The Johns Hopkins Neurosciences Intensive Care Nursery Tenth Anniversary (2009-2019): A Historical Reflection and Vision for the Future

Carrasco, Melisa; Stafstrom, Carl E.; Tekes, Aylin; Parkinson, C; Northington, Frances J.

doi:10.1177/2329048x20907761

Cited by 4 publications

(2 citation statements)

References 51 publications

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“…Third, we speculate that implementation of therapeutic hypothermia as a neuroprotective strategy for neonates with hypoxic‐ischemic encephalopthy 33 may have reduced the risk of epilepsy in our study participants. Finally, comprehensive neurocritical care 34–38 including conventional EEG monitoring 19 for all neonates with seizures in our patient cohort, may have facilitated prompt seizure detection and treatment which might also have contributed to lower rates of post‐neonatal epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

et al. 2021

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Objective We aimed to evaluate early‐life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods Neonates with acute symptomatic seizures born 7/2015‐3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One‐hour EEG was recorded at age three months. Post‐neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills – WIDEA‐FS) were assessed. Cox regression was used to assess epilepsy‐free survival. Results Among 282 infants, 37 (13%) had post‐neonatal epilepsy by 24‐months [median age of onset 7‐months (IQR 3–14)]. Among those with post‐neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug‐resistant epilepsy. Most children with post‐neonatal epilepsy had abnormal neurodevelopment at 24‐months (WIDEA‐FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6–17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9–5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4–5.9). In an adjusted model, days of neonatal EEG‐confirmed seizures (HR 1.4 per day, 95% CI 1.2–1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9–7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three‐month EEG was not associated with epilepsy. Significance In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post‐neonatal epilepsy by age 24‐months. However, there was a high risk of severe neurodevelopmental impairment and drug‐resistant seizures among children with post‐neonatal epilepsy. Days of EEG‐confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow‐up planning, and future research to prevent post‐neonatal epilepsy.

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Section: Discussionmentioning

confidence: 99%

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

et al. 2021

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“…Worldwide neonatal neurocritical care programs (NNCCP) continue to expand ( 12 , 13 ). Sophisticated technologies using enhanced informatics contribute to new diagnostic approaches.…”

Section: Current Programs Emphasize Neonatal Neurocritical Carementioning

confidence: 99%

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

Scher

2021

Front. Pediatr.

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Gene–environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.

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Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

et al. 2022

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The Johns Hopkins Neurosciences Intensive Care Nursery Tenth Anniversary (2009-2019): A Historical Reflection and Vision for the Future

Cited by 4 publications

References 51 publications

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

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