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Vega-del-Val C, Arnaez J, Ochoa-Sangrador C, Garrido-Barbero M, García-Alix A. Incidence of encephalopathy and comorbidity in infants with perinatal asphyxia: a comparative prospective cohort study. Front Pediatr 2024; 12:1363576. [PMID: 38601274 PMCID: PMC11004398 DOI: 10.3389/fped.2024.1363576] [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: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Programs that aim to improve the detection hypoxic-ischemic encephalopathy (HIE) should establish which neonates suffering from perinatal asphyxia need to be monitored within the first 6 h of life. Method An observational prospective cohort study of infants with gestational age ≥35 weeks, and above 1,800g, were included according to their arterial cord pH value (ApH): ≤7.00 vs. 7.01-7.10. Data was collected including obstetrical history, as well as neonatal comorbidities, including the presence of HIE, that happened within 6 h of life. A standardized neurological exam was performed at discharge. Results There were 9,537 births; 176 infants with ApH 7.01-7.10 and 117 infants with ApH ≤7.00. All 9 cases with moderate-to-severe HIE occurred among infants with ApH ≤7.00. The incidence of global and moderate-severe HIE was 3/1,000 and 1/1,000 births, respectively. Outcome at discharge (abnormal exam or death) showed an OR 12.03 (95% CI 1.53, 94.96) in infants with ApH ≤7.00 compared to ApH 7.01-7.10 cohort. Ventilation support was 5.1 times (95% CI 2.87, 9.03) more likely to be needed by those with cord ApH ≤7.00 compared to those with ApH 7.01-7.10, as well as hypoglycemia (37% vs. 25%; p = 0.026). In 55%, hypoglycemia occurred despite oral and/or intravenous glucose administration had been already initiated. Conclusions Cord pH 7.00 might be a safe pH cut-off point when developing protocols to monitor infants born with acidemia in order to identify infants with moderate or severe HIE early on. There is non-negligible comorbidity in the ApH ≤7.00 cohort, but also in the 7.01-7.10 cohort.
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Affiliation(s)
| | - Juan Arnaez
- Neonatology Unit, Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
| | - Carlos Ochoa-Sangrador
- Department of Investigation Unit, Hospital Virgen de la Concha, Zamora, Spain
- Ciencias de la Salud, Escuela Universitaria de Enfermería, Zamora, Spain
| | | | - Alfredo García-Alix
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
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2
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Redpath S, Moore H, Sucha E, Agarwal A, Barrowman N, Lemyre B, St. Germain L. Therapeutic Hypothermia on Transport: The Quest for Efficiency: Results of a Quality Improvement Project. Pediatr Qual Saf 2022; 7:e556. [PMID: 35720863 PMCID: PMC9197372 DOI: 10.1097/pq9.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
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3
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Chevin M, Chabrier S, Dinomais M, Bedell BJ, Sébire G. Benefits of hypothermia in neonatal arterial ischemic strokes: A preclinical study. Int J Dev Neurosci 2020; 80:257-266. [PMID: 32115740 DOI: 10.1002/jdn.10022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is currently no targeted treatment available for neonatal arterial ischemic strokes (NAIS). Epidemiological studies demonstrated that perinatal infection/inflammation, peripartum hypoxia, and occlusion of the internal carotid tree are the main determinants of NAIS. The well-established benefit of therapeutic hypothermia (HT) in neonatal encephalopathy due to diffuse hypoxia-ischemia provides a rationale for the potential use of HT as a neuroprotective strategy in NAIS. METHODS We used a rat model to reproduce the most prevalent human physiopathological scenario of NAIS. The neuroprotective effect of HT was measured by morphometric magnetic resonance imaging, [18 F] fluorodeoxyglucose (FDG) metabolic activity by positron emission tomography/computed tomography, and behavioral tests. RESULTS HT (a) prevented the occurrence of 44% of NAIS, (b) reduced the volume of strokes by 37%, (c) enhanced [18 F] FDG metabolic activity within the territory of the occluded carotid artery, and (d) improved motor behavior. Both morphometric and metabolic techniques showed consistently that HT provided a neuroprotective effect located in the motor cortex, hippocampus, and caudate-putamen. CONCLUSION Through combining anatomical, metabolic imaging, and behavioral studies, our study provides evidence of neuroprotective effects of HT in NAIS. These results are potentially translational to human NAIS.
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Affiliation(s)
- Mathilde Chevin
- Department of Pediatrics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Stéphane Chabrier
- Department of Pediatrics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.,Centre national de référence de l'AVC de l'enfant, CIC1408, CHU Saint-Étienne, INSERM, Saint-Étienne, France.,INSERM, Université Saint-Étienne, Université Lyon, UMR1059 Sainbiose, Saint-Étienne, France
| | - Mickaël Dinomais
- Département de Médecine Physique et de Réadaptation, Centre National de référence de l'AVC de l'enfant, CHU Angers, Université d'Angers, Angers, France.,Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, Université d'Angers, Angers, France
| | - Barry J Bedell
- Department of Neurology and Neurosurgery, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Guillaume Sébire
- Department of Pediatrics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
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4
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Gupta N, Shipley L, Goel N, Browning Carmo K, Leslie A, Sharkey D. Neurocritical care of high-risk infants during inter-hospital transport. Acta Paediatr 2019; 108:1965-1971. [PMID: 31321815 DOI: 10.1111/apa.14940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022]
Abstract
The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high-risk neonates when in-utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high-risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter-hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams.
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Affiliation(s)
- Neelam Gupta
- University of Southampton Southampton UK
- Wessex Southampton Oxford Neonatal Transport (SONeT) & Neonatal Intensive Care Services University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Lara Shipley
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
| | - Nitin Goel
- Neonatal Intensive Care Unit University Hospital of Wales Cardiff Wales UK
| | - Kathryn Browning Carmo
- Faculty of Medicine and Healthcare University of Sydney Sydney NSW Australia
- Grace Centre for Newborn Intensive Care Children's Hospital at WestmeadSCHN and NETS NSW Sydney NSW Australia
| | - Andrew Leslie
- CenTre Neonatal Transport Service University Hospitals of Leicester NHS Trust Leicester UK
| | - Don Sharkey
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
- CenTre Neonatal Transport Service Nottingham University Hospitals NHS Trust Nottingham UK
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5
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Prevention of excessive hypothermia in infants with hypoxic ischemic encephalopathy prior to admission to a quaternary care center: a neonatal outreach educational project. J Perinatol 2019; 39:1417-1427. [PMID: 31092886 DOI: 10.1038/s41372-019-0391-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Excessive hypothermia is common in infants that receive passive cooling for hypoxic ischemic encephalopathy (HIE). Our goal was to reduce the number of infants with admission temperature <33 °C from 33% to less than 10% by December 2017. METHODS Outcome measures included the number of infants with admission temperature <33 °C and number of infants with temperature within therapeutic range. Interventions included implementation of passive cooling guidelines and outreach education to birth hospitals and transport team. We used statistical process control chart to compare outcomes over a 3 year period. RESULTS The number of infants with admission temperature <33 °C decreased from 33.3% to 5.5% (p = 0.013). The number of infants with admission temperature within target range for hypothermia therapy increased from 61.1% to 77.7% (p = 0.014). Balancing measures and complications remained unchanged. CONCLUSION Implementation of passive cooling guidelines and outreach education led to significant decrease in excessive hypothermia in infants with HIE.
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6
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Bingham A, Laptook AR. Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Herrera TI, Edwards L, Malcolm WF, Smith PB, Fisher KA, Pizoli C, Gustafson KE, Goldstein RF, Cotten CM, Goldberg RN, Bidegain M. Outcomes of preterm infants treated with hypothermia for hypoxic-ischemic encephalopathy. Early Hum Dev 2018; 125:1-7. [PMID: 30144709 DOI: 10.1016/j.earlhumdev.2018.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and efficacy in preterm infants are scarce. OBJECTIVE Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia. METHODS A retrospective cohort analysis of all preterm infants <36 weeks' gestation with HIE who received whole body hypothermia in a single center from January 2007 to April 2015. The primary outcome was death or moderate to severe NDI defined by moderate or severe cerebral palsy, severe hearing or visual impairment, or cognitive score < 85 on the Bayley Scales of Infant Development III (BSID III) at 18-24 months' adjusted age. RESULTS 30 infants with a median gestational age and birthweight of 35 weeks' (range; 33-35) and 2575 g (1850-4840) and a median first postnatal blood pH of 6.81 (6.58-7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54-110), 83 (46-118), and 78 (46-112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes. CONCLUSION Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.
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Affiliation(s)
- Tamara I Herrera
- Servicio de Recién Nacidos del Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Laura Edwards
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - William F Malcolm
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - P Brian Smith
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America
| | - Kimberley A Fisher
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - Carolyn Pizoli
- Division of Pediatric Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathryn E Gustafson
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - Ricki F Goldstein
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - C Michael Cotten
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - Ronald N Goldberg
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America
| | - Margarita Bidegain
- Division of Neonatology, Duke University School of Medicine, Durham, NC, United States of America.
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8
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Piastra M, De Luca D, Genovese O, Tosi F, Caliandro F, Zorzi G, Massimi L, Visconti F, Pizza A, Biasucci DG, Conti G. Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience. J Intensive Care Med 2017; 34:1003-1009. [PMID: 28847237 DOI: 10.1177/0885066617726049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH. METHODS Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable. RESULTS Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift (P = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors (P = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series. CONCLUSION The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele De Luca
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Neonatal and Pediatric Intensive Care, Paris Sud Hospital, Paris, France
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Federica Tosi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Pediatric Neuroanesthesiology, Emergency Department Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Francesca Caliandro
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giulia Zorzi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, "A. Gemelli" Teaching Hospital, Catholic University Medical School, Rome, Italy
| | - Federico Visconti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Alessandro Pizza
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele G Biasucci
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
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9
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Hypothermia Prevents Retinal Damage Generated by Optic Nerve Trauma in the Rat. Sci Rep 2017; 7:6966. [PMID: 28761115 PMCID: PMC5537267 DOI: 10.1038/s41598-017-07294-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/26/2017] [Indexed: 11/11/2022] Open
Abstract
Ocular and periocular traumatisms may result in loss of vision. Hypothermia provides a beneficial intervention for brain and heart conditions and, here, we study whether hypothermia can prevent retinal damage caused by traumatic neuropathy. Intraorbital optic nerve crush (IONC) or sham manipulation was applied to male rats. Some animals were subjected to hypothermia (8 °C) for 3 h following surgery. Thirty days later, animals were subjected to electroretinography and behavioral tests. IONC treatment resulted in amplitude reduction of the b-wave and oscillatory potentials of the electroretinogram, whereas the hypothermic treatment significantly (p < 0.05) reversed this process. Using a descending method of limits in a two-choice visual task apparatus, we demonstrated that hypothermia significantly (p < 0.001) preserved visual acuity. Furthermore, IONC-treated rats had a lower (p < 0.0001) number of retinal ganglion cells and a higher (p < 0.0001) number of TUNEL-positive cells than sham-operated controls. These numbers were significantly (p < 0.0001) corrected by hypothermic treatment. There was a significant (p < 0.001) increase of RNA-binding motif protein 3 (RBM3) and of BCL2 (p < 0.01) mRNA expression in the eyes exposed to hypothermia. In conclusion, hypothermia constitutes an efficacious treatment for traumatic vision-impairing conditions, and the cold-shock protein pathway may be involved in mediating the beneficial effects shown in the retina.
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10
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Dukhovny D, Zupancic JAF. Longer and deeper cooling for hypoxic ischemic encephalopathy in neonates does not reduce mortality. Acta Paediatr 2017; 106:1200. [PMID: 28295535 DOI: 10.1111/apa.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - John A. F. Zupancic
- Harvard Medical School; Boston MA USA
- Beth Israel Deaconess Medical Center; Boston MA USA
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11
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Manley BJ, Owen LS, Hooper SB, Jacobs SE, Cheong JLY, Doyle LW, Davis PG. Towards evidence-based resuscitation of the newborn infant. Lancet 2017; 389:1639-1648. [PMID: 28443558 DOI: 10.1016/s0140-6736(17)30547-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 01/07/2023]
Abstract
Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials.
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Affiliation(s)
- Brett J Manley
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Louise S Owen
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC Australia
| | - Susan E Jacobs
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Peter G Davis
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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12
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Tsuda K, Mukai T, Iwata S, Shibasaki J, Tokuhisa T, Ioroi T, Sano H, Yutaka N, Takahashi A, Takeuchi A, Takenouchi T, Araki Y, Sobajima H, Tamura M, Hosono S, Nabetani M, Iwata O. Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan. Sci Rep 2017; 7:39508. [PMID: 28051172 PMCID: PMC5209702 DOI: 10.1038/srep39508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/22/2016] [Indexed: 01/14/2023] Open
Abstract
Therapeutic hypothermia is recommended for moderate and severe neonatal encephalopathy, but is being applied to a wider range of neonates than originally envisaged. To examine the clinical use of therapeutic hypothermia, data collected during the first 3 years (2012-2014) of the Baby Cooling Registry of Japan were analysed. Of 485 cooled neonates, 96.5% were ≥36 weeks gestation and 99.4% weighed ≥1,800 g. Severe acidosis (pH < 7 or base deficit ≥16 mmol/L) was present in 68.9%, and 96.7% required resuscitation for >10 min. Stage II/III encephalopathy was evident in 88.3%; hypotonia, seizures and abnormal amplitude-integrated electroencephalogram were observed in the majority of the remainder. In-hospital mortality was 2.7%; 90.7% were discharged home. Apgar scores and severity of acidosis/encephalopathy did not change over time. The time to reach the target temperature was shorter in 2014 than in 2012. The proportion undergoing whole-body cooling rose from 45.4% to 81.6%, while selective head cooling fell over time. Mortality, duration of mechanical ventilation and requirement for tube feeding at discharge remained unchanged. Adherence to standard cooling protocols was high throughout, with a consistent trend towards cooling being achieved more promptly. The mortality rate of cooled neonates was considerably lower than that reported in previous studies.
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Affiliation(s)
- Kennosuke Tsuda
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeo Mukai
- Center for Advanced Medical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Sachiko Iwata
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.,Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Fukuoka, Japan
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Takuya Tokuhisa
- Division of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Perinatal Medical Center, Himeji Red Cross Hospital, Hyogo, Japan
| | - Hiroyuki Sano
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Toshiki Takenouchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Araki
- Faculty of Informatics, Shizuoka University, Shizuoka, Japan
| | - Hisanori Sobajima
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masanori Tamura
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigeharu Hosono
- Division of Neonatology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Osuke Iwata
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.,Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Fukuoka, Japan
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13
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Abstract
Birth asphyxia, also termed perinatal hypoxia-ischemia, is a modifiable condition as evidenced by improved outcomes of infants ≥36 weeks' gestation provided hypothermia treatment in randomized trials. Preterm animal models of asphyxia in utero demonstrate that hypothermia can provide short-term neuroprotection for the developing brain, supporting the interest in extending therapeutic hypothermia to preterm infants. This review focuses on the challenge of identifying preterm infants with perinatal asphyxia; the neuropathology of hypoxic-ischemic brain injury across extreme, moderate, and late preterm infants; and patterns of brain injury, use of therapeutic hypothermia, and approach to patient selection for neuroprotective treatments among preterm infants.
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Affiliation(s)
- Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA.
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Larrayoz IM, Rey-Funes M, Contartese DS, Rolón F, Sarotto A, Dorfman VB, Loidl CF, Martínez A. Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures. PLoS One 2016; 11:e0161458. [PMID: 27556928 PMCID: PMC4996528 DOI: 10.1371/journal.pone.0161458] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/05/2016] [Indexed: 12/05/2022] Open
Abstract
Hypothermia has been proposed as a therapeutic intervention for some retinal conditions, including ischemic insults. Cold exposure elevates expression of cold-shock proteins (CSP), including RNA-binding motif protein 3 (RBM3) and cold inducible RNA-binding protein (CIRP), but their presence in mammalian retina is so far unknown. Here we show the effects of hypothermia on the expression of these CSPs in retina-derived cell lines and in the retina of newborn and adult rats. Two cell lines of retinal origin, R28 and mRPE, were exposed to 32°C for different time periods and CSP expression was measured by qRT-PCR and Western blotting. Neonatal and adult Sprague-Dawley rats were exposed to a cold environment (8°C) and expression of CSPs in their retinas was studied by Western blotting, multiple inmunofluorescence, and confocal microscopy. RBM3 expression was upregulated by cold in both R28 and mRPE cells in a time-dependent fashion. On the other hand, CIRP was upregulated in R28 cells but not in mRPE. In vivo, expression of CSPs was negligible in the retina of newborn and adult rats kept at room temperature (24°C). Exposure to a cold environment elicited a strong expression of both proteins, especially in retinal pigment epithelium cells, photoreceptors, bipolar, amacrine and horizontal cells, Müller cells, and ganglion cells. In conclusion, CSP expression rapidly rises in the mammalian retina following exposure to hypothermia in a cell type-specific pattern. This observation may be at the basis of the molecular mechanism by which hypothermia exerts its therapeutic effects in the retina.
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Affiliation(s)
- Ignacio M. Larrayoz
- Angiogenesis Study Group, Center for Biomedical Research of La Rioja (CIBIR), 26006, Logroño, Spain
- * E-mail:
| | - Manuel Rey-Funes
- Laboratorio de Neuropatología Experimental, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), Facultad de Medicina, Universidad de Buenos Aires, CONICET, Paraguay 2155 (C1428ABG), Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniela S. Contartese
- Laboratorio de Neuropatología Experimental, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), Facultad de Medicina, Universidad de Buenos Aires, CONICET, Paraguay 2155 (C1428ABG), Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Rolón
- Laboratorio de Neuropatología Experimental, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), Facultad de Medicina, Universidad de Buenos Aires, CONICET, Paraguay 2155 (C1428ABG), Ciudad Autónoma de Buenos Aires, Argentina
| | - Anibal Sarotto
- Laboratorio de Neuropatología Experimental, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), Facultad de Medicina, Universidad de Buenos Aires, CONICET, Paraguay 2155 (C1428ABG), Ciudad Autónoma de Buenos Aires, Argentina
| | - Veronica B. Dorfman
- Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y Diagnóstico (CEBBAD), Universidad Maimónides, Hidalgo 775 (C1405BCK), Ciudad Autónoma de Buenos Aires, Argentina
| | - Cesar F. Loidl
- Laboratorio de Neuropatología Experimental, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), Facultad de Medicina, Universidad de Buenos Aires, CONICET, Paraguay 2155 (C1428ABG), Ciudad Autónoma de Buenos Aires, Argentina
- Laboratorio de Neurociencia, Facultad de Ciencias Médicas, Universidad Católica de Cuyo. San Juan, Argentina
| | - Alfredo Martínez
- Angiogenesis Study Group, Center for Biomedical Research of La Rioja (CIBIR), 26006, Logroño, Spain
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Celik Y, Atıcı A, Gulası S, Okuyaz C, Makharoblıdze K, Sungur MA. Comparison of selective head cooling versus whole-body cooling. Pediatr Int 2016; 58:27-33. [PMID: 26189647 DOI: 10.1111/ped.12747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/11/2015] [Accepted: 06/09/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study compared selective head cooling (SHC) and whole-body cooling (WBC) in newborns with hypoxic-ischemic encephalopathy (HIE). METHODS We conducted a prospective randomized small-scale pilot study in newborns with HIE, born after >35 weeks of gestation. The patients were randomly assigned to receive SHC or WBC. RESULTS The SHC group consisted of 17 patients, and the WBC group, 12 patients. There was no significant difference in adverse effects related to cooling therapy between the two groups. During the 12 month study period, seven patients in the SHC group and four in the WBC group died, but the difference was not significant (P = 0.667). Among the patients alive at 12 months after treatment, six in the SHC group and four in the WBC group had severe disabilities; the difference was not significant (P = 0.671). When the composite outcome of death or severe disability was evaluated, the difference between the SHC group (77%, n = 13) and the WBC group (67%, n = 8) was not significant (P = 0.562). Moreover, the number of survivors without disability at 12 months after treatment did not differ significantly between the SHC group (n = 3) and the WBC group (n = 4; P = 0.614). CONCLUSIONS There were no significant differences in adverse effects, 12 month neuromotor development, or mortality rate between SHC and WBC in newborns with HIE, born after >35 weeks of gestation.
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Affiliation(s)
- Yalcın Celik
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Aytug Atıcı
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Selvi Gulası
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Khatuna Makharoblıdze
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, School of Medicine, Mersin University, Mersin, Turkey
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Çelik Y, Atıcı A, Gülaşı S, Makharoblıdze K, Eskandari G, Sungur MA, Akbayır S. The effects of selective head cooling versus whole-body cooling on some neural and inflammatory biomarkers: a randomized controlled pilot study. Ital J Pediatr 2015; 41:79. [PMID: 26472263 PMCID: PMC4608056 DOI: 10.1186/s13052-015-0188-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023] Open
Abstract
Background Therapeutic hypothermia (TH) has become standard care in newborns with moderate to severe hypoxic ischemic encephalopathy (HIE), and the 2 most commonly used methods are selective head cooling (SHC) and whole body cooling (WBC). This study aimed to determine if the effects of the 2 methods on some neural and inflammatory biomarkers differ. Materials and methods This prospective randomized pilot study included newborns delivered after >36 weeks of gestation. SHC or WBC was administered randomly to newborns with moderate to severe HIE that were prescribed TH. The serum interleukin (IL)-1β, IL-6, neuron-specific enolase (NSE), brain-specific creatine kinase (CK-BB), tumor necrosis factor-alpha (TNF-α), and protein S100 levels, the urine S100B level, and the urine lactate/creatinine (L/C) ratio were evaluated 6 and 72 h after birth. The Bayley Scales of Infant and Toddler Development-III was administered at month 12 for assessment of neurodevelopmental findings. Results The SHC group included 14 newborns, the WBC group included 10, the mild HIE group included 7, and the control group included 9. All the biomarker levels in the SHC and WBC groups at 6 and 72 h were similar, and all the changes in the biomarker levels between 6 and 72 h were similar in both groups. The serum IL-6 and protein S100 levels at 6 h in the SHC and WBC groups were significantly higher than in the control group. The urine L/C ratio at 6 h in the SHC and WBC groups was significantly higher than in the mild HIE and control groups. The IL-6 level and L/C ratio at 6 and 72 h in the patients that had died or had disability at month 12 were significantly higher than in the patients without disability at month 12. Conclusion The effects of SHC and WBC on the biomarkers evaluated did not differ. The urine L/C ratio might be useful for differentiating newborns with moderate and severe HIE from those with mild HIE. Furthermore, the serum IL-6 level and the L/C ratio might be useful for predicting disability and mortality in newborns with HIE.
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Affiliation(s)
- Yalçın Çelik
- Mersin University School of Medicine, Department of Neonatology Care Unit, 33343, Mersin, Turkey.
| | - Aytuğ Atıcı
- Mersin University Faculty of Medicine, Department of Neonatology, 33343, Mersin, Turkey.
| | - Selvi Gülaşı
- Mersin University School of Medicine, Department of Neonatology, 33343, Mersin, Turkey.
| | - Khatuna Makharoblıdze
- Mersin University Faculty of Medicine, Department of Pediatric Neurology, 33343, Mersin, Turkey.
| | - Gülçin Eskandari
- Mersin University Faculty of Medicine, Department of Biochemistry, 33343, Mersin, Turkey.
| | - Mehmet Ali Sungur
- Mersin University Faculty of Medicine, Department of Biostatistics, 33343, Mersin, Turkey.
| | - Serin Akbayır
- Mersin University Faculty of Medicine, Department of Biochemistry, 33343, Mersin, Turkey.
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Atıcı A, Çelik Y, Gülaşı S, Turhan AH, Okuyaz Ç, Sungur MA. Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: short term results. Turk Arch Pediatr 2015; 50:27-36. [PMID: 26078694 DOI: 10.5152/tpa.2015.2167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022]
Abstract
AIM In this study, it was aimed to investigate which method was superior by applying selective head cooling or whole body cooling therapy in newborns diagnosed with moderate or severe hypoxic ischemic encephalopathy. MATERIALS AND METHOD Newborns above the 35th gestational age diagnosed with moderate or severe hypoxic ischemic encephalopathy were included in the study and selective head cooling or whole body cooling therapy was performed randomly. The newborns who were treated by both methods were compared in terms of adverse effects in the early stage and in terms of short-term results. Ethics committee approval was obtained for the study (06.01.2010/35). RESULTS Fifty three babies diagnosed with hypoxic ischemic encephalopathy were studied. Selective head cooling was applied to 17 babies and whole body cooling was applied to 12 babies. There was no significant difference in terms of adverse effects related to cooling therapy between the two groups. When the short-term results were examined, it was found that the hospitalization time was 34 (7-65) days in the selective head cooling group and 18 (7-57) days in the whole body cooling group and there was no significant difference between the two groups (p=0.097). Four patients in the selective head cooling group and two patients in the whole body cooling group were discharged with tracheostomy because of the need for prolonged mechanical ventilation and there was no difference between the groups in terms of discharge with tracheostomy (p=0.528). Five patients in the selective head cooling group and three patients in the whole body cooling group were discharged with a gastrostomy tube because they could not be fed orally and there was no difference between the groups in terms of discharge with a gastrostomy tube (p=0.586). One patient who was applied selective head cooling and one patient who was applied whole body cooling died during hospitalization and there was no difference between the groups in terms of mortality (p=0.665). CONCLUSIONS There is no difference between the methods of selective head cooling and whole body cooling in terms of adverse effects and short-term results.
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Affiliation(s)
- Aytuğ Atıcı
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yalçın Çelik
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Selvi Gülaşı
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ali Haydar Turhan
- Department of Pediatrics, Division of Neanotology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Çetin Okuyaz
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, Turkey
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5'-adenosine monophosphate-induced hypothermia attenuates brain ischemia/reperfusion injury in a rat model by inhibiting the inflammatory response. Mediators Inflamm 2015; 2015:520745. [PMID: 25873763 PMCID: PMC4385688 DOI: 10.1155/2015/520745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/03/2014] [Accepted: 10/22/2014] [Indexed: 12/24/2022] Open
Abstract
Hypothermia treatment is a promising therapeutic strategy for brain injury. We previously demonstrated that 5′-adenosine monophosphate (5′-AMP), a ribonucleic acid nucleotide, produces reversible deep hypothermia in rats when the ambient temperature is appropriately controlled. Thus, we hypothesized that 5′-AMP-induced hypothermia (AIH) may attenuate brain ischemia/reperfusion injury. Transient cerebral ischemia was induced by using the middle cerebral artery occlusion (MCAO) model in rats. Rats that underwent AIH treatment exhibited a significant reduction in neutrophil elastase infiltration into neuronal cells and matrix metalloproteinase 9 (MMP-9), interleukin-1 receptor (IL-1R), tumor necrosis factor receptor (TNFR), and Toll-like receptor (TLR) protein expression in the infarcted area compared to euthermic controls. AIH treatment also decreased the number of terminal deoxynucleotidyl transferase dUTP nick end labeling- (TUNEL-) positive neuronal cells. The overall infarct volume was significantly smaller in AIH-treated rats, and neurological function was improved. By contrast, rats with ischemic brain injury that were administered 5′-AMP without inducing hypothermia had ischemia/reperfusion injuries similar to those in euthermic controls. Thus, the neuroprotective effects of AIH were primarily related to hypothermia.
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Smit E, Liu X, Jary S, Cowan F, Thoresen M. Cooling neonates who do not fulfil the standard cooling criteria - short- and long-term outcomes. Acta Paediatr 2015; 104:138-45. [PMID: 25164710 DOI: 10.1111/apa.12784] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/20/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
AIM Therapeutic hypothermia is effective and without serious adverse effects in term infants with hypoxic-ischaemic encephalopathy. It is unknown whether other neonatal patient groups could benefit from therapeutic hypothermia. Since 2006, our centre has offered cooling to infants fulfilling the standard cooling criteria, but also to those who did not. METHODS Observational study with prospective data collection over a 6-year period in a regional cooling centre. Complications and outcome were compared between infants who were cooled not fulfilling the standard inclusion and exclusion criteria as set out in the CoolCap/TOBY protocol (n = 36) and infants who fulfilled the standard entry criteria (n = 129). RESULTS 21.8% of cooled infants did not fulfil standard cooling entry criteria. This included infants cooled >6 postnatal hours, late preterm infants, and infants with postnatal collapse, major cranial haemorrhage, congenital cardiac disease and surgical conditions. Complication rates and long-term outcome did not differ significantly between the groups, apart from in infants with a major cranial haemorrhage, who had higher rates of coagulopathy and the worst outcome (80% death/disability). CONCLUSION Cooling can be considered for infants with neonatal encephalopathy following postnatal collapse or preterm birth, those with underlying surgical or cardiac conditions, and infants starting cooling >6 postnatal hours.
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Affiliation(s)
- Elisa Smit
- Department of Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Bristol UK
- Neonatal Intensive Care Unit; St Michaels Hospital; University Hospitals Bristol; Bristol UK
| | - Xun Liu
- Department of Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Bristol UK
| | - Sally Jary
- Department of Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Bristol UK
- Neonatal Intensive Care Unit; St Michaels Hospital; University Hospitals Bristol; Bristol UK
| | - Frances Cowan
- Department of Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Bristol UK
- Institute of Clinical Sciences; Imperial College; London UK
| | - Marianne Thoresen
- Department of Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Bristol UK
- Neonatal Intensive Care Unit; St Michaels Hospital; University Hospitals Bristol; Bristol UK
- Department of Physiology; University of Oslo; Oslo Norway
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Chevallier M, Ego A, Cans C, Debillon T. Adherence to hypothermia guidelines: a French multicenter study of fullterm neonates. PLoS One 2013; 8:e83742. [PMID: 24391817 PMCID: PMC3877096 DOI: 10.1371/journal.pone.0083742] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/07/2013] [Indexed: 11/18/2022] Open
Abstract
AIM The objective of this study was to describe the French practice of hypothermia treatment (HT) in full-term newborns with hypoxic-ischemic encephalopathy (HIE) and to analyze the deviations from the guidelines of the French Society of Neonatology. MATERIALS AND METHODS From May 2010 to March 2012 we recorded all cases of HIE treated by HT in a French national database. The population was divided into three groups, "optimal HT" (OHT), "late HT" (LHT) and "non-indicated" HT (NIHT), according to the guidelines. RESULTS Of the 311 newborns registered in the database and having HT, 65% were classified in the OHT group, 22% and 13% in the LHT and NIHT groups respectively. The severity of asphyxia and HIE were comparable between newborns with OHT and LHT, apart from EEG. HT was initiated at a mean time of 12 hours of life in the LHT group. An acute obstetrical event was more likely to be identified among newborns with LHT (46%), compared to OHT (34%) and NIHT (22%). There was a gradation in the rate of complications from the NIHT group (29%) to the LHT (38%) group and the OHT group (52%). Despite an insignificant difference in the rates of death or abnormal neurological examination at discharge, nearly 60% of newborns in the OHT group had an MRI showing abnormalities, compared to 44% and 49% in the LHT and NIHT groups respectively. CONCLUSION The conduct of the HT for HIE newborns is not consistent with French guidelines for 35% of newborns, 22% being explained by an excessive delay in the start of HT, 13% by the lack of adherence to the clinical indications. This first report illustrates the difficulties in implementing guidelines for HT and should argue for an optimization of perinatal care for HIE.
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Affiliation(s)
- Marie Chevallier
- Neonatology and Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
| | - Anne Ego
- Clinical Research Center (CICO3), Grenoble University Hospital, Grenoble, France
| | - Christine Cans
- THEMAS (Techniques pour l'évaluation et la modélisation des actions de santé), Joseph Fourier University-Grenoble1, Grenoble, France
| | - Thierry Debillon
- Neonatology and Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
- * E-mail:
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