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Quiñones Cardona V, Cohen SS, Cook N, Cizmeci MN, Chandel A, DiGeronimo R, Gogcu S, Jano E, Kojima K, Lee KS, McAdams RM, Menkiti O, Mietzsch U, Peeples E, Sewell E, Shenberger JS, Massaro AN, Natarajan G, Rao R, Dizon MLV. The Current State of Neonatal Neurodevelopmental Follow-up Programs in North America: A Children's Hospitals Neonatal Consortium Report. Am J Perinatol 2024; 41:1956-1964. [PMID: 38458236 DOI: 10.1055/a-2283-8843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers. STUDY DESIGN This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC). RESULTS Survey response rate was 76%, and 97% of respondents had a formal NDFU program. Programs were commonly staffed by neonatologists (80%), physical therapists (77%), and nurse practitioners (74%). Median gestational age at birth identified for follow-up was ≤32 weeks (range 26-36). Median duration was 3 years (range 2-18). Ninety-seven percent of sites used Bayley Scales of Infant and Toddler Development, but instruments used varied across ages. Scores were recorded in discrete electronic data fields at 43% of sites. Social determinants of health data were collected by 63%. Care coordination and telehealth services were not universally available. CONCLUSION NDFU clinics are almost universal within CHNC centers. Commonalities and variances in practice highlight opportunities for data sharing and development of best practices. KEY POINTS · Neonatal NDFU clinics help transition high-risk infants home.. · Interdisciplinary neonatal intensive care unit follow-up brings together previously separated outpatient service lines.. · This study reviews the current state of neonatal NDFU in North America..
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Affiliation(s)
- Vilmaris Quiñones Cardona
- Division of Neonatology, Department of Pediatrics, Drexel University, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Susan S Cohen
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Noah Cook
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mehmet N Cizmeci
- Division of Neonatology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amit Chandel
- Division of Neonatology, Department of Pediatrics, Wake Forest University, Brenner Children's Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Robert DiGeronimo
- Division of Neonatology, Department of Pediatrics, University of Washington Medical School, Seattle Children's Hospital, Seattle, Washington
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest University, Brenner Children's Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Eni Jano
- Division of Neonatology, Department of Pediatrics, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California
| | - Katsuaki Kojima
- Division of Neonatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's, Cincinnati, Ohio
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan M McAdams
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, American Family Children's Hospital, Madison, Wisconsin
| | - Ogechukwu Menkiti
- Division of Neonatology, Department of Pediatrics, Drexel University, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington Medical School, Seattle Children's Hospital, Seattle, Washington
| | - Eric Peeples
- Department of Pediatrics, Division of Neonatology, University of Nebraska, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Elizabeth Sewell
- Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey S Shenberger
- Division of Neonatology, Department of Pediatrics, University of Connecticut, Connecticut Childrens, Harford, Connecticut
| | - An N Massaro
- Division of Neonatology, Department of Pediatrics, George Washington University, Children's National Medical Center, Washington, District of Columbia
| | - Girija Natarajan
- Division of Neonatology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan
| | - Rakesh Rao
- Division of Neonatology, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
| | - Maria L V Dizon
- Division of Neonatology, Department of Pediatrics, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Lew CO, Calabrese E, Chen JV, Tang F, Chaudhari G, Lee A, Faro J, Juul S, Mathur A, McKinstry RC, Wisnowski JL, Rauschecker A, Wu YW, Li Y. Artificial Intelligence Outcome Prediction in Neonates with Encephalopathy (AI-OPiNE). Radiol Artif Intell 2024; 6:e240076. [PMID: 38984984 DOI: 10.1148/ryai.240076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Purpose To develop a deep learning algorithm to predict 2-year neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy using MRI and basic clinical data. Materials and Methods In this study, MRI data of term neonates with encephalopathy in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial (ClinicalTrials.gov: NCT02811263), who were enrolled from 17 institutions between January 25, 2017, and October 9, 2019, were retrospectively analyzed. The harmonized MRI protocol included T1-weighted, T2-weighted, and diffusion tensor imaging. Deep learning classifiers were trained to predict the primary outcome of the HEAL trial (death or any neurodevelopmental impairment at 2 years) using multisequence MRI and basic clinical variables, including sex and gestational age at birth. Model performance was evaluated on test sets comprising 10% of cases from 15 institutions (in-distribution test set, n = 41) and 10% of cases from two institutions (out-of-distribution test set, n = 41). Model performance in predicting additional secondary outcomes, including death alone, was also assessed. Results For the 414 neonates (mean gestational age, 39 weeks ± 1.4 [SD]; 232 male, 182 female), in the study cohort, 198 (48%) died or had any neurodevelopmental impairment at 2 years. The deep learning model achieved an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.60, 0.86) and 63% accuracy in the in-distribution test set and an AUC of 0.77 (95% CI: 0.63, 0.90) and 78% accuracy in the out-of-distribution test set. Performance was similar or better for predicting secondary outcomes. Conclusion Deep learning analysis of neonatal brain MRI yielded high performance for predicting 2-year neurodevelopmental outcomes. Keywords: Convolutional Neural Network (CNN), Prognosis, Pediatrics, Brain, Brain Stem Clinical trial registration no. NCT02811263 Supplemental material is available for this article. © RSNA, 2024 See also commentary by Rafful and Reis Teixeira in this issue.
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Affiliation(s)
- Christopher O Lew
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Evan Calabrese
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Joshua V Chen
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Felicia Tang
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Gunvant Chaudhari
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Amanda Lee
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - John Faro
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Sandra Juul
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Amit Mathur
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Robert C McKinstry
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Jessica L Wisnowski
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Andreas Rauschecker
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Yvonne W Wu
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Yi Li
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
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3
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Faingold R, Prempunpong C, Garfinkle J, St Martin C, Menegotto F, Boyle R, Aguilera JM, Nguyen KA, Sant'Anna GM. Association between Early Basal Ganglia and Thalami Perfusion Assessed by Color Doppler Ultrasonography and Brain Injury in Infants with Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study. J Pediatr 2024; 271:114086. [PMID: 38705232 DOI: 10.1016/j.jpeds.2024.114086] [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: 12/04/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To evaluate associations between neurologic outcomes and early measurements of basal ganglia (BG) and thalamic (Th) perfusion using color Doppler ultrasonography (CDUS) in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Prospective study of infants with mild (n = 18), moderate (n = 17), and severe HIE (n = 14) and controls (n = 17). Infants with moderate-severe HIE received therapeutic hypothermia (TH). CDUS was performed at 24-36 hours and brain magnetic resonance imaging (MRI) at a median of 10 days. Development was followed through 2.5-5 years. The primary outcome was the association between BG and Th perfusion and brain MRI injury. Secondary analyses focused on associations between perfusion measurements and admission neurologic examinations, MRI scores in infants treated with TH, and motor and sensory disability, or death. An exploratory analysis assessed the accuracy of BG and Th perfusion to predict brain MRI injury in infants treated with TH. RESULTS Increased BG and Th perfusion on CDUS was observed in infants with severe MRI scores and those with significant motor and neurosensory disability or death through 2.5-5 years (P < .05). Infants with severe HIE showed increased BG and Th perfusion (P < .005) compared with infants with moderate HIE. No differences were identified between the between the control and mild HIE groups. Th perfusion ≥0.237 cm/second (Area under the curve of 0.824) correctly classified 80% of infants with severe MRI scores. CONCLUSIONS Early dynamic CDUS of the BG and Th is a potential biomarker of severe brain injury in infants with HIE and may be a useful adjunct to currently used assessments.
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Affiliation(s)
- Ricardo Faingold
- Pediatric Radiology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | | | - Jarred Garfinkle
- Pediatrics, Neonatal Division, McGill University Health Center, Montreal, Canada
| | - Christine St Martin
- Pediatric Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Flavia Menegotto
- Pediatric Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Rose Boyle
- Neonatal Division, University of Alberta, Edmonton, Canada
| | | | - Kim-Anh Nguyen
- Pediatrics, Neonatal Follow-Up Division, Jewish General Hospital, McGill University Health Center, Montreal, Canada
| | - Guilherme M Sant'Anna
- Pediatrics, Neonatal Division, Research Institute and Member of the Experimental Medicine Department, McGill University Health Center, Montreal, Canada.
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Roychaudhuri S, Hannon K, Sunwoo J, Garvey AA, El-Dib M. Quantitative EEG and prediction of outcome in neonatal encephalopathy: a review. Pediatr Res 2024; 96:73-80. [PMID: 38503980 DOI: 10.1038/s41390-024-03138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Electroencephalogram (EEG) is an important biomarker for neonatal encephalopathy (NE) and has significant predictive value for brain injury and neurodevelopmental outcomes. Quantitative analysis of EEG involves the representation of complex EEG data in an objective, reproducible and scalable manner. Quantitative EEG (qEEG) can be derived from both a limited channel EEG (as available during amplitude integrated EEG) and multi-channel conventional EEG. It has the potential to enable bedside clinicians to monitor and evaluate details of cortical function without the necessity of continuous expert input. This is particularly useful in NE, a dynamic and evolving condition. In these infants, continuous, detailed evaluation of cortical function at the bedside is a valuable aide to management especially in the current era of therapeutic hypothermia and possible upcoming neuroprotective therapies. This review discusses the role of qEEG in newborns with NE and its use in informing monitoring and therapy, along with its ability to predict imaging changes and short and long-term neurodevelopmental outcomes. IMPACT: Quantitative representation of EEG data brings the evaluation of continuous brain function, from the neurophysiology lab to the NICU bedside and has a potential role as a biomarker for neonatal encephalopathy. Clinical and research applications of quantitative EEG in the newborn are rapidly evolving and a wider understanding of its utility is valuable. This overview summarizes the role of quantitative EEG at different timepoints, its relevance to management and its predictive value for short- and long-term outcomes in neonatal encephalopathy.
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Affiliation(s)
- Sriya Roychaudhuri
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katie Hannon
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John Sunwoo
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Aisling A Garvey
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Estiphan T, Sturza J, Shellhaas RA, Carlson MD. A novel clinical risk scoring system for neurodevelopmental outcomes among survivors of neonatal hypoxic-ischemic encephalopathy (HIE). Pediatr Neonatol 2024; 65:354-358. [PMID: 38057259 DOI: 10.1016/j.pedneo.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE We aimed to develop a risk scoring system as a predictor of 24-month neurodevelopmental outcomes (cognitive, language, and motor) for neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). METHODS This was a chart review of infants with HIE treated with therapeutic hypothermia who were admitted to the Neonatal Intensive Care Unit (NICU) at the University of Michigan between 2009 and 2019 and followed in the neonatal developmental clinic until 24 months of age. We examined bivariate associations between the neonatal characteristics and Bayley-III scores. We then performed stepwise logistic regression. To create the risk scores, a participant was given one point for each of the factors included in the final model. RESULTS Fifty-five infants were included. The final model for Bayley cognitive abnormality included abnormal neonatal neurologic exam (p < 0.0001), white matter/watershed MRI abnormality (p = 0.01), 5-min Apgar score (p = 0.02), and EEG-confirmed seizures (p = 0.04). The model for language abnormality included abnormal neurologic exam (p = 0.0002), seizures (p = 0.007), clinical severity of HIE (p = 0.06), and basal ganglia/thalamus MRI abnormality (p = 0.17). The model for motor abnormality included seizures (p = 0.03), abnormal neurologic exam (p = 0.06) and basal ganglia/thalamus MRI abnormality (p = 0.02). The positive predictive values for the risk scores were 60 %, 85 % and 71 %, respectively, for the Bayley-III cognitive, language and motor domains. CONCLUSION Our study identifies early clinical features that differentially predict domains of neurodevelopmental outcome and associated risk scores that may be of value to both clinicians and families. This novel scoring system should next be validated in a larger, prospective study.
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Affiliation(s)
- Theresa Estiphan
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.
| | - Julie Sturza
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Renée A Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Martha D Carlson
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Damien J, Vannasing P, Tremblay J, Petitpas L, Marandyuk B, Balasingam T, El Jalbout R, Paquette N, Donofrio G, Birca A, Gallagher A, Pinchefsky EF. Relationship between EEG spectral power and dysglycemia with neurodevelopmental outcomes after neonatal encephalopathy. Clin Neurophysiol 2024; 163:160-173. [PMID: 38754181 DOI: 10.1016/j.clinph.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/28/2024] [Accepted: 03/23/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE We investigated how electroencephalography (EEG) quantitative measures and dysglycemia relate to neurodevelopmental outcomes following neonatal encephalopathy (NE). METHODS This retrospective study included 90 neonates with encephalopathy who received therapeutic hypothermia. EEG absolute spectral power was calculated during post-rewarming and 2-month follow-up. Measures of dysglycemia (hypoglycemia, hyperglycemia, and glycemic lability) and glucose variability were computed for the first 48 h of life. We evaluated the ability of EEG and glucose measures to predict neurodevelopmental outcomes at ≥ 18 months, using logistic regressions (with area under the receiver operating characteristic [AUROC] curves). RESULTS The post-rewarming global delta power (average all electrodes), hyperglycemia and glycemic lability predicted moderate/severe neurodevelopmental outcome separately (AUROC = 0.8, 95%CI [0.7,0.9], p < .001) and even more so when combined (AUROC = 0.9, 95%CI [0.8,0.9], p < .001). After adjusting for NE severity and magnetic resonance imaging (MRI) brain injury, only global delta power remained significantly associated with moderate/severe neurodevelopmental outcome (odds ratio [OR] = 0.9, 95%CI [0.8,1.0], p = .04), gross motor delay (OR = 0.9, 95%CI [0.8,1.0], p = .04), global developmental delay (OR = 0.9, 95%CI [0.8,1.0], p = .04), and auditory deficits (OR = 0.9, 95%CI [0.8,1.0], p = .03). CONCLUSIONS In NE, global delta power post-rewarming was predictive of outcomes at ≥ 18 months. SIGNIFICANCE EEG markers post-rewarming can aid prediction of neurodevelopmental outcomes following NE.
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Affiliation(s)
- Janie Damien
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada.
| | - Phetsamone Vannasing
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Julie Tremblay
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Laurence Petitpas
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada.
| | - Bohdana Marandyuk
- Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Thameya Balasingam
- Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Ramy El Jalbout
- Department of Radiology, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Natacha Paquette
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada.
| | - Gianluca Donofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; Service of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
| | - Ala Birca
- Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Service of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Anne Gallagher
- Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada.
| | - Elana F Pinchefsky
- Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Service of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
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Pawale D, Fursule A, Tan J, Wagh D, Patole S, Rao S. Prevalence of hearing impairment in neonatal encephalopathy due to hypoxia-ischemia: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03261-w. [PMID: 38769399 DOI: 10.1038/s41390-024-03261-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: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND This systematic review was undertaken to estimate the overall prevalence of hearing impairment in survivors of neonatal HIE. METHODS PubMed, EMBASE, CINAHL, EMCARE and Cochrane databases, mednar (gray literature) were searched till January 2023. Randomized controlled trials and observational studies were included. The main outcome was estimation of overall prevalence of hearing impairment in survivors of HIE. RESULTS A total of 71studies (5821 infants assessed for hearing impairment) were included of which 56 were from high income countries (HIC) and 15 from low- or middle-income countries (LMIC). Overall prevalence rate of hearing impairment in cooled infants was 5% (95% CI: 3-6%, n = 4868) and 3% (95% CI: 1-6%, n = 953) in non-cooled HIE infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). CONCLUSIONS These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE. There is a need for more data from LMICs and standardization of reporting hearing impairment. IMPACT The overall prevalence rate of hearing impairment in cooled infants with HIE was 5% (95% CI: 3-6%) and 3% (95% CI: 1-6%) in the non-cooled infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE.
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Affiliation(s)
- Dinesh Pawale
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Anurag Fursule
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Jason Tan
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Deepika Wagh
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Sanjay Patole
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Neonatology, King Edwards Memorial Hospital, Perth, WA, Australia
| | - Shripada Rao
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia.
- School of Medicine, University of Western Australia, Crawley, WA, Australia.
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Langeslag JF, Onland W, Groenendaal F, de Vries LS, van Kaam AH, de Haan TR. Association Between Seizures and Neurodevelopmental Outcome at Two and Five Years in Asphyxiated Newborns With Therapeutic Hypothermia. Pediatr Neurol 2024; 153:152-158. [PMID: 38387280 DOI: 10.1016/j.pediatrneurol.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To investigate the association between the presence and severity of seizures in asphyxiated newborns and their neurodevelopmental outcome at ages two and five years. METHODS Retrospective data analysis from a prospectively collected multicenter cohort of 186 term-born asphyxiated newborns undergoing therapeutic hypothermia (TH) in 11 centers in the Netherlands and Belgium. Seizures were diagnosed by amplitude-integrated electroencephalography (EEG) and raw EEG signal reading up to 48 hours after rewarming. Neurodevelopmental outcome was assessed by standardized testing at age two and five years. Primary outcome was death or long-term neurodevelopmental impairment (NDI) including cerebral palsy. Associations were calculated using univariate and multivariate logistic regression analyses adjusting for Thompson score and a validated brain magnetic resonance imaging (MRI) score. RESULTS Seventy infants (38%) had seizures during TH or rewarming, and 44 (63%) of these needed two or more antiseizure medications (ASMs). Overall mortality was 21%. Follow-up data from 147 survivors were available for 137 infants (93%) at two and for 94 of 116 infants (81%) at five years. NDI was present in 26% at two and five years. Univariate analyses showed a significant association between seizures and death or NDI, but this was no longer significant after adjusting for Thompson and MRI score in the multivariate analysis; this was also true for severe seizures (need for two or more ASMs) or seizures starting during rewarming. CONCLUSION The presence or severity of seizures in newborns undergoing TH for hypoxic-ischemic encephalopathy was not independently associated with death or NDI up to age five years after adjusting for several confounders.
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Affiliation(s)
- Juliette F Langeslag
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Brain Center, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Brain Center, Utrecht, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Timo R de Haan
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.
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Melaku G, Mergia G, Getahun SB, Semagn S, Awoke Z, Kabthymer RH, Abebe M. Hypoxic-ischaemic encephalopathy based on clinical signs and symptoms and associated factors among neonates, Southern Ethiopian public hospitals: a case-control study. Ann Med Surg (Lond) 2024; 86:35-41. [PMID: 38222722 PMCID: PMC10783229 DOI: 10.1097/ms9.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024] Open
Abstract
Background Hypoxic-ischaemic encephalopathy (HIE) is a severe condition that results from reduced oxygen supply and blood flow to the brain, leading to brain injury and potential long-term neurodevelopmental impairments. This study aimed to identify the maternal and neonatal factors associated with hypoxic-ischaemic encephalopathy among Neonates. Methods The authors conducted a case-control study in 15 public hospitals with 515 neonates and mothers (175 cases and 340 controls). The authors used a questionnaire and clinical records created and managed by Kobo software to collect data. The authors diagnosed hypoxic-ischaemic encephalopathy (HIE) by clinical signs and symptoms. The authors used logistic regression to identify HIE factors. Results Hypoxic-ischaemic encephalopathy (HIE) was associated with maternal education, ultrasound checkup, gestational age, delivery mode, and labour duration. Illiterate mothers [adjusted odds ratio (AOR)= 1.913, 95% CI: 1.177, 3.109], no ultrasound checkup (AOR= 1.859, 95% CI: 1.073, 3.221), preterm (AOR= 4.467, 95% CI: 1.993, 10.012) or post-term birth (AOR= 2.903, 95% CI: 1.325, 2.903), caesarean section (AOR= 7.569, 95% CI: 4.169, 13.741), and prolonged labour (AOR= 3.591, 95% CI: 2.067, 6.238) increased the incidence of HIE. Conclusion This study reveals the factors for hypoxic-ischaemic encephalopathy among neonates in Ethiopia. The authors found that neonates born to illiterate women, those who experienced prolonged labour, those whose mothers did not have ultrasound checkups during pregnancy, those delivered by caesarean section, and those born preterm, or post-term were more likely to develop hypoxic-ischaemic encephalopathy. These findings indicate that enhancing maternal education and healthcare services during pregnancy and delivery may positively reduce hypoxic-ischaemic encephalopathy among neonates.
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Geva N, Geva Y, Salem SY, Marks KA, Rotem R, Abramsky R, Hershkovitz R, Shelef I, Novik EF, Weintraub AY, Shany E. The association of intrapartum deceleration and acceleration areas with MRI findings in neonatal encephalopathy. Pediatr Res 2023; 94:1119-1124. [PMID: 36964444 DOI: 10.1038/s41390-023-02575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/11/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is an important contributor to disability worldwide. The current cardiotocography (CTG) predictive value for neonatal outcome is limited. OBJECTIVE To assess the association of intrapartum CTG deceleration and acceleration areas with early MRI cerebral pathology in infants with HIE. METHODS Term and near-term low-risk pregnancies that resulted in HIE, treated with therapeutic hypothermia with sufficient CTG records from a single, tertiary hospital between 2013 and 2021 were enrolled. Accelerations and decelerations areas, their minimum and maximum depths, and duration were calculated as well as the acceleration-to-deceleration area ratio during the 120 min prior to delivery. These data were assessed for associations with higher degrees of abnormality on early MRI scans. RESULTS A total of 77 infants were included in the final analysis. Significant associations between increased total acceleration area (p = 0.007) and between a higher acceleration-to-deceleration area ratio (p = 0.003) and better MRI results were detected. CONCLUSION In neonates treated for HIE, acceleration area and acceleration-to-deceleration ratio are associated with the risk of neonatal brain MRI abnormalities. To increase the role of these measurements as a relevant clinical tool, larger, more powered prospective trials are needed, using computerized real-time analysis. IMPACT The current cardiotocography predictive value for neonatal outcome is limited. This study aimed to assess the association of intrapartum deceleration and acceleration areas with the degree of cerebral injury in early cerebral MRI of neonates with encephalopathy. Lower acceleration area and acceleration-to-deceleration ratio were found to be associated with a higher degree of neonatal brain injury. Brain MRI is a marker of long-term outcome; its association with cardiotocography indices supports their association with long-term outcome in these neonates. Future computer-based CTG area analysis could assist in delivery room decision making to better time interventions and prevent hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Neta Geva
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel.
| | - Yael Geva
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Kyla Anna Marks
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Reut Rotem
- Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Ramy Abramsky
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Ilan Shelef
- Department of Medical Imaging, Soroka Medical Center and the, Ben-Gurion University of the Negev Zlotowski Center for Neuroscience, Beer-Sheva, Israel
| | - Evelyn Farkash Novik
- Department of Medical Imaging, Soroka Medical Center and the, Ben-Gurion University of the Negev Zlotowski Center for Neuroscience, Beer-Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Eilon Shany
- Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
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Juul SE, Voldal E, Comstock BA, Massaro AN, Bammler TK, Mayock DE, Heagerty PJ, Wu YW, Numis AL. Association of High-Dose Erythropoietin With Circulating Biomarkers and Neurodevelopmental Outcomes Among Neonates With Hypoxic Ischemic Encephalopathy: A Secondary Analysis of the HEAL Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2322131. [PMID: 37418263 PMCID: PMC10329214 DOI: 10.1001/jamanetworkopen.2023.22131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/18/2023] [Indexed: 07/08/2023] Open
Abstract
Importance The ability to predict neurodevelopmental impairment (NDI) for infants diagnosed with hypoxic ischemic encephalopathy (HIE) is important for parental guidance and clinical treatment as well as for stratification of patients for future neurotherapeutic studies. Objectives To examine the effect of erythropoietin on plasma inflammatory mediators in infants with moderate or severe HIE and to develop a panel of circulating biomarkers that improves the projection of 2-year NDI over and above the clinical data available at the time of birth. Design, Setting, and Participants This study is a preplanned secondary analysis of prospectively collected data from infants enrolled in the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) Trial, which tested the efficacy of erythropoietin as an adjunctive neuroprotective therapy to therapeutic hypothermia. The study was conducted at 17 academic sites comprising 23 neonatal intensive care units in the United States between January 25, 2017, and October 9, 2019, with follow-up through October 2022. Overall, 500 infants born at 36 weeks' gestation or later with moderate or severe HIE were included. Intervention Erythropoietin treatment 1000 U/kg/dose on days 1, 2, 3, 4 and 7. Main Outcomes and Measures Plasma erythropoietin was measured in 444 infants (89%) within 24 hours after birth. A subset of 180 infants who had plasma samples available at baseline (day 0/1), day 2, and day 4 after birth and either died or had 2-year Bayley Scales of Infant Development III assessments completed were included in the biomarker analysis. Results The 180 infants included in this substudy had a mean (SD) gestational age of 39.1 (1.5) weeks, and 83 (46%) were female. Infants who received erythropoietin had increased concentrations of erythropoietin at day 2 and day 4 compared with baseline. Erythropoietin treatment did not alter concentrations of other measured biomarkers (eg, difference in interleukin [IL] 6 between groups on day 4: -1.3 pg/mL; 95% CI, -4.8 to 2.0 pg/mL). After adjusting for multiple comparisons, we identified 6 plasma biomarkers (C5a, interleukin [IL] 6, and neuron-specific enolase at baseline; IL-8, tau, and ubiquitin carboxy-terminal hydrolase-L1 at day 4) that significantly improved estimations of death or NDI at 2 years compared with clinical data alone. However, the improvement was only modest, increasing the AUC from 0.73 (95% CI, 0.70-0.75) to 0.79 (95% CI, 0.77-0.81; P = .01), corresponding to a 16% (95% CI, 5%-44%) increase in correct classification of participant risk of death or NDI at 2 years. Conclusions and Relevance In this study, erythropoietin treatment did not reduce biomarkers of neuroinflammation or brain injury in infants with HIE. Circulating biomarkers modestly improved estimation of 2-year outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02811263.
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Sewell EK, Shankaran S, McDonald SA, Hamrick S, Wusthoff CJ, Adams-Chapman I, Chalak LF, Davis AS, Van Meurs K, Das A, Maitre N, Laptook A, Patel RM. Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: an observational study. Arch Dis Child Fetal Neonatal Ed 2023; 108:421-428. [PMID: 36732048 PMCID: PMC10293046 DOI: 10.1136/archdischild-2022-324612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess variability in continuation of antiseizure medication (ASM) at discharge and to evaluate if continuation of ASM at discharge is associated with death or disability among infants with hypoxic-ischaemic encephalopathy (HIE) and seizures. DESIGN Retrospective study of infants enrolled in three National Institute of Child Health and Human Development Neonatal Research Network Trials of therapeutic hypothermia. SETTING 22 US centres. PATIENTS Infants with HIE who survived to discharge and had clinical or electrographic seizures treated with ASM. EXPOSURES ASM continued or discontinued at discharge. OUTCOMES Death or moderate-to-severe disability at 18-22 months, using trial definitions. Multivariable logistic regression evaluated the association between continuation of ASM at discharge and the primary outcome, adjusting for severity of HIE, hypothermia trial treatment arm, use of electroencephalogram, discharge on gavage feeds, Apgar Score at 5 min, birth year and centre. RESULTS Of 302 infants included, 61% were continued on ASMs at discharge (range 13%-100% among 22 centres). Electroencephalogram use occurred in 92% of the cohort. Infants with severe HIE comprised 24% and 22% of those discharged with and without ASM, respectively. The risk of death or moderate-to-severe disability was greater for infants continued on ASM at discharge, compared with those infants discharged without ASM (44% vs 28%, adjusted OR 2.14; 95% CI 1.13 to 4.05). CONCLUSIONS In infants with HIE and seizures, continuation of ASM at discharge varies substantially among centres and may be associated with a higher risk of death or disability at 18-22 months of age.
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Affiliation(s)
- Elizabeth K Sewell
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Seetha Shankaran
- Pediatrics Neonatology, Wayne State University Childrens Hospital of MI, Detroit, Michigan, USA
| | | | - Shannon Hamrick
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | | | - Ira Adams-Chapman
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Lina F Chalak
- Pediatrics, UT Southwestern Dallas, dallas, Texas, USA
| | - Alexis S Davis
- Pediatrics, Stanford University, Palo Alto, California, USA
| | - Krisa Van Meurs
- Division of Neonatology, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Abhik Das
- RTI International, Rockville, Maryland, USA
| | - Nathalie Maitre
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Abbott Laptook
- Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Ravi Mangal Patel
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
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Tian T, Gan T, Chen J, Lu J, Zhang G, Zhou Y, Li J, Shao H, Liu Y, Zhu H, Wu D, Jiang C, Shao J, Shi J, Yang W, Zhu W. Graphic Intelligent Diagnosis of Hypoxic-Ischemic Encephalopathy Using MRI-Based Deep Learning Model. Neonatology 2023; 120:441-449. [PMID: 37231912 DOI: 10.1159/000530352] [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: 11/15/2022] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Heterogeneous MRI manifestations restrict the efficiency and consistency of neuroradiologists in diagnosing hypoxic-ischemic encephalopathy (HIE) due to complex injury patterns. This study aimed to develop and validate an intelligent HIE identification model (termed as DLCRN, deep learning clinical-radiomics nomogram) based on conventional structural MRI and clinical characteristics. METHODS In this retrospective case-control study, full-term neonates with HIE and healthy controls were collected in two different medical centers from January 2015 to December 2020. Multivariable logistic regression analysis was implemented to establish the DLCRN model based on conventional MRI sequences and clinical characteristics. Discrimination, calibration, and clinical applicability were used to evaluate the model in the training and validation cohorts. Grad-class activation map algorithm was implemented to visualize the DLCRN. RESULTS 186 HIE patients and 219 healthy controls were assigned to the training, internal validation, and independent validation cohorts. Birthweight was incorporated with deep radiomics signatures to create the final DLCRN model. The DLCRN model achieved better discriminatory power than simple radiomics models, with an area under the curve (AUC) of 0.868, 0.813, and 0.798 in the training, internal validation, and independent validation cohorts, respectively. The DLCRN model was well calibrated and has clinical potential. Visualization of the DLCRN highlighted the lesion areas that conformed to radiological identification. CONCLUSION Visualized DLCRN may be a useful tool in the objective and quantitative identification of HIE. Scientific application of the optimized DLCRN model may save time for screening early mild HIE, improve the consistency of HIE diagnosis, and guide timely clinical management.
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Affiliation(s)
- Tian Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tongjia Gan
- Medical Imaging Center, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Jun Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of CT and MRI, The First Affiliated Hospital, College of Medicine, Shihezi University, Shihezi, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiran Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoyue Shao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufei Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongquan Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengcheng Jiang
- Department of Radiology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Jianbo Shao
- Medical Imaging Center, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Shi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhong Yang
- Department of Radiology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Quinones Cardona V, Rao R, Zaniletti I, Joe P, Johnson YR, DiGeronimo R, Hamrick SE, Lee KS, Mietzsch U, Natarajan G, Peeples ES, Wu TW, Hossain T, Flibotte J, Chandel A, Distler A, Shenberger JS, Oghifobibi O, Massaro AN, Dizon MLV. Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy. JAMA Netw Open 2023; 6:e233770. [PMID: 36943267 PMCID: PMC10031395 DOI: 10.1001/jamanetworkopen.2023.3770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
IMPORTANCE Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes. OBJECTIVE To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children's hospitals participating in the Children's Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022. EXPOSURES Infants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles. MAIN OUTCOMES AND MEASURES The main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared. RESULTS Among the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P < .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P < .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high- or medium-hospitalization cost centers and death or NDI. High- and medium-EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High- and medium-laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High-antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]). CONCLUSIONS AND RELEVANCE Hospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.
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Affiliation(s)
- Vilmaris Quinones Cardona
- St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Rakesh Rao
- St Louis Children's Hospital, St Louis, Missouri
| | | | - Priscilla Joe
- UCSF Benioff Children's Hospital, Oakland, California
| | - Yvette R Johnson
- Cook's Children's Medical Center, Department of Pediatrics, Texas Christian University Medical School, Fort Worth
| | | | - Shannon E Hamrick
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Kyong-Soon Lee
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ulrike Mietzsch
- Seattle Children's Hospital, University of Washington, Seattle
| | - Girija Natarajan
- Children's Hospital of Michigan, Central Michigan University, Detroit
| | | | - Tai-Wei Wu
- Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | | | - John Flibotte
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amit Chandel
- Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy Distler
- St Louis Children's Hospital, St Louis, Missouri
| | - Jeffrey S Shenberger
- Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - An N Massaro
- Childrens National Health Systems, Washington, DC
| | - Maria L V Dizon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Bourel-Ponchel E, Querne L, Flamein F, Ghostine-Ramadan G, Wallois F, Lamblin MD. The prognostic value of neonatal conventional-EEG monitoring in hypoxic-ischemic encephalopathy during therapeutic hypothermia. Dev Med Child Neurol 2023; 65:58-66. [PMID: 35711160 PMCID: PMC10084260 DOI: 10.1111/dmcn.15302] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/28/2023]
Abstract
AIM To determine the prognostic value of conventional electroencephalography (EEG) monitoring in neonatal hypoxic-ischemic encephalopathy (HIE). METHOD In this multicentre retrospective study, 95 full-term neonates (mean of 39.3wks gestational age [SD 1.4], 36 [38%] females, 59 [62%] males) with HIE (2013-2016) undergoing therapeutic hypothermia were divided between favourable or adverse outcomes. Background EEG activity (French classification scale: 0-1-2-3-4-5) and epileptic seizure burden (epileptic seizure scale: 0-1-2) were graded for seven 6-hour periods. Conventional EEG monitoring was investigated by principal component analysis (PCA), with clustering methods to extract prognostic biomarkers of development at 2 years and infant death. RESULTS Eighty-one per cent of infants with an adverse outcome had a French classification scale equal to or greater than 3 after H48 (100% at H6-12). The H6-12 epileptic seizure scale was equal to or greater than 1 for 39%, increased to 52% at H30-36 and then remained equal to or greater than 1 for 39% after H48. Forty-five per cent of infants with a favourable outcome had a H6-12 French classification scale equal to or greater than 3, which dropped to 5% after H48; 13% had a H6-12 epileptic seizure scale equal to or greater than 1 but no seizures after H48. Clustering methods based on PCA showed the high efficiency (96%) of conventional EEG monitoring for outcome prediction and allowed the definition of three prognostic EEG biomarkers: H6-78 French classification scale mean, H6-78 French classification scale slope, and H30-78 epileptic seizure scale mean. INTERPRETATION Early lability and recovery of physiological features is prognostic of a favourable outcome. Seizure onset from the second day should also be considered to accurately predict neurodevelopment in HIE and support the importance of conventional EEG monitoring in HIE in infants cooled with therapeutic hypothermia. WHAT THIS PAPER ADDS Comprehensive analysis showed the high prognostic efficiency (96%) of conventional electroencephalography (EEG) monitoring. Prognostic EEG biomarkers consist of the grade of background EEG activity, its evolution, and the mean seizure burden. Persistent seizures (H48) without an improvement in background EEG activity were consistently associated with an adverse outcome.
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Affiliation(s)
- Emilie Bourel-Ponchel
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Pediatric Neurophysiology Unit, Amiens Picardie University Hospital, Amiens, France
| | - Laurent Querne
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Department of Pediatric Neurology, Amiens-Picardie University Hospital, Amiens, France
| | - Florence Flamein
- Department of Neonatology, University Hospital of Lille, Lille, France
| | - Ghida Ghostine-Ramadan
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Neonatal Intensive Care Unit, Amiens-Picardie University Hospital, Amiens, France
| | - Fabrice Wallois
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Pediatric Neurophysiology Unit, Amiens Picardie University Hospital, Amiens, France
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16
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Liu G, Cheng S, Wan L, Li Y, Zhao Q, Liu J, Jiang X. Correlation analysis of NT-proBNP (N-terminal probrain natriuretic peptide), 25-Hydroxyvitamin D, HMGB1(High-mobility group box 1), ACTA (endogenous activin A), blood glucose level, and electrolyte level with developmental quotient scores in neonates with hypoxic-ischemic encephalopathy. BMC Pediatr 2022; 22:739. [PMID: 36577981 PMCID: PMC9795784 DOI: 10.1186/s12887-022-03606-6] [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: 06/08/2022] [Accepted: 08/25/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To investigate the correlation between N-terminal probrain natriuretic peptide (NT-proBNP), 25-hydroxyvitamin D (25-(OH) D), high-mobility group box 1(HMGB1), endogenous activin A (ACTA), blood glucose level, electrolyte levels and developmental quotient (DQ) scores of Hypoxic-ischemic encephalopathy (HIE). METHODS In this retrospective study, a total of 90 neonates diagnosed with HIE who were admitted to our hospital from January 2018 to June 2021 were retrospectively enrolled, and 40 healthy full-term neonates born in our hospital during the same period were randomly selected. Neonates with HIE and healthy conditions were set as the study group and control group, respectively. Neonates with HIE are divided into three subgroups, mild, moderate, and severe, based on the severity of HIE. The Gesell Developmental Scale (GDS) was used to assess neural development of neonates at 9 to 12 months postnatal. Biomarkers of peripheral venous blood were measured and collected in all neonates, including NT-proBNP, (25-(OH) D), HMGB1, ACTA, electrolyte levels and blood glucose levels. General demographic information and Apgar score were compared between the two groups. The differences between the two groups of biomarkers were compared and the correlation between these biomarkers and DQ scores was evaluated. RESULTS There was no significant difference in gestational age, maternal age, gender, way of birth, birth weight, gestational age and whether the mother was a primipara between the two groups (P>0.05). The 10 min Apgar score of the study group (5.87±0.36) was lower than that of the control group (9.37±0.32) with significant difference (P<0.05). The levels of NT-proBNP, HMGB1, and ACTA in the study group were higher than that in the control group (243.87±21.29 pmol/L vs. 116.98±22.19 pmol/L; 8.92±1.87 μg/L vs. 3.28±1.08 μg/L; 23.78±0.89 ng/ml vs. 2.98±0.38 ng/ml), while the levels of 25-(OH) D and electrolyte levels were lower than that in the control group (24.28±1.87 vs. 31.29±1.93; K+: 4.49±0.23 mmol/L vs. 4.73±0.21 mmol/L; Na+: 118.76±13.02 mmol/L vs. 134.28±12.29 mmol/L; Ca2+: 1.77±0.23 mmol/L vs. 2.35±0.26 mmol/L; Mg2+: 0.61±0.17 mmol/L vs. 0.91±0.17 mmol/L), with statistically significant differences (P<0.001). The levels of NT-probNP, HMGB1, ACTA and the incidence of hypoglycemia were the highest in the severe group, which were significantly higher than those in the moderate group and mild group (P<0.05). The levels of NT-probNP, HMGB1, ACTA and the incidence of hypoglycemia were the lowest in the mild group. The 25-(OH) D level, the incidence of hyperglycemia and electrolyte levels were the lowest in the severe group, which were significantly lower than those in the moderate and mild groups (all P<0.05). Meanwhile, the 25-(OH) D level, the incidence of hyperglycemia and electrolyte levels in the moderate group were lower than those in the mild group, and the differences were statistically significant (all P<0.05). The incidence of hyperglycemia in severe group (16 cases) was the lowest, significantly lower than that in moderate group (17 cases) and mild group (22 cases), and the difference was statistically significant (all P<0.05). The DQ scores of HIE neonates were negatively correlated with NT-proBNP, HMGB1, and ACTA (r=-0.671, -0.421, -0.518, all P< 0.001). The DQ scores was positively correlated with levels of 25-(OH) D and blood glucose level (r =0.621, 0.802, all P< 0.001). The DQ scores was also positively correlated with levels of potassium, sodium, calcium and magnesium (0.367, 0.782, 0.218, 0.678, all P<0.001). CONCLUSION The NT-proBNP, HMGB1, ACTA, 25-(OH) D, blood glucose levels and electrolyte levels are correlated with the severity of HIE, and developmental quotient scores in neonates with HIE. These biomarkers are suggestive for assessing the prognosis of neonate with HIE.
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Affiliation(s)
- Guiling Liu
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
| | - Sisi Cheng
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
| | - Li Wan
- Shijiazhuang Center for Disease Control and Prevention institute of Epidemic Diseases, Shijiazhuang, China
| | - Yanyan Li
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
| | - Qian Zhao
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
| | - Jianxin Liu
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
| | - Xiufang Jiang
- grid.452458.aDepartment of Pediatrics, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031 China
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17
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Nyman J, Mikkonen K, Metsäranta M, Toiviainen-Salo S, Vanhatalo S, Lauronen L, Nevalainen P. Poor aEEG background recovery after perinatal hypoxic ischemic encephalopathy predicts postneonatal epilepsy by age 4 years. Clin Neurophysiol 2022; 143:116-123. [DOI: 10.1016/j.clinph.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/02/2022] [Indexed: 11/26/2022]
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18
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Natarajan G, Hamrick SE, Zaniletti I, Lee KS, Mietzsch U, DiGeronimo R, Dizon MLV, Peeples ES, Yanowitz TD, Wu TW, Flibotte J, Joe P, Massaro AN, Rao R. Opioid exposure during therapeutic hypothermia and short-term outcomes in neonatal encephalopathy. J Perinatol 2022; 42:1017-1025. [PMID: 35474129 DOI: 10.1038/s41372-022-01400-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the association between opioid exposure during therapeutic hypothermia (TH) for perinatal hypoxic-ischemic encephalopathy (HIE) and in-hospital outcomes. STUDY DESIGN In this retrospective cohort study, linked data were accessed on infants ≥36 weeks gestation, who underwent TH for HIE, born from 2010-2016 in 23 Neonatal Intensive Care Units participating in Children's Hospitals Neonatal Consortium and Pediatric Health Information Systems. We excluded infants who received opioids for >5 days. RESULTS The cohort (n = 1484) was categorized as No opioid [240(16.2%)], Low opioid (1-2 days) [574 (38.7%)] and High opioid group (HOG, 3-5 days) [670 (45.2%)]. After adjusting for HIE severity, opioids were not associated with abnormal MRI, but were associated with decreased likelihood of complete oral feeds at discharge. HOG had increased likelihood of prolonged hospital stay and ventilation. CONCLUSION Opioid exposure during TH was not associated with abnormal MRI; its association with adverse short-term outcomes suggests need for cautious empiric use.
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Affiliation(s)
- Girija Natarajan
- Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA.
| | | | | | - Kyong-Soon Lee
- Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Ulrike Mietzsch
- Pediatrics/Neonatology, Seattle Children's Hospital/University of Washington, Seattle, WA, USA
| | - Robert DiGeronimo
- Pediatrics/Neonatology, Seattle Children's Hospital/University of Washington, Seattle, WA, USA
| | - Maria L V Dizon
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric S Peeples
- Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Toby D Yanowitz
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tai-Wei Wu
- Neonatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - John Flibotte
- Pediatrics/ Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Priscilla Joe
- Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - An N Massaro
- Neonatology, Children's National Health Systems, Washington, DC, USA
| | - Rakesh Rao
- Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
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19
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Ghesquière L, Perbet R, Lacan L, Hamoud Y, Stichelbout M, Sharma D, Nguyen S, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model. Acta Obstet Gynecol Scand 2022; 101:758-770. [PMID: 35502642 DOI: 10.1111/aogs.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic-ischemic encephalopathy in a fetal sheep model. MATERIAL AND METHODS The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH <7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test. RESULTS Acute anoxic-ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index (r = -0.784; p = 0.021) in phase C and with HRV long-term variability (r = -0.677; p = 0.045) and short-term variability (r = -0.837; p = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV. CONCLUSIONS Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal-specific HRV markers.
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Affiliation(s)
- Louise Ghesquière
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Romain Perbet
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laure Lacan
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Yasmine Hamoud
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Morgane Stichelbout
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Dyuti Sharma
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Pediatric Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sylvie Nguyen
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Storme
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Véronique Houfflin-Debarge
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Julien De Jonckheere
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Clinical Investigation Center - Technological Innovation (CIC-IT 1403), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Charles Garabedian
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
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20
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Flibotte J, Laptook AR, Shankaran S, McDonald SA, Baserga MC, Bell EF, Cotten CM, Das A, DeMauro SB, DuPont TL, Eichenwald EC, Heyne R, Jensen EA, Van Meurs KP, Dysart K. Blanket temperature during therapeutic hypothermia and outcomes in hypoxic ischemic encephalopathy. J Perinatol 2022; 42:348-353. [PMID: 34999716 PMCID: PMC9121861 DOI: 10.1038/s41372-021-01302-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Determine whether blanket temperatures during therapeutic hypothermia (TH) are associated with 18-22 month outcomes for infants with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN Retrospective cohort study of 181 infants with HIE who received TH in two randomized trials within the Neonatal Research Network. We defined summative blanket temperature constructs and evaluated for association with a primary composite outcome of death or moderate/ severe disability at 18-22 months. RESULTS Each 0.5 °C above 33.5 °C in the mean of the highest quartile blanket temperature was associated with a 52% increase in the adjusted odds of death/ disability (aOR 1.52, 95% CI 1.09-2.11). Having >8 consecutive blanket temperatures above 33.5 °C rendered an aOR of death/disability of 5.04 in the first 24 h (95% CI 1.54-16.6) and 6.92 in the first 48 h (95% CI 2.20-21.8) of TH. CONCLUSIONS Higher blanket temperature during TH may be an early, clinically useful biomarker of HIE outcome.
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Affiliation(s)
- John Flibotte
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Abbot R Laptook
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Scott A McDonald
- Biostatistics and Epidemiology, RTI International, Research Triangle Park, NC, USA
| | - Mariana C Baserga
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | | | - Abhik Das
- Biostatistics and Epidemiology, RTI International, Rockville, MD, USA
| | - Sara B DeMauro
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tara L DuPont
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Eric C Eichenwald
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erik A Jensen
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Krisa P Van Meurs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kevin Dysart
- Division of Neonatal and Perinatal Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
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21
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Delval A, Girard B, Lacan L, Chaton L, Flamein F, Storme L, Derambure P, The Tich SN, Lamblin MD, Betrouni N. Neurophysiological recordings improve the accuracy of the evaluation of the outcome in perinatal hypoxic ischemic encephalopathy. Eur J Paediatr Neurol 2022; 36:51-56. [PMID: 34890946 DOI: 10.1016/j.ejpn.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. METHODS 30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. RESULTS Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. INTERPRETATION We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France.
| | - Barbara Girard
- Children Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Flavigny sur Moselle, France
| | - Laure Lacan
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Laurence Chaton
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Florence Flamein
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France
| | - Laurent Storme
- Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Philippe Derambure
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Sylvie Nguyen The Tich
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Marie-Dominique Lamblin
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Nacim Betrouni
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France
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22
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Tian Q, Pan Y, Zhang Z, Li M, Xu LX, Gong M, Miao P, Jiang X, Yang X, Feng CX, Pan J, Yu Y, Sun B, Ding X. Predictive value of early amplitude integrated electroencephalogram (aEEG) in sleep related problems in children with perinatal hypoxic-ischemia (HIE). BMC Pediatr 2021; 21:410. [PMID: 34537048 PMCID: PMC8449491 DOI: 10.1186/s12887-021-02796-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background While great attention has been paid to motor and cognitive impairments in children with neonatal Hypoxic-Ischemic Encephalopathy (HIE), sleep related circadian rhythm problems, although commonly present, are often neglected. Subsequently, no early clinical indicators have been reported to correlate with sleep-related circadian dysfunction during development. Methods In this study, we first analyzed patterns of the amplitude integrated electroencephalogram (aEEG) in a cohort of newborns with various degrees of HIE. Next, during follow-ups, we collected information of sleep and circadian related problems in these patients and performed correlation analysis between aEEG parameters and different sleep/circadian disorders. Results A total of 101 neonates were included. Our results demonstrated that abnormal aEEG background pattern is significantly correlated with circadian rhythmic (r = 0.289, P = 0.01) and breathing issues during sleep (r = 0.237, P = 0.037). In contrast, the establishment of sleep–wake cycle (SWC) showed no correlation with sleep/circadian problems. Detailed analysis showed that summation of aEEG score, along with low base voltage (r = 0.272, P = 0.017 and r = -0.228, P = 0.048, respectively), correlates with sleep circadian problems. In contrast, background pattern (BP) score highly correlates with sleep breathing problem (r = 0.319, P = 0.004). Conclusion Abnormal neonatal aEEG pattern is correlated with circadian related sleep problems. Our study thus provides novel insights into predictive values of aEEG in sleep-related circadian problems in children with HIE. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02796-9.
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Affiliation(s)
- Qiuyan Tian
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Yizhi Pan
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Zheng Zhang
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Mei Li
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Li-Xiao Xu
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Min Gong
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Po Miao
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Xiaolu Jiang
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Xiaofeng Yang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Chen-Xi Feng
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Jian Pan
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Yun Yu
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
| | - Bin Sun
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
| | - Xin Ding
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
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23
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Poppe T, Willers Moore J, Arichi T. Individual focused studies of functional brain development in early human infancy. Curr Opin Behav Sci 2021. [DOI: 10.1016/j.cobeha.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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24
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Abstract
Neonatal encephalopathy due to perinatal hypoxia-ischemia (hypoxic-ischemic encephalopathy [HIE]) occurs at a rate of 1 to 3 per 1000 live births. Therapeutic hypothermia is the standard of care and the only currently available therapy to reduce the risk of death or disability in newborns with moderate to severe HIE. Hypothermia therapy needs to be initiated within 6 hours after birth in order to provide the best chance for neuroprotection. All pediatricians and delivery room attendants should be trained to recognize encephalopathy and understand the eligibility criteria for treatment. The modified Sarnat examination is the most frequently used tool to assess the degree of encephalopathy and has six categories, each of which can have mild, moderate, severe abnormalities. Apart from historical and biochemical criteria, a neonate must have 3 of 6 categories scored in the moderate or severe range in order to qualify for hypothermia as was done in the randomized trials. Whether an infant qualifies or there is concern that an infant might have HIE, transfer to a center that can perform treatment should be initiated immediately. Hypothermia significantly reduces the risk of death or moderate to severe impairments at 2 years and at school age. On average, only 7 neonates need to be treated for one neonate to benefit. Although easy in concept, implementation of hypothermia does require expertise and should be carried out under the guidance of a neonatologist. If infants are passively cooled prior to transport, core temperature needs to be closely monitored with a target of 33.5°C ± 0.5°C. Maintenance of homeostasis is important in order to prevent conditions that may result in additional brain injury. Seizures are common in neonates with HIE, but electrographic seizures are rare in the first few hours after birth if the insult occurred during labor and delivery. Prophylactic antiepileptic drugs should not be administered. Brain monitoring in the form of electroencephalogram (EEG) and or amplitude-integrated EEG should be implemented as soon as possible to help with prognosis and to accurately diagnose seizures.
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Affiliation(s)
- Sonia Lomeli Bonifacio
- NeuroNICU, Division of Neonatal and Developmental Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, USA.
| | - Shandee Hutson
- Department of Neonatology, NICN, Sharp Mary Birch Hospital for Women and Newborns, 8555 Aero Drive #104, San Diego, CA 92123, USA
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25
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Zhou KQ, McDouall A, Drury PP, Lear CA, Cho KHT, Bennet L, Gunn AJ, Davidson JO. Treating Seizures after Hypoxic-Ischemic Encephalopathy-Current Controversies and Future Directions. Int J Mol Sci 2021; 22:ijms22137121. [PMID: 34281174 PMCID: PMC8268683 DOI: 10.3390/ijms22137121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia.
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