PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia

Despite of significant progress in the development of technologies of clinical monitoring and the fetus and newborn pathology study, perinatal asphyxia or, more accurately – cerebral ischemia (CI) remain serious condition, causing significant mortality and long-term morbidity. Chi-acquired syndrome characterized by clinical and laboratory signs of acute brain injury due to asphyxia (ie, hypoxia, acidosis). The paper reflects the main clinical signs and neurosonographic lesion of the Central nervous system (CNS) in neonatal newborn infants with different gestational age who underwent CI mild to moderate severity.

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Neurodevelopmental Outcome at 12 Months of Postnatal Magnesium Sulphate Therapy for Perinatal Asphyxia

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15565 ◽

2017 ◽

Vol 36 (3) ◽

pp. 256-262

Author(s):

Raj Prakash ◽

M.R. Savitha ◽

B. Krishnamurthy

Keyword(s):

Placebo Group ◽

Developmental Delay ◽

Magnesium Sulphate ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Treatment Protocol ◽

Short Term ◽

Term Outcome ◽

Magnesium Therapy

Introduction: Postnatal magnesium therapy has been proposed as a novel neuroprotective agent for perinatal asphyxia. A few studies reported short term neurological benefit with magnesium. It is uncertain whether magnesium therapy has any long term effect on neurodevelopment.Material and Methods: We randomly assigned 120 term asphyxiated infants to receive either magnesium sulphate infusion or placebo postnatally in first 48 hours of life. Babies were treated as per the standard treatment protocol for asphyxia. Short term outcome at discharge was previously reported and a follow up evaluation at 12 months was done. The primary outcome was a composite of death or disability, developmental delay and neuromotor tone abnormality at 12 months.Results: Out of 120 infants, 69 infants had moderate-severe hypoxic-ischemic encephalopathy (HIE) during initial NICU stay. Among 69 infants with moderate-severe HIE, 41 infant could be followed up. Out of 41 infants, 22 were in magnesium group and 19 in placebo group. Of 22 infants assigned to magnesium therapy, 3(13.6%) died or survived with neurodevelopmental disability as compared with 5 of 19 infants (26.3%) assigned to placebo (p=0.32). The developmental outcome evaluated found developmental delay in 3 of 22 infants in magnesium group vs 5 of 19 infants in placebo group (p=0.32). Ameil-Tisonneuromotor tone assessment revealed tone abnormality in 3 of 22 infants in study group vs 4 of 19 infants in placebo group (p=0.53).Conclusion: Magnesium therapy for perinatal asphyxia may not result in favourable long term neurodevelopmental outcome, though no significant adverse effect has been documented.J Nepal Paediatr Soc 2016;36(3):256-262

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Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015

Children ◽

10.3390/children8010023 ◽

2021 ◽

Vol 8 (1) ◽

pp. 23

Author(s):

Yen-Ju Chen ◽

Wen-Hao Yu ◽

Li-Wen Chen ◽

Chao-Ching Huang ◽

Lin Kang ◽

...

Keyword(s):

Gestational Age ◽

Significant Risk ◽

Neonatal Resuscitation ◽

Comfort Care ◽

Before And After ◽

Long Term Follow Up ◽

Neonatal Resuscitation Program ◽

Definition Of ◽

The Impact

Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

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Cord blood nucleated red blood cell count as a predictor of long term sequelae in cases of perinatal asphyxia: a one-year follow-up study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183510 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1805

Author(s):

Ashok Kumar ◽

Rupa Dalmia Singh ◽

Shashank Suryavanshi ◽

Kriti Mohan

Keyword(s):

Cord Blood ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Prospective Longitudinal Study ◽

Medical College ◽

Nucleated Red Blood Cells ◽

Red Blood Cell Count ◽

One Year ◽

Prospective Longitudinal

Background: Nucleated red blood cells (NRBCs) can be easily found in cord blood and its >20/100 WBCs has been distinguished as a marker of perinatal asphyxia at birth. Authors conducted this study to find out if there exists a relation between NRBCs at birth and its effects on long term neurological outcome in patients of perinatal asphyxia.Methods: This was a prospective longitudinal study conducted in the Department of Pediatrics in collaboration with Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur from December 2014 to September 2016.Results: On assessing the long term neurodevelopmental outcome in newborns with HIE at birth, Authors found that cord blood NRBCs had no direct influence on the final neurodevelopmental outcome at 1 year of life as did HIE staging.Conclusions: Authors propose that cord blood NRBC counts of > 20/100 WBCs is a good predictor of asphyxia at birth but is definitely not an indicator of forth coming developmental delay.

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Cord Blood IL-16 Is Associated with 3-Year Neurodevelopmental Outcomes in Perinatal Asphyxia and Hypoxic-Ischaemic Encephalopathy

Developmental Neuroscience ◽

10.1159/000471508 ◽

2017 ◽

Vol 39 (1-4) ◽

pp. 59-65 ◽

Cited By ~ 10

Author(s):

Caroline E. Ahearne ◽

Ruby Y. Chang ◽

Brian H. Walsh ◽

Geraldine B. Boylan ◽

Deirdre M. Murray

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Roc Curve ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Prospective Longitudinal

Activation of the inflammatory pathway is increasingly recognized as an important mechanism of injury following neonatal asphyxia and encephalopathy. This process may contribute to the poor prognosis seen in some cases, despite therapeutic hypothermia. Our group has previously identified raised interleukin (IL)-6 and IL-16, measured in umbilical cord blood at birth, to be predictive of grade of hypoxic-ischaemic encephalopathy (HIE). Our aim in this study was to examine the ability of these cytokines to predict the 3-year neurodevelopmental outcome in the same cohort. As part of a prospective, longitudinal cohort study set in a single tertiary maternity unit, term infants with biochemical and clinical evidence of perinatal asphyxia were recruited at birth. Umbilical cord blood was collected and analyzed for IL-6 and IL-16 using a Luminex assay. The neurodevelopmental outcome of these infants was assessed at 3 years using the Bayley Scales of Infant and Toddler Development (Edition 3). Early cord blood measurement of IL-6 and IL-16 and long-term outcome were available in 33/69 infants. Median (IQR) IL-16 differentiated infants with a severely abnormal outcome (n = 6) compared to all others (n = 27), (646 [466-1,085] vs. 383.5 [284-494] pg/mL; p = 0.012). IL-16 levels were able to predict a severe outcome with an area under the receiver-operating characteristic (ROC) curve of 0.827 (95% CI 0.628-1.000; p = 0.014). Levels ≥514 pg/mL predicted a severe outcome with a sensitivity of 83% and a specificity of 81%. IL-16 also outperformed other routine biochemical markers available at birth for the prediction of severe outcome. APGAR scores at 1 and 10 min were also predictive of a severe outcome (p = 0.022 and p = 0.036, respectively). A combination of IL-16 with these clinical markers did not improve predictive value, but IL-16 combined with electroencephalogram grading increased the area under the ROC curve. IL-6 did not show any association with 3-year outcome. This is the first report studying the association of IL-16 measured at birth with long-term outcome in a cohort of neonates with perinatal asphyxia. IL-16 may be an early biomarker of severe injury and aid in the long-term prognostication in infants with HIE.

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Heart Rate Assessment during Neonatal Resuscitation

Healthcare ◽

10.3390/healthcare8010043 ◽

2020 ◽

Vol 8 (1) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

Peter A. Johnson ◽

Georg M. Schmölzer

Keyword(s):

Heart Rate ◽

Infant Mortality ◽

Current Practice ◽

Clinical Status ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Novel Technologies ◽

Hypoxic Injury ◽

Neonatal Resuscitation Program ◽

Neonatal Transition

Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.

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Assessment of long-term neurodevelopmental outcome following trials of medicinal products in newborn infants

Pediatric Research ◽

10.1038/s41390-019-0526-1 ◽

2019 ◽

Vol 86 (5) ◽

pp. 567-572 ◽

Cited By ~ 2

Author(s):

Neil Marlow ◽

◽

Lex W. Doyle ◽

Peter Anderson ◽

Samantha Johnson ◽

...

Keyword(s):

Newborn Infants ◽

Neurodevelopmental Outcome ◽

Medicinal Products

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Outcome of vein of Galen malformation presenting in the neonatal period

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316495 ◽

2019 ◽

Vol 104 (11) ◽

pp. 1064-1069 ◽

Cited By ~ 2

Author(s):

Stephanie Malarbi ◽

Julia K Gunn-Charlton ◽

Alice C Burnett ◽

Trisha M Prentice ◽

Amy Williams ◽

...

Keyword(s):

Middle Childhood ◽

Neonatal Intensive Care ◽

Neonatal Period ◽

Newborn Infants ◽

Neurodevelopmental Outcome ◽

Neurodevelopmental Outcomes ◽

Eligibility Criteria ◽

Neuroimaging Data ◽

Nicu Admission

ObjectiveVein of Galenaneurysmal malformation (VGAM) is a rare but important congenital malformation presenting to neonatal intensive care units (NICUs), and with a change from surgical to endovascular management, survival for this condition has improved. However, there is little reported about the medical management decisions of infants with this condition and the associated long-term neurodevelopmental outcomes. We aim to report a single centre experience of both acute treatment and long-term outcomes of VGAM for those infants admitted to our NICU soon after birth.DesignRetrospective cohort study over a 15-year period from 2001 to 2015 inclusive.SettingA quaternary NICU at The Royal Children’s Hospital, Melbourne, Australia.Participants24 newborn infants referred for management of VGAM. There were no eligibility criteria set for this study; all presenting infants were included.InterventionsNone.Main outcomes measuresClinical neuroimaging data were gathered. Surviving children were formally assessed with a battery of tests administered by a neuropsychologist and occupational therapist/physiotherapist at various ages across early to middle childhood.ResultsFifteen neonates with VGAM did not survive beyond their NICU admission. 10 of these were not offered endovascular intervention. Of the nine surviving infants, only one had a normal neurodevelopmental outcome.ConclusionsThe mortality of VGAM presenting in the neonatal period was high, and rates of normal neurodevelopmental outcome for survivors were low. These findings contribute to our understanding of which neonates should be treated and highlights the importance of providing clinical neurodevelopmental follow-up to survivors beyond their infant years.

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