Childhood Outcomes After Hypothermia for Neonatal Encephalopathy

Shankaran, Seetha; Pappas, Athina; McDonald, Scott A.; Vohr, Betty R.; Hintz, Susan R.; Yolton, Kimberly; Gustafson, Kathryn E.; Leach, Theresa M.; Green, Charles; Bara, Rebecca; Huitema, Carolyn M. Petrie; Ehrenkranz, Richard A.; Tyson, Jon E.; Das, Abhik; Hammond, Jane; Peralta‐Carcelen, Myriam; Evans, Patricia W.; Heyne, Roy J.; Wilson-Costello, Deanne E.; Vaucher, Yvonne E.; Bauer, Charles R.; Dusick, Anna M.; Adams‐Chapman, Ira; Goldstein, Ricki F.; Guillet, Ronnie; Papile, L.A.; Higgins, Rosemary D.

doi:10.1097/01.ogx.0000419766.08585.32

Cited by 51 publications

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“…Lastly, the end point of neurological outcomes of 12 months was reassuring because the sensitivity of the 1year evaluation of the Bayley Scales of Infant Development in predicting the longer neurologic outcome was 96%. 41 In conclusion, the predictive value of aEEG on adverse neurological outcomes was significant.…”

Section: Discussionmentioning

confidence: 79%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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Objective To determine the efficacy and the prognostic value of amplitude‐integrated electroencephalography (aEEG) in term and near‐term neonates with high risk of neurological sequelae. Methods Infants of ≥35 weeks of gestation diagnosed with neonatal encephalopathy or with high risk of brain injury were included. All eligible infants underwent aEEG within 6 h after clinical assessment. The infants were followed up 12 months to evaluate neurological development. Results A total of 250 infants were eligible, of which 85 had normal aEEG, 81 had mildly abnormal aEEG, and 84 had severely abnormal aEEG. Of these infants, 168 were diagnosed with different neonatal encephalopathies, 27 with congenital or metabolic diseases, and 55 with high risk of brain injury. In all, 22 infants died, 19 were lost to follow‐up, and 209 completed the follow‐up at 12 months, of which 62 were diagnosed with a neurological disability. Statistical analysis showed that severely abnormal aEEG predicted adverse neurological outcome with a sensitivity of 70.2%, a specificity of 87.1%, a positive predictive value of 75.6%, and a negative predictive value of 83.7%. Interpretation aEEG can predict adverse outcomes in high‐risk neonates and is a useful method for monitoring neonates with high risk of adverse neurological outcomes.

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Section: Discussionmentioning

confidence: 79%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

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“…Systemic hypothermia (32-34°C Tc) after cardiac arrest may reduce mortality and increase the rate of favorable neurologic outcome after 6 months (Hypothermia after Cardiac Arrest Study Group, 2002). It is gaining popularity as a therapy, typically started at 33 AE 0.5°C Tc within 6 h after delivery in patients with perinatal HIE (Shankaran et al, 2012). Cellular changes following hypoxic ischemic brain injury may trigger a pathologic cascade that can result in delayed neuronal apoptosis.…”

Section: Disorders Other Than Epilepsymentioning

confidence: 99%

Therapeutic brain hypothermia, its mechanisms of action, and its prospects as a treatment for epilepsy

2013

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SUMMARYCooling the core body temperature to 32-35°C, is almost standard practice for conditions such as cardiac arrest in adults, and perinatal hypoxic ischemic encephalopathy in neonates. Limited clinical data, and more extensive animal experiments, indicate that hypothermia could help control seizures, and could be applied directly to the brain using implantable devices. These data have fostered further research to evaluate whether cooling would be a viable means to treat refractory epilepsy.Although the effect of temperature on cellular physiology has long been recognized, with possibly dual effects on pyramidal cells and interneurons, the exact mechanisms underlying its beneficial effects, in particular in epilepsy, are yet to be discovered. This article reviews currently available clinical and laboratory data with a focus on cellular mechanisms of action and prospects of hypothermia as a treatment for intractable seizures.

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“…1 Historically, HIE resulted in significant morbidity and mortality 2 ; however, in recent years, therapeutic hypothermia (TH) has emerged as the standard of care, leading to reductions in death or major neurodevelopmental disability. [3][4][5][6][7][8][9] In addition, TH may reduce seizures in neonates with moderate HIE. 10 Despite these improvements, the incidence of acute symptomatic seizures remains high, and many neonates experience a high seizure burden.…”

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confidence: 99%

Early discontinuation of antiseizure medications in neonates with hypoxic–ischemic encephalopathy

2017

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Summary Objective Neonates with hypoxic-ischemic encephalopathy (HIE) managed with therapeutic hypothermia (TH) often experience acute symptomatic seizures, prompting treatment with anti-seizure medications (ASM). Because the risk of seizure occurrence after hospital discharge is unknown, the optimal ASM treatment duration is unclear. We aimed to determine the risk of seizure occurrence after hospital discharge and the impact of ASM treatment duration on this outcome. Methods We performed a single-center, retrospective study of consecutive neonates with HIE managed with TH who received ASM for acute symptomatic seizures from June 2010 through December 2014. Neonates were monitored with continuous EEG during TH. Results Follow-up data were available for 59/72 (82%) neonates who survived to discharge, with a median follow-up period of 19 months (interquartile range 11, 25). Acute symptomatic seizures occurred in 35 (59%), including electrographic seizures in 21 (36%). ASM were continued upon discharge in 17 of 35 neonates (49%). Seizures occurred in follow-up in 4 neonates (11%). No patient for whom ASM were discontinued prior to discharge experienced seizures during the follow-up period. Significance Among neonates with HIE, seizures after hospital discharge were rare in those with acute symptomatic seizures and did not occur in neonates without acute symptomatic seizures. ASM discontinuation prior to discharge did not increase the risk of seizures during the follow-up period, suggesting that ASM may be discontinued in many neonates prior to discharge.

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Childhood Outcomes After Hypothermia for Neonatal Encephalopathy

Cited by 51 publications

References 0 publications

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Therapeutic brain hypothermia, its mechanisms of action, and its prospects as a treatment for epilepsy

Early discontinuation of antiseizure medications in neonates with hypoxic–ischemic encephalopathy

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