Foot-to-Foot Contact Among Initial Goal-Directed Movements Supports the Prognostic Value of Fidgety Movements in HIE-Cooled Infants

Background: Few studies conducted to date have observed general movements in infants affected by hypoxic–ischemic encephalopathy (HIE) who underwent therapeutic hypothermia. We investigated whether foot-to-foot contact (FF) could support the predictive value of fidgety movements (FMs) in infants affected by HIE and treated with brain cooling.Methods: Spontaneous motility was video recorded for 3–5 min at 12 weeks post-term age in 58 full-term newborn infants affected by perinatal asphyxia who were cooled due to moderate to severe HIE. FF and FMs were blindly scored by three independent observers. At 24 months, each patient underwent a neurological examination by Amiel-Tison and Grenier.Results: At 24 months, 47 infants had developed typically at neurological examination, eight had developed mild motor impairment, and three developed cerebral palsy (CP). At 12 weeks, 34 (58.6%) infants had shown normal FMs, four of whom developed mild motor impairment. Twenty-four infants (41.4%) exhibited abnormal or no FMs, four of whom developed mild motor impairment and three developed CP. FF was present in 20 infants (34.5%), two of whom developed mild motor impairment. FF was absent in 38 infants (65.5%), six of whom developed mild motor impairment and three developed CP. Both FMs and FF, considered separately, were 100% sensitive for predicting CP at 24 months, but only 61 and 36%, respectively, were specific. Summing the two patterns together, the specificity increases to 73%, considering only CP as an abnormal outcome, and increases to 74% when considering CP plus mild motor impairment. Unexpectedly, fidgety movements were absent in 24 infants with typical motor outcomes, 17 of whom showed a typical motor outcome.Conclusions: FF is already part of motor repertoire at 12 weeks and allows a comparison of spontaneous non-voluntary movements (FMs) to pre-voluntary movements (FF). FF supports FMs for both sensitivity and specificity. A second video recording at 16–18 weeks, when pedipulation is present in healthy infants, is suggested: it may better define the presence or absence of goal-directed motility.

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Renal Injury in Sick Newborn Infants: A Prospective Evaluation Using Urinary β2-Microglobulin Concentrations

PEDIATRICS ◽

10.1542/peds.81.3.432 ◽

1988 ◽

Vol 81 (3) ◽

pp. 432-440

Author(s):

Eric D. Tack ◽

Jeffrey M. Perlman ◽

Alan M. Robson ◽

Cathy Hausel ◽

Charles C. T. Chang

Keyword(s):

Renal Injury ◽

Confidence Limit ◽

Newborn Infants ◽

Tubular Injury ◽

Creatinine Concentration ◽

Term Infants ◽

Urinary Creatinine ◽

Β2 Microglobulin ◽

Sick Newborn ◽

Healthy Infants

Urinary concentrations of β2-microglobulin and creatinine were measured serially in 140 sick infants, of whom 109 were asphyxiated, and in 35 healthy preterm and term infants. First voided urines and samples from days 3 and 7 postpartum were studied. Urinary β2-microglobulin concentrations in healthy infants averaged 1.34 ± 1.34 mg/L (mean ± SD) in first voided specimens and 1.32 ± 0.98 mg/L in day 3 samples; the calculated upper limit of normal (95% confidence limit) was 4.00 mg/L. Elevated values (those exceeding the 95% confidence limit) occurred most often in the sick asphyxiated patients (56%); the first voided sample value in these patients was 10.0 ± 10.4 mg/L. The equivalent value in the sick nonasphyxiated infants was 8.32 ± 7.27 mg/L. Values were significantly and persistently elevated in the sick infants on days 3 and 7. Factoring β2-microglobulin levels by urinary creatinine concentration did not affect the significance of the findings. The increased urinary β2-microglobulin levels were not (1) related to gestational age; low β2-microglobulin values occurred at all gestational ages for both healthy and sick infants; (2) a consequence of urine flow rate; urinary β2-microglobulin did not correlate with urinary creatinine concentration or with urine to plasma creatinine ratio; and (3) a consequence of increased production of β2-microglobulin; urinary and serum β2-microglobulin values did not correlate (r = .03). Thus, we propose that the elevated levels of urinary β2-microglobulin in the sick infants were the consequence of tubular injury. This was associated with hematuria but not with a high incidence of azotemia or oliguria. In the most premature infants (<32 weeks), elevated urinary β2-microglobulin concentrations were associated with significantly increased urinary concentrations of sodium and potassium. These data suggest a higher prevalence of acute tubular injury in sick newborn infants than has been reported in previous studies in which more traditional indices of renal injury were used.

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30 Birth and Rebirth - Parental Experiences of Their Newborn Infants Treated with Hypothermia Following Perinatal Asphyxia

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.0030 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A8-A9

Author(s):

S. K. Nassef ◽

M. Blennow ◽

M. Jirwe

Keyword(s):

Perinatal Asphyxia ◽

Newborn Infants ◽

Parental Experiences

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Metabolic Fuel and Hormone Responses to Fasting in Newborn Infants

PEDIATRICS ◽

10.1542/peds.64.5.613 ◽

1979 ◽

Vol 64 (5) ◽

pp. 613-619

Author(s):

Charles A. Stanley ◽

Endla K. Anday ◽

Lester Baker ◽

Maria Delivoria-Papadopolous

Keyword(s):

Gestational Age ◽

Plasma Glucose ◽

Neonatal Period ◽

Newborn Infants ◽

Older Children ◽

Glucose Levels ◽

Metabolic Fuel ◽

Healthy Infants ◽

Lower Plasma Glucose ◽

Appropriate For Gestational Age

To examine why newborn infants frequently cannot maintain adequate levels of plasma glucose in the interval between delivery and the time they are first fed, circulating metabolic fuel and regulatory hormone concentrations were determined in 44 healthy infants at the end of an eight-hour postnatal fast. Plasma glucose fell below 40 mg/100 ml prior to eight hours in four of 24 term-appropriate-for-gestational-age (AGA), two of nine preterm-AGA, five of six term-small-for-gestational-age (SGA), and three of five preterm-SGA infants. Fuel and hormone patterns in the premature and SGA infants were not different from those found in term-AGA infants. Results in these neonates differed in two areas from the response to fasting seen later in life. In fasted term-AGA infants, ketones were low (β-hydroxybutyrate 0.29 ± 0.04 mM/liter) despite elevated concentrations of fatty acid precursors (1.4 ± 0.07 mM/liter), and the group of infants studied failed to demonstrate the increase in plasma ketones with lower glucose levels (r = +.23, P = .07) which is found in older children. Levels of glucose precursors were two to three times higher in term-AGA infants (lactate 2.9 ± 0.2 mM/liter; alanine 0.48 ± 0.02 mM/liter) than levels found beyond the neonatal period and, in contrast to older children and adults, were not diminished in infants with lower plasma glucose (lactate, r = -.28, P = .035; alanine, r = -.33, P = .02). These differences between the responses to postnatal fasting and those seen beyond the neonatal period suggest that the capacity for both hepatic ketone synthesis and gluconeogenesis is not fully developed at birth.

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Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Journal of Clinical Medicine ◽

10.3390/jcm8081247 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1247

Author(s):

Domenico M. Romeo ◽

Sarah Bompard ◽

Francesca Serrao ◽

Giuseppina Leo ◽

Gianpaolo Cicala ◽

...

Keyword(s):

Neurological Examination ◽

Motor Impairment ◽

Hypoxic Ischemic Encephalopathy ◽

Neurological Assessment ◽

Neurodevelopmental Outcomes ◽

Good Tool ◽

Motor Disabilities ◽

High Risk Infants ◽

Ischemic Encephalopathy

Early neurological assessment in infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia has not been systematically explored. The aims of the present study were to assess whether the Hammersmith Infant Neurological Examination (HINE) is a good tool to predict later neurodevelopmental outcomes at 2 year from birth in this population of infants. A total of 41 term born infants with HIE treated with hypothermia performed the HINE at 12 months and a neurodevelopmental assessment at 24 months. All the infants who had a global HINE score between 67 and 78 were able to walk independently at 2 years and reported a normal developmental quotient; language disorders were observed in a limited number of infants. HINE scores <67 were always associated with motor impairment. In conclusion, the HINE confirms its role as one of the early neurological examination tools for the diagnosis of high risk infants, even in infants with HIE treated with hypothermia. These results can be useful for clinicians involved in the follow up of these infants for early identification of motor disabilities and in planning appropriate intervention.

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PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia

Early Human Development ◽

10.1016/j.earlhumdev.2010.09.154 ◽

2010 ◽

Vol 86 ◽

pp. S57-S58

Author(s):

Ridvan Duran ◽

Işık Görker ◽

Yasemin Küçükuğurluoğlu ◽

Nukhet Aladag Ciftdemir ◽

Ulfet Vatansever Ozbek ◽

...

Keyword(s):

Perinatal Asphyxia ◽

Newborn Infants ◽

Neurodevelopmental Outcome ◽

Neonatal Resuscitation ◽

Neonatal Resuscitation Program

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Autonomic Nervous System Function in Infants With Transposition of the Great Arteries

Biological Research For Nursing ◽

10.1177/1099800411407687 ◽

2011 ◽

Vol 14 (3) ◽

pp. 257-268 ◽

Cited By ~ 9

Author(s):

Tondi M. Harrison ◽

Roger L. Brown

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

High Frequency ◽

Heart Defects ◽

Newborn Infants ◽

Low Frequency ◽

Autonomic Nervous ◽

Healthy Infants ◽

Before And After ◽

High Risk Infants

The ability to maintain and respond to challenges to homeostasis is primarily a function of the autonomic nervous system (ANS). In infants with complex congenital heart defects this ability may be impaired. This study described change in ANS function before and after surgical correction in infants with transposition of the great arteries (TGA) and in healthy infants. A total of 15 newborn infants with TGA were matched with 16 healthy infants on age, gender, and feeding type. The ANS function was measured using heart rate variability (HRV). Data were collected preoperatively in the 1st week of life and postoperatively before, during, and after feeding at 2 weeks and 2 months of age. Infants with TGA demonstrated significantly lower high-frequency and low-frequency HRV preoperatively ( p < .001) when compared with healthy infants. At 2 weeks, infants with TGA were less likely than healthy infants to demonstrate adaptive changes in high-frequency HRV during feeding (Wald Z = 2.002, p = .045), and at 2 months, 40% of TGA infants exhibited delayed postfeeding recovery. Further research is needed to more thoroughly describe mechanisms of a physiologically adaptive response to feeding and to develop nursing interventions supportive of these high-risk infants.

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HEAD TURNING TOWARDS DIFFUSE LIGHT IN THE NEUROLOGICAL EXAMINATION OF NEWBORN INFANTS

Brain ◽

10.1093/brain/87.4.665 ◽

1964 ◽

Vol 87 (4) ◽

pp. 665-672 ◽

Cited By ~ 9

Author(s):

L. GOLDIE ◽

I. J. HOPKINS

Keyword(s):

Neurological Examination ◽

Newborn Infants ◽

Diffuse Light ◽

Head Turning

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Clinical and neurosonographic signs of c entral nervous system in newborns

Vladikavkaz Medico-Biological Bulletin ◽

10.12737/11808 ◽

2014 ◽

Vol 20 (30) ◽

pp. 97-100

Author(s):

Хетагурова ◽

Yuliana Khetagurova ◽

Ревазова ◽

Asya Revazova ◽

Бораева ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Perinatal Asphyxia ◽

Newborn Infants ◽

Clinical Signs ◽

Significant Progress ◽

Moderate Severity ◽

The Central Nervous System ◽

Significant Mortality

Despite of significant progress in the development of technologies of clinical monitoring and the fetus and newborn pathology study, perinatal asphyxia or, more accurately – cerebral ischemia (CI) remain serious condition, causing significant mortality and long-term morbidity. Chi-acquired syndrome characterized by clinical and laboratory signs of acute brain injury due to asphyxia (ie, hypoxia, acidosis). The paper reflects the main clinical signs and neurosonographic lesion of the Central nervous system (CNS) in neonatal newborn infants with different gestational age who underwent CI mild to moderate severity.

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