Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group

Massaro, An N.; Murthy, Karna; Zaniletti, Isabella; Cook, Noah; DiGeronimo, Robert; Dizon, Maria L.V.; Hamrick, Shannon E. G.; McKay, Victor; Natarajan, Girija; Rao, Rakesh; Smith, Danielle; Telesco, Richard; Wadhawan, Rajan; Asselin, Jeanette M.; Durand, David J.; Evans, Jacquelyn R.; Dykes, Francine D.; Reber, Kristina M.; Padula, Michael A.; Pallotto, Eugenia K.; Short, Billie Lou; Mathur, Amit M.

doi:10.1038/jp.2014.190

Cited by 102 publications

(87 citation statements)

References 38 publications

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“…In general, clinical trials have shown improvements in outcomes, such as mortality, seizure rate and neurological outcomes [6]. However, some reports have failed to definitively demonstrate improvements [45]. Even when applied optimally, it appears that hypothermia alone is certainly not a sufficient therapy for neonatal HI, and thus hypothermia is likely to function primarily as an adjunct therapy.…”

Section: Discussionmentioning

confidence: 99%

Effects of Neonatal Hypoxic-Ischemic Injury and Hypothermic Neuroprotection on Neural Progenitor Cells in the Mouse Hippocampus

Kwak¹,

Lim²,

Kang

et al. 2015

Dev Neurosci

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Neonatal hypoxic-ischemic injury (HI) results in widespread cerebral encephalopathy and affects structures that are essential for neurocognitive function, such as the hippocampus. The dentate gyrus contains a reservoir of neural stem and progenitor cells (NSPCs) that are critical for postnatal development and normal adult function of the hippocampus, and may also facilitate the recovery of function after injury. Using a neonatal mouse model of mild-to-moderate HI and immunohistochemical analysis of NSPC development markers, we asked whether these cells are vulnerable to HI and how they respond to both injury and hypothermic therapy. We found that cleaved caspase-3 labeling in the subgranular zone, where NSPCs are located, is increased by more than 30-fold after HI. The population of cells positive for both proliferating cell nuclear antigen and nestin (PCNA+Nes+), which represent primarily actively proliferating NSPCs, are acutely decreased by 68% after HI. The NSPC population expressing NeuroD1, a marker for NSPCs transitioning to become fate-committed neural progenitors, was decreased by 47%. One week after HI, there was a decrease in neuroblasts and immature neurons in the dentate gyrus, as measured by doublecortin (DCX) immunolabeling, and at the same time PCNA+Nes+ cell density was increased by 71%. NSPCs expressing Tbr2, which identifies a highly proliferative intermediate neural progenitor population, increased by 107%. Hypothermia treatment after HI partially rescues both the acute decrease in PCNA+Nes+ cell density at 1 day after injury and the chronic loss of DCX immunoreactivity and reduction in NeuroD1 cell density measured at 1 week after injury. Thus, we conclude that HI causes an acute loss of dentate gyrus NSPCs, and that hypothermia partially protects NSPCs from HI.

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Section: Discussionmentioning

confidence: 99%

Effects of Neonatal Hypoxic-Ischemic Injury and Hypothermic Neuroprotection on Neural Progenitor Cells in the Mouse Hippocampus

Kwak¹,

Lim²,

Kang

et al. 2015

Dev Neurosci

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“…Recent reports suggest a drift in clinical practice as therapeutic hypothermia is offered increasingly to neonates who would not have met eligibility in the original clinical trials 14, 15 . Here, we describe the short-term outcomes (as defined by brain injury on MRI scans in the first 10 days of life) and safety profile of therapeutic hypothermia in preterm neonates born at 34–35 weeks gestational age in comparison with a cohort of term newborn infants with HIE at our institution.…”

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confidence: 99%

Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy

Rao

Trivedi

Vesoulis

et al. 2017

The Journal of Pediatrics

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Objective To evaluate the safety and short-term outcomes of preterm neonates born at 34–35 weeks gestation with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia. Study design Medical records of preterm neonates born at 34–35 weeks gestational age with HIE treated with therapeutic hypothermia were retrospectively reviewed. Short-term safety outcomes and the presence, severity (mild, moderate, severe) and patterns of brain injury on magnetic resonance imaging (MRI) were reviewed using a standard scoring system, and compared with a cohort of term neonates with HIE treated with therapeutic hypothermia. Results Thirty-one preterm and 32 term neonates were identified. Therapeutic hypothermia-associated complications were seen in 90% of preterm infants and 81.3% of term infants (p=0.30). In the preterm infants, hyperglycemia (58.1% vs.31.3%, p=0.03) and rewarming before completion of therapeutic hypothermia (19.4% vs. 0.0%, p=0.009) were more likely compared with term infants. All deaths occurred in the preterm group (12.9% vs. 0%, p=0.04). Neuroimaging showed the presence of injury in 80.6% of preterm infants and 59.4% of term infants (p=0.07), with no differences in injury severity. Injury to the white matter was more prevalent in preterm infants compared with term infants (66.7% vs. 25.0%, p=0.001). Conclusions Therapeutic hypothermia in infants born at 34–35 weeks gestational age appears feasible. Risks of mortality and side effects warrant caution with use of therapeutic hypothermia in preterm infants.

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“…In the medical research, a number of studies on HIE diagnosis have focused on Diffusion Weighted Imaging (DWI) [6][7]21] and Electroencephalogram (EEG) diagnosis [8][9]. In [21], DWIs are acquired for the apparent diffusion coefficient (ADC) map to evaluate the quantification of ischemic injury by employing the watershed and superpixel methods.…”

Section: Introductionmentioning

confidence: 99%

Feature Extraction and Classification to Diagnose Hypoxic-Ischemic Encephalopathy Patients by Using Susceptibility-Weighted MRI Images

Mahmoodi

Darekar

et al. 2017

Communications in Computer and Information Science

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Abstract. In this paper. a method is presented to enable automatic classification of the degree of abnormality of susceptibility-weighted images (SWI) acquired from babies with hypoxic-ischemic encephalopathy (HIE), in order to more accurately predict eventual cognitive and motor outcomes in these infants. SWI images highlight the cerebral venous vasculature and can reflect abnormalities in blood flow and oxygenation, which may be linked to adverse outcomes. A qualitative score based on magnetic resonance imaging (MRI) analyses is assigned to SWIs by specialists to determine the severity of abnormality in an HIE patient. The method allows the detection of image ridges, representing the vessels in SWIs, and the histogram of the ridges grey scales. A curve with only four parameters is fitted to the histograms. These parameters are then used to estimate the SWI abnormality score. The images are classified by using a kNNand multiple SVM classifiers based on the parameters of the fitting curves. The algorithm is tested on an SWI-MRI dataset consisting of 10 healthy infants and 48 infants with HIE with a range of SWI abnormality scores between 1 and 7. The accuracy of classifying babies with HIE vs. those without (ie: healthy controls) using our algorithm with a leave-one-out strategy is measured as 91.38%. Our method is fast and could increase the prognostic value of these scans, thereby improving management of the condition, as well as elucidating the disease mechanisms of HIE.

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Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group

Cited by 102 publications

References 38 publications

Effects of Neonatal Hypoxic-Ischemic Injury and Hypothermic Neuroprotection on Neural Progenitor Cells in the Mouse Hippocampus

Effects of Neonatal Hypoxic-Ischemic Injury and Hypothermic Neuroprotection on Neural Progenitor Cells in the Mouse Hippocampus

Safety and Short-Term Outcomes of Therapeutic Hypothermia in Preterm Neonates 34-35 Weeks Gestational Age with Hypoxic-Ischemic Encephalopathy

Feature Extraction and Classification to Diagnose Hypoxic-Ischemic Encephalopathy Patients by Using Susceptibility-Weighted MRI Images

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