Bedside and laboratory neuromonitoring in neonatal encephalopathy

Chalak, Lina F.; Hellström‐Westas, Lena; Bonifacio, Sonia L.; Tsuchida, Tammy N.; Chock, Valerie Y.; El‐Dib, Mohamed; Massaro, An N.; García‐Alix, Alfredo; Publications,

doi:10.1016/j.siny.2021.101273

Cited by 15 publications

(22 citation statements)

References 98 publications

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“…In a clinical trial of moderate-severe NE term infants, serum S100B and NSE concentrations during whole-body cooling (at 0, 12, 24, and 72 h) also correlated with basal ganglia, global and cortical damage on MRI (at 7-10 days), and short-term neurological outcomes [29]. Overall, the findings are consistent between studies [25,30].…”

Section: S100b Nse and Nfl Neuroproteinssupporting

confidence: 59%

“…Neurobiochemical markers have been of particular interest for prediction in infants with NE [25]. Most of these biomarkers are structural proteins that provide neuronal and axonal support, and traumatic events that compromise neuronal integrity can trigger their release into interstitial cell fluid, cerebrospinal fluid (csf) and the circulation [25, 26]. Multiple markers have been examined in animal and clinical studies.…”

Section: Neurobiochemical Markersmentioning

confidence: 99%

“…S100 calcium-binding protein-beta (S100B) is expressed in astroglial and certain neuronal populations, and neurofilament light chain protein (NfL) and neuron-specific enolase (NSE) are a protein filament and glycolytic enzyme found in the neuronal cytoplasm. Small cohort studies in normothermia and hypothermia-treated infants show these protein concentrations become elevated in NE and correlate with outcomes [25]. For example, higher S100B levels in cord blood at birth from infants ( n = 13) with moderate-severe NE correlated with acidosis, amplitude-integrated EEG (aEEG) pattern and NE severity, and death or disability at 6 years of follow-up, compared to healthy ( n = 21) infants [27].…”

Section: Neurobiochemical Markersmentioning

confidence: 99%

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Prognostic Neurobiomarkers in Neonatal Encephalopathy

Wassink¹,

Harrison²,

Dhillon³

et al. 2022

Dev Neurosci

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Therapeutic hypothermia is now standard-care for infants with moderate-severe neonatal encephalopathy (NE), and improves brain damage on neuroimaging, and neurodevelopmental outcomes. Critically, for effective neuroprotection, hypothermia should be started within 6 h from birth. There is compelling evidence to suggest that a proportion of infants with mild NE have material risk of developing brain damage and poor outcomes. This cohort is increasingly being offered therapeutic hypothermia, despite lack of trial evidence for its benefit. In current practice, infants need to be diagnosed within 6 h of birth for therapeutic treatment, compared to retrospective NE grading in the pre-hypothermia era. This presents challenges as NE is a dynamic brain disorder that can worsen or resolve over time. Neurological symptoms of NE can be difficult to discern in the first few hours after birth, and confounded by analgesics and anesthetic treatment. Using current enrolment criteria, a significant number of infants with NE that would benefit from hypothermia are not treated, and vice versa, infants are receiving mild hypothermia when its benefit will be limited. Better biomarkers are needed to further improve management and treatment of these neonates. In the present review, we examine the latest research, and highlight a central limitation of most current biomarkers: that their predictive value is consistently greatest after most neuroprotective therapies are no longer effective.

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Section: S100b Nse and Nfl Neuroproteinssupporting

confidence: 59%

Section: Neurobiochemical Markersmentioning

confidence: 99%

Section: Neurobiochemical Markersmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Neurobiomarkers in Neonatal Encephalopathy

Wassink¹,

Harrison²,

Dhillon³

et al. 2022

Dev Neurosci

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“…In addition to the overall changes in cerebral oxygenation during the secondary phase, there is evidence from assessment of dynamic perfusion with neural activity that cerebrovascular regulation may be impaired ( 53 ). A small prospective study of wavelet-based neurovascular coupling in term infants with HIE showed that coherence of aEEG and cerebral oxygen saturation during the first 24 h after birth was higher in infants with normal MRI than those with abnormal MRI findings ( 54 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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Perinatal hypoxia-ischemia (HI) is still a significant contributor to mortality and adverse neurodevelopmental outcomes in term and preterm infants. HI brain injury evolves over hours to days, and involves complex interactions between the endogenous protective and pathological processes. Understanding the timing of evolution of injury is vital to guide treatment. Post-HI recovery is associated with a typical neurophysiological profile, with stereotypic changes in cerebral perfusion and oxygenation. After the initial recovery, there is a delayed, prolonged reduction in cerebral perfusion related to metabolic suppression, followed by secondary deterioration with hyperperfusion and increased cerebral oxygenation, associated with altered neurovascular coupling and impaired cerebral autoregulation. These changes in cerebral perfusion are associated with the stages of evolution of injury and injury severity. Further, iatrogenic factors can also affect cerebral oxygenation during the early period of deranged metabolism, and improving clinical management may improve neuroprotection. We will review recent evidence that changes in cerebral oxygenation and metabolism after HI may be useful biomarkers of prognosis.

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“…Die NIRS kann Bestandteil eines multimodalen Neuromonitoring für kritisch kranke Neugeborene sein, wie z. B. bei schwerer HIE [ 16 ].…”

Section: Nah-infrarot-spektroskopieunclassified

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

Felderhoff-Müser

Hüning

2022

Monatsschr Kinderheilkd

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Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.

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Bedside and laboratory neuromonitoring in neonatal encephalopathy

Cited by 15 publications

References 98 publications

Prognostic Neurobiomarkers in Neonatal Encephalopathy

Prognostic Neurobiomarkers in Neonatal Encephalopathy

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

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