Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury

2020 ◽  
Vol 13 (4) ◽  
pp. 449-458 ◽  
Author(s):  
E.H. Xu ◽  
M. Claveau ◽  
E.W. Yoon ◽  
K.J. Barrington ◽  
K. Mohammad ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Outcome ◽  
Large Population ◽  
Birth Asphyxia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Risk Of Death ◽  
Canadian Population ◽  
Increased Risk ◽  
Initial Severity ◽  
Ischemic Encephalopathy

BACKGROUND: Birth asphyxia in term neonates remains a serious condition that causes significant mortality and long-term neurodevelopmental sequelae despite hypothermia treatment. The objective of this study was to review therapeutic hypothermia practices in a large population of neonates with hypoxic-ischemic encephalopathy (HIE) across Canada and to identify determinants of adverse outcome. METHODS: Our retrospective observational cohort study examined neonates≥36 weeks, admitted to the Canadian Neonatal Network NICUs between 2010 and 2014, diagnosed with HIE, and treated with hypothermia. Adverse outcome was defined as death and/or brain injury. Maternal, birth, and postnatal characteristics were compared between neonates with adverse outcome and those without. The association between the variables which were significantly different (p < 0.05) between the two groups and adverse outcome were further tested, while adjusting for gestational age, birth weight, gender, and initial severity of encephalopathy. RESULTS: A total of 2187 neonates were admitted for HIE; 52% were treated with hypothermia and 40% developed adverse outcome. Initial severity of encephalopathy (moderate, p = 0.006; severe, p < 0.0001), hypotension treated with inotropes (p = 0.001), and renal failure (p = 0.007) were significantly associated with an increased risk of death and/or brain injury. CONCLUSIONS: In asphyxiated neonates treated with hypothermia, not only their initial severity of encephalopathy on admission, but also their cardiac and renal complications during the first days after birth were significantly associated with risk of death and/or brain injury. Careful monitoring and cautious management of these complications is warranted.

scholarly journals Current Controversies in Newer Therapies to Treat Birth Asphyxia

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Pia Wintermark
Keyword(s):  
Brain Injury ◽  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Birth Asphyxia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Monitoring Technology ◽  
The Past ◽  
Neuroprotective Strategy ◽  
Ischemic Encephalopathy

Despite major advances in monitoring technology and knowledge of fetal and neonatal pathophysiology, neonatal hypoxic-ischemic encephalopathy (HIE) remains one of the main causes of severe adverse neurological outcome in children. Until recently, there were no therapies other than supportive measures. Over the past several years, mild hypothermia has been proven to be safe to treat HIE. Unfortunately, this neuroprotective strategy seems efficient in preventing brain injury in some asphyxiated newborns, but not in all of them. Thus, there is increasing interest to rapidly understand how to refine hypothermia therapy and add neuroprotective or neurorestorative strategies. Several promising newer treatments to treat birth asphyxia and prevent its devastating neurological consequences are currently being tested. In this paper, the physiopathology behind HIE, the currently available treatment, the potential alternatives, and the next steps before implementation of these other treatments are reviewed.

Erythropoietin in perinatal hypoxic-ischemic encephalopathy: a systematic review and meta-analysis

2019 ◽  
Vol 47 (4) ◽  
pp. 478-489 ◽  
Author(s):  
Abdul Razak ◽  
Asif Hussain
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Meta Analysis ◽  
Hypoxic Ischemic Encephalopathy ◽  
Cochrane Central Register ◽  
Risk Of Death ◽  
Ischemic Encephalopathy ◽  
Reduced Risk

Abstract Background Erythropoietin (EPO) appears to confer neuroprotection to the injured brain. Randomized clinical trials (RCTs) have demonstrated its safety in neonates with hypoxic-ischemic encephalopathy (HIE); however, the evidence is unclear. The objective of this study was to examine the role of EPO in perinatal HIE by a systematic review and meta-analysis. Methods Database search included Embase, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Central Register of Controlled Trials (CENTRAL). RCTs reporting a death, neurodevelopmental outcomes or brain injury were included. Two authors extracted the data independently from included studies and assessed the level of evidence (LOE). Results Six RCTs (EPO=5 and darbepoetin α=1) involving 454 neonates were included. A trend toward a lower risk of death was identified in infants treated with EPO [EPO with or without hypothermia: five RCTs, 368 participants, relative risk (RR) 0.74, 95% confidence interval (CI) 0.47–1.19, LOE−low; EPO without hypothermia: four RCTs, 318 participants, RR 0.89, 95% CI 0.49–1.32, LOE−low]. EPO treatment without hypothermia compared to placebo resulted in a reduced risk of cerebral palsy (two RCTs, 230 participants, RR 0.47, 95% CI 0.27–0.80, LOE−moderate) and moderate to severe cognitive impairment (two RCTs, 226 participants, RR 0.49, 95% CI 0.28–0.85, LOE−moderate). A reduced risk of brain injury was identified in EPO treated infants (EPO with or without hypothermia, two RCTs, 148 participants, RR 0.70, 95% CI 0.53–0.92, LOE−moderate). Conclusion EPO administration in neonates with perinatal HIE reduces the risk of brain injury, cerebral palsy and cognitive impairment. The evidence is limited to suggest its role as an adjuvant to hypothermia. Larger powered trials are underway to overcome this limitation.

scholarly journals Prognostic Value of Continuous Electroencephalogram Delta Power in Neonates With Hypoxic-Ischemic Encephalopathy

2020 ◽  
Vol 35 (8) ◽  
pp. 517-525 ◽  
Author(s):  
Srinivas Kota ◽  
An N. Massaro ◽  
Taeun Chang ◽  
Tareq Al-Shargabi ◽  
Caitlin Cristante ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Outcome ◽  
Favorable Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Injury Death ◽  
Delta Power ◽  
Outcome Group ◽  
Continuous Eeg ◽  
Eeg Recordings ◽  
Ischemic Encephalopathy

The objective was to examine the discriminatory ability of electroencephalogram (EEG) delta power in neonates with hypoxic-ischemic encephalopathy (HIE) with well-defined outcomes. Prolonged continuous EEG recordings from term neonates with HIE during therapeutic hypothermia enrolled in a prospective observational study were examined. Adverse outcome was defined as death or severe brain injury by magnetic resonance imaging (MRI); favorable outcome was defined as normal or mild injury by MRI. Neonates were stratified by Sarnat grade of encephalopathy at admission. EEG was partitioned into 10-minute nonoverlapping artifact- and seizure-free epochs. Delta power was calculated and compared between the groups using receiver operating characteristic (ROC) analyses and Wilcoxon rank-sum tests. An area under the ROC curve >0.7 with P <.05 was considered a significant separation between groups. The favorable outcome group (n = 67) had higher delta power than the adverse outcome group (n = 28) across the majority of time periods from 9 to 90 hours of life. Delta power discriminated outcome groups for neonates with moderate encephalopathy (63 favorable and 14 adverse outcome) earlier in cooling (9-42 hours of life) than neonates with severe encephalopathy (21-42 hours of life). Outcome groups were differentiated after 81 hours of life in neonates with moderate and severe encephalopathy. Delta power can distinguish cooled HIE neonates with adverse outcome independently of the encephalopathy grade at presentation. Delta power may be a real-time continuous biomarker of evolving encephalopathy and brain injury/death in neonates with HIE.

scholarly journals A STUDY OF NEONATES WITH BIRTH ASPHYXIA FOR SEQUELAE OVER 2 YEARS

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Dr. Y. Vamseedhar ◽  
Dr. B.K. Niranjan
Keyword(s):  
Carbon Dioxide ◽  
Cerebral Palsy ◽  
Arterial Oxygen Tension ◽  
Birth Asphyxia ◽  
Glucose Production ◽  
Hypoxic Ischemic Encephalopathy ◽  
Arterial Oxygen ◽  
Spastic Cerebral Palsy ◽  
Increased Risk ◽  
Ischemic Encephalopathy

Introduction: Birth asphyxia is associated with reduction in the arterial oxygen tension, accumulation of carbon dioxide and fall in blood pH. Acidosis occurs due to anerobic utilization of glucose, production of lactic acid and accumulation of carbon dioxide. Aim: To study outcome of neonates who suffered birth asphyxia and Hypoxic–ischemic encephalopathy (HIE) in a teaching hospital over a period of 2 years. Materials & Methods: 325 neonates with birth asphyxia and hypoxic ischemic encephalopathy were studied, with well defined inclusion and exclusion criteria. They were treated according to standard protocols. Observations : 106 neonates of HIE-I, 58 neonates of HIE-II, and 59 neonates of HIE-III were followed up: for various outcomes like death due to complications, cerebral palsy, developmental delay with epilepsy, hearing handicap etc. Results: In HIE-I no case progressed to cerebral palsy, in HIE-II 24.13% progressed into CP and in HIE-III 54.2% developed spastic cerebral palsy. Conclusion: Infants with severe grades of HIE have increased risk of long term neurological sequlae. Keywords: Neonate, Birth asphyxia, Acidosis, Neonatal encephalopathy

scholarly journals Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study

2019 ◽  
Vol 60 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Anneleen Dereymaeker ◽  
Vladimir Matic ◽  
Jan Vervisch ◽  
Perumpillichira J. Cherian ◽  
Amir H. Ansari ◽  
...  
Keyword(s):  
At Risk ◽  
Pilot Study ◽  
Adverse Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Ischemic Encephalopathy

MRI IN HYPOXIC ISCHEMIC ENCEPHALOPATHY WITH CLINICAL FOLLOW UP

2021 ◽  
pp. 43-48
Author(s):  
M R Shashikumar ◽  
Narasipur Lingaiah Rajendrakumar ◽  
Sanjay P ◽  
Nanjaraj Chakenalli Puttaraj ◽  
Shruti Shruti ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Mr Imaging ◽  
Developmental Disorders ◽  
Brain Mri ◽  
Birth Asphyxia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Preterm Neonates ◽  
Diffusion Restriction ◽  
Ischemic Encephalopathy

Introduction: HIE is often clinically suspected in the setting of a known perinatal stress event arising from a complicated or difcult delivery. The most sensitive and specic imaging technique for examining infants with suspected hypoxicischemic brain injury is MR imaging. It also gives information about the timing and specic patterns of injury and also suggest diagnoses other than HIE such as metabolic disorders and developmental disorders of the brain. MRI is also a useful tool in the determination of prognosis and also follow-up of HIE. Aim: This study was undertaken to evaluate the various MRI appearances of hypoxic ischemic encephalopathy in term and preterm neonates and to correlate the MRI appearances with clinical outcome. Materials and Methods: All neonates with history of birth asphyxia, referred for MRI examination to the Department of Radio-Diagnosis, K. R. Hospital attached to Mysore Medical College and Research Institute, during January 2018 to January 2019. All MRI scans were performed on GE optima MR360 1.5 Tesla. Sequences used were T1W axial, T1 FLAIR axial, T2W axial, T2 FLAIR axial, T1W sag, T2W coronal, T2W GRE axial, DWI axial and ADC maps. Results: 30 babies with clinically suspicion of HIE and positive ndings on MR imaging were evaluated in our study. Out of 30 babies, 18 were term and 12 babies were preterm. Periventricular luecomalacia is most common MRI pattern in preterm and central pattern in term neonates. 16 babies had abnormal developmental outcome at 6 months follow up study. 16 babies with diffusion restriction in corpus callosum, 12 had abnormal outcome. 7 out of 10 babies with loss of normal signal in internal capsule had abnormal outcome. Babies with diffusion restriction in basal ganglia had gross developmental delay. Conclusion: MRI is the modality of choice for evaluation of HIE because of excellent gray – white matter resolution, well-depiction of myelination pattern and multi-planar imaging capabilities. There is a strong relation between the MRI appearances of birth asphyxia and the clinical outcome. Therefore MRI has a strong role in prognosticating lesions.

Blood Carbon Dioxide Levels and Adverse Outcome in Neonatal Hypoxic-Ischemic Encephalopathy

2009 ◽  
Vol 27 (05) ◽  
pp. 361-365 ◽  
Author(s):  
Montasser Nadeem ◽  
Deirdre Murray ◽  
Geraldine Boylan ◽  
Eugene Dempsey ◽  
C. Anthony Ryan
Keyword(s):  
Carbon Dioxide ◽  
Adverse Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Carbon Dioxide Levels ◽  
Ischemic Encephalopathy

scholarly journals Serum Biomarkers of MRI Brain Injury in Neonatal Hypoxic Ischemic Encephalopathy Treated With Whole-Body Hypothermia

2013 ◽  
Vol 14 (3) ◽  
pp. 310-317 ◽  
Author(s):  
An N. Massaro ◽  
Andreas Jeromin ◽  
Nadja Kadom ◽  
Gilbert Vezina ◽  
Ronald L. Hayes ◽  
...  
Keyword(s):  
Brain Injury ◽  
Serum Biomarkers ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Mri Brain ◽  
Ischemic Encephalopathy
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