Methods for Monitoring Risk of Hypoxic Damage in Fetal and Neonatal Brains: A Review

Fetal, perinatal, and neonatal asphyxia are vital health issues for the most vulnerable groups in human beings, including fetuses, newborns, and infants. Severe reduction in oxygen and blood supply to the fetal brain can cause hypoxic-ischemic encephalopathy, leading to long-term neurological disorders, including mental impairment and cerebral palsy. Such neurological disorders are major healthcare concerns. Therefore, there has been a continuous effort to develop clinically useful diagnostic tools for accurately and quantitatively measuring and monitoring blood and oxygen supply to the fetal and neonatal brain to avoid severe consequences of asphyxia Hypoxic-Ischemic Encephalopathy (HIE) and Neonatal Encephalopathy (NE). Major diagnostic technologies used for this purpose include fetal heart rate monitoring (FHRM), fetus scalp blood sampling (FBS), ultrasound (US) imaging, magnetic resonance imaging (MRI), x-ray computed tomography (CT), and nuclear medicine. In addition, given the limitations and shortcomings of traditional diagnostic methods, emerging technologies such as near-infrared spectroscopy (NIRS) and photoacoustic (PA) imaging have also been introduced as stand-alone or complementary solutions to address this critical gap in fetal and neonatal care. This review provides a thorough overview of the traditional and emerging technologies for monitoring fetal and neonatal brain oxygenation status and describes their clinical utility, performance, advantages, and disadvantages.

Download Full-text

Prognostic Value of Brain Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy: A Meta-analysis

Journal of Child Neurology ◽

10.1177/0883073817726681 ◽

2017 ◽

Vol 32 (13) ◽

pp. 1065-1073 ◽

Cited By ~ 8

Author(s):

Iván Sánchez Fernández ◽

J. Leon Morales-Quezada ◽

Samuel Law ◽

Paggie Kim

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Prognostic Value ◽

Meta Analysis ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Hypoxic Ischemic Encephalopathy ◽

Resonance Imaging ◽

Neonatal Brain ◽

Ischemic Encephalopathy

Objective: To quantify the prognostic value of neonatal brain magnetic resonance imaging (MRI) in neonatal hypoxic-ischemic encephalopathy. Methods: Meta-analysis of studies with ≥35-week neonates with hypoxic-ischemic encephalopathy who underwent brain MRI within age 4 weeks and had neurodevelopmental follow-up for at least 12 months. Results: An abnormal neonatal brain MRI was more frequent among patients with unfavorable neurodevelopmental outcome: odds ratio = 18.2 (95% confidence interval: 9.4-34.9), P <.0001. The prognostic value of neonatal brain MRI in moderate hypoxic-ischemic encephalopathy had an odds ratio of 17.7 (95% confidence interval: 5.3-59.3) and in severe hypoxic-ischemic encephalopathy, the odds ratio was 125.0 (95% confidence interval: 2.0-7917.1). Therapeutic hypothermia did not change the prognostic value of neonatal brain MRI (odds ratio for hypothermia, 14.0 [95% confidence interval: 3.1-63.6], vs no hypothermia, 18.1 [95% confidence interval: 10.0-33.1], P = .7525). Conclusion: Neonatal brain MRI provides prognostic information on outcome beyond early infancy in hypoxic-ischemic encephalopathy and therapeutic hypothermia does not change its prognostic value.

Download Full-text

Acute Perinatal Sentinel Events, Neonatal Brain Injury Pattern, and Outcome of Infants Undergoing a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.09.026 ◽

2017 ◽

Vol 180 ◽

pp. 275-278.e2 ◽

Cited By ~ 14

Author(s):

Seetha Shankaran ◽

Abbot R. Laptook ◽

Scott A. McDonald ◽

Susan R. Hintz ◽

Patrick D. Barnes ◽

...

Keyword(s):

Brain Injury ◽

Injury Pattern ◽

Hypoxic Ischemic Encephalopathy ◽

Neonatal Brain ◽

Neonatal Brain Injury ◽

Sentinel Events ◽

Ischemic Encephalopathy

Download Full-text

Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy

American Journal of Perinatology ◽

10.1055/s-0040-1717068 ◽

2020 ◽

Author(s):

Sabine Bousleiman ◽

Dwight J. Rouse ◽

Cynthia Gyamfi-Bannerman ◽

Yongmei Huang ◽

Mary E. D'Alton ◽

...

Keyword(s):

Umbilical Cord ◽

Apgar Score ◽

Hypoxic Ischemic Encephalopathy ◽

Apgar Scores ◽

Fetal Heart Rate Monitoring ◽

Emergency Cesarean ◽

Increased Risk ◽

Secondary Outcomes ◽

Ischemic Encephalopathy ◽

Umbilical Cord Ph

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

Download Full-text

Placental pathology and neonatal brain MRI in a randomized trial of erythropoietin for hypoxic–ischemic encephalopathy

Pediatric Research ◽

10.1038/s41390-019-0493-6 ◽

2019 ◽

Vol 87 (5) ◽

pp. 879-884 ◽

Cited By ~ 7

Author(s):

Yvonne W. Wu ◽

Amy M. Goodman ◽

Taeun Chang ◽

Sarah B. Mulkey ◽

Fernando F. Gonzalez ◽

...

Keyword(s):

Randomized Trial ◽

Brain Mri ◽

Hypoxic Ischemic Encephalopathy ◽

Placental Pathology ◽

Neonatal Brain ◽

Ischemic Encephalopathy

Download Full-text

Review of the modern pulp condition diagnosis

Эндодонтия Today ◽

10.36377/1683-2981-2020-18-1-42-45 ◽

2020 ◽

Vol 18 (1) ◽

pp. 42-45

Author(s):

A. V. Mitronin ◽

D. A. Ostanina ◽

Yu. A. Mitronin

Keyword(s):

Minimally Invasive ◽

Clinical Effectiveness ◽

Diagnostic Methods ◽

Permanent Teeth ◽

Diagnostic Tools ◽

Diagnostic Reliability ◽

Advantages And Disadvantages ◽

The Status ◽

Condition Diagnosis

The review gives a contemporary notion about vital pulp minimally invasive diagnosis of temporary and permanent teeth. The latest information in Russian and foreign articles concerning new diagnostic methods that were proposed to increase diagnostic reliability is given in present review. The authors analysed advantages and disadvantages of diagnostic tools, studied their clinical effectiveness and made a conclusion about the possibility of predicting the status of pulses in the long term.

Download Full-text

Abstract T P372: Comparing Methods for Detecting White Matter Abnormalities in Neonates With Hypoxic-Ischemic Encephalopathy

Stroke ◽

10.1161/str.46.suppl_1.tp372 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Monica Ly ◽

Tania Nanavati ◽

Chris Frum ◽

Paola Pergami

Keyword(s):

Gestational Age ◽

Region Of Interest ◽

Hypoxic Ischemic Encephalopathy ◽

Strongly Correlated ◽

Neonatal Brain ◽

Diffusion Analysis ◽

Sensitivity Specificity ◽

Automated Protocol ◽

Age Range ◽

Ischemic Encephalopathy

Purpose: To compare manual region of interest (ROI) labeling and tract-based spatial statistics (TBSS) by their ability to detect group-wise differences in fractional anisotropy (FA) in the neonatal brain. Materials and Methods: Diffusion weighted data were obtained for nine infants with hypoxic-ischemic encephalopathy (HIE) (6 males, 3 females; gestational age range, 36-40 weeks; mean gestational age, 37.8 weeks) and eleven healthy-born infants (10 males, 1 female; gestational age range, 36-40 weeks; mean gestational age, 38.4 weeks) on a 3T scanner. For manual ROI labeling, eight ROIs were drawn freehand for each subject. For TBSS, all FA data underwent an optimized, automated protocol for neonates. Each method was evaluated for detection of decreased FA in HIE infants, sensitivity, specificity, and variability. Results: FA values from manual ROI and TBSS were strongly correlated. Both methods found decreased FA in most ROIs for HIE infants. There was no significant interaction between method and group, indicating a similar ability to detect FA differences. Sensitivity (manual: 0.71, TBSS: 0.69), specificity (manual and TBSS: 0.72), and standard error (manual: 0.009, TBSS: 0.007) were comparable. Conclusions: Manual ROI labeling and TBSS are comparable methods of diffusion analysis to detect group differences in FA in the neonatal brain

Download Full-text

Can Neonatal Brain MRI be Performed during Active Cooling?

American Journal of Perinatology ◽

10.1055/s-0037-1620270 ◽

2018 ◽

Vol 35 (09) ◽

pp. 837-839

Author(s):

Dhanashree Rajderkar ◽

Nicole Copenhaver ◽

Kristine Boykin ◽

Michael Weiss ◽

Marisa Pacella

Keyword(s):

Diagnostic Imaging ◽

Therapeutic Hypothermia ◽

Study Design ◽

Brain Mri ◽

Hypoxic Ischemic Encephalopathy ◽

Target Temperature ◽

Neonatal Brain ◽

Active Cooling ◽

Temperature Probe ◽

Ischemic Encephalopathy

Objective Due to logistical constraints, physicians traditionally delay diagnostic imaging for neonatal hypoxic-ischemic encephalopathy (HIE) until the neonate has completed all 72 hours of therapeutic hypothermia and rewarming. In some cases, neonates may require neuroimaging before 72 hours has passed. Study Design We present a case in which an MRI was acquired during active hypothermia. Results Upon return to the NICU, Baby X's temperature probe read 33.6 degrees, indicating that hypothermia was likely maintained at the target temperature. Conclusion Active hypothermia is possible during MRI.

Download Full-text

Diagnosis of Chlamydia trachomatis genital infections in the era of genomic medicine

Brazilian Journal of Microbiology ◽

10.1007/s42770-021-00533-z ◽

2021 ◽

Author(s):

Seema Shetty ◽

Christina Kouskouti ◽

Uwe Schoen ◽

Nikolaos Evangelatos ◽

Shashidhar Vishwanath ◽

...

Keyword(s):

Low Income ◽

Patient Management ◽

Genomic Medicine ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Genital Infections ◽

Omics Technologies ◽

Public Health Burden ◽

Advantages And Disadvantages ◽

The Impact

Abstract Purpose Chlamydial genital infections constitute significant sexually transmitted infections worldwide. The often asymptomatic status of C. trachomatis (CT) infections leads to an increased burden on human reproductive health, especially in middle- and low-income settings. Early detection and management of these infections could play a decisive role in controlling this public health burden. The objective of this review is to provide an insight into the evolution of diagnostic methods for CT infections through the development of new molecular technologies, emphasizing on -omics’ technologies and their significance as diagnostic tools both for effective patient management and control of disease transmission. Methods Narrative review of the diagnostic methodologies of CT infections and the impact of the introduction of -omics’ technologies on their diagnosis by review of the literature. Results Various methodologies are discussed with respect to working principles, required specifications, advantages, and disadvantages. Implementing the most accurate methods in diagnosis is highlighted as the cornerstone in managing CT infections. Conclusion Diagnostics based on -omics’ technologies are considered to be the most pertinent modalities in CT testing when compared to other available methods. There is a need to modify these effective and accurate diagnostic tools in order to render them more available and feasible in all settings, especially aiming on turning them to rapid point-of-care tests for effective patient management and disease control.

Download Full-text