Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy: Electrographic Seizures and Magnetic Resonance Imaging Evidence of Injury

Srinivasakumar, Preethi; Zempel, John; Wallendorf, Michael; Lawrence, Russell; Inder, Terrie E.; Mathur, Amit M.

doi:10.1016/j.jpeds.2013.01.041

Cited by 118 publications

(82 citation statements)

References 29 publications

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“…Increased seizure burden has been significantly independently associated with more severe injury on MRI (OR 5.00, 95% CI 1.47 to 17.05, p=0.01)32 and with poorer scores on neurodevelopmental follow-up at 18 months 33. Therapeutic hypothermia reduces seizure burden in infants with mild–moderate, but not severe HIE 34. A rebound increase in seizures can be seen with rewarming 32…”

Section: Advances In the Management Of Hiementioning

confidence: 99%

See 1 more Smart Citation

Management and investigation of neonatal encephalopathy: 2017 update

Martinello

Hart

Yap

et al. 2017

Arch Dis Child Fetal Neonatal Ed

153

122

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This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help determine the cause. Over the last 7 years, infants with moderate to severe HIE have benefited from the introduction of routine therapeutic hypothermia; the number needed to treat for an additional beneficial outcome is 7 (95% CI 5 to 10). More recent research has focused on optimal resuscitation practices for babies with cardiorespiratory depression, such as delayed cord clamping after establishment of ventilation and resuscitation in air. Around a quarter of infants with asystole at 10 min after birth who are subsequently cooled have normal outcomes, suggesting that individualised decision making on stopping resuscitation is needed, based on access to intensive treatment unit and early cooling. The full benefit of cooling appears to have been exploited in our current treatment protocols of 72 hours at 33.5°C; deeper and longer cooling showed adverse outcome. The challenge over the next 5–10 years will be to assess which adjunct therapies are safe and optimise hypothermic brain protection in phase I and phase II trials. Optimal care may require tailoring treatments according to gender, genetic risk, injury severity and inflammatory status.

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Section: Advances In the Management Of Hiementioning

confidence: 99%

“…33 Therapeutic hypothermia reduces seizure burden in infants with mild-moderate, but not severe HIE. 34 A rebound increase in seizures can be seen with rewarming. 32 There are no universal guidelines for the management of seizures in neonatal HIE with strategies differing between centres.…”

Section: Supportive Carementioning

confidence: 99%

Management and investigation of neonatal encephalopathy: 2017 update

Martinello

Hart

Yap

et al. 2017

Arch Dis Child Fetal Neonatal Ed

153

122

View full text Add to dashboard Cite

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“…As the original trials were powered to detect a change in radiographic brain injury, the antiepileptic properties of hypothermia were not initially known. However, more recently a measurable seizure reduction has been described in infants with mild to moderate encephalopathy [23,24]. These findings offer hope for the future use of adjunctive non-pharmacologic anti-epileptic treatment methods and deserve further evaluation.…”

Section: Trends In Seizure Treatmentmentioning

confidence: 99%

Advances in Management of Neonatal Seizures

Vesoulis

Mathur

2014

Indian J Pediatr

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Seizures are more common in the neonatal period than any other time in the human lifespan. A high index of suspicion for seizures should be maintained for infants who present with encephalopathy soon after birth, have had a stroke, central nervous system (CNS) infection or intracranial hemorrhage or have a genetic or metabolic condition associated with CNS malformations. Complicating the matter, most neonatal seizures lack a clinical correlate with only subtle autonomic changes and often no clinical indication at all. Over the last three decades, several tools have been developed to enhance the detection and treatment of neonatal seizures. The use of electroencephalography (EEG) and the later development of amplitude-integrated EEG (aEEG), allows for Neurologists and non-Neurologists alike, to significantly increase the sensitivity of seizure detection. When applied to the appropriate clinical setting, time to diagnosis and start of therapy is greatly reduced. Phenobarbital maintains the status of first-line therapy in worldwide use. However, newer anti-epileptic agents such as, levetiracetam, bumetanide, and topiramate are increasingly being applied to the neonatal population, offering the potential for seizure treatment with a significantly better side-effect profile. Seizures in premature infants continue to confound clinicians and researchers alike. Though the apparent seizure burden is significant and there is an association between seizures and adverse outcomes, the two are not cleanly correlated. Compounding the issue, GABA-ergic anti-epileptic drugs are not only less effective in this age group due to reversed neuronal ion gradients but may also cause harm. Selecting an appropriate treatment group remains a challenge.

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“…Improved neurologic outcomes have been documented, although they are not without certain shortcomings (e.g., infection risk, thromboembolic phenomena). The risk for the development of seizures after neonatal hypoxicischemic insults may be decreased by mild systemic cooling (Srinivasakumar et al, 2013). However, systemic cooling can only be used for short time periods in an intensive care setting.…”

Section: Discussionmentioning

confidence: 99%