Effect of neonatal resuscitation courses on long-term neurodevelopmental outcomes of newborn infants with perinatal asphyxia

ObjectivesAntenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 340/7–366/7 weeks of gestation), when the benefits of ACS are subtle.DesignPopulation-based, retrospective cohort.SettingOntario, Canada, between 2006 and 2011.PatientsAll live singleton infants born during the LPT period with a minimum 5-year follow-up.InterventionsExposure to ACS prior to 340/7 weeks of gestation.Main outcome measuresSuspected neurocognitive disorder, audiometry testing or visual testing.ResultsOverall, 25 668 infants were eligible for analysis, of whom 2689 (10.5%) received ACS. Infants in the ACS group had lower mean birth weight and higher rates of birth weight <10th percentile, neonatal resuscitation and neonatal intensive care unit admission. At 5 years of age, ACS exposure was associated with an increased risk of suspected neurocognitive disorder (adjusted HR (aHR) 1.12, 95% CI 1.05 to 1.20), audiometry testing (aHR 1.20, 95% CI 1.10 to 1.31) and visual testing (aHR 1.06, 95% CI 1.01 to 1.11).ConclusionIn children born during the LPT period, exposure to ACS prior to 340/7 weeks of gestation is associated with an increased utilisation of the healthcare system related to audiometry and visual testing and suspected neurocognitive disorders by 5 years of age.

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Clinical and neurosonographic signs of c entral nervous system in newborns

Vladikavkaz Medico-Biological Bulletin ◽

10.12737/11808 ◽

2014 ◽

Vol 20 (30) ◽

pp. 97-100

Author(s):

Хетагурова ◽

Yuliana Khetagurova ◽

Ревазова ◽

Asya Revazova ◽

Бораева ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Perinatal Asphyxia ◽

Newborn Infants ◽

Clinical Signs ◽

Significant Progress ◽

Moderate Severity ◽

The Central Nervous System ◽

Significant Mortality

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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The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia

Brain and Development ◽

10.1016/j.braindev.2007.05.009 ◽

2008 ◽

Vol 30 (1) ◽

pp. 43-46 ◽

Cited By ~ 35

Author(s):

Rıdvan Duran ◽

Nükhet Aladağ ◽

Ülfet Vatansever ◽

Necdet Süt ◽

Betül Acunaş

Keyword(s):

Perinatal Asphyxia ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Mortality And Morbidity ◽

Neonatal Resuscitation Program ◽

The Impact

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Validation of Raised Cord Blood Interleukin-16 in Perinatal Asphyxia and Neonatal Hypoxic-Ischaemic Encephalopathy in the BiHiVE2 Cohort

Developmental Neuroscience ◽

10.1159/000491386 ◽

2018 ◽

Vol 40 (3) ◽

pp. 271-277

Author(s):

Marc P. O’Sullivan ◽

Klaudia M. Sikora ◽

Caroline Ahearne ◽

Deirdre M. Twomey ◽

Mikael Finder ◽

...

Keyword(s):

Cord Blood ◽

Perinatal Asphyxia ◽

Enzyme Linked Immunosorbent Assay ◽

Blood Levels ◽

Neurodevelopmental Outcomes ◽

Term Infants ◽

Significant Difference ◽

Elisa Technique ◽

Umbilical Cord Blood Serum

The role of inflammation is an important factor in the progression of hypoxic-ischaemic encephalopathy (HIE). We have previously shown that interleukin-16 (IL-16) is increased in infants with moderate and severe HIE and relates to poor neurodevelopmental outcomes. We aimed to validate IL-16 as a cord blood-based biomarker for HIE and to examine its relationship to long-term outcomes. The study sample consisted of 105 full-term infants who experienced perinatal asphyxia (PA) (with and without an encephalopathy) along with healthy, gestational age-matched newborn controls. Umbilical cord blood serum was processed and biobanked at delivery. Infants were assigned a modified Sarnat score at 24 h. Analysis of IL-16 cytokine cord blood levels was performed using the sandwich-based enzyme-linked immunosorbent assay (ELISA) technique. Cord blood-based IL-16 was increased in infants with PA and HIE relative to controls (p = 0.025). IL-16 was also increased in the HIE group relative to controls (p = 0.042). There was no significant difference in IL-16 across grades of HIE or in those with abnormal outcomes at 2 years of age. This study validates findings that cord blood-based IL-16 levels are increased in infants with PA, including those who go on to develop HIE.

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Rapid Neurodevelopmental Assessment (RNDA) : An Important Tool for Assessment of Psychomotor Development in Children with Perinatal Events

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i1.53581 ◽

2021 ◽

Vol 20 (1) ◽

pp. 16-21

Author(s):

Dhananjoy Das ◽

Kawsar Sultana ◽

Golam Mohammed Tayeb Ali ◽

Tanuka Barua ◽

Mahmood A Chowdhury Arzu

Keyword(s):

High Risk ◽

Neonatal Jaundice ◽

Perinatal Asphyxia ◽

Psychomotor Development ◽

Fine Motor ◽

Speech Impairment ◽

Neurodevelopmental Outcomes ◽

Gross Motor ◽

History Of

Background: Infants with various perinatal events are at risks for long term neurodevelopmental impairments. Neurodevelopmental assessment at early life has been considered as a valuable tool for prediction of neurodevelopmental outcomes in this population. This present study aimed to identify the neurodevelopmental impairments in high risk children by Rapid Neurodevelopment Assessment (RNDA) Materials and methods : This was a cross sectional study conducted in the Autism and Child Development Centre of Chattogram Maa Shishu-O-General Hospital during the period of 0ctober to December 2018. Babies aged 0 -2 years with different perinatal events like prematurity, birth asphyxia, neonatal jaundice, and without any adverse event; that attended RNDA clinic underwent Rapid Neurodevelopmental Assessment (RNDA) to find at risk children for long term neurodevelopmental impairments. Results: Among the 50 study subjects,Perinatal asphyxia was found in 41(82%). 26(52%) had history of IUGR, 22(44%) had Preterm delivery and 25(50%) had history of Neonatal convulsion. History of neonatal jaundice was found in 14(28%) cases. 5(10%) children did not have any perinatal event. The Mean ± SD age of study subjects was 7.38±7.31month. Severe impairment in gross motor and fine motor function were found in 25(50%) and 24(48%) respondents respectively. Vision was severely impaired in 10(20%) cases. Severe cognition and behavior impairment were found in 8(16%) and 3(6%) cases accordingly. Severe hearing and speech impairment were found in 2(4%) & 10(20%) cases respectively. Severe seizure was found in 19(39%) cases. Study subjects with the history of delayed cry or Perinatal asphyxia had significantly decreased fine motor skills. Children born with IUGR had significant gross motor and fine motor skill impairment. Significant speech & cognitive impairment were observed in children with neonatal jaundice. Seizure was found significant in study subjects with a history of neonatal convulsion. Conclusion: Rapid Neurodevelopment Assessment (RNDA) plays an important role for early identification of neurodevelopmental impairments of high-risk infants and thus screening for these can promote early therapeutic intervention and subsequent follow up, leading to better outcome. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 16-21

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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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Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Children ◽

10.3390/children8070594 ◽

2021 ◽

Vol 8 (7) ◽

pp. 594

Author(s):

Amy L. Lesneski ◽

Payam Vali ◽

Morgan E. Hardie ◽

Satyan Lakshminrusimha ◽

Deepika Sankaran

Keyword(s):

Blood Flow ◽

Pulmonary Hypertension ◽

Oxygen Saturation ◽

Ductus Arteriosus ◽

Neonatal Resuscitation ◽

Meconium Aspiration Syndrome ◽

Ovine Model ◽

Neurodevelopmental Outcomes ◽

Meconium Aspiration ◽

Blood Flows

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

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Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0437 ◽

2020 ◽

Vol 48 (4) ◽

pp. 329-334

Author(s):

Soo Jin Han ◽

Seung Mi Lee ◽

Sohee Oh ◽

Subeen Hong ◽

Jeong Won Oh ◽

...

Keyword(s):

Cord Blood ◽

Neonatal Morbidity ◽

Adverse Outcomes ◽

Control Group ◽

Long Term Outcomes ◽

Neurodevelopmental Outcomes ◽

Monochorionic Twin ◽

Increased Risk ◽

Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

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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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