Presentation
In the present study, we sought to investigate the efficacy of human neural stem cells derived from human embryonic stem cells in a rat model of neonatal HI and the mechanisms enhancing brain repair. [ncbi.nlm.nih.gov]
Case Study A 29-year-old woman presents at a local hospital in labor with her first child. She has had an uncomplicated 40-week gestation and at presentation is 6 cm dilated and 90 percent effaced; membranes are intact. [praxis.iuhealth.org]
In this review we briefly highlight the present and potential forthcoming therapeutic treatments aimed at attenuation of the detrimental effects of neonatal hypoxia-ischemia. [ingentaconnect.com]
Coexisting periventricular white matter injury and germinal matrix bleed may be present. [pediatricneurosciences.com]
Neurologic
- Extrapyramidal Symptoms
Basal ganglia (BG) and thalamic involvement result in extrapyramidal symptoms. Multicystic encephalopathy is associated with quadriplegia, bulbar and choreoathetoid symptoms, microcephaly and mental retardation. [pediatricneurosciences.com]
- Hyporeflexia
[…] feeds Alertness Alert Irritable, poorly responsive, or comatose Tone Normal Hypotonia or hypertonia Respiratory status Normal Respiratory distress (need for continuous positive airway pressure or mechanical ventilation) Reflexes Normal Hyperreflexia, hyporeflexia [clinicalgate.com]
Workup
Neuroimaging with cranial ultrasound (US), computed tomography and magnetic resonance imaging are valuable tools in the workup of patients with HIE. [pediatricneurosciences.com]
Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal and ophthalmic examination See Workup [emedicine.medscape.com]
Treatment
This makes it impossible for physicians to develop a definitive treatment for neonatal cases of HIE. The basic goal of HIE treatment is to support the baby’s affected organs. [birthinjuryguide.org]
The treatment is called hypothermia (brain cooling) treatment and research shows that it halts almost every injurious process that starts to occur when the brain experiences an oxygen-depriving insult. [abclawcenters.com]
The only available effective treatment, hypothermia, neither provides complete brain protection nor stimulates the repair necessary for neurodevelopmental outcome. [ingentaconnect.com]
A sub-aim of this study was to determine the efficacy of the negative geotaxis test in the study of neonatal H/I injury before the administration of any treatments. [ourarchive.otago.ac.nz]
Treatment of infants with HIE remains generally supportive with attention to resuscitation, fluid and electrolyte homeostasis, maintenance of acid-base balance, nutrition and feeding issues and treatment of seizures. [ncbi.nlm.nih.gov]
Prognosis
[…] injury in term and preterm neonates, the treatment and the prognosis. [pediatricneurosciences.com]
For preterm infants, compared with term infants, the overall prognosis is worse. [radiopaedia.org]
Abnormal clinical neurological findings persisting beyond the first 7-10 days of life usually indicate poor prognosis. Among these, abnormalities of muscle tone and posture (hypotonia, rigidity, weakness) should be carefully noted. [slideshare.net]
Most deaths occur in the first days after birth due to multiple organ failure or redirection of care to comfort measures as a result of the grim prognosis. [emedicine.medscape.com]
Return of normal brain activity and sleep-wake cycles within 48 hours is linked to a more favorable prognosis.” [praxis.iuhealth.org]
Etiology
Clinical Management As many etiologies of neonatal encephalopathy have specific therapies, the clinician’s initial task is to determine the underlying etiology through careful history taking, neurological examination, and laboratory and brain imaging [clinicalgate.com]
Etiology of neonatal seizures. NeoReviews. 2004 Aug. 5(8):e327. [Full Text]. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct. 33(10):696-705. [Medline]. [emedicine.medscape.com]
TIAs share the same underlying etiology as strokes; a disruption of cerebral blood flow. [en.wikipedia.org]
The major etiologies for this type of injury are prolonged difficult delivery and long standing antenatal risk factors. Again, DWI is the earliest to change and show cortical and subcortical white matter restriction [Figure 14] A. [ijri.org]
Epidemiology
Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86(6):329-338. Drury PP, Bennet L, Gunn AJ. Mechanisms of hypothermic neuroprotection. Semin Fetal Neonatal Med. 2010;15(5):287-292. [praxis.iuhealth.org]
Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev 2010;86:329-38. [ PUBMED ] 2. Barkovich AJ, editor. Brain and spine injuries in infancy and childhood. In: Pediatric Neuroimaging. 4 th ed. [pediatricneurosciences.com]
In a review of the literature, Graham et al found that cerebral palsy is associated with intrapartum hypoxia-ischemia in only 14.5% of cases. [21] Epidemiology United States data In the United States and in most technologically advanced countries, the [emedicine.medscape.com]
Pathophysiology
CONCLUSIONS: SHED transplantation into the HI-injured brain resulted in remarkable neurological and pathophysiological recovery. [ncbi.nlm.nih.gov]
"Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms." NeuroRehabilitation 26 (1): 5-13. Calvert, J. W. and J. H. Zhang (2005). "Pathophysiology of an hypoxic-ischemic insult during the perinatal period." [internationalbrain.org]
Berger R, Garnier Y: Pathophysiology of perinatal brain damage. Brain Res Brain Res Rev 1999 Aug; 30(2): de Haan HH, Hasaart TH: Neuronal death after perinatal asphyxia. [slideshare.net]
This excessive NO production plays an important role in the pathophysiology of perinatal hypoxic-ischemic brain injury. [emedicine.medscape.com]
Prevention
Application of this knowledge will allow us to identify strategies for early intervention and prevent the course of damage caused by hypoxic-ischemic injury. Copyright 2001 Harcourt Publishers Ltd. [ncbi.nlm.nih.gov]
Prevent hypoxia, hypercapnia, and hypocapnia; the latter is due to inadequate hyperventilation, which may lead to severe hypoperfusion of the brain. [slideshare.net]
Sonia Bonifacio: Preventing Brain Damage in Newborns Intensive Care Nursery Glossary Intensive Care Nursery Parents' Guide UCSF Research & Clinical Trials Newborn Brain Research Institute Search for a Clinical Trial Reviewed by health care specialists [ucsfbenioffchildrens.org]