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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Neonatal encephalopathy is defined as a pathologic neurobehavioral state with altered level of consciousness and other signs of neurologic and motor dysfunction. It is caused by many conditions, both transitory (e.g. hypoglycemia, maternal drugs) and permanent (e.g. hypoxic-ischemic encephalopathy, neonatal stroke), which may result in a permanent neurologic impairment [14, 15].
The neonate
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
Neonatal encephalopathy is a clinical condition suggesting that brain injury has occurred. There is a broad differential diagnosis. Neonatal encephalopathy is often, but not always, associated with events during and after labour. Thus the neonatal approach is to evaluate with an open mind about the diagnosis and assess the baby systematically before making a diagnosis and offering a prognosis. It may take 1 week or more to come to a conclusion. In the meantime, the baby is treated aggressively for a number of conditions.
Fetal compromise in the first stage of labour
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Neonatal behaviour and early-onset medical complications also provide some prognostic information. Neonatal encephalopathy refers to disturbed neurological function in the first week of life. Signs include difficulty maintaining respiration, depressed tone and reflexes, altered level of consciousness and seizures. Moderate to severe neonatal encephalopathy will be seen in most cases of brain damage secondary to intrapartum complications. However, neonatal encephalopathy has poor sensitivity with 75 percent of cases having no clinical signs of intrapartum hypoxia.
Can we delineate brain injury in full-term neonates using serum biomarkers?
Published in Brain Injury, 2021
Nikolaos Efstathiou, Aristidis Slavakis, Vasiliki Drossou, Katerina Kantziou, Vasiliki Dermetzoglou, Vasiliki Soubasi
Brain injury has always been a great challenge for clinicians, regarding both therapeutic approach and long-term outcome. Neonatal Encephalopathy (NE) is associated with substantial morbidity and mortality. Therefore, early identification of neonates at risk and early application of neuroprotective strategies are of great clinical importance. Moreover, a better understanding of underlying pathophysiology, especially regarding the timing of brain injury, would be important. Τhe challenge is even bigger considering the numerous factors that hamper clinical judgment and decision-making in the first hours of life. Specifically, clinical evaluation in critically ill neonates immediately after birth is subjective and may change over time (1). Additionally, magnetic resonance imaging (MRI) has practical difficulties and limited sensitivity during the first 24 hours of life (2,3), time in which critical therapeutic decisions must be made. Moreover, multiple studies report that clinical scoring and electrophysiological evaluation in neonates undergoing therapeutic hypothermia are poor predictors of the outcome (2,4). All the above factors accentuate the urgency of new diagnostic, monitoring and prognostic strategies to help the bedside clinician.
Cooling therapy for the management of hypoxic-ischaemic encephalopathy in middle-income countries: we can, but should we?
Published in Paediatrics and International Child Health, 2019
Ironically, the safety and efficacy of cooling therapy in low- and middle-income countries (LMIC) which shoulder 99% of the encephalopathy disease burden remains unclear [7]. Cooling therapy should not be considered in settings without basic facilities for neonatal care. In a pilot randomised controlled trial involving 36 infants with neonatal encephalopathy admitted to the neonatal unit in Mulago Hospital, Kampala, Uganda, Robertson and colleagues reported five times higher mortality (risk ratio 5, 95% confidence interval 0.7–37) in the cooled infants [8]. The Mulago neonatal unit lacked basic neonatal care and there were no facilities for respiratory support. However, many neonatal units in middle-income countries (MIC) including India and South Africa do have adequate facilities for neonatal intensive care. These centres can easily provide cooling therapy if they wish to do so.
Attention and visuo-spatial function in children without cerebral palsy who were cooled for neonatal encephalopathy: a case-control study
Published in Brain Injury, 2019
James Tonks, Grace Cloke, Richard Lee-Kelland, Sally Jary, Marianne Thoresen, Frances M Cowan, Ela Chakkarapani
A study of estimated incidence rates indicates that neonatal encephalopathy (NE) secondary to intrapartum events affected as many as 1.15 million babies worldwide during 2010 (1). In the UK, the incidence (95% confidence intervals) of NE secondary to perinatal asphyxia per 1000 live births in 2015 was 2.6 (2.5 to 2.8) (2). Without any neuroprotective treatment, nearly 36% of these infants develop cerebral palsy by 6-to-7 years (3). Children with NE are at an increased risk of developing motor, cognitive and visuo-spatial, sensorimotor, attention and executive impairments (4). Clinical trials have shown that moderate cooling following NE, (reducing the core temperature to 33–34°C within 6 hours of birth for three days – termed therapeutic hypothermia (TH)) reduces death and disability at 18 months (5), the incidence and severity of cerebral palsy (CP) (6) and furthermore, survival with an IQ>85 is increased (3). TH is now the standard care for infants with NE (7).