Early-onset thrombocytopenia in near-term and term infants with perinatal asphyxia

ObjectiveTo describe the clinical characteristics, MRI findings and neurodevelopmental outcome of infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who were not selected for therapeutic hypothermia (TH).DesignRetrospective cohort study.Setting and patients(Near-)term infants with documented perinatal asphyxia referred to two Dutch level III neonatal units with neonatal encephalopathy (NE) and seizures <24 hours after birth not treated with TH. Infants with a diagnosis other than NE following perinatal asphyxia causing the seizures were excluded.Main outcome measuresClinical characteristics, findings on cranial MRI performed within 8 days after birth and neurodevelopmental outcome assessed using the Griffiths Mental Development Scales at 18 months or Bayley Scales of Infant and Toddler Development–Third Edition at 2 years of age.Results39 infants were included. All had abnormalities on MRI. Predominant white matter/watershed injury was the most common pattern of injury, 23 (59%). 7 (18%) infants had predominant basal ganglia/thalamus injury, 3 (8%) near total brain injury, 5 (13%) arterial ischaemic stroke, 1 (3%) an intraventricular haemorrhage. Adverse outcome was seen in 51%: 6 died, 11 developed cerebral palsy (spastic n=8, dyskinetic n=3), 2 had neurodevelopmental delay, 1 had severe hearing impairment.ConclusionsAll infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who did not receive TH had abnormalities on MRI. 51% had an adverse outcome. Better methods for recognition of infants who might benefit from TH and careful neurodevelopmental follow-up are urgently needed.

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Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord

Children ◽

10.3390/children8050353 ◽

2021 ◽

Vol 8 (5) ◽

pp. 353

Author(s):

Jayasree Nair ◽

Lauren Davidson ◽

Sylvia Gugino ◽

Carmon Koenigsknecht ◽

Justin Helman ◽

...

Keyword(s):

Blood Flow ◽

Perinatal Asphyxia ◽

Arterial Blood Flow ◽

Positive Pressure ◽

Optimal Timing ◽

Delayed Cord Clamping ◽

Arterial Blood ◽

Cord Clamping ◽

Sustained Inflation ◽

Near Term

The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.

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Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

Journal of Perinatology ◽

10.1038/s41372-021-01132-4 ◽

2021 ◽

Author(s):

Phoebe Ivain ◽

Paolo Montaldo ◽

Aamir Khan ◽

Ramyia Elagovan ◽

Constance Burgod ◽

...

Keyword(s):

Meta Analysis ◽

Neonatal Encephalopathy ◽

Neurodevelopmental Outcomes ◽

Term Infants ◽

Middle Income ◽

Middle Income Countries ◽

Pooled Data ◽

Risk Of Death ◽

Low Middle Income Countries ◽

Near Term

Abstract Objective We examined whether erythropoietin monotherapy improves neurodevelopmental outcomes in near-term and term infants with neonatal encephalopathy (NE) in low-middle income countries (LMICs). Methods We searched Pubmed, Embase, and Web of Science databases to identify studies that used erythropoietin (1500–12,500 units/kg/dose) or a derivative to treat NE. Results Five studies, with a total of 348 infants in LMICs, were retrieved. However, only three of the five studies met the primary outcome of death or neuro-disability at 18 months of age or later. Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later (p < 0.05). Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56 (95% CI: 0.42–0.75)). Conclusion The pooled data suggest that erythropoietin monotherapy may improve outcomes after NE in LMICs where therapeutic hypothermia is not available.

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Intermodal Enhancement of Stimulus Localisation in Infants Born Prematurely

Perceptual and Motor Skills ◽

10.2466/pms.1989.69.1.43 ◽

1989 ◽

Vol 69 (1) ◽

pp. 43-50 ◽

Cited By ~ 2

Author(s):

Nigel Foreman ◽

Alistair Fielder

Keyword(s):

Visual Fields ◽

Visual Stimuli ◽

Peripheral Stimulus ◽

Term Infants ◽

Visual Enhancement ◽

Sensory Space ◽

Near Term ◽

Gestational Age At Birth ◽

Age At Birth ◽

Prematurely Born Infants

The interaction of auditory and visual modalities in the enhancement of orientation was examined in premature and near-term infants by presenting them auditory or visual stimuli or auditory-visual stimulus combinations at various positions in sensory space. In 4.5–15-mo.-olds, brisk orienting responses could be elicited to very peripheral stimulus positions but only when the stimulus consisted of a spatially coherent auditory-visual combination (i.e., where a sound and a light occurred at the same point in space). This occurred for all infants, irrespective of age or gestational age at birth. First, the result shows that infants can respond to visual stimuli at eccentric positions, beyond the supposed limits of their effective visual fields as measured by standard perimetry. Second, the result extends earlier studies showing that intersensory integration and stimulus localisation develop relatively normally in prematurely born infants. The auditory-visual enhancement test as used here may have a number of further uses and applications in the clinic and laboratory.

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Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Resuscitation ◽

10.1016/j.resuscitation.2009.11.005 ◽

2010 ◽

Vol 81 (3) ◽

pp. 327-330 ◽

Cited By ~ 22

Author(s):

Vincenzo Zanardo ◽

Gary Weiner ◽

Massimo Micaglio ◽

Nicoletta Doglioni ◽

Ramona Buzzacchero ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Delivery Room ◽

Term Infants ◽

Near Term

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Time Course of Brainstem Pathophysiology during First Month in Term Infants after Perinatal Asphyxia, Revealed by MLS BAER Latencies and Intervals

Pediatric Research ◽

10.1203/01.pdr.0000084084.62571.12 ◽

2003 ◽

Vol 54 (5) ◽

pp. 680-687 ◽

Cited By ~ 37

Author(s):

Ze D Jiang ◽

Dorothea M Brosi ◽

Jin Wang ◽

Xiu Xu ◽

Guo Q Chen ◽

...

Keyword(s):

Time Course ◽

Perinatal Asphyxia ◽

Term Infants

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Magnesium sulfate for term infants following perinatal asphyxia

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd004494.pub2 ◽

2021 ◽

Author(s):

Alison Kent ◽

Zsuzsoka Kecskes ◽

Tim Cochrane

Keyword(s):

Magnesium Sulfate ◽

Perinatal Asphyxia ◽

Term Infants

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Bovine Milk Oligosaccharides with Sialyllactose for Preterm Piglets

Nutrients ◽

10.3390/nu10101489 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1489 ◽

Cited By ~ 4

Author(s):

Karina Obelitz-Ryom ◽

Amalie Rendboe ◽

Duc Nguyen ◽

Silvia Rudloff ◽

Anne Brandt ◽

...

Keyword(s):

Bacterial Colonization ◽

Bovine Milk ◽

Protective Effects ◽

Gut Development ◽

Artificial Rearing ◽

Milk Oligosaccharides ◽

Term Infants ◽

Brain Functions ◽

Near Term ◽

Dietary Treatments

Oligosaccharides support gut development and bacterial colonization in term infants, but it is unknown if they benefit preterm infants. Using preterm pigs, we investigated effects of bovine milk supplements enriched with oligosaccharides to improve gut development and colonization. Caesarean-delivered preterm pigs (n = 57) were reared for 19 days. The pigs were fed bovine milk supplemented with an oligosaccharide-enriched whey containing sialyllactose, or a heterogeneous oligosaccharide ingredient. To evaluate the influence of artificial rearing, near-term, vaginally born pigs raised by their sow (n = 12) were compared with artificially reared, caesarean-delivered near-term pigs (n = 14). In preterm pigs, the clinical outcome, gut function, gut microbiota, and systemic immunity were similar among dietary treatments. Natural rearing increased growth rates, gut functions, colon short chain fatty acid concentrations and bacterial diversity, relative to artificial rearing. In conclusion, supplements with bovine milk oligosaccharides were well tolerated, but did not improve gut maturation or clinical outcomes in artificially reared preterm piglets. Immaturity at birth, coupled with artificial rearing, may render the neonate unresponsive to the gut-protective effects of milk oligosaccharides. Whether bovine milk oligosaccharides may affect other endpoints (e.g., brain functions) in conditions of immaturity remains to be investigated.

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