A combined a-EEG and MR spectroscopy study in term newborns with hypoxic–ischemic encephalopathy

Ancora, Gina; Soffritti, Silvia; Lodi, Raffaele; Tonon, Caterina; Grandi, Sara; Locatelli, Chiara; Nardi, Laura; Bisacchi, Nicoletta; Testa, Claudia; Tani, Giovanni; Ambrosetto, Paolo; Faldella, Giacomo

doi:10.1016/j.braindev.2009.11.008

Cited by 33 publications

(21 citation statements)

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“…There was a consistent predominance of male cases across NE birth cohorts in different regions and mortality levels (pooled proportion adjusted for population sex ratio at birth, 58.7% males (55.6–61.8%)) ( Supplementary Information online). The adjusted proportion of male cases ranged from 48.5% in the Democratic Republic of Congo (57) to 70.6% in Italy (58). The NE sex risk ratios were adjusted for the live birth sex ratio for the year of the study, then pooled by random-effects meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Study name = country and median year of study. Citations: Australia (1989) (115), Australia (1995) (67), Australia (1996) (116), Canada (1993) (31), France (2000) (117,118), Ireland (2004) (118), Italy (1998) (119), Italy (2001) (120), Italy (2004) (58), Italy (2005) (121), Multi-country (2001) (122), Multi-country (2004) (105), Multi-country (2004) (107), Netherlands (1995) (123), Netherlands (1998) (124), Netherlands (2001) (125), New Zealand (1998) (126), New Zealand (1998) (127), Singapore (1994) (128), Sweden (1985) (59), Sweden (1988) (53), Switzerland (1981) (129), Switzerland (1994) (130), United Kingdom (1994) (51), United Kingdom (1997) (131), United Kingdom (2004) (106), United States (1997) (132), United States (1999) (133), United States (2002) (134). …”

Section: Figurementioning

confidence: 99%

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Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990

et al. 2013

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Background:Intrapartum hypoxic events (“birth asphyxia”) may result in stillbirth, neonatal or postneonatal mortality, and impairment. Systematic morbidity estimates for the burden of impairment outcomes are currently limited. Neonatal encephalopathy (NE) following an intrapartum hypoxic event is a strong predictor of long-term impairment.Methods:Linear regression modeling was conducted on data identified through systematic reviews to estimate NE incidence and time trends for 184 countries. Meta-analyses were undertaken to estimate the risk of NE by sex of the newborn, neonatal case fatality rate, and impairment risk. A compartmental model estimated postneonatal survivors of NE, depending on access to care, and then the proportion of survivors with impairment. Separate modeling for the Global Burden of Disease 2010 (GBD2010) study estimated disability adjusted life years (DALYs), years of life with disability (YLDs), and years of life lost (YLLs) attributed to intrapartum-related events.Results:In 2010, 1.15 million babies (uncertainty range: 0.89–1.60 million; 8.5 cases per 1,000 live births) were estimated to have developed NE associated with intrapartum events, with 96% born in low- and middle-income countries, as compared with 1.60 million in 1990 (11.7 cases per 1,000 live births). An estimated 287,000 (181,000–440,000) neonates with NE died in 2010; 233,000 (163,000–342,000) survived with moderate or severe neurodevelopmental impairment; and 181,000 (82,000–319,000) had mild impairment. In GBD2010, intrapartum-related conditions comprised 50.2 million DALYs (2.4% of total) and 6.1 million YLDs.Conclusion:Intrapartum-related conditions are a large global burden, mostly due to high mortality in low-income countries. Universal coverage of obstetric care and neonatal resuscitation would prevent most of these deaths and disabilities. Rates of impairment are highest in middle-income countries where neonatal intensive care was more recently introduced, but quality may be poor. In settings without neonatal intensive care, the impairment rate is low due to high mortality, which is relevant for the scale-up of basic neonatal resuscitation.

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Section: Resultsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990

et al. 2013

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“…Th e importance of inositol in development of the nervous system is underscored also by Kok et al (2003) in a study that shows that in fetuses presenting with hydrocephaly, the inositol values are far below normal. Currently, using nuclear magnetic resonance spectroscopy (Ancora et al 2010), myo-inositol is being investigated as a potential biomarker for hypoxia ischaemic encephalopathy in infants, as well as its role in other central nervous system and psychiatric disorders (Machado-Vieira et al 2011;Wang et al 2009). …”

Section: It Can Be Hypothesized That the Reduced Production Of Fetal mentioning

confidence: 99%

Myoinositol: A new marker of intrauterine growth restriction?

Dessì

Fanos

2013

Journal of Obstetrics and Gynaecology

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Inositol is a cyclic sugar alcohol which occurs naturally in a variety of stereoisomers, the most common of which is myo-inositol. Inositol phosphoglycan molecules have been isolated from mammalian tissues and are a major component of the intracellular mediators of insulin action. The fetus with intrauterine growth retardation (IUGR) activates a series of adaptive mechanisms to increase the chances for survival, such as a saving of glucose to ensure nutrition of the vital organs, with a consequent reduction in insulin secretion. It can be hypothesized that the reduced production of fetal insulin leads to an excretion of inositol from the intracellular to the extracellular compartment, with a consequent increase of the metabolite in plasma and urine and a decrease inside the cells. Recently, reports suggesting that the increase in extracellular myo-inositol may be a valid marker of an altered glucose metabolism during fetal development in IUGR have been published.

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“…To evaluate the predictive value of an abnormal aEEG in infants not treated with hypothermia thirteen studies including 671 patients were included [12,15–17,21,23–28,31,34]. Seven studies including 360 patients assessed the predictive value of an abnormal aEEG in patients treated with hypothermia [17,29–34].…”

Section: Resultsmentioning

confidence: 99%

Amplitude Integrated Electroencephalogram as a Prognostic Tool in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review

et al. 2016

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IntroductionPerinatal management and prognostic value of clinical evaluation and diagnostic tools have changed with the generalization of therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy (HIE)Aimto ascertain the prognostic value of amplitude integrated electroencephalogram (aEEG) in neonates with HIE considering hours of life and treatment with TH.MethodsA systematic review was performed. Inclusion criteria were studies including data of neonates with HIE, treated or not with TH, monitored with aEEG and with neurodevelopmental follow-up of at least 12 months. The period of bibliographic search was until February 2016. No language restrictions were initially applied. Consulted databases were MEDLINE, Scopus, CINHAL and the Spanish language databases GuiaSalud and Bravo. Article selection was performed by two independent reviewers. Quality for each individual paper selected was evaluated using QUADAS-2. Review Manager (RevMan) version 5.3 software was used. Forest plots were constructed to graphically show sensitivity and specificity for all included studies, separating patients treated or not with hypothermia. Summary statistics were estimated using bivariate models and random effects approaches with the R package MADA from summary ROC curves. Meta-regression was used to estimate heterogeneity and trends.Resultsfrom the 403 articles initially identified, 17 were finally included and critically reviewed. In infants not treated with hypothermia the maximum reliability of an abnormal aEEG background to predict death or moderate/severe disability was at 36 hours of life, when a positive post-test probability of 97.90% was achieved (95%CI 88.40 to 99.40%). Positive likelihood ratio (+LR) at these hours of life was 26.60 (95%CI 4.40 to 94.90) and negative likelihood ratio (-LR) was 0.23 (95%CI 0.10 to 0.44). A high predictive value was already present at 6 hours of life in this group of patients, with a positive post-test probability of 88.20% (95%CI 79.80 to 93%) and a +LR of 4.34 (95%CI 2.31 to 7.73). In patients treated with TH the maximum predictive eliability was achieved at 72 hours of life (post-test probability of 95.70%, 95%CI 84.40 to 98.50%). +LR at this age was 24.30 (95%CI 5.89 to 71.30) and–LR was 0.40 (95%CI 0.25 to 0.57). Predictive value of aEEG at 6 hours of life was low in these patients (59.10%, 95%CI 55.70 to 63%).ConclusionThis study confirms that aEEG´s background activity, as recorded during the first 72 hours after birth, has a strong predictive value in infants with HIE treated or not with TH. Predictive values of traces throughout the following 72 hours are a helpful guide when considering and counselling parents about the foreseeable long-term neurological outcome

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A combined a-EEG and MR spectroscopy study in term newborns with hypoxic–ischemic encephalopathy

Cited by 33 publications

References 28 publications

Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990

Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990

Myoinositol: A new marker of intrauterine growth restriction?

Amplitude Integrated Electroencephalogram as a Prognostic Tool in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review

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