Identifying Ways to Fix Outcome Disparities among Outborns Needing Therapeutic Hypothermia

2020 ◽  
Author(s):  
Mary Jo A. Harbert ◽  
Rachelle Sey ◽  
Kathy Arnell ◽  
Maynard Rasmussen
Keyword(s):  
Brain Injury ◽  
Cord Blood ◽  
Therapeutic Hypothermia ◽  
Ph Value ◽  
Secondary Analysis ◽  
Blood Gases ◽  
Rapid Identification ◽  
Target Temperature ◽  
Neonatal Encephalopathy ◽  
Chest Compressions

Abstract Objective This study examined patterns of care after birth in newborns treated with therapeutic hypothermia to identify remediable causes for the poorer outcomes observed in outborn infants. Study Design This was a secondary analysis of 150 newborns (68 outborn) prospectively enrolled at our center in the Vermont Oxford Neonatal Encephalopathy Registry from January 2008 to October 2016. Results The 5-minute Apgar's score and cord pH value did not differ, but cord blood gases were obtained far less frequently in outborns (p = 0.002). Outborns needed more chest compressions (p = 0.01) and epinephrine (p = 0.04), and had more brain injury on neuroimaging (p = 0.05). Outborns took longer to reach target hypothermia temperature (p < 0.0001). Conclusion The lack of cord gas values and longer time to reach target temperature observed in the outborns are two observed differences in care that can be potentially remedied by providing education and resources at delivering hospitals in rapid identification of hypothermia candidates, though further research is needed to define the effects of such measures. Possible solutions are also discussed here.

scholarly journals Preemptive Morphine During Therapeutic Hypothermia After Neonatal Encephalopathy: A Secondary Analysis

2020 ◽  
Vol 10 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Natasha Liow ◽  
Paolo Montaldo ◽  
Peter J. Lally ◽  
Justinas Teiserskas ◽  
Paul Bassett ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Secondary Analysis ◽  
Neonatal Encephalopathy

scholarly journals Characterization of Death in Neonatal Encephalopathy in the Hypothermia Era

2016 ◽  
Vol 32 (4) ◽  
pp. 360-365 ◽  
Author(s):  
Monica E. Lemmon ◽  
Renee D. Boss ◽  
Sonia L. Bonifacio ◽  
Audrey Foster-Barber ◽  
A. James Barkovich ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Magnetic Resonance Images ◽  
Time Of Death ◽  
Severe Brain Injury ◽  
Neonatal Encephalopathy ◽  
Total Brain ◽  
Over Time

This study aimed to characterize the circumstances of death in encephalopathic neonates treated with therapeutic hypothermia. Patients who died after or during treatment with therapeutic hypothermia between 2007-2014 were identified. Patient circumstance of death was characterized using an established paradigm. Thirty-one of 229 patients died (14%) at a median of 3 days of life. Most who died were severely encephalopathic on examination (90%) and had severely abnormal electroencephalographic (EEG) findings (87%). All those who had magnetic resonance images (n = 13) had evidence of moderate-severe brain injury; 6 had near-total brain injury. Cooling was discontinued prematurely in 61% of patients. Most patients (90%) were physiologically stable at the time of death; 81% died following elective extubation for quality of life considerations. Three patients (10%) died following withholding or removal of artificial hydration and nutrition. Characterization of death in additional cohorts is needed to identify differences in decision making practices over time and between centers.

scholarly journals Serial plasma biomarkers of brain injury in infants with neonatal encephalopathy treated with therapeutic hypothermia

2021 ◽  
Author(s):  
Meaghan M. McGowan ◽  
Alexandra C. O’Kane ◽  
Gilbert Vezina ◽  
Taeun Chang ◽  
Nicole Bendush ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Neonatal Encephalopathy ◽  
Plasma Biomarkers

scholarly journals Beyond Hypothermia: Alternative Therapies for Hypoxic Ischemic Encephalopathy

2013 ◽  
Vol 7 (1) ◽  
pp. 26-40 ◽  
Author(s):  
Andrea Hobson ◽  
Julie Baines ◽  
Michael D. Weiss
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Alternative Therapies ◽  
Ischemic Brain Injury ◽  
Neonatal Encephalopathy ◽  
Complete Protection ◽  
Ischemic Insult ◽  
Ischemic Brain ◽  
Hypoxic Ischemic Brain Injury ◽  
Ischemic Encephalopathy

Neonatal encephalopathy remains a significant cause of death and disability worldwide. Therapeutic hypothermia has become a mainstay of therapy and has demonstrated the potential for neuroprotection and repair after neonatal hypoxic-ischemic brain injury. However, it has become apparent from published trials that hypothermia alone will not serve as complete protection nor benefit all neonates. The complicated cascade of events in a hypoxic-ischemic insult lends itself to multiple types of therapy, making a multi-faceted approach to treatment attractive. This review critically discusses the broad range of medical therapies currently being studied and summarizes the animal and human studies that have been done to date. Therapies that may act synergistically with cooling therapy are also discussed.

Meta-Analysis of the Efficacy and Safety of Therapeutic Hypothermia in Children with Acute Traumatic Brain Injury

2015 ◽  
Vol 83 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Bin-Fei Zhang ◽  
Jiao Wang ◽  
Zun-Wei Liu ◽  
Yong-Lin Zhao ◽  
Dan-Dong Li ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Acute Traumatic Brain Injury

scholarly journals Umbilical cord blood therapy modulates neonatal hypoxic ischemic brain injury in both females and males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tayla R. Penny ◽  
Yen Pham ◽  
Amy E. Sutherland ◽  
Joohyung Lee ◽  
Graham Jenkin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Significant Risk ◽  
Immunohistochemical Analysis ◽  
Significant Risk Factor ◽  
Tissue Loss ◽  
Artery Ligation ◽  
Rat Pups

AbstractPreclinical and clinical studies have shown that sex is a significant risk factor for perinatal morbidity and mortality, with males being more susceptible to neonatal hypoxic ischemic (HI) brain injury. No study has investigated sexual dimorphism in the efficacy of umbilical cord blood (UCB) cell therapy. HI injury was induced in postnatal day 10 (PND10) rat pups using the Rice-Vannucci method of carotid artery ligation. Pups received 3 doses of UCB cells (PND11, 13, 20) and underwent behavioural testing. On PND50, brains were collected for immunohistochemical analysis. Behavioural and neuropathological outcomes were assessed for sex differences. HI brain injury resulted in a significant decrease in brain weight and increase in tissue loss in females and males. Females and males also exhibited significant cell death, region-specific neuron loss and long-term behavioural deficits. Females had significantly smaller brains overall compared to males and males had significantly reduced neuron numbers in the cortex compared to females. UCB administration improved multiple aspects of neuropathology and functional outcomes in males and females. Females and males both exhibited injury following HI. This is the first preclinical evidence that UCB is an appropriate treatment for neonatal brain injury in both female and male neonates.

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