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Engel C, Rüdiger M, Benders MJNL, van Bel F, Allegaert K, Naulaers G, Bassler D, Klebermaß-Schrehof K, Vento M, Vilan A, Falck M, Mauro I, Metsäranta M, Vanhatalo S, Mazela J, Metsvaht T, van der Vlught R, Franz AR. Correction: Detailed statistical analysis plan for ALBINO: effect of Allopurinol in addition to hypothermia for hypoxic-ischemic Brain Injury on Neurocognitive Outcome - a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III). Trials 2024; 25:192. [PMID: 38491488 PMCID: PMC10941458 DOI: 10.1186/s13063-024-08031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Affiliation(s)
- Corinna Engel
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany.
| | - Mario Rüdiger
- Universitätsklinikum C. G. Carus - Medizinische Fakultät der TU Dresden, Dresden, Germany
| | | | - Frank van Bel
- Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | | | | | - Dirk Bassler
- UniversitaetsSpital Zuerich, Zuerich, Switzerland
| | | | - Maximo Vento
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Vilan
- Centro Hospitalar Universitário São João Porto, Porto, Portugal
| | - Mari Falck
- Oslo Uni- versitetssykehus HF, Oslo, Norway
| | - Isabella Mauro
- Azienda sanitaria universitaria integrata di Udine, Udine, Italy
| | | | | | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Axel R Franz
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany
- University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
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Chock VY, Vesoulis ZA, El-Dib M, Austin T, van Bel F. The Future of Neonatal Cerebral Oxygenation Monitoring: Directions After the SafeBoosC-III Trial. J Pediatr 2024; 270:114016. [PMID: 38492916 DOI: 10.1016/j.jpeds.2024.114016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA.
| | | | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Veldhuis MS, Dix LML, Breur JMPJ, de Vries WB, Koopman C, Eijsermans MJC, Swanenburg de Veye HFN, Molenschot MC, Lemmers PMA, van Bel F, Vijlbrief DC. Role of patent ductus arteriosus in preterms in long-term outcome. Early Hum Dev 2024; 190:105953. [PMID: 38330542 DOI: 10.1016/j.earlhumdev.2024.105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to determine long-term neurodevelopmental outcome and cerebral oxygenation in extremely preterm infants, comparing those with a hemodynamic significant patent ductus arteriosus (hsPDA) to those without. STUDY DESIGN We included infants born before 28 weeks of gestation from 2008 to 2010 with routine echocardiography. Prior to echocardiography, regional cerebral oxygen saturation was measured. At 5 years of age, we evaluated neurodevelopmental outcomes using the Movement Assessment Battery for Children 2nd Dutch edition for motor skills and the Wechsler Preschool and Primary Scale of Intelligence 3rd Dutch edition for cognition. RESULTS A total of 66 infants (gestational age 26.6 ± 0.9 weeks, birth weight 912 ± 176 g) were included, 34 infants with a hsPDA (including treatment). The group infants with hsPDA showed lower pre-closure cerebral saturation levels (58.2 % ±7.8 % versus 62.8 % ±7.0 %; p = 0.01). At 5 years, impaired motor outcome occurred more often in infants with hsPDA (17 (53 %) vs. 7 (23 %); p = 0.01). In multivariate analysis existence of hsPDA remained unfavourably related to the motor subdomain "aiming and catching". There were no potential effects of hsPDA on cognitive performance at 5 years of age. CONCLUSION Treatment-receiving infants with hsPDA appear to exhibit motor deficits, specifically in "aiming and catching", by the age 5. Persistent ductal patency could be a contributing factor.
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Affiliation(s)
- Moniek S Veldhuis
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura M L Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes M P J Breur
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Corine Koopman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria J C Eijsermans
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Mirella C Molenschot
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel C Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
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Engel C, Rüdiger M, Benders MJNL, van Bel F, Allegaert K, Naulaers G, Bassler D, Klebermaß-Schrehof K, Vento M, Vilan A, Falck M, Mauro I, Metsäranta M, Vanhatalo S, Mazela J, Metsvaht T, van der Vlught R, Franz AR. Detailed statistical analysis plan for ALBINO: effect of Allopurinol in addition to hypothermia for hypoxic-ischemic Brain Injury on Neurocognitive Outcome - a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III). Trials 2024; 25:81. [PMID: 38267942 PMCID: PMC10809613 DOI: 10.1186/s13063-023-07828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Despite therapeutic hypothermia (TH) and neonatal intensive care, 45-50% of children affected by moderate-to-severe neonatal hypoxic-ischemic encephalopathy (HIE) die or suffer from long-term neurodevelopmental impairment. Additional neuroprotective therapies are sought, besides TH, to further improve the outcome of affected infants. Allopurinol - a xanthine oxidase inhibitor - reduced the production of oxygen radicals and subsequent brain damage in pre-clinical and preliminary human studies of cerebral ischemia and reperfusion, if administered before or early after the insult. This ALBINO trial aims to evaluate the efficacy and safety of allopurinol administered immediately after birth to (near-)term infants with early signs of HIE. METHODS/DESIGN The ALBINO trial is an investigator-initiated, randomized, placebo-controlled, double-blinded, multi-national parallel group comparison for superiority investigating the effect of allopurinol in (near-)term infants with neonatal HIE. Primary endpoint is long-term outcome determined as survival with neurodevelopmental impairment versus death versus non-impaired survival at 2 years. RESULTS The primary analysis with three mutually exclusive responses (healthy, death, composite outcome for impairment) will be on the intention-to-treat (ITT) population by a generalized logits model according to Bishop, Fienberg, Holland (Bishop YF, Discrete Multivariate Analysis: Therory and Practice, 1975) and ."will be stratified for the two treatment groups. DISCUSSION The statistical analysis for the ALBINO study was defined in detail in the study protocol and implemented in this statistical analysis plan published prior to any data analysis. This is in accordance with the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. TRIAL REGISTRATION ClinicalTrials.gov NCT03162653. Registered on 22 May 2017.
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Affiliation(s)
- Corinna Engel
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany.
| | - Mario Rüdiger
- Universitätsklinikum C. G. Carus - Medizinische Fakultät der TU Dresden, Dresden, Germany
| | | | - Frank van Bel
- Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | | | | | - Dirk Bassler
- UniversitaetsSpital Zuerich, Zuerich, Switzerland
| | | | - Maximo Vento
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Vilan
- Centro Hospitalar Universitário São João Porto, Porto, Portugal
| | - Mari Falck
- Oslo Universitetssykehus HF, Oslo, Norway
| | - Isabella Mauro
- Azienda sanitaria universitaria integrata di Udine, Udine, Italy
| | | | | | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Axel R Franz
- Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany
- University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
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Abramsky R, Acun C, Alt J, Aly H, Arad N, Baak LM, Bakalar D, Balasingham T, Bammler T, Benders MJNL, Benitez D, Boni E, Boylan G, Campbell E, Castri P, Chandrashekar P, Chavez-Valdez R, Chen M, Chiodin E, Comstock B, Damien J, Damien J, de Vries LS, de Vries L, Dickman J, Doucette L, Duckworth E, Duckworth E, Echeverria-Palacio C, El Jalbout R, El-Dib M, Elshibiny H, Flock D, Gallagher A, Gasperoni E, Glass H, Harteman JC, Harvey-Jones K, Hazan I, Heagerty P, Inder T, Jantzie L, Juul S, Karnati S, Kute N, Lacaille H, Lange F, Lemmers PMA, Liu W, Llaguno N, Magalhães M, Mambule I, Marandyuk B, Marks K, Martin LJ, Massaro A, Mathieson S, Mathieson S, McCaul MC, Meehan C, Meledin I, Menna E, Menzato F, Mintoft A, Mitra S, Nakimuli A, Nanyunya C, Norris G, Northington FJ, Numis A, O'Reilly JJ, Ortiz S, Padiyar S, Paquette N, Parmeggiani L, Patrizi S, Pavlidis E, Pellegrin S, Penn AA, Petitpas L, Pinchefsky E, Ponta A, Puthuraya JPS, Rais R, Robertson NJ, Rodrigues D, Salandin M, Salzbank J, Sánchez L, Schalij N, Serrano-Tabares C, Shany E, Staffler A, Steggerda S, Tachtsidis I, Tann C, Tataranno ML, Trabatti C, Tremblay J, Tromp S, Tucker K, Turnbill V, Vacher CM, van Bel F, van der Aa NE, Van Meurs K, Van Steenis A, van Wyk L, Vannasing P, Variane G, Verma V, Voldal E, Wagenaar N, Wu Y, Wustoff C. Proceedings of the 14th International Newborn Brain Conference: Neonatal Neurocritical Care, seizures, and continuous aEEG and /or EEG monitoring. J Neonatal Perinatal Med 2023; 16:S33-S62. [PMID: 37599542 DOI: 10.3233/npm-239003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
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6
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Baak LM, Wagenaar N, van der Aa NE, Groenendaal F, Dudink J, Tataranno ML, Mahamuud U, Verhage CH, Eijsermans RMJC, Smit LS, Jellema RK, de Haan TR, ter Horst HJ, de Boode WP, Steggerda SJ, Prins HJ, de Haar CG, de Vries LS, van Bel F, Heijnen CJ, Nijboer CH, Benders MJNL. Feasibility and safety of intranasally administered mesenchymal stromal cells after perinatal arterial ischaemic stroke in the Netherlands (PASSIoN): a first-in-human, open-label intervention study. Lancet Neurol 2022; 21:528-536. [DOI: 10.1016/s1474-4422(22)00117-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/22/2022]
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Favié LMA, Peeters-Scholte CMPCD, Bakker A, Tjabbes H, Egberts TCG, van Bel F, Rademaker CMA, Vis P, Groenendaal F. Translation from animal to clinical studies, choosing the optimal moment. Pediatr Res 2020; 88:836-837. [PMID: 32074625 DOI: 10.1038/s41390-020-0820-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/08/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Laurent M A Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - Anouk Bakker
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carin M A Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Peter Vis
- LAP&P Consultants BV, Leiden, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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9
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van Bel F, Naulaers G. Cerebral venous volume changes and pressure autoregulation in critically ill infants: an editorial comment. J Perinatol 2020; 40:693-694. [PMID: 32157218 DOI: 10.1038/s41372-020-0646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
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Favié LMA, Peeters-Scholte CMPCD, Bakker A, Tjabbes H, Egberts TCG, van Bel F, Rademaker CMA, Vis P, Groenendaal F. Pharmacokinetics and short-term safety of the selective NOS inhibitor 2-iminobiotin in asphyxiated neonates treated with therapeutic hypothermia. Pediatr Res 2020; 87:689-696. [PMID: 31578035 DOI: 10.1038/s41390-019-0587-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonatal encephalopathy following perinatal asphyxia is a leading cause for neonatal death and disability, despite treatment with therapeutic hypothermia. 2-Iminobiotin is a promising neuroprotective agent additional to therapeutic hypothermia to improve the outcome of these neonates. METHODS In an open-label study, pharmacokinetics and short-term safety of 2-iminobiotin were investigated in neonates treated with therapeutic hypothermia. Group A (n = 6) received four doses of 0.16 mg/kg intravenously q6h. Blood sampling for pharmacokinetic analysis and monitoring of vital signs for short-term safety analysis were performed. Data from group A was used to determine the dose for group B, aiming at an AUC0-48 h of 4800 ng*h/mL. RESULTS Exposure in group A was higher than targeted (median AUC0-48 h 9522 ng*h/mL); subsequently, group B (n = 6) received eight doses of 0.08 mg/kg q6h (median AUC0-48 h 4465 ng*h/mL). No changes in vital signs were observed and no adverse events related to 2-iminobiotin occurred. CONCLUSION This study indicates that 2-iminobiotin is well tolerated and not associated with any adverse events in neonates treated with therapeutic hypothermia after perinatal asphyxia. Target exposure was achieved with eight doses of 0.08 mg/kg q6h. Optimal duration of therapy for clinical efficacy needs to be determined in future clinical trials.
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Affiliation(s)
- Laurent M A Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands. .,Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | | | - Anouk Bakker
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carin M A Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Peter Vis
- LAP&P Consultants BV, Leiden, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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11
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Camfferman FA, de Goederen R, Govaert P, Dudink J, van Bel F, Pellicer A, Cools F. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res 2020; 87:50-58. [PMID: 32218536 PMCID: PMC7098887 DOI: 10.1038/s41390-020-0777-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Very and extremely preterm infants frequently have brain injury-related long-term neurodevelopmental problems. Altered perfusion, for example, seen in the context of a hemodynamically significant patent ductus arteriosus (PDA), has been linked to injury of the immature brain. However, a direct relation with outcome has not been reviewed systematically. METHODS A systematic review was conducted to provide an overview of the value of different cerebral arterial blood flow parameters assessed by Doppler ultrasound, in relation to brain injury, to predict long-term neurodevelopmental outcome in preterm infants. RESULTS In total, 23 studies were included. Because of heterogeneity of studies, a meta-analysis of results was not possible. All included studies on resistance index (RI) showed significantly higher values in subjects with a hemodynamically significant PDA. However, absolute differences in RI values were small. Studies using Doppler parameters to predict brain injury and long-term neurodevelopmental outcome were inconsistent. DISCUSSION There is no clear evidence to support the routine determination of RI or other Doppler parameters in the cerebral arteries to predict brain injury and long-term neurodevelopmental outcome in the preterm infant. However, there is evidence that elevated RI can point to the presence of a hemodynamically significant PDA.
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Affiliation(s)
- Fleur A Camfferman
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Robbin de Goederen
- Dutch Craniofacial Centre Rotterdam, Department of Plastic and Reconstructive Surgery, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Jeroen Dudink
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Albrecht M, Zitta K, Groenendaal F, van Bel F, Peeters-Scholte C. Neuroprotective strategies following perinatal hypoxia-ischemia: Taking aim at NOS. Free Radic Biol Med 2019; 142:123-131. [PMID: 30818057 DOI: 10.1016/j.freeradbiomed.2019.02.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 12/13/2022]
Abstract
Perinatal asphyxia is characterized by oxygen deprivation and lack of perfusion in the perinatal period, leading to hypoxic-ischemic encephalopathy and sequelae such as cerebral palsy, mental retardation, cerebral visual impairment, epilepsy and learning disabilities. On cellular level PA is associated with a decrease in oxygen and glucose leading to ATP depletion and a compromised mitochondrial function. Upon reoxygenation and reperfusion, the renewed availability of oxygen gives rise to not only restoration of cell function, but also to the activation of multiple detrimental biochemical pathways, leading to secondary energy failure and ultimately, cell death. The formation of reactive oxygen species, nitric oxide and peroxynitrite plays a central role in the development of subsequent neurological damage. In this review we give insight into the pathophysiology of perinatal asphyxia, discuss its clinical relevance and summarize current neuroprotective strategies related to therapeutic hypothermia, ischemic postconditioning and pharmacological interventions. The review will also focus on the possible neuroprotective actions and molecular mechanisms of the selective neuronal and inducible nitric oxide synthase inhibitor 2-iminobiotin that may represent a novel therapeutic agent for the treatment of hypoxic-ischemic encephalopathy, both in combination with therapeutic hypothermia in middle- and high-income countries, as well as stand-alone treatment in low-income countries.
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Affiliation(s)
- Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Karina Zitta
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cacha Peeters-Scholte
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Neurophyxia BV, 's Hertogenbosch, the Netherlands.
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Cohen E, Baerts W, Caicedo Dorado A, Naulaers G, van Bel F, Lemmers PMA. Cerebrovascular autoregulation in preterm fetal growth restricted neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104:F467-F472. [PMID: 30355781 DOI: 10.1136/archdischild-2017-313712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/12/2018] [Accepted: 09/22/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the effect of fetal growth restriction (FGR) on cerebrovascular autoregulation in preterm neonates during the first 3 days of life. DESIGN Case-control study. SETTING Neonatal intensive care unit of the Wilhelmina Children's Hospital, The Netherlands. PATIENTS 57 FGR (birth weight <10th percentile) and 57 appropriate for gestational age (AGA) (birth weight 20th-80th percentiles) preterm neonates, matched for gender, gestational age, respiratory and blood pressure support. METHODS The correlation between continuously measured mean arterial blood pressure and regional cerebral oxygen saturation was calculated to generate the cerebral oximetry index (COx). Mean COx was calculated for each patient for each postnatal day. The percentage of time with impaired autoregulation (COx>0.5) was also calculated. RESULTS FGR neonates had higher mean COx values than their AGA peers on day 2 (0.15 (95% CI 0.11 to 0.18) vs 0.09 (95% CI 0.06 to 0.13), p=0.029) and day 3 (0.17 (95% CI 0.13 to 0.20) vs 0.09 (95% CI 0.06 to 0.12), p=0.003) of life. FGR neonates spent more time with impaired autoregulation (COx value >0.5) than controls on postnatal day 2 (19% (95% CI 16% to 22%) vs 14% (95% CI 12% to 17%), p=0.035) and day 3 (20% (95% CI 17% to 24%) vs 15% (95% CI 12% to 18%), p=0.016). CONCLUSION FGR preterm neonates more frequently display impaired cerebrovascular autoregulation compared with AGA peers on days 2 and 3 of life which may predispose them to brain injury. Further studies are required to investigate whether this impairment persists beyond the first few days of life and whether this impairment is linked to poor neurodevelopmental outcome.
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Affiliation(s)
- Emily Cohen
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands.,The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander Caicedo Dorado
- Department of Applied Mathematics and Computer Science, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogota, Colombia
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Leuven, Leuven, Belgium
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
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14
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Wagenaar N, van den Berk DJM, Lemmers PMA, van der Aa NE, Dudink J, van Bel F, Groenendaal F, de Vries LS, Benders MJNL, Alderliesten T. Brain Activity and Cerebral Oxygenation After Perinatal Arterial Ischemic Stroke Are Associated With Neurodevelopment. Stroke 2019; 50:2668-2676. [PMID: 31390967 PMCID: PMC6756254 DOI: 10.1161/strokeaha.119.025346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. In infants with perinatal arterial ischemic stroke (PAIS), early prognosis of neurodevelopmental outcome is important to adequately inform parents and caretakers. Early continuous neuromonitoring after PAIS may improve early prognosis. Our aim was to study early cerebral electrical activity and oxygenation measured by amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in term neonates with PAIS and relate these to the development of cerebral palsy and cognitive deficit.
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Affiliation(s)
- Nienke Wagenaar
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Daphne J M van den Berk
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Petra M A Lemmers
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Niek E van der Aa
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Jeroen Dudink
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Frank van Bel
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Floris Groenendaal
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Linda S de Vries
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Manon J N L Benders
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Thomas Alderliesten
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
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15
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Annink KV, Franz AR, Derks JB, Rudiger M, Bel FV, Benders MJNL. Allopurinol: Old Drug, New Indication in Neonates? Curr Pharm Des 2019; 23:5935-5942. [PMID: 28925896 DOI: 10.2174/1381612823666170918123307] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is an important cause of neonatal mortality and neurological morbidity, even despite hypothermia treatment. Neuronal damage in these infants is partly caused by the production of superoxides via the xanthine-oxidase pathway and concomitant free radical formation. Allopurinol is a xanthine-oxidase inhibitor and can potentially reduce the formation of these superoxides that lead to brain damage in HIE. METHODS The aim of this review is to provide an overview of the animal and clinical data about the neuroprotective effect of allopurinol in HIE and the relevant mechanisms leading to brain injury in HIE. RESULTS A possible neuroprotective effect of allopurinol has been suggested based on several preclinical studies in rats, piglets and sheep. Allopurinol seemed to inhibit the formation of superoxide and to scavenge free radicals directly, but the effect on brain damage was inconclusive in these preclinical trials. The neuroprotective effect was also investigated in neonates with HIE. In three small studies, in which, allopurinol was administered postnatally and a pilot and one multi-center study, in which, allopurinol was administered antenatally, a possible beneficial effect was found. After combining the data of 2 postnatal allopurinol studies, long-term follow-up was only beneficial in infants with moderate HIE, therefore, large-scale studies are needed. Additionally, safety, pharmacokinetics and the neuroprotective effect of allopurinol in other neonatal populations are discussed in this review. CONCLUSION The available literature is not conclusive whether allopurinol is a neuroprotective add-on therapy in infants with HIE. More research is needed to establish the neuroprotective effect of allopurinol especially in combination with hypothermia.
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Affiliation(s)
- Kim V Annink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - Axel R Franz
- Department of Neonatology and Centre for Paediatric Clinical Studies, Universitatsklinikum Tubingen, Germany
| | - Jan B Derks
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, University Utrecht, Netherlands
| | - Mario Rudiger
- Department of Neonatology and Paediatric Intensive Care, Universitatsklinikum Carl Gustav Carus, TU Dresden, Germany
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
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16
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Maiwald CA, Annink KV, Rüdiger M, Benders MJNL, van Bel F, Allegaert K, Naulaers G, Bassler D, Klebermaß-Schrehof K, Vento M, Guimarães H, Stiris T, Cattarossi L, Metsäranta M, Vanhatalo S, Mazela J, Metsvaht T, Jacobs Y, Franz AR. Effect of allopurinol in addition to hypothermia treatment in neonates for hypoxic-ischemic brain injury on neurocognitive outcome (ALBINO): study protocol of a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III). BMC Pediatr 2019; 19:210. [PMID: 31248390 PMCID: PMC6595623 DOI: 10.1186/s12887-019-1566-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
Background Perinatal asphyxia and resulting hypoxic-ischemic encephalopathy is a major cause of death and long-term disability in term born neonates. Up to 20,000 infants each year are affected by HIE in Europe and even more in regions with lower level of perinatal care. The only established therapy to improve outcome in these infants is therapeutic hypothermia. Allopurinol is a xanthine oxidase inhibitor that reduces the production of oxygen radicals as superoxide, which contributes to secondary energy failure and apoptosis in neurons and glial cells after reperfusion of hypoxic brain tissue and may further improve outcome if administered in addition to therapeutic hypothermia. Methods This study on the effects of ALlopurinol in addition to hypothermia treatment for hypoxic-ischemic Brain Injury on Neurocognitive Outcome (ALBINO), is a European double-blinded randomized placebo-controlled parallel group multicenter trial (Phase III) to evaluate the effect of postnatal allopurinol administered in addition to standard of care (including therapeutic hypothermia if indicated) on the incidence of death and severe neurodevelopmental impairment at 24 months of age in newborns with perinatal hypoxic-ischemic insult and signs of potentially evolving encephalopathy. Allopurinol or placebo will be given in addition to therapeutic hypothermia (where indicated) to infants with a gestational age ≥ 36 weeks and a birth weight ≥ 2500 g, with severe perinatal asphyxia and potentially evolving encephalopathy. The primary endpoint of this study will be death or severe neurodevelopmental impairment versus survival without severe neurodevelopmental impairment at the age of two years. Effects on brain injury by magnetic resonance imaging and cerebral ultrasound, electric brain activity, concentrations of peroxidation products and S100B, will also be studied along with effects on heart function and pharmacokinetics of allopurinol after iv-infusion. Discussion This trial will provide data to assess the efficacy and safety of early postnatal allopurinol in term infants with evolving hypoxic-ischemic encephalopathy. If proven efficacious and safe, allopurinol could become part of a neuroprotective pharmacological treatment strategy in addition to therapeutic hypothermia in children with perinatal asphyxia. Trial registration NCT03162653, www.ClinicalTrials.gov, May 22, 2017.
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Affiliation(s)
- Christian A Maiwald
- University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.,Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany
| | - Kim V Annink
- Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Mario Rüdiger
- Universitätsklinikum C. G. Carus - Medizinische Fakultät der TU Dresden, Dresden, Germany
| | | | - Frank van Bel
- Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | | | | | - Dirk Bassler
- UniversitaetsSpital Zuerich, Zuerich, Switzerland
| | | | - Maximo Vento
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Tom Stiris
- Oslo Universitetssykehus HF, Oslo, Norway
| | - Luigi Cattarossi
- Azienda sanitaria universitaria integrata di Udine, Udine, Italy
| | | | | | - Jan Mazela
- Poznan University of Medical Sciences - Department of Neonatology, Poznan, Poland
| | | | | | - Axel R Franz
- University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany. .,Center for Pediatric Clinical Studies (CPCS), University Hospital Tuebingen, Tuebingen, Germany.
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17
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Alderliesten T, van Bel F, van der Aa NE, Steendijk P, van Haastert IC, de Vries LS, Groenendaal F, Lemmers P. Low Cerebral Oxygenation in Preterm Infants Is Associated with Adverse Neurodevelopmental Outcome. J Pediatr 2019; 207:109-116.e2. [PMID: 30577979 DOI: 10.1016/j.jpeds.2018.11.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether high and low levels of cerebral oxygenation (regional cerebral oxygenation [rScO2]) in infants born at <32 weeks of gestation were associated with adverse long-term outcome. STUDY DESIGN Observational cohort study including preterm infants born at <32 weeks of gestation at the Wilhelmina Children's Hospital, The Netherlands, between April 2006 and April 2013. The rScO2 was continuously monitored for 72 hours after birth using near-infrared spectroscopy. Outcome was assessed at 15 and 24 months of corrected age by certified investigators. An unfavorable composite outcome was defined as an outcome score below -1 SD or death. Various rScO2 thresholds were explored. RESULTS In total, 734 infants were eligible for analysis, 60 of whom died. Associations with an unfavorable cognitive outcome in multivariable analysis were comparable for time spent with a rScO2 below 55% and -1.5 SD (according to published reference values), with an OR of 1.4 (CI 1.1-1.7) for 20% of time below either threshold. Results at 15 months were comparable with results at 24 months. Results were not statistically significant for thresholds defining high values of rScO2. The composite motor outcome was not significantly related to either low or high values or rScO2. CONCLUSIONS Low, but not high, rScO2 was associated with an unfavorable cognitive outcome. This suggests the use of a threshold of rScO2 <55% for future clinical studies when using adult near-infrared sensors (rScO2 <65% for neonatal sensors, approximately).
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Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
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18
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van Bel F, Vaes J, Groenendaal F. Prevention, Reduction and Repair of Brain Injury of the Preterm Infant. Front Physiol 2019; 10:181. [PMID: 30949060 PMCID: PMC6435588 DOI: 10.3389/fphys.2019.00181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/14/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Josine Vaes
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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19
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Favié LMA, Groenendaal F, van den Broek MPH, Rademaker CMA, de Haan TR, van Straaten HLM, Dijk PH, van Heijst A, Dudink J, Dijkman KP, Rijken M, Zonnenberg IA, Cools F, Zecic A, van der Lee JH, Nuytemans DHGM, van Bel F, Egberts TCG, Huitema ADR. Pharmacokinetics of morphine in encephalopathic neonates treated with therapeutic hypothermia. PLoS One 2019; 14:e0211910. [PMID: 30763356 PMCID: PMC6375702 DOI: 10.1371/journal.pone.0211910] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Morphine is a commonly used drug in encephalopathic neonates treated with therapeutic hypothermia after perinatal asphyxia. Pharmacokinetics and optimal dosing of morphine in this population are largely unknown. The objective of this study was to describe pharmacokinetics of morphine and its metabolites morphine-3-glucuronide and morphine-6-glucuronide in encephalopathic neonates treated with therapeutic hypothermia and to develop pharmacokinetics based dosing guidelines for this population. STUDY DESIGN Term and near-term encephalopathic neonates treated with therapeutic hypothermia and receiving morphine were included in two multicenter cohort studies between 2008-2010 (SHIVER) and 2010-2014 (PharmaCool). Data were collected during hypothermia and rewarming, including blood samples for quantification of morphine and its metabolites. Parental informed consent was obtained for all participants. RESULTS 244 patients (GA mean (sd) 39.8 (1.6) weeks, BW mean (sd) 3,428 (613) g, male 61.5%) were included. Morphine clearance was reduced under hypothermia (33.5°C) by 6.89%/°C (95% CI 5.37%/°C- 8.41%/°C, p<0.001) and metabolite clearance by 4.91%/°C (95% CI 3.53%/°C- 6.22%/°C, p<0.001) compared to normothermia (36.5°C). Simulations showed that a loading dose of 50 μg/kg followed by continuous infusion of 5 μg/kg/h resulted in morphine plasma concentrations in the desired range (between 10 and 40 μg/L) during hypothermia. CONCLUSIONS Clearance of morphine and its metabolites in neonates is affected by therapeutic hypothermia. The regimen suggested by the simulations will be sufficient in the majority of patients. However, due to the large interpatient variability a higher dose might be necessary in individual patients to achieve the desired effect. TRIAL REGISTRATION www.trialregister.nl NTR2529.
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Affiliation(s)
- Laurent M. A. Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel P. H. van den Broek
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Carin M. A. Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timo R. de Haan
- Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Peter H. Dijk
- Department of Neonatology, Groningen University Medical Centre, Groningen, the Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud university medical center-Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Koen P. Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, the Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge A. Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Johanna H. van der Lee
- Paediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Alwin D. R. Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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20
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Plomgaard AM, Alderliesten T, van Bel F, Benders M, Claris O, Cordeiro M, Dempsey E, Fumagalli M, Gluud C, Hyttel-Sorensen S, Lemmers P, Pellicer A, Pichler G, Greisen G. No neurodevelopmental benefit of cerebral oximetry in the first randomised trial (SafeBoosC II) in preterm infants during the first days of life. Acta Paediatr 2019; 108:275-281. [PMID: 29908039 PMCID: PMC6585779 DOI: 10.1111/apa.14463] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/20/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
AIM Cerebral hypoxia has been associated with neurodevelopmental impairment. We studied whether reducing cerebral hypoxia in extremely preterm infants during the first 72 hours of life affected neurological outcomes at two years of corrected age. METHODS In 2012-2013, the phase II randomised Safeguarding the Brains of our smallest Children trial compared visible cerebral near-infrared spectroscopy (NIRS) monitoring in an intervention group and blinded NIRS monitoring in a control group. Cerebral hypoxia was significantly reduced in the intervention group. We followed up 115 survivors from eight European centres at two years of corrected age, by conducting a medical examination and assessing their neurodevelopment with the Bayley Scales of Infant and Toddler Development, Second or Third Edition, and the parental Ages and Stages Questionnaire (ASQ). RESULTS There were no differences between the intervention (n = 65) and control (n = 50) groups with regard to the mean mental developmental index (89.6 ± 19.5 versus 88.4 ± 14.7, p = 0.77), ASQ score (215 ± 58 versus 213 ± 58, p = 0.88) and the number of children with moderate-to-severe neurodevelopmental impairment (10 versus six, p = 0.58). CONCLUSION Cerebral NIRS monitoring was not associated with long-term benefits or harm with regard to neurodevelopmental outcome at two years of corrected age.
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Affiliation(s)
- Anne M. Plomgaard
- Department of Neonatology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Thomas Alderliesten
- Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Frank van Bel
- Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Manon Benders
- Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Olivier Claris
- Department of Neonatology; Hospices Civils de Lyon; Claude Bernard University; Lyon France
| | - Malaika Cordeiro
- Department of Neonatology; La Paz University Hospital; Madrid Spain
| | | | - Monica Fumagalli
- NICU; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milan Italy
| | - Christian Gluud
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Simon Hyttel-Sorensen
- Department of Neonatology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Petra Lemmers
- Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Adelina Pellicer
- Department of Neonatology; La Paz University Hospital; Madrid Spain
| | - Gerhard Pichler
- Department of Pediatrics; Research Unit for Neonatal Micro- and Macrocirculation; Medical University of Graz; Graz Austria
| | - Gorm Greisen
- Department of Neonatology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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21
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Favié LMA, Groenendaal F, van den Broek MPH, Rademaker CMA, de Haan TR, van Straaten HLM, Dijk PH, van Heijst A, Simons SHP, Dijkman KP, Rijken M, Zonnenberg IA, Cools F, Zecic A, van der Lee JH, Nuytemans DHGM, van Bel F, Egberts TCG, Huitema ADR. Phenobarbital, Midazolam Pharmacokinetics, Effectiveness, and Drug-Drug Interaction in Asphyxiated Neonates Undergoing Therapeutic Hypothermia. Neonatology 2019; 116:154-162. [PMID: 31256150 PMCID: PMC6878731 DOI: 10.1159/000499330] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phenobarbital and midazolam are commonly used drugs in (near-)term neonates treated with therapeutic hypothermia for hypoxic-ischaemic encephalopathy, for sedation, and/or as anti-epileptic drug. Phenobarbital is an inducer of cytochrome P450 (CYP) 3A, while midazolam is a CYP3A substrate. Therefore, co-treatment with phenobarbital might impact midazolam clearance. OBJECTIVES To assess pharmacokinetics and clinical anti-epileptic effectiveness of phenobarbital and midazolam in asphyxiated neonates and to develop dosing guidelines. METHODS Data were collected in the prospective multicentre PharmaCool study. In the present study, neonates treated with therapeutic hypothermia and receiving midazolam and/or phenobarbital were included. Plasma concentrations of phenobarbital and midazolam including its metabolites were determined in blood samples drawn on days 2-5 after birth. Pharmacokinetic analyses were performed using non-linear mixed effects modelling; clinical effectiveness was defined as no use of additional anti-epileptic drugs. RESULTS Data were available from 113 (phenobarbital) and 118 (midazolam) neonates; 68 were treated with both medications. Only clearance of 1-hydroxy midazolam was influenced by hypothermia. Phenobarbital co-administration increased midazolam clearance by a factor 2.3 (95% CI 1.9-2.9, p < 0.05). Anticonvulsant effectiveness was 65.5% for phenobarbital and 37.1% for add-on midazolam. CONCLUSIONS Therapeutic hypothermia does not influence clearance of phenobarbital or midazolam in (near-)term neonates with hypoxic-ischaemic encephalopathy. A phenobarbital dose of 30 mg/kg is advised to reach therapeutic concentrations. Phenobarbital co-administration significantly increased midazolam clearance. Should phenobarbital be substituted by non-CYP3A inducers as first-line anticonvulsant, a 50% lower midazolam maintenance dose might be appropriate to avoid excessive exposure during the first days after birth.
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Affiliation(s)
- Laurent M A Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands, .,Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands,
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Carin M A Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Peter H Dijk
- Department of Neonatology, Groningen University Medical Centre, Groningen, The Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Sinno H P Simons
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge A Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Johanna H van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Debbie H G M Nuytemans
- Clinical Research Coordinator PharmaCool Study, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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22
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Abstract
The original version of this article contained an error in the legend of Fig. 3, which incorrectly read:Figure 3. a The patterns of arterial saturation (SaO2; orange), and rScO2 (blue) and mean arterial blood pressure (MABP; red) of an extremely preterm infant on postnatal day 1. The initial rScO2 values were very low (red box). These low values seemed to be associated with PaCO2 values below 30 mmHg (brown squares; starting at 24 mmHg. SaO2 and MABPs values were always normal. When PaCO2 values increased above values of 30 mmHg (brown arrow) the rScO2 increased and eventually normalized. b The patterns of rScO2 (blue) and mean arterial blood pressure (MABP; red) of a very preterm girl, starting on postnatal day 1, was especially marked by a steep decrease in cerebral oxygenation (rScO2; red box) to very low values (<40%). Echocardiographic investigation early on postnatal day 2 revealed a hemodynamically significant ductus arteriosus. Subsequent ductal closure with indomethacin (2 courses) was followed by normalization of cerebral oxygenation. c The patterns of heart rate (HR), arterial saturation (SaO2) and rScO2 (red box) in a preterm neonate.with severe anemia. The rather low rScO2 recovered following packed red blood cell transfusion (courtesy Prof. Gunnar Naulaers, UZ Leuven).This has been corrected in both the PDF and HTML versions of the article.
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Affiliation(s)
- Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jonathan P Mintzer
- Division of Neonatal-Perinatal Medicine, Stony Brook Children's Hospital, Stony Brook, NY, USA
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23
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van Bel F, Mintzer JP. Monitoring cerebral oxygenation of the immature brain: a neuroprotective strategy? Pediatr Res 2018; 84:159-164. [PMID: 29907853 DOI: 10.1038/s41390-018-0026-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 11/09/2022]
Abstract
Monitoring of cerebral oxygenation (rScO2) with near-infrared spectroscopy (NIRS) is a feasible noninvasive bedside technique in the NICU. This review discusses the possible neuroprotective role of "pattern recognition" of NIRS-derived rScO2 in preterm neonates with regard to the prevention of severe intraventricular hemorrhage and hypoxia/hyperoxia-related white matter injury. This neuroprotective role of rScO2 monitoring is discussed as a modality to aid in the early detection of cerebral oxygenation conditions predisposing to these complications. Practical guidelines are provided concerning management of abnormal rScO2 patterns as well as a brief discussion concerning the need for international consensus and the legal aspects associated with the introduction of a new NICU bedside monitoring strategy.
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Affiliation(s)
- Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jonathan P Mintzer
- Division of Neonatal-Perinatal Medicine, Stony Brook Children's Hospital, Stony Brook, New York, USA
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24
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Diederen CMJ, van Bel F, Groenendaal F. Complications During Therapeutic Hypothermia After Perinatal Asphyxia: A Comparison with Trial Data. Ther Hypothermia Temp Manag 2018; 8:211-215. [PMID: 29733266 DOI: 10.1089/ther.2017.0046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Complications of therapeutic hypothermia (HT) after perinatal asphyxia of a cohort of infants were compared with complications reported in the Cochrane review. The occurrence during moderate HT of bradycardia, arrhythmia, hypotension, use of inotropes, pulmonary hypertension requiring NO inhalation, air leak syndrome, elevated liver enzymes, necrotizing enterocolitis, sepsis, oliguria, thrombocytopenia, coagulopathy, and electrolyte disturbances was assessed in 168 infants with therapeutic HT following perinatal asphyxia and compared to the incidence of complications published previously in the Cochrane review. In our cohort, mortality and adverse neurodevelopmental outcome were 31% and 6%, respectively, and not different from previously published studies. Nine out of 12 complications occurred more often in our cohort, one complication (oliguria) less often compared to previous results. The incidence of bradycardia and subcutaneous fat necrosis was not significantly different from previous reports. Complications during therapeutic HT in our cohort of infants occurred more often than reported previously. A detailed evaluation of possible complications is relevant for optimal monitoring during therapeutic HT.
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Affiliation(s)
- Carlijn M J Diederen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, the Netherlands
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25
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Dix LML, van Bel F, Baerts W, Lemmers PMA. Effects of caffeine on the preterm brain: An observational study. Early Hum Dev 2018; 120:17-20. [PMID: 29604486 DOI: 10.1016/j.earlhumdev.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Caffeine improves neurodevelopmental outcome of preterm infants. This study analyses the effects of caffeine on the neonatal brain. We hypothesized that caffeine has a neuroprotective effect through an increase in oxygen metabolism; reflected by increased cerebral oxygen extraction, electrical function, and perfusion. METHODS Preterm infants <32 weeks gestation (GA) receiving their primary dose caffeine-base (10 mg/kg) were included. Ten minutes of stable monitoring were selected before, during, and every hour up to 6 h after caffeine. Near-infrared spectroscopy monitored regional cerebral oxygenation (rScO2) and extraction (FTOE). Amplitude-integrated electroencephalogram (aEEG) monitored minimum, mean and maximum amplitudes. Spontaneous activity transients (SAT) rate and the interval between SATs (ISI) were calculated. Mean arterial blood pressure (MABP), heart rate (HR) and arterial oxygen saturation (SaO2) were monitored. Arterial pCO2's were collected before and 4 h after caffeine. Brain perfusion was assessed 1 h before and 3 h after caffeine by Doppler-measured resistance-index (RI), peak systolic velocity (PSV) and end-diastolic velocity (EDV), in the anterior cerebral artery (ACA) and internal carotid artery (ICA). Results were presented in mean ± SD. RESULTS 34 infants, mean GA 28.8 ± 2.1 wk, were included. rScO2 significantly decreased from 69 ± 11 to 63 ± 12 1 h after caffeine, and recovered at 6 h (66 ± 10). FTOE increased correspondingly. MABP and HR increased significantly. PSV in the ACA decreased slightly. Other Doppler variables, aEEG parameters, and SaO2 were unaffected. CONCLUSION Caffeine increases oxygen extraction, suggesting a (transient) stimulating effect on brain metabolism. However, no substantial changes were found in brain perfusion and in electrical brain activity.
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Affiliation(s)
- Laura M L Dix
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands.
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands
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26
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Favié LMA, Cox AR, van den Hoogen A, Nijboer CHA, Peeters-Scholte CMPCD, van Bel F, Egberts TCG, Rademaker CMA, Groenendaal F. Nitric Oxide Synthase Inhibition as a Neuroprotective Strategy Following Hypoxic-Ischemic Encephalopathy: Evidence From Animal Studies. Front Neurol 2018; 9:258. [PMID: 29725319 PMCID: PMC5916957 DOI: 10.3389/fneur.2018.00258] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy following perinatal asphyxia is a leading cause of neonatal death and disability worldwide. Treatment with therapeutic hypothermia reduced adverse outcomes from 60 to 45%. Additional strategies are urgently needed to further improve the outcome for these neonates. Inhibition of nitric oxide synthase (NOS) is a potential neuroprotective target. This article reviews the evidence of neuroprotection by nitric oxide (NO) synthesis inhibition in animal models. METHODS Literature search using the EMBASE, Medline, Cochrane, and PubMed databases. Studies comparing NOS inhibition to placebo, with neuroprotective outcome measures, in relevant animal models were included. Methodologic quality of the included studies was assessed. RESULTS 26 studies were included using non-selective or selective NOS inhibition in rat, piglet, sheep, or rabbit animal models. A large variety in outcome measures was reported. Outcome measures were grouped as histological, biological, or neurobehavioral. Both non-selective and selective inhibitors show neuroprotective properties in one or more outcome measures. Methodologic quality was either low or moderate for all studies. CONCLUSION Inhibition of NO synthesis is a promising strategy for additional neuroprotection. In humans, intervention can only take place after the onset of the hypoxic-ischemic event. Therefore, combined inhibition of neuronal and inducible NOS seems the most likely candidate for human clinical trials. Future studies should determine its safety and effectiveness in neonates, as well as a potential sex-specific neuroprotective effect. Researchers should strive to improve methodologic quality of animal intervention studies by using a systematic approach in conducting and reporting of these studies.
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Affiliation(s)
- Laurent M. A. Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arlette R. Cox
- Department of Pharmacy, Academic Medical Center, Amsterdam, Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cora H. A. Nijboer
- Laboratory of NeuroImmunology and Developmental Origins of Disease (NIDOD), University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Frank van Bel
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Carin M. A. Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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27
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Wagenaar N, Nijboer CH, van Bel F. Repair of neonatal brain injury: bringing stem cell-based therapy into clinical practice. Dev Med Child Neurol 2017; 59:997-1003. [PMID: 28786482 DOI: 10.1111/dmcn.13528] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 12/15/2022]
Abstract
Hypoxic-ischaemic brain injury is one of most important causes of neonatal mortality and long-term neurological morbidity in infants born at term. At present, only hypothermia in infants with perinatal hypoxic-ischaemic encephalopathy has shown benefit as a neuroprotective strategy. Otherwise, current treatment options for neonatal brain injury mainly focus on controlling (associated) symptoms. Regeneration of the injured neonatal brain with stem cell-based therapies is emerging and experimental results are promising. At present, increasing efforts are made to bring stem cell-based therapies to the clinic. Among all progenitor cell types, mesenchymal stromal (stem) cells seem to be most promising for human use given their neuroregenerative properties and favourable safety profile. This review summarizes the actual state, potential hurdles and possibilities of stem cell-based therapy for neonatal brain injury in the clinical setting. An early version of this paper was presented at the Groningen Early Intervention Meeting which was held in April 2016.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Cora H Nijboer
- Laboratory of NeuroImmunology and Developmental Origins of Disease, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
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28
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Dix LML, Weeke LC, de Vries LS, Groenendaal F, Baerts W, van Bel F, Lemmers PMA. Carbon Dioxide Fluctuations Are Associated with Changes in Cerebral Oxygenation and Electrical Activity in Infants Born Preterm. J Pediatr 2017; 187:66-72.e1. [PMID: 28578157 DOI: 10.1016/j.jpeds.2017.04.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/05/2017] [Accepted: 04/20/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effects of acute arterial carbon dioxide partial pressure changes on cerebral oxygenation and electrical activity in infants born preterm. STUDY DESIGN This retrospective observational study included ventilated infants born preterm with acute fluctuations of continuous end-tidal CO2 (etCO2) as a surrogate marker for arterial carbon dioxide partial pressure, during the first 72 hours of life. Regional cerebral oxygen saturation and fractional tissue oxygen extraction were monitored with near-infrared spectroscopy. Brain activity was monitored with 2-channel electroencephalography. Spontaneous activity transients (SATs) rate (SATs/minute) and interval between SATs (in seconds) were calculated. Ten-minute periods were selected for analysis: before, during, and after etCO2 fluctuations of ≥5 mm Hg. RESULTS Thirty-eight patients (mean ± SD gestational age of 29 ± 1.8 weeks) were included, with 60 episodes of etCO2 increase and 70 episodes of etCO2 decrease. During etCO2 increases, brain oxygenation increased (regional cerebral oxygen saturation increased, fractional tissue oxygen extraction decreased; P < .01) and electrical activity decreased (SATs/minute decreased, interval between SATs increased; P < .01). All measures recovered when etCO2 returned to baseline. During etCO2 decreases, brain oxygenation decreased (regional cerebral oxygen saturation decreased, fractional tissue oxygen extraction decreased; P < .01) and brain activity increased (SATs/minute increased, P < .05), also with recovery after return of etCO2 to baseline. CONCLUSION An acute increase in etCO2 is associated with increased cerebral oxygenation and decreased brain activity, whereas an acute decrease is associated with decreased cerebral oxygenation and slightly increased brain activity. Combining continuous CO2 monitoring with near-infrared spectroscopy may enable the detection of otherwise undetected fluctuations in arterial carbon dioxide partial pressure that may be harmful to the neonatal brain.
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Affiliation(s)
- Laura Marie Louise Dix
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Lauren Carleen Weeke
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Linda Simone de Vries
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
| | - Petra Maria Anna Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands.
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29
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Plomgaard AM, Alderliesten T, Austin T, van Bel F, Benders M, Claris O, Dempsey E, Fumagalli M, Gluud C, Hagmann C, Hyttel-Sorensen S, Lemmers P, van Oeveren W, Pellicer A, Petersen TH, Pichler G, Winkel P, Greisen G. Early biomarkers of brain injury and cerebral hypo- and hyperoxia in the SafeBoosC II trial. PLoS One 2017; 12:e0173440. [PMID: 28328980 PMCID: PMC5362210 DOI: 10.1371/journal.pone.0173440] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The randomized clinical trial, SafeBoosC II, examined the effect of monitoring of cerebral oxygenation by near-infrared spectroscopy combined with a guideline on treatment when cerebral oxygenation was out of the target range. Data on cerebral oxygenation was collected in both the intervention and the control group. The primary outcome was the reduction in the burden of cerebral hypo- and hyperoxia between the two groups. In this study we describe the associations between the burden of cerebral hypo- and hyperoxia, regardless of allocation to intervention or control group, and the biomarkers of brain injury from birth till term equivalent age that was collected as secondary and explorative outcomes in the SafeBoosC II trial. METHODS Cerebral oxygenation was continuously monitored during the first 72h of life in 166 extremely preterm infants. Cranial ultrasound was performed at day 1,4,7,14, and 35 and at term. Electroencephalogram (EEG) was recorded at 64h. Blood-samples taken at 6 and 64 hours were analysed for the brain injury biomarkers; S100beta, brain-fatty-acid-binding-protein, and neuroketal. All analyses were conducted post hoc. RESULTS Significantly more infants with a cerebral burden of hypoxia within the 4th quartile versus infants within quartile 1-3 were diagnosed with severe intracranial haemorrhage (11/39 versus 11/117, p = 0.003), had low burst rate on EEG (12/28 versus 21/103, p = 0.015), or died (14/41 versus 18/123, p = 0.006), whereas none of these events were significantly associated with cerebral hyperoxia. The blood biomarkers were not significantly associated with the burden of cerebral hypo- or hyperoxia. CONCLUSIONS The explorative analysis showed that early burden of cerebral hypoxia, but not hyperoxia was significantly associated with low brain electrical activity and severe intracranial haemorrhage while none of the three blood biomarkers were associated with the burden of either cerebral hypo- or hyperoxia.
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Affiliation(s)
- Anne M. Plomgaard
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Alderliesten
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Topun Austin
- Rosie Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frank van Bel
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Manon Benders
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | | | - Monica Fumagalli
- NICU,Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cornelia Hagmann
- Clinic of Neonatology, University of Zurich, Zurich, Switzerland
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Tue H. Petersen
- Research Unit on Brain Injury Neurorehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Gerhard Pichler
- Department of Pediatrics, Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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30
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Alderliesten T, De Vis JB, Lemmers PMA, Hendrikse J, Groenendaal F, van Bel F, Benders MJNL, Petersen ET. Brain oxygen saturation assessment in neonates using T 2-prepared blood imaging of oxygen saturation and near-infrared spectroscopy. J Cereb Blood Flow Metab 2017; 37:902-913. [PMID: 27151900 PMCID: PMC5363470 DOI: 10.1177/0271678x16647737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although near-infrared spectroscopy is increasingly being used to monitor cerebral oxygenation in neonates, it has a limited penetration depth. The T2-prepared Blood Imaging of Oxygen Saturation (T2-BIOS) magnetic resonance sequence provides an oxygen saturation estimate on a voxel-by-voxel basis, without needing a respiratory calibration experiment. In 15 neonates, oxygen saturation measured by T2-prepared blood imaging of oxygen saturation and near-infrared spectroscopy were compared. In addition, these measures were compared to cerebral blood flow and venous oxygen saturation in the sagittal sinus. A strong linear relation was found between the oxygen saturation measured by magnetic resonance imaging and the oxygen saturation measured by near-infrared spectroscopy ( R2 = 0.64, p < 0.001). Strong linear correlations were found between near-infrared spectroscopy oxygen saturation, and magnetic resonance imaging measures of frontal cerebral blood flow, whole brain cerebral blood flow and venous oxygen saturation in the sagittal sinus ( R2 = 0.71, 0.50, 0.65; p < 0.01). The oxygen saturation obtained by T2-prepared blood imaging of oxygen saturation correlated with venous oxygen saturation in the sagittal sinus ( R2 = 0.49, p = 0.023), but no significant correlations could be demonstrated with frontal and whole brain cerebral blood flow. These results suggest that measuring oxygen saturation by T2-prepared blood imaging of oxygen saturation is feasible, even in neonates. Strong correlations between the various methods work as a cross validation for near-infrared spectroscopy and T2-prepared blood imaging of oxygen saturation, confirming the validity of using of these techniques for determining cerebral oxygenation.
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Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Thomas Alderliesten, Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE Ut, The Netherlands.
| | - Jill B De Vis
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra MA Lemmers
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon JNL Benders
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esben T Petersen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Abstract
Cerebral oxygenation is not always reflected by systemic arterial oxygenation. Therefore, regional cerebral oxygen saturation (rScO2) monitoring with near-infrared spectroscopy (NIRS) is of added value in neonatal intensive care. rScO2 represents oxygen supply to the brain, while cerebral fractional tissue oxygen extraction, which is the ratio between rScO2 and systemic arterial oxygen saturation, reflects cerebral oxygen utilization. The balance between oxygen supply and utilization provides insight in neonatal cerebral (patho-)physiology. This review highlights the potential and limitations of cerebral oxygenation monitoring with NIRS in the neonatal intensive care unit.
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Affiliation(s)
- Laura Marie Louise Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
| | - Petra Maria Anna Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
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Abstract
[This corrects the article on p. 46 in vol. 5, PMID: 28352624.].
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Affiliation(s)
- Laura Marie Louise Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands.,Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Petra Maria Anna Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
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Cohen E, Dix L, Baerts W, Alderliesten T, Lemmers P, van Bel F. Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates. Neonatology 2017; 111:126-132. [PMID: 27756065 DOI: 10.1159/000448873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. OBJECTIVE We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. METHODS We monitored regional cerebral oxygen saturation (rScO2) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). RESULTS In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO2 [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. CONCLUSIONS Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.
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Affiliation(s)
- Emily Cohen
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
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Dix L, Molenschot M, Breur J, de Vries W, Vijlbrief D, Groenendaal F, van Bel F, Lemmers P. Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F520-F526. [PMID: 27034323 DOI: 10.1136/archdischild-2015-309192] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/15/2016] [Accepted: 03/03/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND A haemodynamically significant patent ductus arteriosus (hsPDA) is clinically suspected and confirmed by echocardiographic examination. A hsPDA decreases cerebral blood flow and oxygen saturation by the ductal steal phenomenon. AIM To determine the relationship between echocardiographic parameters, cerebral oxygenation and a hsPDA in preterm infants. METHODS 380 preterm infants (<32 weeks gestational age) born between 2008 and 2010 were included. Blinded echocardiographic examination was performed on the second, fourth and sixth day after birth. Examinations were deblinded when hsPDA was clinically suspected. Regional cerebral oxygen saturation (rScO2) was continuously monitored by near-infrared spectroscopy during 72 h after birth, and afterwards for at least 1 h before echocardiography. Echocardiographic parameters included ductal diameter, end-diastolic flow in the left pulmonary artery, left atrium/aorta ratio and ductal flow pattern. RESULTS rScO2 was significantly related only to ductal diameter over time. Mixed modelling analysed the course of rScO2 over time, where infants were divided into four groups: a closed duct, an open haemodynamically insignificant duct (non-sPDA), a hsPDA, which was successfully closed during study period (SC hsPDA) or a hsPDA, which was unsuccessfully closed during study period (UC hsPDA). SC hsPDA infants showed the highest rScO2 on day 6, while UC hsPDA infants had the lowest rScO2 values. CONCLUSIONS Ductal diameter is the only echocardiographic parameter significantly related to cerebral oxygenation over time. Cerebral oxygenation takes a different course over time depending on the status of the duct. Low cerebral oxygenation may be suggestive of a hsPDA.
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Affiliation(s)
- Laura Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Mirella Molenschot
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Johannes Breur
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Willem de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Daniel Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
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Affiliation(s)
| | - Frank van Bel
- Neonatology; University Medical Centre; Utrecht The Netherlands
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36
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Snijder RA, Egberts TC, Lucas P, Lemmers PM, van Bel F, Timmerman AM. Dosing errors in preterm neonates due to flow rate variability in multi-infusion syringe pump setups: An in vitro spectrophotometry study. Eur J Pharm Sci 2016; 93:56-63. [DOI: 10.1016/j.ejps.2016.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
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Riera J, Hyttel-Sorensen S, Bravo MC, Cabañas F, López-Ortego P, Sanchez L, Ybarra M, Dempsey E, Greisen G, Austin T, Claris O, Fumagalli M, Gluud C, Lemmers P, Pichler G, Plomgaard AM, van Bel F, Wolf M, Pellicer A. The SafeBoosC phase II clinical trial: an analysis of the interventions related with the oximeter readings. Arch Dis Child Fetal Neonatal Ed 2016; 101:F333-8. [PMID: 26645538 PMCID: PMC4941140 DOI: 10.1136/archdischild-2015-308829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The SafeBoosC phase II randomised clinical trial recently demonstrated the benefits of a combination of cerebral regional tissue oxygen saturation (rStO2) by near-infrared spectroscopy (NIRS) and a treatment guideline to reduce the oxygen imbalance in extremely preterm infants. AIMS To analyse rStO2-alarm-related clinical decisions and their heterogeneity in the NIRS experimental group (NIRS monitoring visible) and their impact on rStO2 and SpO2. METHODS Continuous data from NIRS devices and the alarms (area under the curve of the rStO2 out of range had accumulated 0.2%h during 10 min), clinical data at discrete time points and interventions prompted by the alarms were recorded. RESULTS Sixty-seven infants had data that fulfilled the requirements for this analysis. 1107 alarm episodes were analysed. The alarm triggered a treatment guideline intervention in 25% of the cases; the type of intervention chosen varied among clinical sites. More than 55% of alarms were not followed by an intervention ('No action'); additionally, in 5% of alarms the rStO2 value apparently was considered non-reliable and the sensor was repositioned. The percentage of unresolved alarms at 30 min after 'No action' almost doubled the treatment guideline intervention (p<0.001). Changes in peripheral oxygen saturation (SpO2), were observed only after treatment guideline interventions. CONCLUSIONS This study shows that 25% of rStO2 alarms were followed by a clinical intervention determined by the treatment guideline. However, the rStO2 and SpO2 returned to normal ranges after the intervention, supporting the notion that decisions taken by the clinicians were appropriate. TRIAL REGISTRATION NUMBER ClinicalTrial.gov NCT01590316.
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Affiliation(s)
- Joan Riera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain,Center for Biomedical Technology, Technical University, Madrid, Spain
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Fernando Cabañas
- Biomedical Research Foundation, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | | | - Laura Sanchez
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Marta Ybarra
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Topun Austin
- Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivier Claris
- Department of Neonatology, Hopital Femme Mere Enfants, Bron, France
| | - Monica Fumagalli
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | | | - Frank van Bel
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
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Alderliesten T, De Vis JB, Lemmers PMA, van Bel F, Benders MJNL, Hendrikse J, Petersen ET. T 2-prepared velocity selective labelling: A novel idea for full-brain mapping of oxygen saturation. Neuroimage 2016; 139:65-73. [PMID: 27291495 DOI: 10.1016/j.neuroimage.2016.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM Disturbances in cerebral oxygenation saturation (SO2) have been linked to adverse outcome in adults, children, and neonates. In intensive care, the cerebral SO2 is increasingly being monitored by Near-InfraRed Spectroscopy (NIRS). Unfortunately NIRS has a limited penetration depth. The "modified T2-prepared Blood Imaging of Oxygen Saturation" (T2-BIOS) MR sequence provides a step towards full brain SO2 measurement. MATERIALS AND METHODS Tissue SO2, and venous SO2 (SvO2) were obtained simultaneously by T2-BIOS during a respiratory challenge in ten healthy volunteers. These two measures were compared to SO2 that was obtained by a single probe MR-compatible NIRS setup, and to cerebral blood flow and venous SO2 that were obtained by arterial spin labelling and T2-TRIR, respectively. RESULTS SO2-T2-BIOS and SO2-NIRS had a mean bias of -4.0% (95% CI -21.3% to 13.3%). SvO2-T2-BIOS correlated with SO2-NIRS (R2=0.41, p=0.002) and SvO2-T2-TRIR (R2=0.87, p=0.002). In addition, SO2-NIRS correlated with SvO2-T2-TRIR (R2=0.85, p=0.003) Frontal cerebral blood flow correlated with SO2-T2-BIOS (R2=0.21, p=0.04), but was not significant in relation to SO2-NIRS. DISCUSSION/CONCLUSION Full brain SO2 assessment by any technique may help validating NIRS and may prove useful in guiding the clinical management of patient populations with cerebral injury following hypoxic-ischaemic events. The agreement between NIRS and T2-BIOS provides confidence in measuring cerebral SO2 by either technique. As it stands now, the T2-BIOS represents a novel idea and future work will focus on improvements to make it a reliable tool for SO2 assessment.
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Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE, Utrecht, The Netherlands.
| | - Jill B De Vis
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE, Utrecht, The Netherlands.
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE, Utrecht, The Netherlands.
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE, Utrecht, The Netherlands.
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Room KE04.123.1, PO Box 85090, 3584 AE, Utrecht, The Netherlands.
| | - Jeroen Hendrikse
- Department of Radiology,University Medical Center Utrecht, Room: E.01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Esben T Petersen
- Department of Radiology,University Medical Center Utrecht, Room: E.01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
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Plomgaard AM, van Oeveren W, Petersen TH, Alderliesten T, Austin T, van Bel F, Benders M, Claris O, Dempsey E, Franz A, Fumagalli M, Gluud C, Hagmann C, Hyttel-Sorensen S, Lemmers P, Pellicer A, Pichler G, Winkel P, Greisen G. The SafeBoosC II randomized trial: treatment guided by near-infrared spectroscopy reduces cerebral hypoxia without changing early biomarkers of brain injury. Pediatr Res 2016; 79:528-35. [PMID: 26679155 PMCID: PMC4840238 DOI: 10.1038/pr.2015.266] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The SafeBoosC phase II multicentre randomized clinical trial investigated the benefits and harms of monitoring cerebral oxygenation by near-infrared spectroscopy (NIRS) combined with an evidence-based treatment guideline vs. no NIRS data and treatment as usual in the control group during the first 72 h of life. The trial demonstrated a significant reduction in the burden of cerebral hypoxia in the experimental group. We now report the blindly assessed and analyzed treatment effects on electroencephalographic (EEG) outcomes (burst rate and spectral edge frequency 95% (SEF95)) and blood biomarkers of brain injury (S100β, brain fatty acid-binding protein, and neuroketal). METHODS One hundred and sixty-six extremely preterm infants were randomized to either experimental or control group. EEG was recorded at 64 h of age and blood samples were collected at 6 and 64 h of age. RESULTS One hundred and thirty-three EEGs were evaluated. The two groups did not differ regarding burst rates (experimental 7.2 vs. control 7.7 burst/min) or SEF95 (experimental 18.1 vs. control 18.0 Hz). The two groups did not differ regarding blood S100β, brain fatty acid-binding protein, and neuroketal concentrations at 6 and 64 h (n = 123 participants). CONCLUSION Treatment guided by NIRS reduced the cerebral burden of hypoxia without affecting EEG or the selected blood biomarkers.
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Affiliation(s)
- Anne M. Plomgaard
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tue H. Petersen
- Research Unit on Brain Injury Neurorehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Alderliesten
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Topun Austin
- Rosie Maternity Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Frank van Bel
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon Benders
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier Claris
- Department of Neonatology, Hospital Femme Mere Enfants, Bron, France
| | | | - Axel Franz
- Department of Neonatology, University of Tuebingen, Tübingen, Germany
| | - Monica Fumagalli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cornelia Hagmann
- Department of Neonatology, University of Zurich, Zurich, Switzerland
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Lemmers PMA, Benders MJNL, D'Ascenzo R, Zethof J, Alderliesten T, Kersbergen KJ, Isgum I, de Vries LS, Groenendaal F, van Bel F. Patent Ductus Arteriosus and Brain Volume. Pediatrics 2016; 137:peds.2015-3090. [PMID: 27030421 DOI: 10.1542/peds.2015-3090] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A hemodynamically significant patent ductus arteriosus (PDA) can compromise perfusion and oxygenation of the preterm brain. Reports suggest that PDA is associated with increased mortality and morbidity. We hypothesize that long-standing low cerebral oxygenation due to PDA might affect brain volume at term equivalent age. METHODS Observational study in 140 infants investigating the relationship between near-infrared spectroscopy-monitored cerebral oxygen saturation (rSco2) and MRI-assessed regional brain volume and maturation of the posterior limb of the internal capsule at term-equivalent age in 3 groups: those whose PDA closed with indomethacin, those who needed additional surgical closure, and matched controls. RESULTS The surgery group had the lowest rSco2 values before closure (n = 35), 48% ± 9.7% (mean ± SD) as compared with the indomethacin (n = 35), 59% ± 10.4 (P < .001), and control groups (n = 70), 66% ± 6.9 (P < .001); the highest postnatal age before effective treatment; and the lowest volumes of most brain regions at term-equivalent age. Multiple linear regression analysis showed a significant effect of preductal closure rSco2 on cerebellar volume in this group. No differences were found in maturation of the posterior limb of the internal capsule. CONCLUSIONS Long-standing suboptimal cerebral oxygenation due to a PDA may negatively influence brain growth, affecting neurodevelopmental outcome.
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Affiliation(s)
- Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands;
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Rita D'Ascenzo
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands; Division of Neonatology, Salesi's Children Hospital/UPM, Ancona, Italy; and
| | - Jorine Zethof
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Karina J Kersbergen
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Ivana Isgum
- Image Sciences Institute, University Medical Center Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands
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Abstract
An adverse outcome is still encountered in 45% of full-term neonates with perinatal asphyxia who are treated with moderate hypothermia. At present pharmacologic therapies are developed to be added to hypothermia. In the present article, these potential neuroprotective interventions are described based on the molecular pathways set in motion during fetal hypoxia and following reoxygenation and reperfusion after birth. These pathways include excessive production of excitotoxins with subsequent over-stimulation of NMDA receptors and calcium influx in neuronal cells, excessive production of reactive oxygen and nitrogen species, activation of inflammation leading to inappropriate apoptosis, and loss of neurotrophic factors. Possibilities for pharmacologic combination therapy, where each drug will be administered based on the optimal point of time in the cascade of destructive molecular reactions, may further reduce brain damage due to perinatal asphyxia.
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Affiliation(s)
- Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Cohen E, Baerts W, Alderliesten T, Derks J, Lemmers P, van Bel F. Growth restriction and gender influence cerebral oxygenation in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2016; 101:F156-61. [PMID: 26311070 DOI: 10.1136/archdischild-2015-308843] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/04/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. DESIGN Case-control study. SETTING Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. PATIENTS 68 (41 males) small for gestational age (SGA) (birth weight <10th percentile) and 136 (82 males) appropriate for gestational age (AGA) (birth weight 20th-80th percentile) neonates, matched for gender, gestational age, ventilatory and blood pressure support. METHODS Regional cerebral oxygen saturation (rScO2) and cerebral fractional tissue oxygen extraction (cFTOE) as measured by near-infrared spectroscopy throughout the first 72 h of life were compared between SGA and AGA neonates. The effect of gender was also explored within these comparisons. RESULTS SGA neonates demonstrated higher rScO2 (71% SEM 0.2 vs 68% SEM 0.2) and lower cFTOE (0.25 SEM 0.002 vs 0.29 SEM 0.002) than AGA neonates. There was an independent effect of gender on rScO2 and cFTOE, resulting in the finding that SGA males displayed highest rScO2 and lowest cFTOE (73% SEM 0.3 respectively 0.24 SEM 0.003). AGA males and SGA females showed comparable rScO2 (69% SEM 0.2 vs 69% SEM 0.4) and cFTOE (0.28 SEM 0.002 vs 0.28 SEM 0.004). AGA females showed lowest rScO2 and highest cFTOE (66% SEM 0.2 respectively 0.30 SEM 0.002). CONCLUSIONS Growth restriction and gender influence cerebral oxygenation and oxygen extraction in preterm neonates throughout the first 3 days of life.
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Affiliation(s)
- Emily Cohen
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan Derks
- Department of Obstetrics, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
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Plomgaard AM, Hagmann C, Alderliesten T, Austin T, van Bel F, Claris O, Dempsey E, Franz A, Fumagalli M, Gluud C, Greisen G, Hyttel-Sorensen S, Lemmers P, Pellicer A, Pichler G, Benders M. Brain injury in the international multicenter randomized SafeBoosC phase II feasibility trial: cranial ultrasound and magnetic resonance imaging assessments. Pediatr Res 2016; 79:466-72. [PMID: 26571218 PMCID: PMC4823642 DOI: 10.1038/pr.2015.239] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Abnormal cerebral perfusion during the first days of life in preterm infants is associated with higher grades of intraventricular hemorrhages and lower developmental score. In SafeBoosC II, we obtained a significant reduction of cerebral hypoxia by monitoring cerebral oxygenation in combination with a treatment guideline. Here, we describe (i) difference in brain injury between groups, (ii) feasibility of serial cranial ultrasound (cUS) and magnetic resonance imaging (MRI), (iii) local and central cUS assessment. METHODS Hundred and sixty-six extremely preterm infants were included. cUS was scheduled for day 1, 4, 7, 14, and 35 and at term-equivalent age (TEA). cUS was assessed locally (unblinded) and centrally (blinded). MRI at TEA was assessed centrally (blinded). Brain injury classification: no, mild/moderate, or severe. RESULTS Severe brain injury did not differ significantly between groups: cUS (experimental 10/80, control 18/77, P = 0.32) and MRI (5/46 vs. 3/38, P = 0.72). Kappa values for local and central readers were moderate-to-good for severe and poor-to-moderate for mild/moderate injuries. At TEA, cUS and MRI were assessed in 72 and 64%, respectively. CONCLUSION There was no difference in severe brain injury between groups. Acquiring cUS and MRI according the standard operating procedures must be improved for future trials. Whether monitoring cerebral oxygenation during the first 72 h of life prevents brain injury should be evaluated in larger multicenter trials.
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Affiliation(s)
- Anne M Plomgaard
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,()
| | - Cornelia Hagmann
- Clinic of Neonatology, University of Zurich, Zurich, Switzerland
| | - Thomas Alderliesten
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Topun Austin
- Rosie Maternity Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Frank van Bel
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Olivier Claris
- Department of Neonatology, Hospital Femme Mere Enfants, Bron, France
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Axel Franz
- Department of Neonatology, University of Tuebingen, Tübingen, Germany
| | - Monica Fumagalli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Manon Benders
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Caicedo A, Alderliesten T, Naulaers G, Lemmers P, van Bel F, Van Huffel S. A New Framework for the Assessment of Cerebral Hemodynamics Regulation in Neonates Using NIRS. Adv Exp Med Biol 2016; 876:501-509. [PMID: 26782251 DOI: 10.1007/978-1-4939-3023-4_63] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We present a new framework for the assessment of cerebral hemodynamics regulation (CHR) in neonates using near-infrared spectroscopy (NIRS). In premature infants, NIRS measurements have been used as surrogate variables for cerebral blood flow (CBF) in the assessment of cerebral autoregulation (CA). However, NIRS measurements only reflect changes in CBF under constant changes in arterial oxygen saturation (SaO2). This condition is unlikely to be met at the bedside in the NICU. Additionally, CA is just one of the different highly coupled mechanisms that regulate brain hemodynamics. Traditional methods for the assessment of CA do not take into account the multivariate nature of CHR, producing inconclusive results. In this study we propose a newly developed multivariate methodology for the assessment of CHR. This method is able to effectively decouple the influences of SaO2 from the NIRS measurements, and at the same time, produces scores indicating the strength of the coupling between the systemic variables and NIRS recordings. We explore the use of this method, and its derived scores, for the monitoring of CHR using data from premature infants who developed a grade III-IV intra-ventricular hemorrhage during the first 3 days of life.
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Affiliation(s)
- Alexander Caicedo
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, KU Leuven, Leuven, Belgium. .,iMinds Medical IT, Leuven, Belgium.
| | - Thomas Alderliesten
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Petra Lemmers
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, KU Leuven, Leuven, Belgium.,iMinds Medical IT, Leuven, Belgium
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Alderliesten T, Dix L, Baerts W, Caicedo A, van Huffel S, Naulaers G, Groenendaal F, van Bel F, Lemmers P. Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res 2016; 79:55-64. [PMID: 26389823 DOI: 10.1038/pr.2015.186] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2 - rScO2)/SaO2) for small adult and neonatal NIRS sensors. METHODS In this study, 999 infants born preterm (GA <32 wk) were monitored with NIRS during the first 72 h of life. Mixed modeling was used to generate reference curves grouped per 2 wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. RESULTS Average rScO2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. CONCLUSION rScO2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care.
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Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura Dix
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander Caicedo
- Department of Electrical Engineering (ESAT), Division SCD, KU Leuven, Leuven, Belgium.,iMinds-KU Leuven Future Health Department, Leuven, Belgium
| | - Sabine van Huffel
- Department of Electrical Engineering (ESAT), Division SCD, KU Leuven, Leuven, Belgium.,iMinds-KU Leuven Future Health Department, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital The Gasthuisberg, Leuven, Belgium
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
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van Tilborg E, Heijnen CJ, Benders MJ, van Bel F, Fleiss B, Gressens P, Nijboer CH. Impaired oligodendrocyte maturation in preterm infants: Potential therapeutic targets. Prog Neurobiol 2015; 136:28-49. [PMID: 26655283 DOI: 10.1016/j.pneurobio.2015.11.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
Preterm birth is an evolving challenge in neonatal health care. Despite declining mortality rates among extremely premature neonates, morbidity rates remain very high. Currently, perinatal diffuse white matter injury (WMI) is the most commonly observed type of brain injury in preterm infants and has become an important research area. Diffuse WMI is associated with impaired cognitive, sensory and psychological functioning and is increasingly being recognized as a risk factor for autism-spectrum disorders, ADHD, and other psychological disturbances. No treatment options are currently available for diffuse WMI and the underlying pathophysiological mechanisms are far from being completely understood. Preterm birth is associated with maternal inflammation, perinatal infections and disrupted oxygen supply which can affect the cerebral microenvironment by causing activation of microglia, astrogliosis, excitotoxicity, and oxidative stress. This intricate interplay of events negatively influences oligodendrocyte development, causing arrested oligodendrocyte maturation or oligodendrocyte cell death, which ultimately results in myelination failure in the developing white matter. This review discusses the current state in perinatal WMI research, ranging from a clinical perspective to basic molecular pathophysiology. The complex regulation of oligodendrocyte development in healthy and pathological conditions is described, with a specific focus on signaling cascades that may play a role in WMI. Furthermore, emerging concepts in the field of WMI and issues regarding currently available animal models are put forward. Novel insights into the molecular mechanisms underlying impeded oligodendrocyte maturation in diffuse WMI may aid the development of novel treatment options which are desperately needed to improve the quality-of-life of preterm neonates.
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Affiliation(s)
- Erik van Tilborg
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cobi J Heijnen
- Laboratory of Neuroimmunology, Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manon J Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bobbi Fleiss
- Inserm, Paris U1141, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS, Paris 1141, France; Centre for the Developing Brain, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Pierre Gressens
- Inserm, Paris U1141, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS, Paris 1141, France; Centre for the Developing Brain, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Cora H Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands.
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Yoshida S, Martines J, Lawn JE, Wall S, Souza JP, Rudan I, Cousens S, Aaby P, Adam I, Adhikari RK, Ambalavanan N, Arifeen SE, Aryal DR, Asiruddin S, Baqui A, Barros AJ, Benn CS, Bhandari V, Bhatnagar S, Bhattacharya S, Bhutta ZA, Black RE, Blencowe H, Bose C, Brown J, Bührer C, Carlo W, Cecatti JG, Cheung PY, Clark R, Colbourn T, Conde-Agudelo A, Corbett E, Czeizel AE, Das A, Day LT, Deal C, Deorari A, Dilmen U, English M, Engmann C, Esamai F, Fall C, Ferriero DM, Gisore P, Hazir T, Higgins RD, Homer CS, Hoque DE, Irgens L, Islam MT, de Graft-Johnson J, Joshua MA, Keenan W, Khatoon S, Kieler H, Kramer MS, Lackritz EM, Lavender T, Lawintono L, Luhanga R, Marsh D, McMillan D, McNamara PJ, Mol BWJ, Molyneux E, Mukasa GK, Mutabazi M, Nacul LC, Nakakeeto M, Narayanan I, Olusanya B, Osrin D, Paul V, Poets C, Reddy UM, Santosham M, Sayed R, Schlabritz-Loutsevitch NE, Singhal N, Smith MA, Smith PG, Soofi S, Spong CY, Sultana S, Tshefu A, van Bel F, Gray LV, Waiswa P, Wang W, Williams SLA, Wright L, Zaidi A, Zhang Y, Zhong N, Zuniga I, Bahl R. Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2015; 6:010508. [PMID: 26401272 PMCID: PMC4576458 DOI: 10.7189/jogh.06.010508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK ; Saving Newborn Lives, Save the Children, Washington, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Joăo Paulo Souza
- Department of Social Medicine, Ribeirăo Preto School of Medicine, University of Săo Paulo, Brazil
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Aaby
- Bandim Health Project, Indepth Network, Guinea-Bissau
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan
| | | | | | - Shams Ei Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Dhana Raj Aryal
- Department of Neonatology Paropakar Maternity and women's Hospital, Nepal
| | - Sk Asiruddin
- TRAction Bangladesh Project, University Research Co., LLC
| | | | - Aluisio Jd Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Brazil
| | - Christine S Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, and University of Southern Denmark/Odense University Hospital, Denmark
| | - Vineet Bhandari
- Program in Perinatal Research, Yale University School of Medicine, USA
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, India
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, USA
| | | | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Germany
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Po-Yin Cheung
- Departments of Pediatrics, Pharmacology & Surgery, University of Alberta, Canada
| | | | - Tim Colbourn
- University College London Institute for Global Health, UK
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, USA
| | - Erica Corbett
- Independent consultant maternal health research, Rwanda
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Hungary
| | - Abhik Das
- Biostatistics and Epidemiology, RTI International, USA
| | | | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases National Institute of Health, USA
| | | | - Uğur Dilmen
- Pediatrics and Neonatology, Yıldırım Beyazıt University Medical Faculty, Turkey
| | - Mike English
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK and KEMRi-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Cyril Engmann
- Newborn Health, Family Health Division, The Bill & Melinda Gates Foundation and the University of North Carolina Schools of Medicine and Public Health, USA
| | | | - Caroline Fall
- International Paediatric Epidemiology; Affiliations: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | | | - Peter Gisore
- School of Medicine, Child Health and Pediatrics, Moi University, Kenya
| | - Tabish Hazir
- Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan
| | - Rosemary D Higgins
- Eunice Kennedy Shriver NICHD Neonatal Research Network, Pregnancy and Perinatology, Branch, National Institute of Health, USA
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Australia
| | - D E Hoque
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Lorentz Irgens
- University of Bergen and Norwegian Institute of Public Health, Norway
| | - M T Islam
- Japan International Cooperation Agency (JICA), Bangladesh
| | | | | | | | - Soofia Khatoon
- Paediatrics and Head of Department Shaheed Suhrawardy Medical College, Bangladesh
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institute, Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), USA
| | - Tina Lavender
- University of Manchester School of Nursing Midwifery & Social Work, University of Manchester, UK
| | | | | | | | | | - Patrick J McNamara
- Departments of Paediatrics & Physiology, University of Toronto; Physiology & Experimental Medicine program, Hospital for Sick Children, Toronto, Canada
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, the Netherlands
| | | | - G K Mukasa
- International Baby Food Action Network, Uganda
| | - Miriam Mutabazi
- STRIDES for Family Health, Management Sciences for Health, Uganda
| | - Luis Carlos Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Margaret Nakakeeto
- Kampala Children's Hospital Limited and Childhealth Advocacy International, Uganda
| | - Indira Narayanan
- United States Agency for International Development /Maternal and Child Health Integrated Program, USA
| | | | - David Osrin
- Wellcome Trust Senior Research Fellow in Clinical Science, Institute for Global Health, University College London, UK
| | - Vinod Paul
- All India Institute of Medical Sciences, India
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | | | - Mary Alice Smith
- Environmental Health Science Department, University of Georgia, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Sajid Soofi
- Department of Pediatrics & Child Health, Women & Child Health Division, Aga Khan University, Pakistan
| | - Catherine Y Spong
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Bangladesh
| | - Antoinette Tshefu
- Kinshasa School of Public Health, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Frank van Bel
- Department of Neonatology, University of Utrecht, the Netherlands
| | | | - Peter Waiswa
- Division of Global Health, Karolinska Institutet, Sweden
| | - Wei Wang
- School of Medical Sciences, Edith Cowan University, Australia and School of Public Health, Capital Medical University, China
| | | | - Linda Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | | | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, China
| | - Nanbert Zhong
- Developmental Genetics Laboratory, New York State Institute for Basic Research in Developmental Disabilities, USA
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Caicedo A, Varon C, Alderliesten T, Lemmers P, van Bel F, Naulaers G, Van Huffel S. Differences in the cerebral hemodynamics regulation mechanisms of premature infants with intra-ventricular hemorrhage assessed by means of phase rectified signal averaging. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:4208-11. [PMID: 25570920 DOI: 10.1109/embc.2014.6944552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cerebral hemodynamics regulation consists of several mechanisms that try to keep brain homeostasis. In premature infants, due to the immaturity of their cerebral vascular bed, these mechanisms might be impaired exposing their brain to damage. The status of the cerebral regulation mechanism is classically assessed by measuring the coupling between some systemic variables, such as Mean arterial blood pressure (MABP) and concentration of blood gases, with surrogate measurements for cerebral blood flow, such as brain tissue oxygenation (rScO2) measured by means of Near-infrared Spectroscopy. We hypothesized that the coupled dynamics between systemic variables and rScO2 is different in premature infants that suffered from brain damage than in those with a favorable clinical outcome. Therefore, we explore the use of phase rectified signal averaging (PRSA) and bi-variate PRSA (BPRSA) in order to identify these differences. We found that the coupled dynamics between changes in MABP and cerebral oxygenation was different in premature infants that suffered III-IV grade intra-ventricular haemorrhage (IVH), when compared to control subjects.
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Alderliesten T, Favie LMA, Neijzen RW, Auwärter V, Nijboer CHA, Marges REJ, Rademaker CMA, Kempf J, van Bel F, Groenendaal F. Correction: Neuroprotection by Argon Ventilation after Perinatal Asphyxia: A Safety Study in Newborn Piglets. PLoS One 2015. [PMID: 26200666 PMCID: PMC4511670 DOI: 10.1371/journal.pone.0133818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0113575.].
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Tataranno ML, Alderliesten T, de Vries LS, Groenendaal F, Toet MC, Lemmers PMA, Vosse van de RE, van Bel F, Benders MJNL. Early oxygen-utilization and brain activity in preterm infants. PLoS One 2015; 10:e0124623. [PMID: 25965343 PMCID: PMC4429123 DOI: 10.1371/journal.pone.0124623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/17/2015] [Indexed: 12/24/2022] Open
Abstract
The combined monitoring of oxygen supply and delivery using Near-InfraRed spectroscopy (NIRS) and cerebral activity using amplitude-integrated EEG (aEEG) could yield new insights into brain metabolism and detect potentially vulnerable conditions soon after birth. The relationship between NIRS and quantitative aEEG/EEG parameters has not yet been investigated. Our aim was to study the association between oxygen utilization during the first 6 h after birth and simultaneously continuously monitored brain activity measured by aEEG/EEG. Forty-four hemodynamically stable babies with a GA < 28 weeks, with good quality NIRS and aEEG/EEG data available and who did not receive morphine were included in the study. aEEG and NIRS monitoring started at NICU admission. The relation between regional cerebral oxygen saturation (rScO2) and cerebral fractional tissue oxygen extraction (cFTOE), and quantitative measurements of brain activity such as number of spontaneous activity transients (SAT) per minute (SAT rate), the interval in seconds (i.e. time) between SATs (ISI) and the minimum amplitude of the EEG in μV (min aEEG) were evaluated. rScO2 was negatively associated with SAT rate (β=-3.45 [CI=-5.76- -1.15], p=0.004) and positively associated with ISI (β=1.45 [CI=0.44-2.45], p=0.006). cFTOE was positively associated with SAT rate (β=0.034 [CI=0.009-0.059], p=0.008) and negatively associated with ISI (β=-0.015 [CI=-0.026- -0.004], p=0.007). Oxygen delivery and utilization, as indicated by rScO2 and cFTOE, are directly related to functional brain activity, expressed by SAT rate and ISI during the first hours after birth, showing an increase in oxygen extraction in preterm infants with increased early electro-cerebral activity. NIRS monitored oxygenation may be a useful biomarker of brain vulnerability in high-risk infants.
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Affiliation(s)
- Maria Luisa Tataranno
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Thomas Alderliesten
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S. de Vries
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mona C. Toet
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M. A. Lemmers
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renè E. Vosse van de
- Dept. of Medical Technology and Clinical Physics, University Services, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for the Developing Brain, King's College London, London, United Kingdom
- * E-mail:
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