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Debillon T, Beck J, Guellec I, Vilotitch A, Pierrat V, Baud O, Sentilhes L, Kayem G, Ego A. [Investigation of a French cohort of neonatal anoxo-ischemic encephalopathy in the era of therapeutic hypothermia: Questions and answers]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:473-480. [PMID: 38428637 DOI: 10.1016/j.gofs.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To improve knowledge of neonatal hypoxic-ischemic encephalopathy, a prospective, nationwide, population-based cohort of affected children is being set up between September 2015 and March 2017. METHODS During this period, 794 cases are collected, with information on pregnancy, delivery, neonatal stay and outcome at the end of hospitalization. Clinical and parental questionnaire follow-up is planned until the child is 4 years old. RESULTS This article presents the clinical presentation of the newborns included, the analysis of factors associated with short-term outcome at hospital discharge and the organizational factors associated with treatment with therapeutic hypothermia. CONCLUSION These data illustrate the value of a prospective cohort to analyze the management of anoxo-ischemic encephalopathy in France.
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Affiliation(s)
- Thierry Debillon
- Service de réanimation et médecine néonatale, CHU Grenoble Alpes, 38000 Grenoble, France; Département de santé publique, université de Grenoble Alpes, CNRS, institut d'ingénierie et de management Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France.
| | - Jonathan Beck
- Service de médecine et réanimation néonatale, réanimation soins continus pédiatriques, CHU de Reims, bâtiments Alix de Champagne et American Memorial Hospital II, 51100 Reims, France
| | - Isabelle Guellec
- Service de réanimation néonatale, CHU de Nice, université de Nice Cote d'Azur, 06000 Nice, France; Obstetrical Perinatal and Pediatric Epidemiology Research Team, université Paris Cité, CRESS, EPOPE, Inserm, INRAE, 75004 Paris, France
| | - Antoine Vilotitch
- University de Grenoble Alpes, unité de Data Engineering, Pôle de santé publique, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Véronique Pierrat
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, université Paris Cité, CRESS, EPOPE, Inserm, INRAE, 75004 Paris, France; Département de néonatalogie, CHI de Créteil, 94000 Créteil, France
| | - Olivier Baud
- Division de néonatalogie, département de pédiatrie, université de Genève, Genève, Suisse
| | - Loïc Sentilhes
- Département de gynécologie et obstétrique, hôpital universitaire de Bordeaux, 33000 Bordeaux, France
| | - Gilles Kayem
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, université Paris Cité, CRESS, EPOPE, Inserm, INRAE, 75004 Paris, France; Département d'obstétrique et de gynécologie, hôpital Trousseau, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75012 Paris, France
| | - Anne Ego
- Département de santé publique, université de Grenoble Alpes, CNRS, institut d'ingénierie et de management Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France; Inserm CIC U1406, 38000 Grenoble, France
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Xie Q, Liao YH, He WJ, Han PP, Wu J. Evaluation of Neonatal Cerebral Circulation Under Hypoxic Ischemic Risk Factors Based on Quantitative Analysis of Cerebral Veins with Magnetic Resonance Susceptibility Weighted Imaging. Clin Neuroradiol 2024:10.1007/s00062-024-01432-0. [PMID: 38922421 DOI: 10.1007/s00062-024-01432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To observe the regulation of cerebral circulation in vivo based on image segmentation algorithms for deep learning in medical imaging to automatically detect and quantify the neonatal deep medullary veins (DMVs) on susceptibility weighted imaging (SWI) images. To evaluate early cerebral circulation self-rescue for neonates undergoing risk of cerebral hypoxia-ischaemia in vivo. METHODS SWI images and clinical data of 317 neonates with or without risk of cerebral hypoxia-ischaemia were analyzed. Quantitative parameters showing the number, width, and curvature of DMVs were obtained using an image segmentation algorithm. RESULTS The number of DMVs was greater in males than in females (p < 0.01), and in term than in preterm infants (p = 0.001). The width of DMVs was greater in term than in preterm infants (p < 0.01), in low-risk than in high-risk group (p < 0.01), and in neonates without intracranial extracerebral haemorrhage (ICECH) than with ICECH (p < 0.05). The curvature of DMVs was greater in term than in preterm infants (P < 0.05). The width of both bilateral thalamic veins and anterior caudate nucleus veins were positively correlated with the number of DMVs; the width of bilateral thalamic veins was positively correlated with the width of DMVs. CONCLUSION The DMVs quantification based on image segmentation algorithm may provide more detailed and stable quantitative information in neonate. SWI vein quantification may be an observable indicator for in vivo assessment of cerebral circulation self-regulation in neonatal hypoxic-ischemic brain injury.
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Affiliation(s)
- Qi Xie
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China.
| | - Yan-Hui Liao
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
- Department of Nuclear Medicine, Meizhou, People's Hospital, 514031, Meizhou, China
| | - Wen-Juan He
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
| | - Peng-Peng Han
- Institute of Software Application Technology, 511458, Guangzhou, China
| | - Jun Wu
- Institute of Software Application Technology, 511458, Guangzhou, China
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Gauci PA, Racinet C, Ouellet P, Daboval T, Trolli SED, Delotte J. Eucapnic pH coupled with arterial cord pH improves hypoxic-ischemic encephalopathy prediction. Int J Gynaecol Obstet 2024; 165:1114-1121. [PMID: 38193307 DOI: 10.1002/ijgo.15350] [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: 08/26/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To consider the classical use of "pH < 7.0 and/or a base deficiency ≥12 mmol/L" as markers of the risk of neonatal hypoxic-ischemic encephalopathy (HIE), recalling various criticisms of the use of these markers in favor of that of neonatal eucapnic pH, which appears to be a better marker of this risk. METHODS Fifty-five cases of acidemia with pH < 7.00 were collected from a cohort from the Nice University Hospital with eight cases of HIE. We compared the receiver operating characteristics curves established from the positive likelihood ratio (+LR) for each case of: umbilical cord artery pH (pHa), neonatal eucapnic pH (pH euc-n) in isolation (not matched to pHa), and matched pHa to its own pH euc-n. RESULTS The areas under the curve (AUC) are identical for pHa and pH euc-n, but AUC for the matched pair pHa-pH euc-n appears superior but non-significant because of the small number in our cohort. However, using the bootstrap method, the partial AUC for a sensitivity greater than 75% indicates the significant superiority (P < 0.01) of the matched pair pHa-pH euc-n approach. CONCLUSION The originality of this study lies in the use of two methodologic approaches: (1) standardized partial analysis of the AUCs of the pHa curve and that of pHa matched to its own pH euc-n, and (2) bootstrap statistical technique, that allowed us to conclude (P < 0.01) that the combined use of pH measured at the cord coupled with its eucapnic correction is better for diagnosing metabolic acidosis and best predicting the risk of HIE.
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Affiliation(s)
- Pierre-Alexis Gauci
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine CHU de Nice, University of Côte d'Azur, Nice, France
| | | | - Paul Ouellet
- Vitalité Health Network, Northwest zone, Adjunct Professor (Ret.), Department of Surgery, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Thierry Daboval
- Department of Neonatology, Ottawa University, Ottawa, Ontario, Canada
| | - Sergio Eleni Dit Trolli
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine CHU de Nice, University of Côte d'Azur, Nice, France
| | - Jérôme Delotte
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine CHU de Nice, University of Côte d'Azur, Nice, France
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Binet L, Debillon T, Beck J, Vilotitch A, Guellec I, Ego A, Chevallier M. Effect of gestational age on cerebral lesions in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326131. [PMID: 38418209 DOI: 10.1136/archdischild-2023-326131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy. DESIGN Secondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy. SETTING French neonatal intensive care units. PATIENTS Neonates with moderate or severe neonatal encephalopathy (NE) born at ≥34 weeks' GA (wGA) between September 2015 and March 2017. MAIN OUTCOME MEASURES The results of MRI performed within the first 12 days were classified in seven injured brain regions: basal ganglia and thalami, white matter (WM), cortex, posterior limb internal capsule, corpus callosum, brainstem and cerebellum. A given infant could have several brain structures affected. Risk of brain lesion according to GA was estimated by crude and adjusted ORs (aOR). RESULTS MRI was available for 626 (78.8%) of the 794 included infants with NE. WM lesions predominated in preterm compared with term infants. Compared with 39-40 wGA neonates, those born at 34-35 wGA and 37-38 wGA had greater risk of WM lesions after adjusting for perinatal factors (aOR 4.0, 95% CI (1.5 to 10.7) and ORa 2.0, 95% CI (1.1 to 3.5), respectively). CONCLUSION WM is the main brain structure affected in late-preterm and early-term infants with NE, with fewer WM lesions as GA increases. This finding could help clinicians to estimate prognosis and improve the understanding of the pathophysiology of NE. TRIAL REGISTRATION NUMBER NCT02676063, ClinicalTrials.gov.
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Affiliation(s)
- Lauren Binet
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
| | - Antoine Vilotitch
- Univversité Grenoble Alpes, Data Engineering Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Guellec
- 7 Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France
| | - Anne Ego
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004, Paris, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
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Ego A, Debillon T, Sourd D, Mitton N, Fresson J, Zeitlin J. Identifying Newborns with Hypoxic-Ischemic Encephalopathy in Hospital Discharge Data: A Validation Study. J Pediatr 2024; 268:113950. [PMID: 38336200 DOI: 10.1016/j.jpeds.2024.113950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Hospital discharge databases (HDDs) are increasingly used for research on health of newborns. Linkage between a French population-based cohort of newborns with hypoxic-ischemic encephalopathy (HIE) and national HDD showed that the HIE ICD-10 code was not accurately reported. Our results suggest that HDD should not be used for research on neonatal HIE without prior validation of HIE ICD-10 codes.
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Affiliation(s)
- Anne Ego
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France; Univ. Grenoble Alpes, Inserm CIC1406, CHU de Grenoble, Grenoble, France.
| | - T Debillon
- Department of Neonatology CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - D Sourd
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - N Mitton
- Department of Bioinformatics CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - J Fresson
- Population Health Office, DREES, Paris, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France
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Deng J, Liao Y, Chen J, Chen A, Wu S, Huang Y, Qian H, Gao F, Wu G, Chen Y, Chen X, Zheng X. N6-methyladenosine demethylase FTO regulates synaptic and cognitive impairment by destabilizing PTEN mRNA in hypoxic-ischemic neonatal rats. Cell Death Dis 2023; 14:820. [PMID: 38092760 PMCID: PMC10719319 DOI: 10.1038/s41419-023-06343-5] [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: 05/08/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
Hypoxic-ischemic brain damage (HIBD) can result in significant global rates of neonatal death or permanent neurological disability. N6-methyladenosine (m6A) modification of RNA influences fundamental aspects of RNA metabolism, and m6A dysregulation is implicated in various neurological diseases. However, the biological roles and clinical significance of m6A in HIBD remain unclear. We currently evaluated the effect of HIBD on cerebral m6A methylation in RNAs in neonatal rats. The m6A dot blot assay showed a global augmentation in RNA m6A methylation post-HI. Herein, we also report on demethylase FTO, which is markedly downregulated in the hippocampus and is the main factor involved with aberrant m6A modification following HI. By conducting a comprehensive analysis of RNA-seq data and m6A microarray results, we found that transcripts with m6A modifications were more highly expressed overall than transcripts without m6A modifications. The overexpression of FTO resulted in the promotion of Akt/mTOR pathway hyperactivation, while simultaneously inhibiting autophagic function. This is carried out by the demethylation activity of FTO, which selectively demethylates transcripts of phosphatase and tensin homolog (PTEN), thus promoting its degradation and reduced protein expression after HI. Moreover, the synaptic and neurocognitive disorders induced by HI were effectively reversed through the overexpression of FTO in the hippocampus. Cumulatively, these findings demonstrate the functional importance of FTO-dependent hippocampal m6A methylome in cognitive function and provides novel mechanistic insights into the therapeutic potentials of FTO in neonatal HIBD.
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Affiliation(s)
- Jianhui Deng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Yanling Liao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Jianghu Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Andi Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Shuyan Wu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Yongxin Huang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Haitao Qian
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Fei Gao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Guixi Wu
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China
| | - Yisheng Chen
- Center for Experimental Research in Clinical Medicine, Fujian Provincial Hospital, 350001, Fuzhou, China
| | - Xiaohui Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China.
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University Fujian Provincial Hospital, Fuzhou, China.
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of Belt and Road, Fuzhou, China.
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Korf JM, McCullough LD, Caretti V. A narrative review on treatment strategies for neonatal hypoxic ischemic encephalopathy. Transl Pediatr 2023; 12:1552-1571. [PMID: 37692539 PMCID: PMC10485647 DOI: 10.21037/tp-23-253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Objective Hypoxic-ischemic encephalopathy (HIE) is a leading cause of death and disability worldwide. Therapeutic hypothermia (TH) represents a significant achievement in the translation of scientific research to clinical application, but it is currently the only neuroprotective treatment for HIE. This review aims to revisit the use of TH for HIE and its longitudinal impact on patient outcomes to readers new to the field of HIE. We discuss how emerging therapies address the broader pathophysiology of injury progression in the neonatal brain days to years after HIE. Methods We included full articles and book chapters published in English on PubMed with references to "hypoxic ischemic encephalopathy", "birth asphyxia", "therapeutic hypothermia", or "neonatal encephalopathy". We limited our review to outcomes on term infants and to new therapeutics that are in the second phase of clinical trials. Key Content and Findings Despite the use of TH for HIE, mortality remains high. Analysis of longitudinal studies reveals a high incidence of ongoing disability even with the implementation of TH. New therapeutics addressing the secondary phase and the less understood tertiary phase of brain injury are in clinical trials as adjunctive treatments to TH to support additional neurological repair and regeneration. Conclusions TH successfully improves outcomes after HIE, and it continues to be optimized. Larger studies are needed to understand its use in mild cases of HIE and if certain factors, such as sex, affect long term outcomes. TH primarily acts in the initial phases of injury, while new pharmaceutical therapies target additional injury pathways into the tertiary phases of injury. This may allow for more effective approaches to treatment and improvement of long-term functional outcomes after HIE.
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Affiliation(s)
- Janelle M. Korf
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Louise D. McCullough
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Viola Caretti
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
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Chaton L, Bourel-Ponchel E, Lamblin MD, Joriot S, Lacan L, Derambure P, Nguyen S, Flamein F. Use of EEG in neonatal hypoxic-ischemic encephalopathy: A French survey of current practice and perspective for improving health care. Neurophysiol Clin 2023; 53:102883. [PMID: 37229978 DOI: 10.1016/j.neucli.2023.102883] [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: 12/05/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Controlled therapeutic hypothermia (CTH) is a standard of care in the management of neonatal hypoxic-ischemic encephalopathy HIE in newborns after 36 weeks of gestational age (WGA) in France. The electroencephalogram (EEG) plays a major role in HIE diagnosis and follow-up. We conducted a French national survey on the current use of EEG in newborn undergoing CTH. METHODS Between July and October 2021, an email survey was sent to the heads of the Neonatal intensive care units (NICUs) in metropolitan and overseas French departments and territories. RESULTS Out of 67, 56 (83%) of NICUs responded. All of them performed CTH in children born after 36 WGA with clinical and biological criteria of moderate to severe HIE. 82% of the NICUs used conventional EEG (cEEG) before 6 h of life (H6), prior to CTH being performed, to inform decisions about its use. However, half of the 56 NICUs had limited access after regular working hours. 51 of the 56 centers (91%) used cEEG, either short-lasting or continuous monitoring during cooling, while 5 centers conducted only amplitude EEG (aEEG). Only 4 of 56 centers (7%) used cEEG systematically both prior to CTH and for continuous monitoring under CTH. DISCUSSION The use of cEEG in the management of neonatal HIE was widespread in NICUs, but with significant disparities when considering 24-hour access. The introduction of a centralized neurophysiological on-call system grouping several NICUs would be of major interest for most centers which do not have the facility of EEG outside working hours.
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Affiliation(s)
- Laurence Chaton
- Service de neurophysiologie clinique, CHU Lille, Lille, France.
| | - Emilie Bourel-Ponchel
- Explorations fonctionnelles du système nerveux pédiatrique, CHU Amiens-Picardie, Amiens, France
| | | | | | - Laure Lacan
- Service de neuropédiatrie CHU Lille, Lille, France
| | - Philippe Derambure
- Service de neurophysiologie clinique, CHU Lille, Lille, France; INSERM U1171, University of Lille, Lille, France
| | - Sylvie Nguyen
- Service de neuropédiatrie CHU Lille, Lille, France; ULR2694-METRICS, University of Lille, Lille, France
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Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort. J Pediatr 2023:S0022-3476(23)00109-9. [PMID: 36828343 DOI: 10.1016/j.jpeds.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/05/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES To assess in newborns with neonatal encephalopathy (NE), presumptively related to a peripartum hypoxic-ischemic event, the frequency of dysglycemia and its association with neonatal adverse outcomes. STUDY DESIGN We conducted a secondary analysis of LyTONEPAL (Long-Term Outcome of Neonatal hypoxic EncePhALopathy in the era of neuroprotective treatment with hypothermia), a population-based cohort study including 545 patients with moderate-to-severe NE. Newborns were categorized by the glycemia values assessed by routine clinical care during the first 3 days of life: normoglycemic (all glycemia measurements ranged from 2.2 to 8.3 mmol/L), hyperglycemic (at least 1 measurement >8.3 mmol/L), hypoglycemic (at least 1 measurement <2.2 mmol/L), or with glycemic lability (measurements included at least 1 episode of hypoglycemia and 1 episode of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on magnetic resonance imaging, regardless of severity or location. RESULTS In total, 199 newborns were categorized as normoglycemic (36.5%), 74 hypoglycemic (13.6%), 213 hyperglycemic (39.1%), and 59 (10.8%) with glycemic lability, based on the 2593 glycemia measurements collected. The primary adverse outcome was observed in 77 (45.8%) normoglycemic newborns, 37 (59.7%) with hypoglycemia, 137 (67.5%) with hyperglycemia, and 40 (70.2%) with glycemic lability (P < .01). With the normoglycemic group as the reference, the aORs and 95% 95% CIs for the adverse outcome were significantly greater for the group with hyperglycemia (aOR 1.81; 95% CI 1.06-3.11). CONCLUSIONS Dysglycemia affects nearly two-thirds of newborns with NE and is independently associated with a greater risk of mortality and/or brain lesions on magnetic resonance imaging. TRIAL REGISTRATION NCT02676063.
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Beck J, Debillon T, Guellec I, Vilotitch A, Loron G, Bednarek N, Ancel PY, Pierrat V, Ego A. Healthcare organizational factors associated with delayed therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: the LyTONEPAL cohort. Eur J Pediatr 2023; 182:181-190. [PMID: 36269426 DOI: 10.1007/s00431-022-04666-7] [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: 09/01/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/12/2023]
Abstract
Initiation of therapeutic hypothermia (TH) within 6 h of life is a major concern for treating neonatal hypoxic ischemic encephalopathy (HIE). We aimed to determine clinical and healthcare organizational factors associated with delayed TH in a French population-based cohort of neonates with moderate/severe HIE. Time to reach a rectal temperature of 34 °C defines optimal and delayed (within and over 6 h, respectively) TH. Clinical and healthcare organizational factors associated with delayed TH were analysed among neonates born in cooling centres (CCs) and non-cooling centres (non-CCs). Among 629 neonates eligible for TH, 574 received treatment (91.3%). TH was delayed in 29.8% neonates and in 20.3% and 36.2% of those born in CCs and non-CCs, respectively. Neonates with moderate HIE were more exposed to delayed TH in both CCs and non-CCs. After adjustment for HIE severity, maternal and neonatal characteristics and circumstances of birth were not associated with increased risk of delayed TH. However, this risk was 2 to 5 times higher in maternities with < 1999 annual births, when the delay between birth and call for transfer (adjusted odds ratio [aOR] 2.47, 95% confidence interval [CI] [1.03 to 5.96]) or between call for transfer and admission (aOR 6.06, 95%CI [2.60 to 14.12]) was > 3 h and when an undesirable event occurred during transfer (aOR 2.66, 95%CI [1.11 to 6.37]. Conclusion: Increasing early identification of neonates who could benefit from TH and access to TH in non-CCs before transfer are modifiable factors that could improve care of neonates with HIE. Trial registration: The trial was registered at ClinicalTrials.gov (NCT02676063). What is Known: • International recommendations are to initiate therapeutic hypothermia before 6 h of life in neonates with moderate or severe hypoxic ischemic encephalopathy. What is New: •In this French population-based cohort of infants with hypoxic ischemic encephalopathy, nearly one-third of neonates eligible for treatment did not have access to hypothermia in the therapeutic window of 6 h of life. . • Among infants born in non-cooling centres, healthcare organizational factors involved in delayed care were the small size of maternities (1999 annual births), a time interval of more than 3 h between birth and call for transfer and between call for transfer and admission in neonatology, and the occurrence of an undesirable event during transfer.
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Affiliation(s)
- Jonathan Beck
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France.
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France.
| | - Thierry Debillon
- Univ. Grenoble Alpes, CNRS, Neonatal Intensive Care Unit Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
| | - Isabelle Guellec
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Neonatal Intensive Care Unit, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Antoine Vilotitch
- Center for Clinical Investigation U1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
- Université de Reims Champagne Ardenne, 3804, 51097, Reims, CReSTIC EA, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
- Université de Reims Champagne Ardenne, 3804, 51097, Reims, CReSTIC EA, France
| | - Pierre-Yves Ancel
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Center for Clinical Investigation P1419, APHP, APHP Centre-Université Paris Cité, 75014, Paris, France
| | - Véronique Pierrat
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Department of Neonatology, CHI Créteil, Créteil, France
| | - Anne Ego
- Center for Clinical Investigation U1406, Grenoble Alpes University Hospital, Grenoble, France
- Public Health Department, Univ. Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
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Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia. Pediatr Res 2022:10.1038/s41390-022-02352-w. [PMID: 36272997 DOI: 10.1038/s41390-022-02352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To re-visit short-term outcomes and associated risk factors of newborns with hypoxic-ischemic encephalopathy (HIE) in an era where hypothermia treatment (HT) is widespread. METHODS This is a prospective population-based cohort in French neonatal intensive care units (NICU). Neonates born at or after 34 weeks of gestational age with HIE were included; main outcomes were in-hospital death and discharge with abnormal or normal MRI. Associations of early perinatal risk factors, present at birth or at admission to NICU, with these outcomes were studied. RESULTS A total of 794 newborns were included and HT was administered to 670 (84.4%); 18.3% died and 28.5% and 53.2% survived with abnormal and normal MRI, respectively. Severe neurological status, Apgar score at 5 mn ≤5, lactate at birth ≥11 mMoles/l, and glycemia ≥100 mg/dL at admission were associated with an increased risk of death (relative risk ratios (aRRR) (95% CI) 19.93 (10.00-39.70), 2.89 (1.22-1.62), 3.06 (1.60-5.83), and 2.55 (1.38-4.71), respectively). Neurological status only was associated with survival with abnormal MRI (aRRR (95% CI) 1.76 (1.15-2.68)). CONCLUSION Despite high use of HT in this cohort, 46.8% died or presented brain lesions. Early neurological and biological examinations were associated with unfavorable outcomes and these criteria could be used to target children who warrant further neuroprotective treatment. TRIAL REGISTRATION Clinical trial registry, NCT02676063, ClinicalTrials.gov. IMPACT In this population-based cohort of newborns with HIE where 84% received hypothermia, 46.8% still had an unfavorable evolution (death or survival with abnormal MRI). Risk factors for death were high lactate, low Apgar score, severe early neurological examination, and high glycaemia. While studies have established risk factors for HIE, few have focused on early perinatal factors associated with short-term prognosis. This French population-based cohort updates knowledge about early risk factors for adverse outcomes in the era of widespread cooling. In the future, criteria associated with an unfavorable evolution could be used to target children who would benefit from another neuroprotective strategy with hypothermia.
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12
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Cerebral injuries in neonatal encephalopathy treated with hypothermia: French LyTONEPAL cohort. Pediatr Res 2022; 92:880-887. [PMID: 34802036 DOI: 10.1038/s41390-021-01846-3] [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: 07/16/2021] [Revised: 10/04/2021] [Accepted: 10/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothermia is widely used for infants with hypoxic-ischemic neonatal encephalopathy but its impact remains poorly described at a population level. We aimed to describe brain imaging in infants born at ≥36 weeks' gestation, with moderate/severe encephalopathy treated with hypothermia. METHODS Descriptive analysis of brain MRI and discharge neurological examination for infants included in the French national multicentric prospective observational cohort LyTONEPAL. RESULTS Among 575 eligible infants, 479 (83.3%) with MRI before 12 days of life were included. MRI was normal for 48.2% (95% CI 43.7-52.8). Among infants with brain injuries, 62.5% (95% CI 56.2-68.5) had damage to more than one structure, 19.8% (95% CI 15.0-25.3) showed a pattern-associating injuries of basal ganglia/thalami (BGT), white matter (WM) and cortex. Overall, 68.4% (95% CI 62.0-74.3) of infants with normal MRI survived with a normal neurological examination. The rate of death was 15.4% (95% CI 12.3-19.0), predominantly for infants with the combined BGT, cortex, and/or WM injuries. CONCLUSIONS Among infants with neonatal encephalopathy treated with hypothermia, two-thirds of those with normal MRI survived with a normal neurological examination at discharge. When present, brain injuries often involved more than one structure. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT02676063). IMPACT In this multicentric cohort of infants with neonatal encephalopathy (LYTONEPAL) two-thirds survived with normal MRI and neurological examination at discharge. In total, 10% of newborns showed a pattern associating injuries of the basal ganglia-thalami, white matter, and cortex, which was correlated with a high risk of death at discharge. The evolution of MRI techniques and sequences in the era of hypothermia calls for a revisiting of imaging protocol in neonatal encephalopathy, especially for the timing. The neurological examination did not give evidence of brain injuries, thus questioning the reproducibility of the clinical exam or the neonatal brain functionality.
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Beck J, Loron G, Ancel PY, Alison M, Hertz Pannier L, Vo Van P, Debillon T, Bednarek N. An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort. CHILDREN 2022; 9:children9040561. [PMID: 35455605 PMCID: PMC9032533 DOI: 10.3390/children9040561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. Results: Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. Conclusion: This study described an overview of brain injuries in hypoxic−ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence.
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Affiliation(s)
- Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
- Correspondence:
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
| | - Pierre-Yves Ancel
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
- Assistance Publique—Hôpitaux de Paris, Clinical Investigation Center P1419, 75004 Paris, France
| | - Marianne Alison
- Service d’Imagerie Pédiatrique, Hôpital Robert Debré, APHP (Assistance Publique—Hôpitaux de Paris), 75019 Paris, France;
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
| | - Lucie Hertz Pannier
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
- UNIACT (Unité de Recherche en NeuroImagerie Applicative Clinique et Translationnelle), Neurospin, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives)-Saclay, 91191 Gif sur Yvette, France
| | - Philippe Vo Van
- Department of Neonatology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Pinel, 69500 Bron, France;
| | - Thierry Debillon
- Neonatal Intensive Care Unit CHU (Centre Hospital-Universitaire) Grenoble Alpes, 38000 Grenoble, France;
- Grenoble INP (Institut d’Ingénierie et de Management), TIMC (Techniques de l’Ingénierie Médicale et de la Complexité)-IMAG (Informatique, Mathématiques et Applications, Grenoble), CNRS (Centre National de la Recherche Scientifique), University Grenoble Alpes, 38000 Grenoble, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
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Lee BL, Glass HC. Cognitive outcomes in late childhood and adolescence of neonatal hypoxic-ischemic encephalopathy. Clin Exp Pediatr 2021; 64:608-618. [PMID: 34044480 PMCID: PMC8650814 DOI: 10.3345/cep.2021.00164] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is the most common cause of neonatal encephalopathy with a global incidence of approximately 1 to 8 per 1,000 live births. Neonatal encephalopathy can cause neurodevelopmental and cognitive impairments in survivors of hypoxic-ischemic insults with and without functional motor deficits. Normal neurodevelopmental outcomes in early childhood do not preclude cognitive and behavioral difficulties in late childhood and adolescence because cognitive functions are not yet fully developed at this early age. Therapeutic hypothermia has been shown to significantly reduced death and severe disabilities in term newborns with HIE. However, children treated with hypothermia therapy remain at risk for cognitive impairments and follow-up is necessary throughout late childhood and adolescence. Novel adjunctive neuroprotective therapies combined with therapeutic hypothermia may enhance the survival and neurodevelopmental outcomes of infants with HIE. The extent and severity of brain injury on magnetic resonance imaging might predict neurodevelopmental outcomes and lead to targeted interven tions in children with a history of neonatal encephalopathy. We provide a summary of the long-term cognitive outcomes in late childhood and adolescence in children with a history of HIE and the association between pattern of brain injury and neurodevelopmental outcomes.
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Affiliation(s)
- Bo Lyun Lee
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hannah C Glass
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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15
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Hamoud Y, Pekar JD, Drumez E, Lacan L, Maboudou P, De Jonckheere J, Storme L, Houfflin-Debarge V, Sharma D, Garabedian C, Ghesquière L. Changes in S100B and troponin levels in a fetal sheep model of worsening acidosis. Eur J Obstet Gynecol Reprod Biol 2021; 264:173-177. [PMID: 34304026 DOI: 10.1016/j.ejogrb.2021.06.042] [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] [Received: 03/21/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND S100B and cardiac troponin T (c-TnT) are relevant biomarkers at birth of hypoxic-ischemic encephalopathy (HIE) and myocardial ischemia secondary to metabolic acidosis during labor, respectively. The purpose was to assess in-utero changes in S100B and c-TnT levels in an experimental model of labor-like acidosis. METHODS Repeated umbilical cord occlusions (UCOs) in ten experiments were performed in mild (phase A, 1 UCO/5 mn), moderate (phase B, 1 UCO/3 mn), and severe (phase C, 1 UCO/2 mn) period. The experiments were stopped if arterial pH reached 6.90. RESULTS UCOs resulted in fetal acidosis with pH dropping to 6.99 ±0.13. When compared to the baseline period fetal S100B increased between phases A and B (7% ± 4 vs 17% ± 13, p = 0.030) and between phases A and C (7% ± 4 vs 24% ± 8, p < 0.001). Fetal c-TnT serum levels increased during occlusions: 102 ng/L (58-119) in phase A, vs 119 ng/L (103-198) in phase B vs 169 ng / L (128-268) in phase C (p < 0.05, for all). When compared to the baseline control period, fetal ΔcTnT was significantly modified throughout UCO series: 5.0% (-3; 45) in phase A, 51% (4; 263) in phase B, and 77% (56.5; 269) in phase C (p < 0.05 for all). CONCLUSIONS S100B and c-TnT increased when fetal acidosis occurred, which reflects the potential neurological damage and fetal cardiovascular adaptation.
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Affiliation(s)
- Yasmine Hamoud
- CHU Lille, Department of Obstetrics, F-59000 Lille, France.
| | - Jean David Pekar
- CHU Lille, Automated Biochemistry (UF 8832), F-59000 Lille, France
| | - Elodie Drumez
- University of Lille, CHU Lille, EA 2694 - Public Health Epidemiology and Quality of Care, F-59000 Lille, France
| | - Laure Lacan
- CHU Lille, Department of Neuropediatrics, F-59000 Lille, France
| | - Patrice Maboudou
- CHU Lille, Automated Biochemistry (UF 8832), F-59000 Lille, France
| | | | - Laurent Storme
- CHU Lille, Department of Neonatology, F-59000 Lille, France
| | | | - Dyuti Sharma
- CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
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