Optimal Duration of Continuous Video-Electroencephalography in Term Infants With Hypoxic-Ischemic Encephalopathy and Therapeutic Hypothermia

2017 ◽  
Vol 32 (6) ◽  
pp. 522-527 ◽  
Author(s):  
Naeem Mahfooz ◽  
Arie Weinstock ◽  
Bushra Afzal ◽  
Mariam Noor ◽  
David Vargas Lowy ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Diagnostic Yield ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Background Suppression ◽  
Term Infants ◽  
Resource Limited ◽  
Optimal Duration ◽  
Ischemic Encephalopathy ◽  
Video Eeg

Continuous video-electroencephalography (EEG) is an important diagnostic and prognostic tool in newborns with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia. The optimal duration of continuous video-EEG during whole-body hypothermia is not known. We conducted a retrospective study of 35 neonates with hypoxic-ischemic encephalopathy undergoing whole-body hypothermia with continuous video-EEG. EEG ictal changes were detected in 9/35 infants (26%). Of these 9 infants, the seizures were initially observed within 30 minutes of EEG monitoring in 6 (67%), within 24 hours in 2 (22%), and during rewarming in 1 infant (11%). No new seizures were detected between 24-72 hours of therapeutic hypothermia. Background suppression was detected in 14 infants (40%) by 24 hours. In neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia, continuous video-EEG has the highest diagnostic yield within the first 24 hours and during the rewarming phase. In the absence of prior seizures or antiepileptic therapy, limiting continuous video-EEG to these periods in resource-limited settings may reduce cost during therapeutic hypothermia.

scholarly journals P.060 Utility analysis of continuous video EEG (cvEEG) monitoring during the treatment of hypoxic ischemic encephalopathy (HIE) in the NICU

2018 ◽  
Vol 45 (s2) ◽  
pp. S31-S31
Author(s):  
MH Braun ◽  
L Bello-Espinosa ◽  
J Appendino ◽  
J Buchhalter ◽  
K Mohammad ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Therapeutic Hypothermia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Utility Analysis ◽  
Term Infants ◽  
Clinical Variables ◽  
Neurological Exam ◽  
Ischemic Encephalopathy ◽  
Video Eeg

Background: Therapeutic hypothermia (TH) improves the outcome in HIE but cvEEG is vital to detect any seizures that occur. Unfortunately, the costs associated with cvEEG can make it impractical. We studied outcomes in TH with the objective of optimizing the length of cvEEG required. Methods: Term infants with HIE were treated with 72 h of TH followed by 6 h of rewarming. cvEEG reports were quantified (background, sharp transients, seizures) and compared with pre and post-cooling variables to determine whether risk stratification was possible. Results: 25/78 infants had seizures during the TH, however, most seizures occurred early, with 7 infants seizing prior to cooling and 15 having their first seizure within 24h. Only 3 infants had their first seizure between 24-48h and none were recorded after. Novel seizures after 24h were brief and did not require treatment. EEG variables such as frequent sharp transients and first seizures within 24h were correlated with MRI abnormalities. Conclusions: For the majority of infants undergoing TH, 24h of cvEEG may be sufficient with few infants requiring longer than 48h. A combination of clinical variables (abnormal neurological exam) and EEG traits (frequency of discharges, seizures) can help to decide on the likelihood of seizures and length of EEG recording needed.

scholarly journals A Successful Whole Body Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy During an ECMO Run in a Newborn

2019 ◽  
Vol 7 ◽  
Author(s):  
Emel Okulu ◽  
Omer Erdeve ◽  
Bahar Bingoler Pekcici ◽  
Tanil Kendirli ◽  
Zeynep Eyileten ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Ischemic Encephalopathy

scholarly journals Is Erythropoietin Combining with Therapeutic Hypothermia an Efficient and Safe Therapy in Neonatal Hypoxic Ischemic Encephalopathy: A Prospective and Randomized Clinical Trial

2020 ◽  
Author(s):  
Liang-yan Zou ◽  
Bing-xue Huang ◽  
Peng Zhang ◽  
Guo-qiang Cheng ◽  
Chun-mei Lu ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Brain Mri ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Control Group ◽  
Term Infants ◽  
Basal Nuclei ◽  
Ischemic Encephalopathy

Abstract BackgroundTo evaluate the efficacy and safety of erythropoietin (Epo) combined with therapeutic hypothermia (TH) in neonatal hypoxic-ischemic encephalopathy (HIE).MethodsA total of 78 term infants with HIE were assigned randomly to receive Epo (n = 40) or placebo (n = 38). All infants received TH. Blood samples before TH, after TH and after Epo/placebo were collected for measuring TH associated adverse events, Epo associated factors and potential neural biomarkers. Basal ganglia/ watershed (BG/W) scoring system was used to assess brain injury in MRI. Neurodevelopmental evaluations were performed at 18 months by using BayleyScales of Infant Development II (Bayley II).ResultsEpo-treated group tend to have lower serum creatine kinase (CK) concentration (114 vs 202, P = .04) and higher serum K+, Mg2+ concentration (5.0 vs 4.5, P = .03; 1.0 vs 0.9, P = .02) than control group after intervention. Brain MRI was performed in 65 (83%) neonatal. Totally brain injury score was in even distribution between two groups (median, 0 vs 0, P = .61), but injury region in cortex plus basal nuclei comparing with in basal nuclei solely was less common in the Epo than in the control group (21% vs 31%, P = .046). Only forty patients (40/78, 51%) succeeded in achieving 18-month follow up data. The totally adverse outcomes were trend to decline in the Epo group (35% vs 60%, P = .21). No adverse events were ascribed to Epo treatment.ConclusionsThe combination of Epo and TH is proved to be feasible, safe and potential effective.Trial registration: ChiCTR-TRC-14004532, date of registration: April 18th, 2014.

scholarly journals Effects of Whole Body Therapeutic Hypothermia on Gastrointestinal Morbidity and Feeding Tolerance in Infants with Hypoxic Ischemic Encephalopathy

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kimberly M. Thornton ◽  
Hongying Dai ◽  
Seth Septer ◽  
Joshua E. Petrikin
Keyword(s):  
Therapeutic Hypothermia ◽  
Median Time ◽  
Retrospective Cohort ◽  
Gastric Tube ◽  
Hypoxic Ischemic Encephalopathy ◽  
Tube Placement ◽  
Whole Body ◽  
Beneficial Effects ◽  
Ischemic Encephalopathy ◽  
Feeding Tolerance

Objective. This retrospective cohort study evaluated the effects of whole body therapeutic hypothermia (WBTH) on gastrointestinal (GI) morbidity and feeding tolerance in infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE).Study Design. Infants ≥ 35 weeks gestational age and ≥1800 grams birth weight with moderate-to-severe HIE treated from 2000 to 2012 were compared. 68 patients had documented strictly defined criteria for WBTH: 32 historical control patients did not receive WBTH (non-WBTH) and 36 cohort patients received WBTH.Result. More of the non-WBTH group infants never initiated enteral feeds (28% versus 6%;P=0.02), never reached full enteral feeds (38% versus 6%,P=0.002), and never reached full oral feeds (56% versus 19%,P=0.002). Survival analyses demonstrated that the WBTH group reached full enteral feeds (median time: 11 versus 9 days;P=0.02) and full oral feeds (median time: 19 versus 10 days;P=0.01) sooner. The non-WBTH group had higher combined outcomes of death and gastric tube placement (47% versus 11%;P=0.001) and death and gavage feeds at discharge (44% versus 11%;P=0.005).Conclusion. WBTH may have beneficial effects on GI morbidity and feeding tolerance for infants with moderate-to-severe HIE.

The General Movements Assessment in Neonates With Hypoxic Ischemic Encephalopathy

2021 ◽  
pp. 088307382098151
Author(s):  
Nicole R. Pouppirt ◽  
Valerie Martin ◽  
Linda Pagnotto-Hammitt ◽  
Alicia J. Spittle ◽  
John Flibotte ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Therapeutic Hypothermia ◽  
Interrater Reliability ◽  
Late Preterm ◽  
Hypoxic Ischemic Encephalopathy ◽  
Clinical Markers ◽  
Term Infants ◽  
Neurologic Outcomes ◽  
General Movements ◽  
Ischemic Encephalopathy

Background: Clinical measures after birth and studies such as electroencephalogram (EEG) and brain imaging do not fully predict neurodevelopmental outcomes of infants with hypoxic-ischemic encephalopathy. Early detection of adverse neurologic outcomes, and cerebral palsy in particular, in high-risk infants is essential for ensuring timely management. The General Movements Assessment is a tool that can be used in the early detection of cerebral palsy in infants with brain injury. The majority of studies on the General Movements Assessment in the late preterm and term population were performed prior to the introduction of therapeutic hypothermia. Aims: To apply the General Movements Assessment in late preterm and term infants with hypoxic-ischemic encephalopathy (including those who received therapeutic hypothermia), to determine if clinical markers of hypoxic-ischemic encephalopathy predict abnormal General Movements Assessment findings, and to evaluate interrater reliability of the General Movements Assessment in this population. Study design: Pilot prospective cohort study Subjects: We assessed 29 late preterm and full-term infants with mild, moderate, and severe hypoxic-ischemic encephalopathy in Philadelphia, PA. Results: Most infants’ general movements normalized by the fidgety age. Only infants with moderate or severe hypoxic-ischemic encephalopathy had abnormal general movements in both the writhing and the fidgety ages (n = 6). Seizure at any point during the initial hospitalization was the clinical sign most predictive of abnormal general movements in the fidgety age (sensitivity 100%, specificity 55%, positive predictive value 40%, negative predictive value 100%). Interrater reliability was greatest during the fidgety age (κ = 0.67). Conclusions: Seizures were the clinical predictor most closely associated with abnormal findings on the General Movements Assessment. However, clinical markers of hypoxic-ischemic encephalopathy are not fully predictive of abnormal General Movements Assessment findings. Larger future studies are needed to evaluate the associations between the General Movements Assessment and childhood neurologic outcomes in patients with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

scholarly journals The feasibility of Telemedicine in Implementation of Therapeutic Hypothermia for Management of Neonatal Hypoxic-Ischemic Encephalopathy in Resource-Limited Areas.

2022 ◽  
Author(s):  
Adnan Hadid ◽  
Taher AL-Shantout ◽  
Rayan Terkawi ◽  
Baraa Aldbes ◽  
Manal Zahran ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Newborn Infants ◽  
Developed Countries ◽  
Mobile App ◽  
Hypoxic Ischemic Encephalopathy ◽  
Target Range ◽  
North West ◽  
The North ◽  
Resource Limited ◽  
Ischemic Encephalopathy

Abstract Background: Telemedicine is widely used in neonatal services in developed countries. Lack of expertise and/or facilities, however, limited its use in developing countries and around areas of military conflicts. To our knowledge, no reports are demonstrating the feasibility of administering therapeutic hypothermia (TH) through telemedicine to neonates with hypoxic-ischemic encephalopathy (HIE) in resource-limited areas.Methodology: This is a retrospective study, evaluating 22 patients who received TH, guided by telemedicine, through a mobile app (Telegram®). We assessed the feasibility of utilizing Telemedicine in guiding the application of TH to infants affected with HIE in the North-West of Syria between July 2020 and July 2021.Results: Out of 5,545 newborn infants delivered during the study period, 22 patients were eligible for TH guided by Telemedicine. Patients were referred for consultation at a median (IQR) of 137 (35-165) minutes of life. A median (IQR) of 12 (3-18) minutes elapsed between the call for a consultation and the consultant response, and a median (IQR) of 30 (0-42) minutes elapsed between seeking the consultation and the initiation of cooling therapy. Eighteen patients completed cooling for 72 hours. The patients' temperatures were within the target range (33-34°C) most of the time (84.1%).Conclusion: Telemedicine is a feasible method to guide the implementation TH for HIE in resource-limited areas. The short-term success rate is relatively high; however, further studies with a larger population are needed to confirm these findings.

scholarly journals Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: A systematic review and meta-analysis of randomized control trials

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247229
Author(s):  
Biruk Beletew Abate ◽  
Melaku Bimerew ◽  
Bereket Gebremichael ◽  
Ayelign Mengesha Kassie ◽  
MesfinWudu Kassaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Therapeutic Hypothermia ◽  
Meta Analysis ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Randomized Control Trials ◽  
Risk Of Mortality ◽  
Randomized Control ◽  
Ischemic Encephalopathy

Background Hypoxic perinatal brain injury is caused by lack of oxygen to baby’s brain and can lead to death or permanent brain damage. However, the effectiveness of therapeutic hypothermia in birth asphyxiated infants with encephalopathy is uncertain. This systematic review and meta-analysis was aimed to estimate the pooled relative risk of mortality among birth asphyxiated neonates with hypoxic-ischemic encephalopathy in a global context. Methods We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search randomized control trials from electronic databases (PubMed, Cochrane library, Google Scholar, MEDLINE, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and meta register of Current Controlled Trials (mCRT)). The authors extracted the author’s name, year of publication, country, method of cooling, the severity of encephalopathy, the sample size in the hypothermic, and non-hypothermic groups, and the number of deaths in the intervention and control groups. A weighted inverse variance fixed-effects model was used to estimate the pooled relative risk of mortality. The subgroup analysis was done by economic classification of countries, methods of cooling, and cooling devices. Publication bias was assessed with a funnel plot and Eggers test. A sensitivity analysis was also done. Results A total of 28 randomized control trials with a total sample of 35, 92 (1832 hypothermic 1760 non-hypothermic) patients with hypoxic-ischemic encephalopathy were used for the analysis. The pooled relative risk of mortality after implementation of therapeutic hypothermia was found to be 0.74 (95%CI; 0.67, 0.80; I2 = 0.0%; p<0.996). The subgroup analysis revealed that the pooled relative risk of mortality in low, low middle, upper-middle and high income countries was 0.32 (95%CI; -0.95, 1.60; I2 = 0.0%; p<0.813), 0.5 (95%CI; 0.14, 0.86; I2 = 0.0%; p<0.998), 0.62 (95%CI; 0.41–0.83; I2 = 0.0%; p<0.634) and 0.76 (95%CI; 0.69–0.83; I2 = 0.0%; p<0.975) respectively. The relative risk of mortality was the same in selective head cooling and whole-body cooling method which was 0.74. Regarding the cooling device, the pooled relative risk of mortality is the same between the cooling cap and cooling blanket (0.74). However, it is slightly lower (0.73) in a cold gel pack. Conclusions Therapeutic hypothermia reduces the risk of death in neonates with moderate to severe hypoxic-ischemic encephalopathy. Both selective head cooling and whole-body cooling method are effective in reducing the mortality of infants with this condition. Moreover, low income countries benefit the most from the therapy. Therefore, health professionals should consider offering therapeutic hypothermia as part of routine clinical care to newborns with hypoxic-ischemic encephalopathy especially in low-income countries.

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