (AKI) nor acute hepatic injury (AHI), isolated AKI, isolated AHI, or both AKI/AHI. Biomarkers and outcomes were described and analyzed. RESULTS Among 188 infants, 55% had no AKI nor AHI, 7% had only AKI, 22% had only AHI and 16% had both AKI and AHI. Infants with both AKI/AHI had the highest mortality (47%) and worse outcomes, compared to other injury groups, although AKI/AHI was not significantly associated with mortality (hazard ratio 2.5; 95% CI 0.9-6.9), after accounting for severity of HIE. For surviving infants, biomarkers of organ injury, on average, normalized by discharge. CONCLUSION Infants with HIE with both AKI/AHI have worse outcomes than infants with AKI or AHI alone.
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Iribarren I, Hilario E, Álvarez A, Alonso-Alconada D. Neonatal multiple organ failure after perinatal asphyxia. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:280.e1-280.e8. [PMID: 36115781 DOI: 10.1016/j.anpede.2022.08.010] [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: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Perinatal asphyxia is an event with far-reaching consequences that can lead not only to the development of neonatal encephalopathy, but also to multiple organ failure (MOF). This ailment may result from the redistribution of blood flow, which would preserve the perfusion of vital organs such as the heart, brain and adrenal glands at the expense of other organs. The objective of the study was to determine the incidence and aetiopathogenesis of failure in the organs most frequently involved in neonatal MOF following perinatal asphyxia. We conducted a systematic literature search in the PubMed, Scopus and Cochrane Library databases using the MeSH terms (ischemia AND hypoxia AND multiorgan dysfunction AND neonat*), (asphyxia AND multiorgan dysfunction AND neonat*) and (liver/kidney/digestive OR gastrointestinal/heart injury AND ischemia AND hypoxia AND neonat*). We selected clinical and preclinical studies published after 2000 and excluded case series, letters to the editor, cohort studies without comparison groups and abstracts. In this study, we found that MOF associated with perinatal asphyxia is a frequent phenomenon with a relevant impact on neonatal morbidity and mortality, as it can cause changes not only in the kidney, liver and gastrointestinal tract, but also cardiomyopathy if the ailment is protracted or severe.
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Affiliation(s)
- Isabel Iribarren
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Enrique Hilario
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Antonia Álvarez
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Daniel Alonso-Alconada
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain.
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23
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Fallo multiorgánico neonatal tras asfixia perinatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Munshi UK, Brown MM, Tauber KA, Horgan MJ. Early Troponin I Levels in Newborns Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Residual Encephalopathy at Discharge. Am J Perinatol 2022; 39:1083-1088. [PMID: 33285603 DOI: 10.1055/s-0040-1721497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Elevation of serum troponin I has been reported in newborns with hypoxic ischemic encephalopathy (HIE), but it is diagnostic and prognostic utility for newborn under 6 hours is not clear. Study the predictive value of early serum troponin I levels in newborns with HIE undergoing therapeutic hypothermia (TH) for persistent residual encephalopathy (RE) at discharge. STUDY DESIGN Retrospective chart review of newborns admitted with diagnosis of HIE to neonatal intensive care unit (NICU) for TH over a period of 3 years. Troponin levels were drawn with the initial set of admission laboratories while initiating TH. Newborns were followed up during hospital course and stratified into three groups based on predischarge examination and their electrical encephalography and cranial MRI findings: Group 1: no RE, Group 2: mild-to-moderate RE, and Group 3: severe RE or needing assisted medical technology or death. Demographic and clinical characteristics including troponin I levels were compared in each group. RESULTS Out of 104 newborns who underwent TH, 65 infants were in Group 1, 26 infants in Group 2, and 13 newborns in Group 3. All groups were comparable in demographic characteristics. There was a significant elevation of serum troponin in group 2 (mild-to-moderate RE) and group 3 (severe RE) as compared with group 1 (no RE). Receiver operator curve analysis for any RE (groups 2 and 3) compared with group 1 (no RE as control) had 0.88 (0.81-0.95) area under curve, p < 0.001. A cut-off level of troponin I ≥0.12 µg/L had a sensitivity of 77% and specificity of 78% for diagnosis of any RE, positive predictive value of 68%, and a negative predictive value of 84%. CONCLUSION In newborns undergoing TH for HIE, the elevation of troponin within 6 hours of age predicts high risk of having RE at discharge. KEY POINTS · Troponin I elevation is a biomarker of myocardial ischemia in adults and children.. · Myocardial ischemia may be part of multi-organ injury in neonatal HIE.. · Early elevation of troponin I level may correlate with the severity of neonatal HIE and predict residual encephalopathy in newborn at discharge from initial hospitalization..
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Affiliation(s)
- Upender K Munshi
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Meredith Monaco Brown
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Kate A Tauber
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Michael J Horgan
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
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Association between multi-organ dysfunction and adverse outcome in infants with hypoxic ischemic encephalopathy. J Perinatol 2022; 42:907-913. [PMID: 35578019 DOI: 10.1038/s41372-022-01413-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate multi-organ dysfunction (MOD) in newborns treated with therapeutic hypothermia (TH) for hypoxic ischemic encephalopathy (HIE), and to compare MOD in those with normal/mild magnetic resonance imaging (MRI) findings to those with moderate to severe MRI findings or death. STUDY DESIGN Retrospective single-center observational study of infants treated with TH. A total of 16 parameters across 7 organ systems were analyzed. Primary outcome was death or moderate to severe brain injury on MRI. RESULT Of 157 infants treated with TH, 77% had ≥2 organ systems with dysfunction. The number of organ systems with dysfunction was strongly associated with death or moderate-to-severe brain injury (p < 0.0001). Hematologic (68%) and hepatic (65%) dysfunction were most common. Neurologic and renal dysfunction were most strongly associated with the primary outcome (OR 13.5 [6.1-29.8] and 11.2 [4.1-30.3], respectively), while pulmonary hypertension was not. CONCLUSION MOD is prevalent in infants undergoing TH for HIE, and the association between MOD and adverse outcomes may impact clinical care and counseling.
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Coleman C, Tambay Perez A, Selewski DT, Steflik HJ. Neonatal Acute Kidney Injury. Front Pediatr 2022; 10:842544. [PMID: 35463895 PMCID: PMC9021424 DOI: 10.3389/fped.2022.842544] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) is a common occurrence in the neonatal intensive care unit (NICU). In recent years, our knowledge of the incidence and impact of neonatal AKI on outcomes has expanded exponentially. Neonatal AKI has been shown to be associated with adverse outcomes including increased length of mechanical ventilation, prolonged length of stay, and rise in mortality. There has also been increasing work suggesting that neonates with AKI are at higher risk of chronic kidney disease (CKD). In the past, AKI had been defined multiple ways. The utilization of the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria as the standard definition for neonatal AKI in research and clinical care has driven the advances in our understanding of neonatal AKI over the last 10 years. This definition has allowed researchers and clinicians to better understand the incidence, risk factors, and outcomes associated with neonatal AKI across populations through a multitude of single-center studies and the seminal, multicenter Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study. As the impacts of neonatal AKI have become clear, a shift in efforts toward identifying those at highest risk, protocolizing AKI surveillance, improving prevention and diagnosis, and expanding kidney support therapy (KST) for neonates has occurred. These efforts also include improving risk stratification (identifying high risk populations, including those with nephrotoxic medication exposure) and diagnostics (novel biomarkers and diagnostic tools). Recent work has also shown that the targeted use of methylxanthines may prevent AKI in a variety of high-risk populations. One of the most exciting developments in neonatal AKI is the advancement in technology to provide KST to neonates with severe AKI. In this comprehensive review we will provide an overview of recent work and advances in the field of neonatal AKI. This will include a detailed review of (1) the definition of neonatal AKI, (2) the epidemiology, risk factors, and outcomes associated with neonatal AKI, (3) improvements in risk stratification and diagnostics, (4) mitigation and treatment, (5) advancements in the provision of KST to neonates, and (6) the incidence and risk of subsequent CKD.
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Affiliation(s)
- Cassandra Coleman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Anita Tambay Perez
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - David T. Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Heidi J. Steflik
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
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Ovali F. Hemodynamic changes and evaluation during hypoxic-ischemic encephalopathy and therapeutic hypothermia. Early Hum Dev 2022; 167:105563. [PMID: 35248984 DOI: 10.1016/j.earlhumdev.2022.105563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
Multiorgan damage is a hallmark of hypoxic-ischemic encephalopathy and cardiovascular and hemodynamic changes during asphyxia contribute significantly to the brain damage. The main insult to the heart is myocardial damage and associated ventricular dysfunction, which is manifested by reduced preload and afterload. The immature myocardium reacts to asphyxia by bradycardia and reduced contractile capacity. Pulmonary hypertension aggrevates cardiac dysfunction. Hypothermia is the only effective treatment for HIE but it may also affect the heart and peripheral vascular system leading to bradycardia and peripheral vasoconstriction. In fact, these effects might be cardioprotective also. Rewarming after hypothermia may increase the heart rate and cardiac metabolism, augmenting the cardiac output. Monitoring of patient with HIE during and after hypothermia is possible by using near-infrared spectroscopy, echocardiography and electrocardiography. Cerebral effects may be monitored by magnetic resonance imaging also. Management should include the physiological status of the patient and appropriate treatments, including inotropes, vasopressors or rarely fluid boluses. Dopamine should not be used unless absolutely necessary. Drugs like melatonin and magnesium are under investigation. All treatments should be evidence-based and targeted echocardiography should be used more often in these vulnerable infants.
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Affiliation(s)
- Fahri Ovali
- Istanbul Medeniyet University, Medical Faculty, Department of Pediatrics, Division of Neonatology, Göztepe, İstanbul, Turkey.
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Shakir W, Abdur-Rehman, Arshad MS, Fatima N. Burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia. Pak J Med Sci 2022; 38:883-887. [PMID: 35634605 PMCID: PMC9121927 DOI: 10.12669/pjms.38.4.5160] [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: 08/11/2021] [Revised: 12/26/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To find out the burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia. Methods This prospective observational study was conducted at The Department of Neonatology, Children's Hospital and The Institute of Child Health, Multan from August 2020 to March 2021.A total of 171 term newborns having asphyxia were enrolled. Detailed history along with clinical and physical examination were done at the time of admission at Neonatal Intensive Care Unit (NICU). All neonates were followed up for duration of 14 days following birth. Echocardiographic patterns as well as electrocardiography grading were described among neonates with cardiovascular abnormalities. Results Out of a total of 171 neonates, there were 94 (55.0%) male and 77 (45.0%) female. Lowe segment cesarean section was the mode of delivery in 72 (42.1%) while normal vaginal delivery was noted in 99 (57.9%). Mean gestational age was noted to be 38.3±1.8 weeks. Mean birth weight was calculated to be 2574.10±122.30 grams. Cardiovascular dysfunction was noted among 60 (35.1%) neonates as exhibited by the use of inotropes while abnormal ECHO was observed in 52 (30.4%), abnormal ECG in 27 (15.8%) and elevated CK-MB in 31 (18.1%). A total of 29 (17.0%) asphyxiated neonates died while among 60 asphyxiated neonates with cardiovascular dysfunction, 23 (38.3%) died and all remaining survived and discharged (p<0.0001). Conclusion Cardiovascular dysfunction among asphyxiated neonates was found to be in high proportion of cases. Cardiovascular dysfunction was noted to have significant association with poor outcome.
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Affiliation(s)
- Waqas Shakir
- Waqas Shakir, FCPS (Pediatrics Medicine), Department of Neonatology, Children’s Hospital and The Institute of Child Health, Multan, Pakistan
| | - Abdur-Rehman
- Abdur Rehman, FCPS Department of Neonatology, Children’s Hospital and The Institute of Child Health, Multan, Pakistan
| | - M. Sohail Arshad
- M. Sohail Arshad, FCPS Department of Pediatric Cardiology, Children’s Hospital and The Institute of Child Health, Multan, Pakistan
| | - Nazia Fatima
- Nazia Fatima, FCPS (Pediatric Medicine), Department of Neonatology, Children’s Hospital and The Institute of Child Health, Multan, Pakistan
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Zhang Y, Lei Y, Jiang H, Li X, Feng H. Analysis of the correlation between the severity of neonatal hypoxic ischemic encephalopathy and multiple organ dysfunction. Am J Transl Res 2022; 14:311-319. [PMID: 35173848 PMCID: PMC8829617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the hypoxic ischemic encephalopathy (HIE) and multiple organ dysfunction (MOD) in neonates and analyze the correlation between the two disorders. METHODS From January 2018 to January 2020, infants with HIE who were born in our hospital at or above 37 weeks of gestation, and those with ischemic hypoxic encephalopathy at or above 2000 grams were selected as study subjects. HIE and MOD monitoring were performed for three days. HIE severity was graded according to reported scores including amplitude integrated EEG. Multiple organ dysfunction was also assessed. The correlation between neonatal hypoxic ischemic encephalopathy and multiple organ dysfunction was analyzed. RESULTS Children with HIE were divided into three grades: mild, moderate and severe. There were statistically significant differences among the three groups in emergency caesarean section, Apgar 5 minutes, systemic hypothermia and neonatal mortality. Differences in MOD scores were found in three HIE stages per day from Day 1 to Day 3. Among children with mild HIE grading, the most common mildly affected organ systems are pH, electrolyte imbalance and liver system, and the least affected organs are kidney and blood systems. Among children with HIE grade of mild and severe, there was no significant difference in moderate-severe organ involvement, and the number of severely affected children was small. CONCLUSION With the increase of HIE severity, multi-organ involvement is aggravated. The organ involvement of HIE children with different degrees of severity is different.
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Affiliation(s)
- Yuantao Zhang
- Department of Neonatology, Affiliated Hospital of Yan'an University Yan'an 716000, Shaanxi, China
| | - Yuan Lei
- Department of Neonatology, Affiliated Hospital of Yan'an University Yan'an 716000, Shaanxi, China
| | - Hong Jiang
- Department of Neonatology, Affiliated Hospital of Yan'an University Yan'an 716000, Shaanxi, China
| | - Xingzhen Li
- Department of Neonatology, Affiliated Hospital of Yan'an University Yan'an 716000, Shaanxi, China
| | - Huiling Feng
- Department of Neonatology, Affiliated Hospital of Yan'an University Yan'an 716000, Shaanxi, China
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30
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Giesinger RE, El Shahed AI, Castaldo MP, Bischoff AR, Chau V, Whyte HEA, El-Khuffash AF, Mertens L, McNamara PJ. Neurodevelopmental outcome following hypoxic ischaemic encephalopathy and therapeutic hypothermia is related to right ventricular performance at 24-hour postnatal age. Arch Dis Child Fetal Neonatal Ed 2022; 107:70-75. [PMID: 34045280 DOI: 10.1136/archdischild-2020-321463] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Our aim was to determine whether right ventricular (RV) dysfunction at 24-hour postnatal age predicts adverse developmental outcome among patients with hypoxic ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). DESIGN Neonates≥35 weeks with HIE/TH were enrolled in a physiological study in the neonatal period (n=46) and either died or underwent neurodevelopmental follow-up at 18 months (n=43). The primary outcome was a composite of death, diagnosis of cerebral palsy or any component of the Bayley Scores of Infant Development III<70. We hypothesised that tricuspid annulus plane systolic excursion (TAPSE) <6 mm and/or RV fractional area change (RV-FAC) <0.29 would predict adverse outcome. RESULTS Nine patients died and 34 patients were followed up at a mean age of 18.9±1.4 months. Both indices of RV systolic performance were abnormal in 15 (35%) patients, TAPSE <6 mm only was abnormal in 4 (9%) patients and RV-FAC <0.29 only was abnormal in 5 (12%) patients (19 had with normal RV function). Although similar at admission, neonates with RV dysfunction had higher cardiovascular and neurological illness severity by 24 hours than those without and severe MRI abnormalities (70% vs 53%, p=0.01) were more common. On logistic regression, TAPSE <6 mm (OR 3.6, 95% CI 1.2 to 10.1; p=0.017) and abnormal brain MRI [OR 21.7, 95% CI 1.4 to 336; p=0.028) were independently associated with adverse outcome. TAPSE <6 mm predicted outcome with a 91% sensitivity and 81% specificity. CONCLUSIONS The role of postnatal cardiovascular function on neurological outcomes among patients with HIE who receive TH merits further study. Quantitative measurement of RV function at 24 hours may provide an additional neurological prognostic tool.
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Affiliation(s)
- Regan E Giesinger
- Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Amr I El Shahed
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael P Castaldo
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adrianne R Bischoff
- Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Vann Chau
- Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hilary E A Whyte
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Luc Mertens
- Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Pediatrics, University of Iowa, Iowa City, Iowa, USA .,Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Sweetman DU, Strickland T, Isweisi E, Kelly L, Slevin MT, Donoghue V, Meehan J, Boylan G, Murphy JFA, El‐Khuffash A, Molloy EJ. Multi-organ dysfunction scoring in neonatal encephalopathy (MODE Score) and neurodevelopmental outcomes. Acta Paediatr 2022; 111:93-98. [PMID: 34528287 DOI: 10.1111/apa.16111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
AIM Neonatal encephalopathy (NE) is associated with an increased risk of multi-organ injury. The lack of standardised definitions for multi-organ dysfunction in NE hinders accurate quantification of these complications. METHODS A simple multi-organ dysfunction in neonatal encephalopathy scoring (MODE) system was created to include the cardiovascular, respiratory, gastrointestinal, haematological and neurological systems with a maximum score of 15. The MODE score was then compared with the grade of NE, Bayley Scales of Infant Development (Bayley-III) at 2 years of age and mortality. The Bayley score was used as it gave an objective score making it easier to compare the MODE score. Bayley score of <90 and/or abnormal MRI as an adverse outcome. RESULTS Infants with perinatal asphyxia (PA:n = 85) were prospectively enrolled (PA only n = 9; NE I = 23; NE II = 42; NE III = 11). Infants with higher MODE scores were significantly more likely to have moderate/severe NE (NE II/III: median scores (IQR) 7(5-10) versus mild NE 2 (1-3); p-value < 0.001) The MODE score was highly predictive of mortality (AUC 0.96, p-value = 0.002). Infants who had an abnormal neurological examination at discharge or abnormal Bayley-III scores had significantly higher MODE scores (p-value = 0.001). CONCLUSION Quantifying multi-organ injury is important to plan optimal early management and long-term follow-up. Additional use of clinical biomarkers may be useful as surrogate endpoints in future clinical trials and link to multi-organ longer-term developmental follow-up.
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Affiliation(s)
- Deirdre Una Sweetman
- Neonatology National Maternity Hospital Dublin Ireland
- National Children’s Research Centre Dublin Ireland
| | - Tammy Strickland
- Paediatrics Trinity College Dublin Trinity Research in Childhood Centre (TRICC) & Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Eman Isweisi
- National Children’s Research Centre Dublin Ireland
- Paediatrics Trinity College Dublin Trinity Research in Childhood Centre (TRICC) & Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Lynne Kelly
- Paediatrics Trinity College Dublin Trinity Research in Childhood Centre (TRICC) & Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | | | | | - Judith Meehan
- Paediatrics Trinity College Dublin Trinity Research in Childhood Centre (TRICC) & Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | | | - John Finbar Anthony Murphy
- Neonatology National Maternity Hospital Dublin Ireland
- School of Medicine The Royal College of Surgeons in Ireland Dublin Ireland
| | - Afif El‐Khuffash
- School of Medicine The Royal College of Surgeons in Ireland Dublin Ireland
- Neonatology The Rotunda Hospital Dublin Ireland
| | - Eleanor J. Molloy
- National Children’s Research Centre Dublin Ireland
- Paediatrics Trinity College Dublin Trinity Research in Childhood Centre (TRICC) & Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
- School of Medicine The Royal College of Surgeons in Ireland Dublin Ireland
- Neonatology CHI at Crumlin Dublin Ireland
- Neonatology Coombe Women’s and Infants University Hospital Dublin Ireland
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Surmeli Onay O, Gunes D, Aydemir O, Tekin N. A single dose of aminophylline administration during therapeutic hypothermia; does it make a difference in glomerular filtration rate? Eur J Pediatr 2021; 180:3367-3377. [PMID: 34046718 DOI: 10.1007/s00431-021-04128-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Aminophylline has been demonstrated to be effective in improving renal functions of the infants suffering from acute kidney injury (AKI) due to perinatal asphyxia. We aimed to evaluate the effect of a single-dose aminophylline on estimated glomerular filtration rate (eGFR), urine output (UO), and incidence and severity of AKI according to the pediatric-modified RIFLE and neonatal RIFLE criteria in newborns with perinatal asphyxia under therapeutic hypothermia. This was a single-center, retrospective cohort study including newborns (gestational age ≥36 weeks) who underwent therapeutic hypothermia due to hypoxic ischemic encephalopathy between 2016 and 2019. Demographic and clinical data were obtained from electronic medical records and patient files. Two patient groups were established: aminophylline group and control group which were only under therapeutic hypothermia. Twenty-one newborns were in the aminophylline group and 13 newborns were in the control group. Our study revealed that on the third day of life (DOL), eGFR was significantly higher in the control group (p=0.025), but UO was significantly higher in the aminophylline group (p=0.021). In the aminophylline group, eGFR on the first DOL was higher than the value on the second DOL (p=0.017) while UO was higher on the second and third DOL compared to the first DOL (1-2 DOL p=0.006, and 1-3 DOL p=0.004). However, in the control group, there was no statistically significant difference in UO over the four DOL. Both groups were similar in the presence, severity, and outcome of AKI.Conclusion: This study demonstrated that aminophylline increases UO even in the infants under therapeutic hypothermia. However, the eGFR did not significantly increase in the aminophylline group. Understanding how therapeutic hypothermia affects pharmacokinetics may help us improve our results in future studies. What is known: • Therapeutic hypothermia (TH) reduces the incidence of acute kidney injury in asphyxiated newborns. • Aminophylline is effective in improving renal functions in asphyxiated newborns. What is new: • This is the first study evaluating the effect of a single dose of aminophylline on renal functions in newborns under TH. • A single dose of aminophylline administration in newborns under TH was associated with increased urine output especially on the third day of life. However, no significant increase was detected in glomerular filtration rate associated with aminophylline administration.
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Affiliation(s)
- Ozge Surmeli Onay
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Damla Gunes
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozge Aydemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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Abstract
Neonatal encephalopathy due to perinatal hypoxia-ischemia (hypoxic-ischemic encephalopathy [HIE]) occurs at a rate of 1 to 3 per 1000 live births. Therapeutic hypothermia is the standard of care and the only currently available therapy to reduce the risk of death or disability in newborns with moderate to severe HIE. Hypothermia therapy needs to be initiated within 6 hours after birth in order to provide the best chance for neuroprotection. All pediatricians and delivery room attendants should be trained to recognize encephalopathy and understand the eligibility criteria for treatment. The modified Sarnat examination is the most frequently used tool to assess the degree of encephalopathy and has six categories, each of which can have mild, moderate, severe abnormalities. Apart from historical and biochemical criteria, a neonate must have 3 of 6 categories scored in the moderate or severe range in order to qualify for hypothermia as was done in the randomized trials. Whether an infant qualifies or there is concern that an infant might have HIE, transfer to a center that can perform treatment should be initiated immediately. Hypothermia significantly reduces the risk of death or moderate to severe impairments at 2 years and at school age. On average, only 7 neonates need to be treated for one neonate to benefit. Although easy in concept, implementation of hypothermia does require expertise and should be carried out under the guidance of a neonatologist. If infants are passively cooled prior to transport, core temperature needs to be closely monitored with a target of 33.5°C ± 0.5°C. Maintenance of homeostasis is important in order to prevent conditions that may result in additional brain injury. Seizures are common in neonates with HIE, but electrographic seizures are rare in the first few hours after birth if the insult occurred during labor and delivery. Prophylactic antiepileptic drugs should not be administered. Brain monitoring in the form of electroencephalogram (EEG) and or amplitude-integrated EEG should be implemented as soon as possible to help with prognosis and to accurately diagnose seizures.
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Affiliation(s)
- Sonia Lomeli Bonifacio
- NeuroNICU, Division of Neonatal and Developmental Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, USA.
| | - Shandee Hutson
- Department of Neonatology, NICN, Sharp Mary Birch Hospital for Women and Newborns, 8555 Aero Drive #104, San Diego, CA 92123, USA
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35
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Iacobelli S, Guignard JP. Maturation of glomerular filtration rate in neonates and infants: an overview. Pediatr Nephrol 2021; 36:1439-1446. [PMID: 32529323 DOI: 10.1007/s00467-020-04632-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
Glomerular filtration rate (GFR) increases progressively throughout fetal life, matures rapidly after birth according to gestational and post-menstrual age, and reaches adult values by 1-year post-natal age. GFR is considered the best marker of kidney function, and in clinical practice, estimated GFR is useful to anticipate complications, establish prognosis, and facilitate treatment decisions. This review article summarizes the maturation of glomerular filtration and the factors and conditions that modulate and impair developing glomerular filtration, and discusses the techniques available to assess GFR in neonates and infants. We focused on simple, reliable, easily available, and cheap techniques to estimate GFR, which may provide valuable information on the renal aspects of the clinical care of this group of patients.
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Affiliation(s)
- Silvia Iacobelli
- Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France. .,Centre d'Etudes Périnatales de l'Océan Indien, EA 7388, CHU La Réunion, Site Sud, Saint Pierre et Université de la Réunion, Réunion, France.
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36
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Taher NAB, Kelly LA, Al-Harbi AI, O'Dea MI, Zareen Z, Ryan E, Molloy EJ, Doherty DG. Altered distributions and functions of natural killer T cells and γδ T cells in neonates with neonatal encephalopathy, in school-age children at follow-up, and in children with cerebral palsy. J Neuroimmunol 2021; 356:577597. [PMID: 33964735 DOI: 10.1016/j.jneuroim.2021.577597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
We enumerated conventional and innate lymphocyte populations in neonates with neonatal encephalopathy (NE), school-age children post-NE, children with cerebral palsy and age-matched controls. Using flow cytometry, we demonstrate alterations in circulating T, B and natural killer cell numbers. Invariant natural killer T cell and Vδ2+ γδ T cell numbers and frequencies were strikingly higher in neonates with NE, children post-NE and children with cerebral palsy compared to age-matched controls, whereas mucosal-associated invariant T cells and Vδ1 T cells were depleted from children with cerebral palsy. Upon stimulation ex vivo, T cells, natural killer cells and Vδ2 T cells from neonates with NE more readily produced inflammatory cytokines than their counterparts from healthy neonates, suggesting that they were previously primed or activated. Thus, innate and conventional lymphocytes are numerically and functionally altered in neonates with NE and these changes may persist into school-age.
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Affiliation(s)
- Nawal A B Taher
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Lynne A Kelly
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Alhanouf I Al-Harbi
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Mary I O'Dea
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland; Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland; National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Zunera Zareen
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland
| | - Emer Ryan
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland; Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland; National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Derek G Doherty
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland.
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Sehgal A, Allison BJ, Miller SL, Polglase GR, McNamara PJ, Hooper SB. Impact of Acute and Chronic Hypoxia-Ischemia on the Transitional Circulation. Pediatrics 2021; 147:peds.2020-016972. [PMID: 33622795 DOI: 10.1542/peds.2020-016972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
The transition from intrauterine life to extrauterine existence encompasses significant cardiorespiratory adaptations. These include rapid lung aeration and increase in pulmonary blood flow (PBF). Perinatal asphyxia and fetal growth restriction can severely hamper this transition. Hypoxia is the common denominator in these 2 disease states, with the former characterized by acute insult and the latter by utero-placental insufficiency and a chronic hypoxemic state. Both may manifest as hemodynamic instability. In this review, we emphasize the role of physiologic-based cord clamping in supplementing PBF during transition. The critical role of lung aeration in initiating pulmonary gas exchange and increasing PBF is discussed. Physiologic studies in animal models have enabled greater understanding of the mechanisms and effects of various therapies on transitional circulation. With data from sheep models, we elaborate instrumentation for monitoring of cardiovascular and pulmonary physiology and discuss the combined effect of chest compressions and adrenaline in improving transition at birth. Lastly, physiologic adaptation influencing management in human neonatal cohorts with respect to cardiac and vascular impairments in hypoxic-ischemic encephalopathy and growth restriction is discussed. Impairments in right ventricular function and vascular mechanics hold the key to prognostication and understanding of therapeutic rationale in these critically ill cohorts. The right ventricle and pulmonary circulation seem to be especially affected and may be explored as therapeutic targets. The role of comprehensive assessments using targeted neonatal echocardiography as a longitudinal, reliable, and easily accessible tool, enabling precision medicine facilitating physiologically appropriate treatment choices, is discussed.
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Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia; .,Departments of Paediatrics and
| | - Beth J Allison
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Suzanne L Miller
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Graeme R Polglase
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Patrick J McNamara
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa; and.,Internal Medicine, University of Iowa Health Care, Iowa City, Iowa
| | - Stuart B Hooper
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Elsadek AE, FathyBarseem N, Suliman HA, Elshorbagy HH, Kamal NM, Talaat IM, Al-Shokary AH, Abdel Maksoud YH, Ibrahim AO, Attia AM, Abdelhalim WA, Abdelghani WE. Hepatic Injury in Neonates with Perinatal Asphyxia. Glob Pediatr Health 2021; 8:2333794X20987781. [PMID: 33614837 PMCID: PMC7868451 DOI: 10.1177/2333794x20987781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Perinatal asphyxia (PA) is a major cause of morbidity and mortality in which dramatic transient impairment in liver functions occurs in some patients. Objectives: We aimed to evaluate the state of the liver in cases of Perinatal asphyxia and to assess the severity of hepatic impairment in relation to different grades of HIE. Patients and Methods: This case-control study was conducted on 100 full-term newborns with perinatal asphyxia (Group I) and 50 healthy neonates served as controls (Group II). All biochemical parameters of liver function were measured on the 1st, 3rd, and 10th day after birth. These parameters include serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, serum bilirubin (total and direct), and international normalized ratio (INR), in both cases and controls. Results: Among babies with PA, 25 (25%) had an Apgar score of 0 to 3 (severe PA), 43 (43%) had an Apgar score of 4 to 5 (moderate PA) and 32 (32%) had an Apgar score of 6 to 7 (mild PA) at 5 minutes of life. HIE was found in 39% among cases of PA and the remaining 61% were normal. Among babies with PA and HIE; 25.7% had stage I, 41% had stage II and 33.3% had stage III. Impaired liver function was reported in 48% of asphyxiated babies. On the first day of life, ALT, AST, ALP, LDH, PT, and INR were significantly higher in Group I compared to Group II. However, total protein and serum albumin were significantly lower in Group I compared to Group II. ALT and AST showed a positive correlation with the severity of HIE. On the third day of life, LDH rises as the stage of HIE progressed from stage 0 to stage 3. The difference in LDH among most stages of HIE was statistically significant. Conclusion: Liver enzymes can be used as an easy early diagnostic marker to differentiate between babies with asphyxia and those without asphyxia. Also, liver enzymes can be used for the detection of the severity of PA.
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Affiliation(s)
| | | | | | - Hatem Hamed Elshorbagy
- Menoufia University, Shebeen Elkom, Egypt.,Alhada and Taif Armed Forces Hospitals, Taif, Saudi Arabia
| | - Naglaa M Kamal
- Alhada and Taif Armed Forces Hospitals, Taif, Saudi Arabia.,Cairo University, Cairo, Egypt
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Wu TW, Noori S. Recognition and management of neonatal hemodynamic compromise. Pediatr Neonatol 2021; 62 Suppl 1:S22-S29. [PMID: 33485823 DOI: 10.1016/j.pedneo.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 01/22/2023] Open
Abstract
Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis, congenital heart anomalies, hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension of the newborn, systemic inflammatory diseases such as necrotizing enterocolitis, and dehydration. Despite the handful of advances in neonatal care through ground-breaking clinical trials, the management of neonatal shock is often dependent on the bedside clinician's experience and training without the aid of high-level evidence. However, the recognition for the importance of comprehensive and serial hemodynamic assessment is growing. There is now a wealth of literature investigating the use of functional echocardiography, near-infrared spectroscopy, and noninvasive impedance-based cardiometry to complement common bedside hemodynamic measures such as blood pressure and heart rate measurement. In this review article, the pathophysiology of neonatal hemodynamic compromise is outlined, and concomitant best-evidence management for hemodynamic compromise in the neonate is proposed.
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Affiliation(s)
- Tai-Wei Wu
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shahab Noori
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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O'Dea MI, Kelly LA, McKenna E, Strickland T, Hurley TP, Butler J, Vavasseur C, El-Khuffash AF, Miletin J, Fallah L, White A, Wyse J, Molloy EJ. Altered Cytokine Endotoxin Responses in Neonatal Encephalopathy Predict MRI Outcomes. Front Pediatr 2021; 9:734540. [PMID: 34712631 PMCID: PMC8547258 DOI: 10.3389/fped.2021.734540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neonatal encephalopathy (NE) is associated with adverse neurodevelopmental outcome and is linked with systemic inflammation. Pro-inflammatory and anti-inflammatory cytokines are known to play a role in the pathology of NE by activating innate immune cells. Methods: Eighty-seven infants were enrolled including 53 infants with NE of whom 52 received therapeutic hypothermia (TH) and 34 term infant healthy controls (TC). Whole blood sampling was performed in the first 4 days of life, and a 14-spot ELISA Multiplex Cytokine Array was carried out on baseline samples or after stimulation with lipopolysaccharide (LPS) as an additional inflammatory stimulus. The cytokine medians were examined for differences between infants with NE and healthy TC; and then short-term outcomes of Sarnat stage, seizures, and MRI brain were examined within the NE group. The potential of LPS stimulation to predict abnormal MRI was explored using receiver operating characteristic (ROC) curves. Results: At baseline, infants with NE had significantly higher levels of erythropoietin (Epo), interleukin (IL)-6, and IL-1ra and significantly lower vascular endothelial growth factor (VEGF) than had controls. All cytokines were increased after LPS stimulation in infants with NE with an excessive Epo and IL-1ra response than in controls. Infants with NE had lower IL-8, IL-2, IL-6, tumor necrosis factor (TNF)-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), VEGF, and interferon (IFN)-γ than controls had following LPS. GM-CSF and IFN-γ, IL-1β, IL-1ra, and VEGF were higher on days 1-2 in NE infants with abnormal neuroimaging. GM-CSF, IFN-γ, and TNF-α levels with LPS stimulation were different upon stimulation between normal and abnormal neuroimaging. TNF-α is the only strong cytokine predictor both pre- and post-LPS stimulation of abnormal brain imaging. Conclusions: Altered cytokine responses are found in infants with NE vs. controls, and more significant differences are unmasked by the additional stimulus of LPS, which potentially improves the predictive power of these cytokines for the detection of abnormal MRIs. Infants with NE undergoing TH demonstrate both trained immunity and tolerance, and understanding these responses will facilitate adjunctive immunomodulatory treatments.
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Affiliation(s)
- Mary Isabel O'Dea
- National Maternity Hospital, Dublin, Ireland.,Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Department of Paediatrics, Tallaght University Hospital, Dublin, Ireland.,Rotunda Hospital, Dublin, Ireland.,Our Lady's Children's Hospital (CHI), Crumlin, Ireland.,National Children's Research Centre (NCRC), Crumlin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Lynne A Kelly
- Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ellen McKenna
- Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Tammy Strickland
- Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Tim P Hurley
- National Maternity Hospital, Dublin, Ireland.,Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Department of Paediatrics, Tallaght University Hospital, Dublin, Ireland.,Rotunda Hospital, Dublin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John Butler
- Meso Scale Discovery, Rockville, MD, United States
| | | | - Afif F El-Khuffash
- Rotunda Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Miletin
- Coombe Women and Infants University Hospital, Dublin, Ireland.,Department of Paediatrics, University College Dublin, Dublin, Ireland
| | - Lida Fallah
- School of Computer Science and Statistics, Faculty of Engineering, Mathematics and Science, Trinity College Dublin, Dublin, Ireland
| | - Arthur White
- School of Computer Science and Statistics, Faculty of Engineering, Mathematics and Science, Trinity College Dublin, Dublin, Ireland
| | - Jason Wyse
- School of Computer Science and Statistics, Faculty of Engineering, Mathematics and Science, Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Department of Pediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Department of Paediatrics, Tallaght University Hospital, Dublin, Ireland.,Our Lady's Children's Hospital (CHI), Crumlin, Ireland.,National Children's Research Centre (NCRC), Crumlin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
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Cardiovascular management following hypoxic-ischemic encephalopathy in North America: need for physiologic consideration. Pediatr Res 2021; 90:600-607. [PMID: 33070162 PMCID: PMC8249436 DOI: 10.1038/s41390-020-01205-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hypotension and hypoxemic respiratory failure are common among neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Right ventricular (RV) dysfunction is associated with adverse neurodevelopment. Individualized management utilizing targeted neonatal echocardiography (TnECHO) may enhance care. METHODS We evaluated the influence of TnECHO programs on cardiovascular practices in HIE/TH patients utilizing a 77-item REDCap survey. Nominated representatives of TnECHO (n = 19) or non-TnECHO (n = 96) sites were approached. RESULTS Seventy-one (62%) sites responded. Baseline neonatal intensive care unit characteristics and HIE volume were comparable between groups. Most centers monitor invasive blood pressure; however, we identified 17 unique definitions of hypotension. TnECHO centers were likelier to trend systolic/diastolic blood pressure and request earlier echocardiography. TnECHO responders were less likely to use fluid boluses; TnECHO responders more commonly chose an inotrope first-line, while non-TnECHO centers used a vasopressor. For HRF, TnECHO centers chose vasopressors with a favorable pulmonary vascular profile. Non-TnECHO centers used more dopamine and more extracorporeal membrane oxygen for patients with HRF. CONCLUSIONS Cardiovascular practices in neonates with HIE differ between centers with and without TnECHO. Consensus regarding the definition of hypotension is lacking and dopamine use is common. The merits of these practices among these patients, who frequently have comorbid pulmonary hypertension and RV dysfunction, need prospective evaluation. IMPACT Cardiovascular care following HIE while undergoing therapeutic hypothermia varies between centers with access to trained hemodynamics specialists and those without. Because cardiovascular dysfunction is associated with brain injury, precision medicine-based care may be an avenue to improving outcomes. Therapeutic hypothermia has introduced new physiological considerations and enhanced survival. It is essential that hemodynamic strategies evolve to keep pace; however, little literature exists. Lack of consensus regarding fundamental definitions (e.g., hypotension) highlights the importance of collaboration among the scientific community to advance the field. The value of enhanced cardiovascular care guided by hemodynamic specialists requires prospective evaluation.
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Abstract
OBJECTIVE The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity. METHODS Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used. RESULTS Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS. CONCLUSIONS Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.
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Michniewicz B, Szpecht D, Sowińska A, Sibiak R, Szymankiewicz M, Gadzinowski J. Biomarkers in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. Childs Nerv Syst 2020; 36:2981-2988. [PMID: 32367165 PMCID: PMC7649177 DOI: 10.1007/s00381-020-04645-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the presented study was to evaluate the differences between selected biochemical markers in infants with moderate or severe hypoxic-ischemic encephalopathy (HIE) and their impact on patient prognosis. METHODS A total of 57 cooled newborns were divided into groups according to Sarnat staging of HIE (A, moderate vs. B, severe). The differences between groups were evaluated depending on the mode of delivery, pregnancy and labor complications, gestational age at birth, birth weight, and Apgar score at 1.3 and 5 min. The differences in biochemical biomarkers of HIE (pH, base excess, serum lactate) as well as biomarkers of hepatic injury (aspartate transaminase, (AST), alanine transaminase (ALT), prothrombin time (PT), and activated partial thromboplastin time (APTT)), kidney failure (creatinine, urea), myocardial injury (troponin T (TnT)), levels of fibrinogen, and platelet counts were also examined. Univariate Kaplan-Meier method was used for survival analyses. RESULTS The biomarker levels in severe HIE newborns compared with moderate were as follows: pH (7.10 vs. 6.99), serum lactate (22.50 vs. 17.00 mg/dL), AST (109.50 vs. 270.55 IU/L), ALT (27.30 vs. 108.05 IU/L), PT (17.00 vs. 44.20 s), APTT (47.75 vs. 47.90 s), TnT (0.22 vs. 0.85 ng/mL), creatinine (0.68 vs. 1.15 mg/dL), urea (44.55 vs. 73.30 mg/dL), and fibrinogen (1.65 vs. 1.90 mg/dL). Survival analyses showed significantly reduced survival for severe HIE infants (75%) vs. moderate HIE (100%). CONCLUSION In conclusion, the severity of HIE can be evaluated based on selected markers; however, their levels do not correspond with future prognosis of newborns.
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Affiliation(s)
- Barbara Michniewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Sibiak
- Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Szymankiewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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A wireless, skin-interfaced biosensor for cerebral hemodynamic monitoring in pediatric care. Proc Natl Acad Sci U S A 2020; 117:31674-31684. [PMID: 33257558 PMCID: PMC7749320 DOI: 10.1073/pnas.2019786117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The standard of clinical care in many pediatric and neonatal neurocritical care units involves continuous monitoring of cerebral hemodynamics using hard-wired devices that physically adhere to the skin and connect to base stations that commonly mount on an adjacent wall or stand. Risks of iatrogenic skin injuries associated with adhesives that bond such systems to the skin and entanglements of the patients and/or the healthcare professionals with the wires can impede clinical procedures and natural movements that are critical to the care, development, and recovery of pediatric patients. This paper presents a wireless, miniaturized, and mechanically soft, flexible device that supports measurements quantitatively comparable to existing clinical standards. The system features a multiphotodiode array and pair of light-emitting diodes for simultaneous monitoring of systemic and cerebral hemodynamics, with ability to measure cerebral oxygenation, heart rate, peripheral oxygenation, and potentially cerebral pulse pressure and vascular tone, through the utilization of multiwavelength reflectance-mode photoplethysmography and functional near-infrared spectroscopy. Monte Carlo optical simulations define the tissue-probing depths for source-detector distances and operating wavelengths of these systems using magnetic resonance images of the head of a representative pediatric patient to define the relevant geometries. Clinical studies on pediatric subjects with and without congenital central hypoventilation syndrome validate the feasibility for using this system in operating hospitals and define its advantages relative to established technologies. This platform has the potential to substantially enhance the quality of pediatric care across a wide range of conditions and use scenarios, not only in advanced hospital settings but also in clinics of lower- and middle-income countries.
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Hagag AA, El Frargy MS, Abd El-Latif AE. Study of Cord Blood Erythropoietin, Leptin and Adiponectin Levels in Neonates with Hypoxic Ischemic Encephalopathy. Endocr Metab Immune Disord Drug Targets 2020; 20:213-220. [PMID: 31345155 DOI: 10.2174/1871530319666190725110619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/20/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypoxic ischemic encephalopathy (HIE) is a serious condition which results in neonatal morbidity and mortality. Early prediction of HIE especially in the first six hours of birth leads to early treatment with better prognosis. AIM The aim of this study was to compare the concentrations of leptin, adiponectin, and erythropoietin between normal neonates and those with HIE for the possible use of these markers for assessment of the degree of HIE and as markers for early prediction of HIE. PATIENTS AND METHODS This study was carried out on 50 appropriate for gestational age (AGA) neonates with HIE born in Tanta University Hospital during the period from June 2016 to March 2018 (Group I). This study also included 50 appropriate for gestational age (AGA) normal neonates not suffering from any complications and matched with group I in age and sex as a control group (Group II). For all neonates in both groups, the following were done: Complete prenatal, natal, and postnatal history, assessment of APGAR score at 5 and 10 minutes, complete clinical examination with special account on clinical evidence of encephalopathy including hypotonia, abnormal oculomotor or pupillary movements, weak or absent suckling, apnea, hyperpnea, or seizures, measurement of cord blood gases and measurement of serum erythropoietin, leptin and adiponectin levels by ELISA immediately after birth. RESULTS There were no significant differences between Group I and Group II regarding gestational age, male to female ratio, mode of delivery, and weight while there were significant differences regarding Apgar score at 1 and 5 minutes with significantly lower Apgar score at 1 and 5 minutes in group I compared with Group II. There were significantly lower cord blood PH and adiponectin level and significantly higher cord blood Leptin and erythropoietin in group I compared with group II. There were significant differences between cord blood adiponectin, leptin, erythropoietin, and PH in different degrees of HIE with significantly lower cord blood adiponectin and PH and significantly higher cord blood leptin and erythropoietin in severe degree of hypoxia compared with moderate degree and in moderate degree compared with mild degree of hypoxia. There was a significant positive correlation between cord blood erythropoietin and leptin and a significant negative correlation between cord blood erythropoietin and both adiponectin and PH in studied neonates with hypoxia. ROC curve showed that EPO had the best sensitivity and specificity followed by leptin then adiponectin while the PH had the least sensitivity and specificity as early predictors of hypoxic neonates. CONCLUSION AND RECOMMENDATIONS Neonates with HIE had lower cord blood PH and adiponectin levels and higher leptin and erythropoietin levels than normal healthy neonates at birth and during the early postnatal period. The significant differences between cord blood erythropoietin, leptin, and adiponectin between neonates with hypoxia compared with normal neonates may arouse our attention about the use of these markers in the cord blood as early predictors of neonatal HIE which can lead early treatment and subsequently better prognosis.
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Affiliation(s)
- Adel A Hagag
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Mohamed S El Frargy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Amal E Abd El-Latif
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Michniewicz B, Al Saad SR, Karbowski LM, Gadzinowski J, Szymankiewicz M, Szpecht D. Organ Complications of Infants with Hypoxic Ischemic Encephalopathy Before Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2020; 11:58-63. [PMID: 33155883 DOI: 10.1089/ther.2020.0035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) is a serious neurological complication that may develop in asphyxiated infants. Severity of encephalopathy may vary, and concurrent multiorgan dysfunctions are commonly observed. Analyzing the incidence of such complications according to severity of HIE, and how they correlate with each other, may shape clinical judgment and allow for early intervention. The study included a total of 57 HIE infants, in which 27/57 (47.37%) met Sarnat inclusion criteria for moderate stage II HIE (Group A) and 30/57 (52.63%) for severe stage III HIE (Group B). Both groups were assessed and compared for incidence of kidney dysfunction, liver dysfunction, coagulopathy, qualitative cardiac abnormalities, respiratory-related dysfunction, and bone marrow insufficiency/thrombocytopenia. All assessments were performed before initiation of therapeutic hypothermia. The complications were further assessed for the presence of correlations. Group B experienced significantly higher incidence of kidney dysfunction (A: 2/27 [7.4%] vs. B: 21/30 [70%], p < 0.001), liver dysfunction (A: 14/27 [51.8%] vs. B: 28/30 [93.3%], p < 0.001), and thrombocytopenia (A: 8/27 [29.6%] vs. B 21/30 [70%], p = 0.002) in our study group. Kidney dysfunction and bone marrow insufficiency showed the highest affiliation with other organ systems in both groups, correlating positively with each other as well as HIE severity, cardiac abnormalities, liver dysfunction, and infant death. A total of 8/57 (14%) infant deaths were observed, all originating from grade III severe HIE group (p = 0.003). Multiorgan dysfunction showed a significant difference between HIE severity (A: 12/27 [44.4%] vs. B: 28/30 [93.3%], p < 0.001). A positive correlation was obtained between multiorgan dysfunction, HIE severity, and infant death. Stage III HIE infants are more likely to experience abnormalities in the kidneys, liver, bone marrow as compared with stage II HIE infants. Correlations between organ complications are present, and should be taken into account during clinical assessment of HIE infants. The probability of mortality is higher in stage III HIE infants with observed multiorgan dysfunctions.
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Affiliation(s)
- Barbara Michniewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Salwan R Al Saad
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz M Karbowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Szymankiewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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Al Amrani F, Racine E, Shevell M, Wintermark P. Death after Birth Asphyxia in the Cooling Era. J Pediatr 2020; 226:289-293. [PMID: 32682749 DOI: 10.1016/j.jpeds.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
In asphyxiated newborn infants treated with hypothermia, 31 of 50 (62%) deaths occurred in unstable infants electively extubated before completing hypothermia treatment. Later deaths occurred after consultation with palliative care (13/19) or clinical ethics (6/19) services, suggesting these decisions were challenging and required support, particularly if nutrition and hydration were withdrawn (n = 4).
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Affiliation(s)
- Fatema Al Amrani
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Eric Racine
- Department of Medicine and Social and Preventive Medicine, University of Montreal, Montreal, Canada; Department of Neurology and Neurosurgery and Medicine, and Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - Michael Shevell
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
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Hurley T, O'Dea M, Aslam S, Aly H, Robertson N, Molloy E. Melatonin treatment for newborns with hypoxic ischaemic encephalopathy. Hippokratia 2020. [DOI: 10.1002/14651858.cd013754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tim Hurley
- Department of Paediatrics; Trinity College Dublin; Dublin Ireland
| | - Mary O'Dea
- Paediatric and Child Health; Trinity College Dublin; Dublin Ireland
| | - Saima Aslam
- Neonatology; National Maternity Hospital; Dublin Ireland
| | - Hany Aly
- Neonatology; Cleveland Clinic Children’s Hospital; Cleveland OH USA
| | - Nikki Robertson
- Obstetrics and Gynaecology; University College London; London UK
| | - Eleanor Molloy
- Paediatric and Child Health; Trinity College Dublin; Dublin Ireland
- Department of Paediatrics; The National Children’s Hospital, Tallaght; Dublin Ireland
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Cerebral blood flow velocity and oxygenation correlate predominantly with right ventricular function in cooled neonates with moderate-severe hypoxic-ischemic encephalopathy. Eur J Pediatr 2020; 179:1609-1618. [PMID: 32367328 DOI: 10.1007/s00431-020-03657-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
The relationship between right ventricular (RV) function and cerebral blood flow (CBF) velocity and cerebral oxygenation was assessed in neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Echocardiographic, transcranial Doppler, and hemodynamic data from 37 neonates with moderate-severe HIE + TH were reviewed. Twenty healthy newborns served as controls. Cardiac dysfunction in HIE + TH was characterized by a predominant RV dysfunction, with concomitantly reduced CBF velocity. A significant correlation was found between CBF velocity and tricuspid annular plane systolic excursion (TAPSE), RV output (RVO), and stroke volume (SVRV), as well as with left ventricular output and stroke volume. Brain oxygenation (rSO2) correlated significantly with RVO, SVRV, TAPSE, ejection fraction, and fractional shortening, whereas cerebral fractional tissue oxygen extraction (FTOEc) correlated with RVO, SVRV, RV myocardial performance index, and superior vena cava flow. CBF velocity and cerebral NIRS correlations were stronger with parameters of right ventricular performance.Conclusion: CBF velocity and brain oxygenation correlate predominantly with RV function in HIE + TH. This suggests a preferential contribution of RV performance to cerebral hemodynamics in this context. What is Known: • Neonates with hypoxic ischemic encephalopathy frequently exhibit alterations of cardiac function and cerebral blood flow. • These are considered organ-specific consequences of perinatal asphyxia. What is New: • We show that cerebral blood flow velocity and brain oxygenation are correlated predominantly with right ventricular function during therapeutic hypothermia. • This suggests a potential direct contribution of right ventricular performance to cerebral hemodynamics in this context.
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Pang R, Mintoft A, Crowley R, Sellwood M, Mitra S, Robertson NJ. Optimizing hemodynamic care in neonatal encephalopathy. Semin Fetal Neonatal Med 2020; 25:101139. [PMID: 33223016 DOI: 10.1016/j.siny.2020.101139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hemodynamic impairment occurs in up to 80% of infants with neonatal encephalopathy (NE). Not all infants benefit from therapeutic hypothermia (HT); there are some indications that the trajectory of brain injury might be modified by neurologic monitoring and early management over the first 72-h period. It is also possible that optimizing hemodynamic management may further improve outomes. The coupling between cerebral blood flow and cerebral metabolism is disrupted in NE, increasing the vulnerability of the newborn brain to secondary injury. Hemodynamic monitoring is usually limited to blood pressure and functional echocardiographic measurements, which may not accurately reflect brain perfusion. This review explores the evidence base for hemodynamic assessment and management of infants with NE while undergoing HT. We discuss the literature behind a systematic approach to a baby with NE with the aim to define best therapies to optimize brain perfusion and reduce secondary injury.
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Affiliation(s)
- Raymand Pang
- Institute for Women's Health, University College London, London, UK
| | - Alison Mintoft
- Institute for Women's Health, University College London, London, UK
| | - Rose Crowley
- Department of Neonatology, University College London Hospital, London, UK
| | - Mark Sellwood
- Department of Neonatology, University College London Hospital, London, UK
| | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, UK
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