Cooling for newborns with hypoxic ischaemic encephalopathy

Jacobs, Susan E; Berg, Marie; Hunt, Rod W.; Tarnow‐Mordi, William; Inder, Terrie E.; Davis, Peter G

doi:10.1002/14651858.cd003311.pub2

Cited by 350 publications

(257 citation statements)

References 48 publications

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“…Perfect antenatal care may prevent perinatal ischaemia and brain cooling, 12 or allopurinol 13 may treat it, whereas genetic counselling may prevent genetic disease. We made the decision to classify these conditions as unavoidable and untreatable to avoid deep ethical discussion.…”

Section: Methodsmentioning

confidence: 99%

Childhood sight impairment: a 10-year picture

Durnian

Cheeseman

Kumar

et al. 2009

Eye

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Introduction Registering a child as visually impaired is a potentially traumatic, but necessary, milestone in paediatric ophthalmology. Registration enables the provision of services essential to maximise the child's potential. Purpose This study was carried out to investigate the changes over a 10-year period in the rates of registration of childhood blindness at a tertiary paediatric ophthalmology department. Particular attention was given to diagnosis, whether the disease was preventable, time to registration, age at registration, and the socioeconomic status of the patient's family. Methods A retrospective analysis of all children registered blind or partially sighted over a 10-year period until December 2006. Results A total of 256 children were registered blind or partially sighted over the 10 years. All cases were analysed. Of these, 58.2% were male and the average age at registration was 76 months; 52.0% were registered as severely sight-impaired. The most common primary diagnosis was cerebral visual impairment (CVI) in 27% cases, followed by optic atrophy in 16%, and the commonest anatomical site involved was the retina in 30.9%. An average of 25.6 (SD 8.0) registrations were carried out each year. The number of registrations per year is increasing. Seven cases (2.7%) were deemed avoidable and 61 cases (23.8%) were deemed potentially treatable. The mean index of multiple deprivation (IMD) score for the English cases (45.1) was significantly higher than of the surrounding area (Po0.0001) Conclusions The yearly rates of registration increased slowly over the 10 years. The most common underlying cause for registration remains CVI, with the yearly proportion of registrations because of CVI not altering. The average age of registration was 6.3 years. A significant proportion of the cases of visual

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Section: Methodsmentioning

confidence: 99%

Childhood sight impairment: a 10-year picture

Durnian

Cheeseman

Kumar

et al. 2009

Eye

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“…An example is therapeutic hypothermia for asphyxiated newborns. Although current evidence demonstrates that hypothermia reduces death and/or major sequelae, almost a half of babies with severe HI encephalopathy do not benefit from this treatment; in addition, its application in substandard environments might be troublesome or even dangerous [64]. Thus, to develop synergistic therapies is warranted.…”

Section: Cannabinoids and Brain Damage In The Immature Brain: Neonatamentioning

confidence: 99%

Cannabinoids in Neurodegenerative Disorders and Stroke/Brain Trauma: From Preclinical Models to Clinical Applications

2015

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Cannabinoids form a singular family of plantderived compounds (phytocannabinoids), endogenous signaling lipids (endocannabinoids), and synthetic derivatives with multiple biological effects and therapeutic applications in the central and peripheral nervous systems. One of these properties is the regulation of neuronal homeostasis and survival, which is the result of the combination of a myriad of effects addressed to preserve, rescue, repair, and/or replace neurons, and also glial cells against multiple insults that may potentially damage these cells. These effects are facilitated by the location of specific targets for the action of these compounds (e.g., cannabinoid type 1 and 2 receptors, endocannabinoid inactivating enzymes, and nonendocannabinoid targets) in key cellular substrates (e.g., neurons, glial cells, and neural progenitor cells). This potential is promising for acute and chronic neurodegenerative pathological conditions. In this review, we will collect all experimental evidence, mainly obtained at the preclinical level, supporting that different cannabinoid compounds may be neuroprotective in adult and neonatal ischemia, brain trauma, Alzheimer's disease, Parkinson's disease, Huntington's chorea, and amyotrophic lateral sclerosis. This increasing experimental evidence demands a prompt clinical validation of cannabinoid-based medicines for the treatment of all these disorders, which, at present, lack efficacious treatments for delaying/arresting disease progression, despite the fact that the few clinical trials conducted so far with these medicines have failed to demonstrate beneficial effects.

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“…Therapeutic hypothermia is neuroprotective in term newborns with hypoxic-ischemic encephalopathy (HIE), 1 but its effect on multiorgan or multisystem dysfunction, 2 a prevalent feature of the neonatal post-asphyxial syndrome, has not been well characterized. As the main pathogenetic processes of HIE and dysfunction of other organs are presumably similar after an hypoxic-ischemic insult, 3 therapeutic hypothermia achieved by either selective head cooling (SHC) or whole-body cooling (WBC) should also protect systemic organs other than the brain.…”

Section: Introductionmentioning

confidence: 99%

Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling

Sarkar

Barks

Bhagat³

et al. 2009

J Perinatol

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Objective: Multiorgan dysfunction in asphyxiated newborns receiving therapeutic hypothermia achieved by either selective head cooling (SHC) or whole-body cooling (WBC) has not been well characterized. The beneficial effect of SHC in organs other than the brain may potentially be limited because unlike WBC, SHC aims to achieve effective brain cooling with lesssystemic hypothermia. However, the relative effects of SHC and WBC with currently available cooling protocols on multiorgan dysfunction are unknown.The aim of this study was to compare the multiorgan dysfunction in infants receiving therapeutic hypothermia induced by either SHC or WBC.Study Design: In 59 asphyxiated newborns who received therapeutic hypothermia by either SHC (n ¼ 31) or WBC (n ¼ 28), the severity of pulmonary, hepatic and renal dysfunction and coagulopathy and electrolyte disturbances were assessed before the start of cooling (baseline), and at specific time intervals (24, 48 and 72 h) throughout cooling. Enrollment criteria, clinical monitoring and treatment during cooling, whether SHC or WBC, were similar, as reported earlier.Result: The presence of clinical respiratory distress, along with the need for ventilatory support for varying duration during cooling, was similar in both the WBC and SHC groups (100 vs 94%, P ¼ 0.49, OR 1.9, 95% CI 1.5-2.5). The use of fresh frozen plasma and platelet transfusion to treat coagulopathy and thrombocytopenia was similar (WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, and WBC 41% vs SHC 32%, P ¼ 0.58, OR 1.4, 95% CI 0.5-4.2, respectively), and equivalent numbers of infants from both groups were treated with vasopressors for >24 h (WBC 59% vs SHC 55%, P ¼ 0.79, OR 1.2, 95% CI 0.4-3.4). The incidence of oliguria (urine output <0.5 ml kg -1 h -1 for >24 h after birth) and rising serum creatinine (with maximum serum creatinine >0.9 mg dl -1 ) was also similar (WBC 18% vs SHC 39%, P ¼ 0.15, OR 0.4, 95% CI 0.1-1.3, and WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, respectively).Laboratory parameters to assess the differential effect of WBC versus SHC on multiorgan dysfunction during 72 h of cooling, which include serum transaminases (serum aspartate aminotransferase and alanine aminotransferase), prothrombin time, partial thromboplastin time, INR, platelet counts, serum creatinine, serum sodium, serum potassium and serum calcium, were similar between the groups at the initiation of cooling and did not differ with the method of cooling. Conclusion:Multiorgan system dysfunction in asphyxiated newborns during cooling remains similar for both cooling methods. Concerns regarding a differential effect of WBC versus SHC on multiorgan dysfunction, other than of the brain, should not be a consideration in selecting a method to produce therapeutic hypothermia.

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Cooling for newborns with hypoxic ischaemic encephalopathy

Cited by 350 publications

References 48 publications

Childhood sight impairment: a 10-year picture

Childhood sight impairment: a 10-year picture

Cannabinoids in Neurodegenerative Disorders and Stroke/Brain Trauma: From Preclinical Models to Clinical Applications

Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: whole-body cooling versus selective head cooling

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