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]
Neurologic
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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]
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]
EEG
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Burst Suppression
As the injury progresses, seizures subside and the electroencephalogram becomes isoelectric or shows a burst suppression pattern. At that time, wakefulness may deteriorate further, and the fontanelle may bulge, suggesting increasing cerebral edema. [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 only available effective treatment, hypothermia, neither provides complete brain protection nor stimulates the repair necessary for neurodevelopmental outcome. [ingentaconnect.com]
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 challenge now is to select from a daunting range of potential treatments. The patient's best interest must be central to ethical decision making at all times. [ncbi.nlm.nih.gov]
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]
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]
The present results should offer important insights into the prognosis for hypoxic-ischemic encephalopathy. 2014 The Authors. Journal of Obstetrics and Gynaecology Research 2014 Japan Society of Obstetrics and Gynecology. [ncbi.nlm.nih.gov]
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]
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]
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]
"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]
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]