Effects of Neonatal Thoracoscopic Surgery on Tissue Oxygenation: A Pilot Study on (Neuro-) Monitoring and Outcomes

Introduction Multiple reports have questioned the feasibility of neonatal thoracoscopic repair of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). The aim of this study is to examine the effects of CO2 pneumothorax on cerebral and renal rSO2 and to assess the potential predictive value of these data on neurodevelopmental outcome after neonatal thoracoscopic surgery for CDH or EA. Materials and Methods A prospective observational pilot study. Cerebral and renal regional tissue oxyhemoglobine saturation (rSO2) rSO2 were assessed using near-infrared spectroscopy (NIRS) during thoracoscopic surgery in neonates with CDH and with EA, in addition to routine anesthesia monitoring. Cerebral and renal rSO2, linked to repeated arterial blood gas analyses, heart rate, blood pressure, and to structured longitudinal neurodevelopmental follow-up. Results Baseline estimated marginal means of cerebral rSO2 values (CDH: 82%, EA: 91%) did not change significantly during pneumothorax (CDH: 81%, EA 79% [n.s. versus baseline]) despite severe acidosis (lowest pH, CDH: 6.99, EA: 7.1). Neurodevelopmental outcomes at 24 months were normal in all 7 patients who were available for evaluation. Conclusion Neonatal thoracoscopic repair of CDH and EA using CO2-pneumothorax leads to severe acidosis. Cerebral rSO2 remained within clinical acceptable limits during intraoperative periods of acidosis. Neurodevelopmental outcome was favorable within the first 24 months. The potential of NIRS to further improve perioperative care and long-term outcome in this specific patient group deserves further investigation.

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Influence of Maternal Preeclampsia on Neurodevelopmental Outcomes of Preterm Infants

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.737 ◽

2018 ◽

Vol 24 (2) ◽

pp. 99

Author(s):

Halil Degirmencioglu ◽

Birgul Say ◽

Zeynep Ustunyurt ◽

Serife Suna Oguz

Keyword(s):

Cerebral Palsy ◽

Preterm Infants ◽

Gestational Age ◽

Infant Development ◽

Neurodevelopmental Outcome ◽

Control Group ◽

Neurodevelopmental Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

The Mean

Objective: The aim of this study was to determine the neurodevelopmental outcome of preterm infants born to mothers with preeclampsia and to compare them with preterm controls.Study design: This was a retrospective, observational study in a large, tertiary, neonatal intensive care unit. Neurodevelopmental evaluations using Bayley Scales of Infant Development II were performed in 226 two-year-old infants with birth weight ≤1500 g and gestational age ≤32 weeks who were born to mothers with preeclampsia and in 493 infants who were born after normotensive pregnancies, matched for gestational age and gender.Results: The mean gestational ages of the infants in the preeclampsia and control groups were 29.9±2.3 weeks and 28.7±4.1 weeks, respectively (p<0.001). A total of 372 infants with a mean age of 19.2±3.2 months were assessed for long-term outcome. The mean mental developmental index score was significantly higher, and the percentage of infants with cerebral palsy was significantly lower, in the preeclampsia group compared with the control group (p=0.03 and p=0.02, respectively). However, no overall significant differences in neurodevelopmental impairment rates were found between the two groups (p=0.08).Conclusion: Maternal preeclampsia seems to be a protector factor for the development of cerebral palsy in preterm infants.

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Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC

Metabolites ◽

10.3390/metabo12010078 ◽

2022 ◽

Vol 12 (1) ◽

pp. 78

Author(s):

Taylor A. Vadset ◽

Ajay Rajaram ◽

Chuan-Heng Hsiao ◽

Miriah Kemigisha Katungi ◽

Joshua Magombe ◽

...

Keyword(s):

Treatment Failure ◽

Near Infrared ◽

Third Ventriculostomy ◽

Clinical Workflow ◽

Neurodevelopmental Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Operative Care ◽

Patients At Risk ◽

Ventricle Volume

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

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Cerebrospinal fluid NCAM-1 concentration is associated with neurodevelopmental outcome in post-hemorrhagic hydrocephalus of prematurity

PLoS ONE ◽

10.1371/journal.pone.0247749 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247749

Author(s):

David D. Limbrick ◽

Diego M. Morales ◽

Chevis N. Shannon ◽

John C. Wellons ◽

Abhaya V. Kulkarni ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Preterm Infants ◽

Infant Development ◽

Neurodevelopmental Outcome ◽

Research Network ◽

Csf Biomarkers ◽

Neurodevelopmental Outcomes ◽

Neurological Disability ◽

Term Outcome ◽

Long Term Outcome

Objective Efforts directed at mitigating neurological disability in preterm infants with intraventricular hemorrhage (IVH) and post hemorrhagic hydrocephalus (PHH) are limited by a dearth of quantifiable metrics capable of predicting long-term outcome. The objective of this study was to examine the relationships between candidate cerebrospinal fluid (CSF) biomarkers of PHH and neurodevelopmental outcomes in infants undergoing neurosurgical treatment for PHH. Study design Preterm infants with PHH were enrolled across the Hydrocephalus Clinical Research Network. CSF samples were collected at the time of temporizing neurosurgical procedure (n = 98). Amyloid precursor protein (APP), L1CAM, NCAM-1, and total protein (TP) were compared in PHH versus control CSF. Fifty-four of these PHH subjects underwent Bayley Scales of Infant Development-III (Bayley-III) testing at 15–30 months corrected age. Controlling for false discovery rate (FDR) and adjusting for post-menstrual age (PMA) and IVH grade, Pearson’s partial correlation coefficients were used to examine relationships between CSF proteins and Bayley-III composite cognitive, language, and motor scores. Results CSF APP, L1CAM, NCAM-1, and TP were elevated in PHH over control at temporizing surgery. CSF NCAM-1 was associated with Bayley-III motor score (R = -0.422, p = 0.007, FDR Q = 0.089), with modest relationships noted with cognition (R = -0.335, p = 0.030, FDR Q = 0.182) and language (R = -0.314, p = 0.048, FDR Q = 0.194) scores. No relationships were observed between CSF APP, L1CAM, or TP and Bayley-III scores. FOHR at the time of temporization did not correlate with Bayley-III scores, though trends were observed with Bayley-III motor (p = 0.0647 and R = -0.2912) and cognitive scores (p = 0.0506 and R = -0.2966). Conclusion CSF NCAM-1 was associated with neurodevelopment in this multi-institutional PHH cohort. This is the first report relating a specific CSF protein, NCAM-1, to neurodevelopment in PHH. Future work will further investigate a possible role for NCAM-1 as a biomarker of PHH-associated neurological disability.

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Long-Term Outcome after Asphyxia and Therapeutic Hypothermia in Late Preterm Infants: A Pilot Study

Healthcare ◽

10.3390/healthcare9080994 ◽

2021 ◽

Vol 9 (8) ◽

pp. 994

Author(s):

Hanne Lademann ◽

Karl Abshagen ◽

Anna Janning ◽

Jan Däbritz ◽

Dirk Olbertz

Keyword(s):

Pilot Study ◽

Preterm Infants ◽

Perinatal Asphyxia ◽

Psychomotor Development ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Developmental Index ◽

Mental Developmental Index

Therapeutic hypothermia (THT) is the recommended treatment for neuroprotection in (near) term newborns that experience perinatal asphyxia with hypoxic-ischemic encephalopathy. The benefit of THT in preterm newborns is unknown. This pilot study aims to investigate long-term outcomes of late preterm asphyctic infants with and without THT compared to term infants. The single-center, retrospective analysis examined medical charts of infants with perinatal asphyxia born between 2008 and 2015. Long-term outcome was assessed using the Bayley Scales of Infant Development 2 at the age of (corrected) 24 months. Term (n = 31) and preterm (n = 8) infants with THT showed no differences regarding their long-term outcomes of psychomotor development (Psychomotor Developmental Index 101 ± 16 vs. 105 ± 11, p = 0.570), whereas preterm infants had a better mental outcome (Mental Developmental Index 105 ± 13 vs. 93 ± 18, p = 0.048). Preterm infants with and without (n = 69) THT showed a similar mental and psychomotor development (Mental Developmental Index 105 ± 13 vs. 96 ± 20, p = 0.527; Psychomotor Developmental Index 105 ± 11 vs. 105 ± 15, p = 0.927). The study highlights the importance of studying THT in asphyctic preterm infants. However, this study shows limitations and should not be used as a basis for decision-making in the clinical context. Results of a multicenter trial of THT for preterm infants (ID No.: CN-01540535) have to be awaited.

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Neurodevelopmental outcome of babies with hypoxic ischemic encephalopathy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173012 ◽

2017 ◽

Vol 5 (7) ◽

pp. 3197

Author(s):

Sirajuddin Nazeer ◽

Senthilkumar K. ◽

Thangavel A. ◽

Uma Maheswari M.

Keyword(s):

Neurological Outcome ◽

Neurodevelopmental Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

Term Outcome ◽

Long Term Outcome ◽

Mri Brain ◽

Early Markers ◽

Cdc Grading ◽

Ischemic Encephalopathy

Background: The aim of the study was to find out the neurodevelopmental outcome of babies with hypoxic ischemic encephalopathy at 6 months of age and to predict early markers of abnormal neurological outcome in those babies.Methods: 50 babies admitted with hypoxic ischemic encephalopathy were enrolled in this prospective study and followed up at 3 and 6 months of age at Mahatma Gandhi Memorial Government Hospital, Trichy. The neurological outcome of the babies was assessed by CDC grading of motor milestones, Trivandrum development screening chart, Amiel Tison angles head circumference and weight measured. USG cranium was done for all the babies and MRI brain was done in babies with abnormal neuro sonogram and abnormal outcome. Vision and hearing were tested clinically.Results: The incidence of abnormal neurological outcome was 14%. The early markers predicting abnormal neurological sequele are identified.Conclusions: Early identification of abnormal neuro behaviour helps in starting early intervention to improve the long term outcome.

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Long-term neurodevelopment in children born with esophageal atresia: a systematic review

Diseases of the Esophagus ◽

10.1093/dote/doab054 ◽

2021 ◽

Author(s):

Camille E van Hoorn ◽

Chantal A ten Kate ◽

Andre B Rietman ◽

Leontien C C Toussaint-Duyster ◽

Robert Jan Stolker ◽

...

Keyword(s):

Cognitive Development ◽

Motor Function ◽

Esophageal Atresia ◽

Current Knowledge ◽

Neurodevelopmental Outcome ◽

Cognitive Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

The One

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

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A Pilot Study for a Prospective, Randomized, Double-Blind Trial of the Influence of Anesthetic Depth on Long-Term Outcome

Survey of Anesthesiology ◽

10.1097/01.sa.0000453217.42441.ef ◽

2014 ◽

Vol 58 (5) ◽

pp. 237-238

Author(s):

Timothy G. Short ◽

Kate Leslie ◽

Douglas Campbell ◽

Matthew T. V. Chan ◽

Tomas Corcoran ◽

...

Keyword(s):

Pilot Study ◽

Double Blind Trial ◽

Double Blind ◽

Term Outcome ◽

Long Term Outcome ◽

Anesthetic Depth ◽

Blind Trial

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Neonatal Hyperbilirubinemia and Long-Term Outcome: Another Look at the Collaborative Perinatal Project

PEDIATRICS ◽

10.1542/peds.92.5.651 ◽

1993 ◽

Vol 92 (5) ◽

pp. 651-657 ◽

Cited By ~ 10

Author(s):

Thomas B. Newman ◽

Mark A. Klebanoff

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Neurodevelopmental Outcome ◽

Clinical Importance ◽

Sensorineural Hearing ◽

Neurologic Examination ◽

Term Outcome ◽

Long Term Outcome ◽

Medical Centers ◽

Motor Abnormalities

Objective. To examine the association between neonatal bilirubin levels and subsequent neurodevelopmental outcome. Design. Prospective cohort study. Setting. 12 US medical centers from 1959 (first births) to 1974 (last follow-up). Participants. 41 324 singleton white or black infants with birth weight ≥2500 g who had neonatal bilirubin measurements recorded and survived at least 1 year. Main outcome measures. Wechsler Intelligence Scale for Children Intelligence Quotient (IQ) at age 7 years, blinded neurologic examination at age 7 years, and sensorineural hearing loss at age 8 years. Results. There was no association between IQ and bilirubin. For example, comparing children who had maximum bilirubin levels ≥342 µmol/L (20 mg/dL) with those who had lower bilirubin levels, adjusted mean IQs were 105.0 and 103.4 in whites (difference + 1.6; 95% confidence interval [CI]: –0.4 to + 3.5) and 91.0 and 93.3 in blacks (difference –2.3; 95% CI: –4.8 to +0.2). Abnormal neurologic examination results were reported in 12 of 268 children (4.5%) with bilirubin ≥342 µmol/L (20 mg/dL) compared with 1249 of 33 004 children (3.8%) with lower levels (relative risk [RR] = 1.2; 95% CI: 0.7 to 2.1). The frequency of abnormal or suspicious neurologic examination results increased in a stepwise fashion with increasing bilirubin level (P < .001), from 4346/29 258 (14.9%) of those with bilirubin levels <171 µmol/L (10 mg/dL) to 60/268 (22.4%) of those with bilirubin levels ≥342 µmol/L (20 mg/dL), apparently due to increasing minor motor abnormalities at higher bilirubin levels. Sensorineural hearing loss was not associated with high bilirubin levels (RR = 1.0; 95% CI: 0.3 to 3.0). Conclusions. Neonatal bilirubin levels seem to have little effect on IQ, definite neurologic abnormalities, or hearing loss. Higher bilirubin levels are associated with minor motor abnormalities, but the clinical importance of this finding is limited by the weakness of the association, the mild nature of the abnormalities, and the lack of evidence that they are prevented by treatment.

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