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 Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions

2021 ◽  
Vol 22 (13) ◽  
pp. 7121
Author(s):  
Kelly Q. Zhou ◽  
Alice McDouall ◽  
Paul P. Drury ◽  
Christopher A. Lear ◽  
Kenta H. T. Cho ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Newborn Infants ◽  
Developing Brain ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
High Quality ◽  
Future Directions ◽  
Phenobarbital Administration ◽  
The Impact ◽  
Ischemic Encephalopathy

Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia.

scholarly journals Comparison of Uncontrolled and Device-Induced Therapeutic Hypothermia in Newborn Infants with Hypoxic Ischemic Encephalopathy

2021 ◽  
Vol 6 (1) ◽  
pp. 88-93
Author(s):  
A. A. Zarubin ◽  
E. S. Filippov ◽  
A. S. Vanyarkina ◽  
O. G. Ivanova ◽  
A. A. Shishkina
Keyword(s):  
High Risk ◽  
Body Temperature ◽  
Therapeutic Hypothermia ◽  
Neuroprotective Effect ◽  
Newborn Infants ◽  
The Body ◽  
Hypoxic Ischemic Encephalopathy ◽  
Temperature Management ◽  
Hypothermia Group ◽  
Ischemic Encephalopathy

Background. Newborn infants who have undergone severe birth asphyxia have a high risk of neurological disorders and death. The most effective method for the treatment of hypoxic ischemic encephalopathy caused by intrapartum asphyxia is therapeutic hypothermia, or targeted temperature management. Currently, there are no large studies comparing its different methods, therefore the aim of our study was to compare the effectiveness of device-induced and uncontrolled therapeutic hypothermia in newborn infants who underwent intrapartum asphyxia.Materials and methods. Study design: we conducted a retrospective, longitudinal, cohort study in 39 newborn infants born in severe asphyxia and receiving uncontrolled therapeutic hypothermia (group 1), and in 48 newborn infants born in severe asphyxia and receiving device-induced therapeutic hypothermia (group 2). Statistical data processing was carried out using standard techniques.Results. The body temperature in newborn infants of both groups was reduced to 33.5 °C within the first hour, but when using uncontrolled therapeutic hypothermia, the body temperature fluctuated from 32 to 35 °C. Device-induced therapeutic hypothermia has a more effective neuroprotective effect as compared to uncontrolled hypothermia (p< 0.05) and more rapidly stabilizes metabolism in newborns due to a decrease in lactate levels (p < 0.05). In newborns device-induced therapeutic hypothermia stabilizes hemodynamics more quickly compared to uncontrolled therapeutic hypothermia (p < 0.05). Device-induced therapeutic hypothermia reduces the period of hospitalization in the neonatal intensive care unit (p < 0.05), the risk of cerebral edema (p < 0.05) and of the repeated episodes of seizures (p < 0.05). Conclusion. Using uncontrolled therapeutic hypothermia causes a high risk of unintentional fluctuations in rectal temperature towards both hypothermia and rewarming, which can aggravate the severe condition of newborn infants. Device-induced therapeutic hypothermia has a more effective neuroprotective effect.

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.

Visual outcomes in children with neonatal hypoxic ischemic encephalopathy treated with therapeutic hypothermia

2021 ◽  
Author(s):  
Jerry Hsu ◽  
Noreen Shaikh ◽  
Hantamalala Ralay Ranaivo ◽  
Andrea C. Pardo ◽  
Rebecca B. Mets-Halgrimson
Keyword(s):  
Therapeutic Hypothermia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Visual Outcomes ◽  
Ischemic Encephalopathy

scholarly journals Mammillary body atrophy and other MRI correlates of school-age outcome following neonatal hypoxic-ischemic encephalopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kim V. Annink ◽  
Linda S. de Vries ◽  
Floris Groenendaal ◽  
Rian M. J. C. Eijsermans ◽  
Manouk Mocking ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Memory Function ◽  
Neurodevelopmental Outcome ◽  
Standard Of Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
School Age ◽  
Brain Volumes ◽  
Mammillary Bodies ◽  
Memory Problems ◽  
Ischemic Encephalopathy

AbstractThe mammillary bodies (MB) and hippocampi are important for memory function and are often affected following neonatal hypoxic ischemic encephalopathy (HIE). The aim of this study was to assess neurodevelopmental outcome in 10-year-old children with HIE with and without therapeutic hypothermia. Additional aims were to assess the associations between MB atrophy, brain volumes (including the hippocampi), white matter microstructure and neurodevelopmental outcome at school-age. Ten-year-old children with HIE were included, who were treated with therapeutic hypothermia (n = 22) or would have qualified but were born before this became standard of care (n = 28). Children completed a neuropsychological and motor assessment and MRI. Mammillary bodies were scored as normal or atrophic at 10 years. Brain volumes were segmented on childhood MRI and DTI scans were analysed using tract-based spatial statistics. Children with HIE suffered from neurocognitive and memory problems at school-age, irrespective of hypothermia. Hippocampal volumes and MB atrophy were associated with total and performance IQ, processing speed and episodic memory in both groups. Normal MB and larger hippocampi were positively associated with global fractional anisotropy. In conclusion, injury to the MB and hippocampi was associated with neurocognition and memory at school-age in HIE and might be an early biomarker for neurocognitive and memory problems.

scholarly journals Inhaled H2 or CO2 Do Not Augment the Neuroprotective Effect of Therapeutic Hypothermia in a Severe Neonatal Hypoxic-Ischemic Encephalopathy Piglet Model

2020 ◽  
Vol 21 (18) ◽  
pp. 6801
Author(s):  
Viktória Kovács ◽  
Gábor Remzső ◽  
Valéria Tóth-Szűki ◽  
Viktória Varga ◽  
János Németh ◽  
...  
Keyword(s):  
Caudate Nucleus ◽  
Therapeutic Hypothermia ◽  
Neuroprotective Effect ◽  
Fold Increase ◽  
Hypoxic Ischemic Encephalopathy ◽  
Mrna Levels ◽  
Treatment Groups ◽  
Apoptosis Inducing Factor ◽  
Co2 Treatment ◽  
Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is still a major cause of neonatal death and disability as therapeutic hypothermia (TH) alone cannot afford sufficient neuroprotection. The present study investigated whether ventilation with molecular hydrogen (2.1% H2) or graded restoration of normocapnia with CO2 for 4 h after asphyxia would augment the neuroprotective effect of TH in a subacute (48 h) HIE piglet model. Piglets were randomized to untreated naïve, control-normothermia, asphyxia-normothermia (20-min 4%O2–20%CO2 ventilation; Tcore = 38.5 °C), asphyxia-hypothermia (A-HT, Tcore = 33.5 °C, 2–36 h post-asphyxia), A-HT + H2, or A-HT + CO2 treatment groups. Asphyxia elicited severe hypoxia (pO2 = 19 ± 5 mmHg) and mixed acidosis (pH = 6.79 ± 0.10). HIE development was confirmed by altered cerebral electrical activity and neuropathology. TH was significantly neuroprotective in the caudate nucleus but demonstrated virtually no such effect in the hippocampus. The mRNA levels of apoptosis-inducing factor and caspase-3 showed a ~10-fold increase in the A-HT group compared to naïve animals in the hippocampus but not in the caudate nucleus coinciding with the region-specific neuroprotective effect of TH. H2 or CO2 did not augment TH-induced neuroprotection in any brain areas; rather, CO2 even abolished the neuroprotective effect of TH in the caudate nucleus. In conclusion, the present findings do not support the use of these medical gases to supplement TH in HIE management.

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