Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome

Toet, Mona C.; Lemmers, Petra; Schelven, Leonard J. van; Bel, Frank van

doi:10.1542/peds.2005-0987

Cited by 214 publications

(194 citation statements)

References 45 publications

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“…10 In a time window between 24 and 48 hours of age in neonates with HIE, rSO 2 was significantly higher in neonates with adverse outcomes as compared with neonates with good outcomes. 8 However, this difference was not significant between 6 and 18 hours of age. In a recent study of neonates with HIE who underwent TH, rSO 2 was reported as slightly higher in HIE with adverse outcomes at 6, 12, and 24 hours of life compared with neonates with good outcomes; however the difference was only significant at 12 hours.…”

Section: Indices Of Cerebral Oxygen Metabolism and Cerebral Blood Flowmentioning

confidence: 79%

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Dehaes

Aggarwal

Lin

et al. 2013

J Cereb Blood Flow Metab

102

121

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Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO 2i ) and CBF indices (CBF i ) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO 2 ) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO 2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO 2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization. Keywords: cerebral blood circulation; cerebral hemoglobin oxygen saturation; cerebral metabolic rate of oxygen consumption; near infrared spectroscopy; neonatal hypoxic ischemic encephalopathy; therapeutic hypothermia INTRODUCTION Neonatal hypoxic ischemic encephalopathy (HIE) occurs in B2 to 3 per 1,000 live births in the USA, with devastating consequences including neurodevelopmental disabilities such as cerebral palsy, life-long cognitive impairment, and epilepsy.1 In HIE, there is a period of reduced blood flow (ischemia) and oxygen delivery (hypoxia) followed by reperfusion with transient energy recovery, and then a secondary energy failure.2 Treatment is aimed at preventing the cascade of events that begin with reperfusion and lead to secondary energy failure and inevitable cell death; this is the 'window of opportunity.' 3 Theories for injury mechanisms in this window suggest a central role for excitotoxicity and oxidative stress with the injury evolving over hours to weeks.2 Therapeutic hypothermia (TH) is the treatment of choice for HIE, as it is the only treatment with proven efficacy and acts through a variety of mechanisms, including those associated with decreased neuronal energy metabolism. 4 Although early studies showed that TH decreased rates of both mortality and disability, recently published long-term outcomes have demonstrated significance only for decreased mortality rates.5 In addition, a recent

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Section: Indices Of Cerebral Oxygen Metabolism and Cerebral Blood Flowmentioning

confidence: 79%

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Dehaes

Aggarwal

Lin

et al. 2013

J Cereb Blood Flow Metab

102

121

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“…3 The in- cidence of asphyxia has been reported as 1-6/1000 live births, depending on the gestational age and birth weight. 4,5 Perinatal asphyxia continues to be a major cause of morbidity and mortality in the neonatal period6. Perinatal asphyxia could be reduced in health centers capable of preventing frequent births, serving high quality antenatal care, closely monitoring high risk pregnancies, providing suitable conditions for giving births, and when needed immediately and correctly intervene to newborn.…”

Section: Introductionmentioning

confidence: 99%

Neonatal asphyxia: A study of 210 cases

Üzel

Kelekçi²,

Devecioğlu³

et al. 2012

J Clin Exp Invest

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ÖZETAmaç: Perinatal asfiksi, yenidoğan döneminin önemli mortalite ve morbidite nedenlerinden biridir. Bu çalış-manın amacı yenidoğan asfiksisi için antenatal, natal ve postnatal risk faktörlerini araştırmak, perinatal asfiksili yenidoğanlarda bilinen risk faktörleri ile Sarnat ve Sarnat skorları ilişkisini ve risk faktörlerinin hastanede kalış süre-si ve sağkalım ile ilişkisini belirlemektir. Gereç ve yöntem:Bu çalışmada perinatal asfiksi tanısı alan 210 vakanın dosya kayıtları geriye dönük olarak incelendi. Hastaların demografik özellikleri, risk faktörleri ve Sarnat and Sarnat klinik evreleme özellikleri analiz edildi. Bulgular:Hastaların %67,7'sinde antepartum, %91'inde intrapartum ve %29,5'inde postpartum risk faktörü bulunmaktaydı. Yıllara göre incelendiğinde perinatal asfiksili olgu %28,1 oranında en fazla 2007 yılında görülürken yıllar içinde bir düşüş ile birlikte %21 oranında 2010 yı-lında tanı almıştı ve evre 3 olgu sayısı ve mortalite oranı anlamlı şekilde azalmıştı (p<0.05).Sonuç: Doğum sırasında ki daha az önlenebilir doğum asfiksisi nedenleri daha sık görülmektedir. Risk faktörleri-nin erken tespit edilmesi yanında uygun prenatal, natal ve postnatal bakım, düşük APGAR skorlu ve acil sezeryan doğumların azalması perinatal asfiksi sıklığını önemli öl-çüde azaltacaktır. Yoğun bakım ihtiyacı ve resüsitasyon yapılan yenidoğanların yeterli donanıma sahip merkezlerde izlenmesi de asfiksiye bağlı komplikasyonları azaltacağını düşünüyoruz.Anahtar kelimeler: Asfiksi, yenidoğan, risk faktörü, prognoz ABSTRACT Objectives: Perinatal asphyxia remains an important cause of neonatal morbidity and mortality. The aim of this study was to investigate antenatal, natal, and postnatal risk factors of neonatal asphyxia, relationship with known risk factors and stage of Sarnat and Sarnat scores, the effect of risk factors on hospital discharge and survival for neonates with perinatal asphyxia. Materials and methods:In this study, we retrospectively analyzed the hospital records of 210 patients diagnosed as perinatal asphyxia. The patients' demographic characteristics, antepartum, intrapartum, and postpartum risk factors and Sarnat and Sarnat clinical staging criteria of newborns were analyzed. Results:The risk factors for asphyxia were detected antepartum period in 67.7% of newborns, intrapartum in 91% and potpartum in of 29.5% of neonates. When cases were examined according to the studied years, perinatal asphyxia ratio was the most frequent in 2007 as 28.1%. With a decline over the years, frequency dropped to %21 in 2010. The number of patients with stage 3 and mortality rate were significantly decreased over the years (p <0.05). Conclusions:Less preventable intrapartum causes of birth asphyxia are seen more frequently. Early detection of risk factors together with appropriate prenatal, natal and postnatal care provision, reduced emergency caesarean sections and will decrease considerably decrease frequency of perinatal asphyxia. We think that following up neonates who needed intensive care in neonatal units sufficientl...

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“…Many research and observational studies were performed with neonates using various types of NIRS/cerebral oximetry monitors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, no food and drug administration (FDA) approved cerebral oximeter is available for neonates. Successful validation of cerebral oximetry for the FDA has been done in human adult volunteer studies under protocols were jugular bulb and arterial blood samples were obtained under different levels of fractional inspired oxygen (FiO 2 ) levels.…”

Section: Introductionmentioning

confidence: 99%

Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter

2006

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Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome

Abstract: rSo2 and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.

Cited by 214 publications

References 45 publications

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Neonatal asphyxia: A study of 210 cases

Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter

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