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The neonate
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
The progress of the encephalopathy can be followed clinically or with amplitude integrated electroencephalography (aEEG, otherwise known as cerebral function monitoring, CFM). aEEG allows a partial assessment of brain activity by measuring two EEG leads and summarizing the signals in ways that are analogous with the CTG. aEEG can show evidence of normal brain activity and changes in behavioural states; or profound abnormality: burst suppression patterns or a ‘flat line’ isoelectric signal. There are intermediate patterns such as loss of continuity.
Neonatal diseases I
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Currently there are two ways to provide hypothermia to neonates, selective brain cooling or total body cooling. Recently there were four large multicenter randomized control trials that were conducted to evaluate the effect of hypothermia in neonates with moderate or severe HIE using one of these two methods of hypothermia. The CoolCap trial included 234 infants who were ‡36 weeks of gestational age with moderate to severe HIE and abnormal amplitude-integrated electroencephalography (aEEG). These infants were randomized to either receive selective head cooling for 72 hours with a goal rectal temperature of 34°C to 35°C or standard care. Therapy with hypothermia was to be initiated within 6 hours of birth. The inclusion criteria were an Apgar score of £5 at 10 minutes after birth, continued need for resuscitation including endotracheal or mask ventilation at 10 minutes after birth, or severe acidosis defined as a pH <7.00 or a base deficit of ‡16 mmol/L on either a cord gas or an arterial or venous sample drawn within 60 minutes of birth. Eligible infants were then assessed for clinical evidence of moderate or severe HIE using the Sarnat criteria (lethargy, stupor, or coma with one or more of the following symptoms: hypotonia, abnormal reflexes (including oculomotor or pupillary), an absent or weak suck, or clinical evidence of seizures. Next an aEEG was used to determine whether the infant had a moderate or severely abnormal aEEG tracing for 20 minutes prior to initiation of hypothermia. Those infants who were randomized to hypothermia were kept cool for 72 hours and then gradually rewarmed by no more than 0.5°C/hr until the infant’s temperature was normal (36.5–37.5°C). They ended up with 116 infants who were treated with hypothermia and 118 who received standard therapy. These infants were followed for 18 months and they found no difference in the primary outcomes of death or severe disability, but when they looked at the subset of infants with moderately abnormal aEEG, those who were cooled had an improved outcome (n = 172, odds ratio 0.42: 95% CI 0.22–0.80: p = 0.009) (32).
Two Useful Umbilical Biomarkers for Therapeutic Hypothermia Decision in Patients with Hypoxic İschemic Encephalopathy with Perinatal Asphyxia: Netrin-1 and Neuron Specific Enolase
Published in Fetal and Pediatric Pathology, 2022
Ufuk Cakir, Burak Ceran, Cuneyt Tayman
The severity assessment of the HIE was performed according to Sarnat and Sarnat score [14]. Moderate-to-severe (II-III) HIE, and decision for moderate whole-body cooling were considered according to the clinical and laboratory criteria: (i) at least one of these: the need for ventilation that continues up to 10 min after birth; 5 min Apgar score ≤ 5; pH < 7.0 or base excess (BE)≤ −16 mmol/L within first 1 h after birth, and (ii) altered level of consciousness, as well as at least one of the findings: abnormal reflexes, hypotonia or seizures. The moderate therapeutic hypothermia protocol was applied to all patients with HIE stage II/III in line with the recommendations of the “Total Body Hypothermia for Perinatal Asphyxia (TOBY)” study group [15]. Amplitude-integrated electroencephalography (aEEG) data were recorded by using an Olympic CFM 6000 (Natus, Seattle, WA) device, and severe abnormal traces were recorded.
Foetal amplitude-integrated electroencephalography: proof of principle of a novel foetal monitoring technique in adult volunteers
Published in Journal of Obstetrics and Gynaecology, 2022
S. Mires, R. S. Kerr, M. Denbow, N. Dahnoun, S. Tancock, D. Osredkar, E. Chakkarapani
Amplitude-integrated electroencephalography (aEEG) is a means of assessing brain function, providing prognostic evidence for morbidity and mortality in neonates. Its role is well established in the neurological assessment of neonates, particularly those at risk of developing encephalopathy secondary to intrapartum hypoxia. Neonatal Intensive Care Units (NICUs) incorporate its use into selecting infants with encephalopathy for therapeutic cooling and identifying neonatal seizures (Toet and Lemmers 2009). Therapeutic hypothermia or ‘cooling’ is the current standard treatment for hypoxic perinatal brain injury, significantly reducing morbidity and mortality. However, death or severe neurodevelopmental disability is still evident in up to one-third of cooled infants with impact on cognitive skills by early school age (National Institute for Health and Care Excellence 2010; Liu et al. 2017; Lee-Kelland et al. 2020).
Changes in amplitude-integrated electroencephalography, neuron-specific enolase, and S100B in neonates with brain injury induced by neonatal hyperbilirubinemia and their significance
Published in Brain Injury, 2021
Xiangjun Cui, Bin Zhou, Jiebin Wu, Dong Yang, Xiao Liu, Yun Wang
Amplitude-integrated electroencephalography (aEEG) is a simplified single-channel EEG monitoring technique. With the characteristics of user-friendly operation and good performance in evaluating neurological function, aEEG can be used to determine the severity of brain injury (8). Currently, it is widely used in the clinical evaluation of neurodevelopment and prognosis of neonates with hypoxic-ischemic encephalopathy. Ruth et al. (9) have pointed out that for children with hypoxic-ischemic encephalopathy who have not received hypothermia therapy within 72 hours of birth, the results of their aEEG are highly efficient in predicting prognosis. Neuron-specific enolase (NSE) mainly originates from neurons in brain tissue. It is released in large quantities when brain tissue is damaged, so it is a common biomarker of brain injury (10). S100B protein is derived from the glial cells of brain tissue. S100B protein at a certain concentration can enhance the proliferation of hippocampus cells, differentiation of nerve cells, and recovery of cognition but will intensify the inflammatory reaction and death of nerve cells when its concentration is increased (11,12). Currently, NSE and S100B have been adopted clinically to evaluate the severity and prognosis of brain injury including traumatic brain injury and hypoxic-ischemic encephalopathy (10,13,14); however, there is little research on the role of NSE, S100B, and aEEG in brain injury induced by NHB.