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Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
No specific guidelines have been established regarding the optimal duration of maintenance treatment, following neonatal convulsions [47]. Discontinuation of AEDs, after a period of clinical seizure control, should be individualised. Our opinion is that continuation of antiepileptic treatment for more than a few weeks is justified only when there is a high likelihood of recurrent seizures, specifically in cases featuring abnormalities of cortical development [3]. For acute conditions such as haemorrhages, mild or moderate hypoxic-ischemic encephalopathy, and cryptogenic neonatal seizures, there is no need to continue therapy. In cases of severe hypoxic-ischaemic encephalopathy or other forms of acquired brain damage, most authors advise maintenance therapy [2,7,16], although the frequency of later epilepsy is poorly known [49] and the feasibility of preventing later epilepsy is at best uncertain.
Children with feeding difficulties: medical and nursing perspectives
Published in Southall Angela, Feeding Problems in Children, 2017
Essex. Charles, Southall. Angela, Southall. Angela, Woolliscroft. Kim
A baby who has birth asphyxia sufficient to cause brain damage is almost always extremely ill with hypoxic ischaemic encephalopathy; he or she requires neonatal intensive care, ventilation and non-oral feeding, and has seizures. A baby whose oesophagus did not form properly (oesophageal atresia) did not have a functioning oesophagus in utero and therefore is likely to present with feeding problems.
Shoulder dystocia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Short-term complications such as fractures of the humerus or clavicle are not uncommon. However, these heal well and have an excellent prognosis. Transient brachial plexus injury, such as Erb’s palsy, is also relatively common. Fortunately, with early recognition, prompt physiotherapy and even neurosurgical treatment, most improve over time, leaving only 1–2 percent of shoulder dystocia cases with long-term dysfunction. Hypoxic–ischaemic encephalopathy may develop after severe cases and carries a risk of later neurodevelopmental disability. Perinatal mortality secondary to shoulder dystocia was reported in 56 cases in the UK in 1994–95, an incidence of approximately 1 in 25,000 births.2
Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications
Published in Journal of Obstetrics and Gynaecology, 2022
J. D. Kammies, L. De Waard, C. J. B. Muller, D. R. Hall
Two babies were diagnosed with hypoxic ischaemic encephalopathy (HIE). The first was a 30-year-old, BMI 53 kg/m2 and a previous lower segment caesarean section, who presented in spontaneous labour at 40w1d to an ‘extremely busy’ labour ward. The second stage of labour lasted 25 min with no mention of any difficulty. Retrospectively, the quality of the external CTG tracing was poor and signs of foetal hypoxia may have been missed. In the second case, the patient had spontaneous onset of labour but developed an abnormal CTG for which an emergency CS was performed. Thick meconium-stained liquor was noted intra-operatively, with the neonate developing meconium aspiration syndrome and HIE. The fourth neonate with an Apgar score of <7 also developed respiratory distress attributed to transient tachypnoea of the newborn (TTN), which later resolved. The mother presented in spontaneous labour at 41 weeks 0 d but required an emergency CS for cephalopelvic disproportion.
Delayed Withholding: Disguising Withdrawal of Life Sustaining Interventions in Extremely Preterm Infants
Published in The American Journal of Bioethics, 2022
Annie Janvier, Keith J. Barrington
The extremely preterm infant, born before 28 weeks of gestational age, has been the focus of much ethical discussion. These infants have a significant risk of mortality and morbidity, and it is not rare to make life and death decisions for them, with their families. Theoretically, decision-making for these patients should be based on similar considerations as for other fragile critically ill patients facing uncertain futures. But this is not the case. For example, older children with meningococcal septicemic shock and multiple organ failure are a group with survival and long-term outcomes similar to extremely preterm infants (and often worse). In such children, the usual decision-making approach is to institute life-sustaining interventions (LSI), and repeatedly evaluate the evolving situation; in the case of major complications affecting survival or long-term outcomes, then potential withdrawal of LSI will be discussed. Full-term newborn infants presenting with shock due to infection, profound cardiac dysfunction, hypoxic ischemic encephalopathy following birth asphyxia or catastrophic metabolic conditions are also usually treated in the same way.
Circular RNA cZNF292 silence alleviates OGD/R-induced injury through up-regulation of miR-22 in rat neural stem cells (NSCs)
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2020
Yaqin Cao, Hui Liu, Jun Zhang, Yubin Dong
Hypoxic-ischaemic encephalopathy (HIE) may take place before or during childbirth. Neurological injuries associated with HIE will bring serious consequences, such as acute death and long-term disability (like blindness, epilepsy and cerebral palsy) [1]. Despite advances in technology, the incidence of cerebral palsy caused by perinatal hypoxic is still higher than 2 per 11,000 newborns [2]. The exhaustion of brain cell energy production, the reduction of tissue glucose metabolism as well as the occurrence and development of cell damage are closely related to HIE [3,4]. Since the time and reason of brain damage caused by HIE are difficult to determine, there are no signals and methods for the effective treatment of HIE currently. The treatment of HIE is still a momentous clinical problem. Therefore, it is pressing to investigate a novel and effective way for HIE treatment.