scholarly journals Effect of Phenobarbitone on Amplitude-Integrated Electroencephalography in Neonates with Hypoxic-Ischemic Encephalopathy during Hypothermia

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Poorva Deshpande ◽  
Amish Jain ◽  
Patrick J. McNamara
Keyword(s):  
Primary Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Significant Suppression ◽  
First Line ◽  
Lower Margin ◽  
Mri Brain ◽  
Pattern Versus ◽  
Ischemic Encephalopathy ◽  
Median Birth Weight ◽  
Background Pattern

<b><i>Background:</i></b> Phenobarbitone induces suppression of cerebral electrical activity on amplitude-integrated electroencephalography (aEEG) in neonates with hypoxic-ischemic encephalopathy (HIE); however, its effect during therapeutic hypothermia (TH) has not been well characterized. <b><i>Objective:</i></b> To evaluate the effect of phenobarbitone on aEEG in neonates with HIE undergoing TH. <b><i>Methods:</i></b> Thirty-five neonates born at ≥35<sup>0</sup> weeks gestational age (GA), who received phenobarbitone as first-line antiepileptic drug during TH for ≥ Sarnat stage II HIE with aEEG recordings were retrospectively studied. Background pattern, upper and lower margin voltages were characterized for a 30-min period before and 30–60 min after phenobarbitone administration. Primary outcome was presence of severely abnormal aEEG pattern after phenobarbitone administration. <b><i>Results:</i></b> Mean (±SD) GA and median birth weight were 38.2 ± 1.9 weeks and 3.1 (2.5–3.9) kg, respectively. Phenobarbitone (10–20 mg/kg), administered at median age 16.8 h, was associated with background pattern worsening in 19/29 (65.5%) cases. Severe background patterns were more prevalent in post- versus pre-phenobarbitone tracings (21/29 [72%] vs. 11/29 [38%]; <i>p</i> = 0.01). Presence of severe pattern versus either continuous normal voltage or discontinuous normal voltage pattern post-phenobarbitone, (20/25 [80%] vs. 3/8 [38%]; <i>p</i> = 0.036) was associated with death or moderate-to-severe injury on MRI brain. Median time to trace recovery, when measurable, was 4 h (45 min–72 h). <b><i>Conclusions:</i></b> Phenobarbitone induces significant suppression on aEEG in infants with HIE undergoing TH. Development of severe aEEG background patterns after phenobarbitone may unmask a population at greater risk of abnormal outcome.

scholarly journals Serum Biomarkers of MRI Brain Injury in Neonatal Hypoxic Ischemic Encephalopathy Treated With Whole-Body Hypothermia

2013 ◽  
Vol 14 (3) ◽  
pp. 310-317 ◽  
Author(s):  
An N. Massaro ◽  
Andreas Jeromin ◽  
Nadja Kadom ◽  
Gilbert Vezina ◽  
Ronald L. Hayes ◽  
...  
Keyword(s):  
Brain Injury ◽  
Serum Biomarkers ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Mri Brain ◽  
Ischemic Encephalopathy

scholarly journals Neurodevelopmental outcome of babies with hypoxic ischemic encephalopathy

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.

scholarly journals P.021 Esophageal cooling for hypoxic ischemic encephalopathy: a feasibility study

2019 ◽  
Vol 46 (s1) ◽  
pp. S19
Author(s):  
T Smith ◽  
P Couillard ◽  
P Hruska ◽  
P McBeth ◽  
J Kortbeek
Keyword(s):  
Cardiac Arrest ◽  
Animal Models ◽  
Feasibility Study ◽  
Primary Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Temperature Management ◽  
Target Temperature ◽  
Cooling Device ◽  
Icu Patients ◽  
Ischemic Encephalopathy

Background: Targeted temperature management (TTM) is a recognized treatment to decrease mortality and improve neurological functionin hypoxic ischemic encephalopathy (HIE). An esophageal cooling device (ECD) has been studied in animal models but human data is limited. ECD appear to offer similar benefits to intravascular cooling catheters with potentially less risk to the patient. We studied whether the ECD could act as a substitute for intravascular cooling catheters. Methods: Eight ICU patients admitted following cardiac arrest who required TTM were enrolled prospectively. The primary outcome measures were timeliness of insertion, ease of insertion, user Likert ratings, time to achieve a target temperature of 36˚C and time target temperature was maintained within 0.5˚C of the 36˚C goal for 24 hours using an ECD. Results: Time to reach target temperature 0 min to 540 min. ECD appeared to be effective at maintaining a target temperature of 36˚C for most patients. In general, the catheter was easy to insert and use. Conclusions: For patients requiring TTM, use of an ECDadequately allowed for TTM goalsto be achieved and maintained. Overall user evaluationwas positive.

Levetiracetam for the Treatment of Seizures in Neonatal Hypoxic Ischemic Encephalopathy

2016 ◽  
Vol 32 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Charu Venkatesan ◽  
Sarah Young ◽  
Mark Schapiro ◽  
Cameron Thomas
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Neonatal Seizures ◽  
First Line ◽  
Single Center Study ◽  
The Mean ◽  
Negative Side Effects ◽  
Ischemic Encephalopathy ◽  
Center Study

The objective of this study was to determine the efficacy and safety of levetiracetam in treatment of neonatal seizures due to hypoxic ischemic encephalopathy. Seizures often persist in neonates with hypoxic ischemic encephalopathy despite phenobarbital. A retrospective single-center study was conducted in neonates ≥36 weeks gestation with hypoxic ischemic encephalopathy. A total of 127 neonates were identified born 2008-2015. Clinical seizures occurred in 83 infants. Fifty-one neonates (61%) had cessation of seizures with only phenobarbital. Thirty-two neonates received levetiracetam after phenobarbital, and the seizures stopped in 27 of these neonates. The mean total loading dose of levetiracetam was 63 mg/kg. Mean maintenance dose of levetiracetam was 65 mg/kg/d. We found no negative side effects in neonates following levetiracetam use. Our study finds that levetiracetam is an efficacious medication in treatment of seizures in the setting of neonatal hypoxic ischemic encephalopathy. Future prospective studies should explore its use as a first-line medication.

scholarly journals Effect of Umbilical Cord Milking on Severity of Hypoxic Ischemic Encephalopathy in Asphyxiated Neonates A Pilot study

2021 ◽  
Author(s):  
Roshith J Kumar ◽  
Manoj Varanattu
Keyword(s):  
Pilot Study ◽  
Umbilical Cord ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
Secondary Outcome ◽  
Control Group ◽  
Case Group ◽  
Ischemic Encephalopathy ◽  
Umbilical Cord Milking

Background: The present study was aimed to evaluate the effect of umbilical cord milking technique on severity of Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated neonates and assessed by Modified Sarnats staging as primary outcome, APGAR score at 5 minutes and Respiratory support requirement as secondary outcome. Methods: This was a randomized, controlled pilot study conducted in neonatology department at a tertiary care centre, Thrissur, Kerala. The neonates were divided into two groups non milking group, control (n=38) and umbilical cord milking, case [UCM] (n=32) and their outcomes were compared. In the intervention group, the cord was cut at 30 cm from umbilical stump within 30 seconds of birth and euthermia was maintained. The umbilical cord was raised and milked from the cut end towards the infant 3 times with speed at 10 cm/sec and then clamped 2 to 3 cm from the umbilical stump. In the control group, the umbilical cord was clamped without doing cord milking. Results: In this study moderate to severe HIE were less in case group 46.9 % than control group 55.1% and less neonates 44.7 % had Mild HIE in control group compared to case group 53.1% even though result was statistically not significant as primary outcome (p value not significant). Eight neonates (21.6%) in control group had Apgar at 5 min score 0 to 3, whereas only 4 (12.5%) neonates in cord milking group. Conclusions: The insufficient knowledge of placental transfusion limits and benefits leads to a wide variation in the management of cord clamping. It would be useful to standardise the UCM procedure in order to offer protocols applicable to clinical practice, and to spread knowledge among professionals through educational programs.

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