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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.
Paediatric orthopaedics
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Cerebral palsy is caused by a non-progressive insult to the developing brain in the perinatal period; in most cases only risk factors, such as prematurity, rather than specific causes, such as hypoxia (HIE, hypoxic ischaemic encephalopathy), can be identified. The effects of cerebral palsy may only become apparent as the child grows and fails to reach expected developmental milestones. At this stage investigations may help with aetiology and may predict the pattern of the cerebral palsy: premature babies may show evidence of periventricular leucomalacia (PVL) on a brain MRI, which is associated with the development of spastic diplegia with relative preservation of intellectual function.
The Clinical Management of Spasticity and Contractures in Cerebral Palsy
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
As obstetric practice has improved over the last 30 years, the spectrum of motor disorders resulting from injury has changed. Difficult delivery resulting in oxygen deprivation and consequent hypoxic ischaemic encephalopathy is now an uncommon event, producing fewer children with total-body cerebral palsy. The management of neonatal jaundice has also led to a reduction in kernicterus that was associated with athetoid1 cerebral palsy and dystonia.2Premature birth leads to a haemorrhagic injury adjacent to the internal capsule as the foetal brain undergoes a rapid reduction in pressure on emerging from the intrauterine environment. Immature cerebral blood vessels are weaker than those at full term and rupture leads to haemorrhage to varying degrees. Severe haemorrhage may be sufficiently extensive to cause bleeding into the ventricles and subsequent clot organisation with obstruction of the cerebral aqueduct, leading to hydrocephalus. Characteristically, the cortico-reticular tracts adjacent to the pyramidal tracts are involved, reducing the inhibitory drive delivered by the reticular system to the cord. Whilst cerebral palsy following premature birth is characterised by spasticity and kernicterus leads to basal ganglia involvement producing athetosis or dystonia, more generalised hypoxic insults produce a mixture of motor disorders as a result of multiple lesions distributed through the hemispheres. Often, hypoxic brain injury will lead to a significant degree of cognitive impairment with learning difficulties during childhood.
MiR-21 participates in the neuroprotection of diazoxide against hypoxic-ischemia encephalopathy by targeting PDCD4
Published in Brain Injury, 2022
Yuxia Chen, Hao Zeng, Huayan Liu
Hypoxic ischemic encephalopathy (HIE) is that cerebral tissue ischemia and hypoxia caused brain damage by various reasons. The most common is neonatal hypoxic ischemic encephalopathy. During the perinatal period, the incidence of hypoxic-ischemic injury is very high, accompanied by a high mortality rate. Hypoxic-ischemic injury can cause permanent damage to newborns, and even life-threatening. Usually surviving newborns suffer from various neurological disorders, such as developmental delay, epilepsy, visual impairment, cerebral palsy and learning disabilities (1,2). At present, therapeutic hypothermia is relatively an effective method for the treatment of neonatal HIE, which is mainly reflected in the reduction of mortality and neurocognitive impairment (3,4). However, there are still almost half of the deaths or permanent disabilities (5), implying that it is extremely important to actively seek other treatments.
Brain abnormalities in infantile esotropia as predictor for consecutive exotropia
Published in Strabismus, 2019
Feyza Calis, Huban Atilla, Pinar Bingol Kiziltunc, Cem Alay
Cerebral MRI findings were consistent with WMDI (three patients) (Figure 1), myelinization delay (one patient), septooptic dysplasia (one patient) and periventricular cysts (one patient) in group 1. Cerebellar hemispheres and vermis hypoplasia (one patient), myelinization delay (one patient), cerebellar atrophy (one patient) were the MRI findings of patients in group 2 (Table 2). Although the incidence of brain lesions had no statistically significance between two groups, type of lesions was different. In group 1, 17.6% of patients had WMDI that was bilateral with a severity of grade 3–4. None of the patients had WMDI in group 2. Associated neurological diseases were cerebral palsy (two patients) and hypoxic ischemic encephalopathy (one patient) in group 1 and hypoxic ischemic encephalopathy (one patient) and mental retardation (one patient) in group 2. These neurological diseases in both groups were diagnosed by the examination of pediatrician or pediatric neurologist subsequently.
Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria
Published in South African Family Practice, 2019
Olusoga Babatunde Ogunfowora, Tinuade Adetutu Ogunlesi, Victor Ayodeji Ayeni
The pattern of neonatal admissions and mortalities had been described earlier; perinatal asphyxia, infections and jaundice played leading roles in neonatal morbidity and mortality in Sagamu.21 Hypoxic-ischaemic encephalopathy is a major complication of perinatal asphyxia, which is associated with remarkable immediate mortality or survival with a variety of neurological deficits.22 Similarly, bilirubin encephalopathy is the most important complication of hyperbilirubinaemia in the newborn, which is associated with mortality or survival with neurological deficits.15 Therefore, acute bilirubin encephalopathy and hypoxic-ischaemic encephalopathy were specifically studied as prototypes of serious neonatal illnesses in this study.