Medicines in neonates
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
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.
Mechanical ventilation and support
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Which of the above is the best ventilator change in the following situations? Each option may be used once, more than once, or not at all. A ventilated term infant with hypoxic ischaemic encephalopathy. Ventilator settings: 18/4 inspiratory time 0.4 seconds, rate 60, flow 8 L/min. Recent blood gas pH 7.5, PCO2 2.5 kPa.A 6-month-old ex-24-week-gestation infant with severe chronic lung disease, ventilated for elective inguinal hernia repair. Ventilatory settings 24/4, flow 8 L/min, in 100% oxygen. The ventilator is alarming ‘not achieving pressure’.A term baby with meconium aspiration syndrome on day 1 of life. Ventilator settings 30/5, rate 60, flow 8 L/min, inspiratory time 0.3 seconds in 100% oxygen. Blood gas acceptable with CO2 of 5.5 but oxygen saturations 82%.A 1-day-old 23 week gestation infant transferred to the local intensive care unit. Ventilator settings 20/4, rate 60, inspiratory time 0.45 seconds, flow 8L/min in 21% oxygen. Blood gas pH 7.19, PCO2 8.5 kPa.
Biological Dimensions of Difference
Christopher J. Nicholls in Neurodevelopmental Disorders in Children and Adolescents, 2018
Should an infant suffer significant troubles breathing during the birth process, a condition might arise in which both reduced blood oxygenation of the brain or reduced perfusion of blood to the brain (or both) can occur, secondary to conditions that affect the cardiac and/or respiratory systems. If disruption of sufficient levels of oxygen circulating in the brain occurs in the presence of reduced blood flow, the term “hypoxic-ischemic encephalopathy” is sometimes used. This condition can be secondary to a wide range of medical conditions, including cardiac arrest, carbon monoxide poisoning, prolonged seizures, and even recurrent obstructive sleep apnea; however, in the newborn child, the use of this term may be reflective of a myriad of problems and is not straightforward (Fatemi, Wilson, & Johnston, 2009). What is important is to recognize that developmental disorders, such as cerebral palsy, may result from medical events surrounding the birth process and that it is important to have asked/considered such factors when taking one’s initial history.
Deep brain stimulation for childhood dystonia: current evidence and emerging practice
Published in Expert Review of Neurotherapeutics, 2018
Lior M. Elkaim, Phillippe De Vloo, Suneil K. Kalia, Andres M. Lozano, George M. Ibrahim
CP encompasses several permanent developmental disorders affecting movement and posture. Affecting roughly 2 of every 1000 children [67], CP is the most common cause of severe early childhood physical disability [68] and the most common indication for DBS in acquired dystonia [17]. The various classifications for CP underline the complexity of the disorder. Some systems classify patients by clinical signs and symptoms; these groups include those with spasticity, ataxia, or dyskinesia (which further divides into dystonic or choreo-athetotic forms) [1]. This section will discuss DBS efficacy on dystonic children and youth with CP, which typically manifests in the entire body, although greater severity is often noted in the upper limbs [68]. Despite its definition as a movement disorder, over half of patients will manifest disturbances of sensation, perception, cognition and communication secondary to comorbid epilepsy, intellectual disability, and musculoskeletal deformity [19]. CP is provoked by non-progressive lesions that occur during fetal or infant brain development. Although CP is by definition non-progressive, the musculoskeletal and neurological sequelae of CP are often progressive in nature. Commonly reported underlying causes include hypoxic ischemic encephalopathy and prematurity, among others [14]. Many pathophysiological mechanisms for CP have been proposed and are discussed elsewhere [69]. Pertaining to DBS, differences in neuronal firing rates [40], abnormal sensory thalamo-cortical pathways [70], and altered plasticity [19] may influence treatment response.
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.
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.