Delayed Onset of Sleep-Wake Cycling with Favorable Outcome in Hypothermic-Treated Neonates with Encephalopathy

Tamura, Toshiki; Rubens, Elayna; Yap, Vivien; Ross, Gail; Engel, Murray; Perlman, Jeffrey M.

doi:10.1016/j.jpeds.2011.01.006

Cited by 42 publications

(29 citation statements)

References 34 publications

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“…This proposal was based on cumulative findings that ACh concentrations in the hippocampus 29 and the thalamus 30 are higher during REM (rapid eye movement) sleep and wakefulness than during non-REM sleep, suggesting that a state-dependent release of ACh mediates the periodicity of the sleep-wake cycle. A recent study suggesting a correlation between the delayed onset of sleep-wake cycling and a favorable outcome in hypothermic-treated infants with encephalopathy 31 may provide a link between the above proposal and the clinical relevance of neuroplasticity. It could, therefore, be argued that the suppressed production of ACh may cause the delayed onset of waking, resulting in a neuroprotective effect.…”

Section: Discussionmentioning

confidence: 89%

Therapeutic Hypothermia Achieves Neuroprotection via a Decrease in Acetylcholine with a Concurrent Increase in Carnitine in the Neonatal Hypoxia-Ischemia

Tamura

Morikawa

Nakanishi

et al. 2015

J Cereb Blood Flow Metab

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Although therapeutic hypothermia is known to improve neurologic outcomes after perinatal cerebral hypoxia-ischemia, etiology remains unknown. To decipher the mechanisms whereby hypothermia regulates metabolic dynamics in different brain regions, we used a two-step approach: a metabolomics to target metabolic pathways responding to cooling, and a quantitative imaging mass spectrometry to reveal spatial alterations in targeted metabolites in the brain. Seven-day postnatal rats underwent the permanent ligation of the left common carotid artery followed by exposure to 8% O2 for 2.5 hours. The pups were returned to normoxic conditions at either 38°C or 30°C for 3 hours. The brain metabolic states were rapidly fixed using in situ freezing. The profiling of 107 metabolites showed that hypothermia diminishes the carbon biomass related to acetyl moieties, such as pyruvate and acetyl-CoA; conversely, it increases deacetylated metabolites, such as carnitine and choline. Quantitative imaging mass spectrometry demarcated that hypothermia diminishes the acetylcholine contents specifically in hippocampus and amygdala. Such decreases were associated with an inverse increase in carnitine in the same anatomic regions. These findings imply that hypothermia achieves its neuroprotective effects by mediating the cellular acetylation status through a coordinated suppression of acetyl-CoA, which resides in metabolic junctions of glycolysis, amino-acid catabolism, and ketolysis.

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Section: Discussionmentioning

confidence: 89%

Therapeutic Hypothermia Achieves Neuroprotection via a Decrease in Acetylcholine with a Concurrent Increase in Carnitine in the Neonatal Hypoxia-Ischemia

Tamura

Morikawa

Nakanishi

et al. 2015

J Cereb Blood Flow Metab

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“…67 In the setting of hypothermia, the presence of cycling can be delayed up to 120 hours of age, yet have a normal outcome. 68 Conversely, failure to establish cycling by 7 days is uniformly associated with mortality and severe brain injury. ►Table 2 summarizes the prognostic value of aEEG in HIE infants undergoing hypothermia.…”

Section: Amplitude-integrated Electroencephalographymentioning

confidence: 99%

Predictors of Long-Term Neurodevelopmental Outcome of Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia

2020

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Hypoxic-ischemic encephalopathy (HIE) is a manifestation of perinatal asphyxial insult that continues to evolve over days to weeks following the initial injury. Therapeutic hypothermia has demonstrated that a proportion of this secondary brain injury may indeed be preventable. However, therapeutic hypothermia has also altered the prognostic utility of many bedside tools that are commonly used as predictors of long-term neurodevelopmental outcome in HIE. Clinicians are often confronted with uncertainty when assessing the prognosis of infants with HIE. Improved understanding of the implications and limitations of individual investigations may inform clinical decisions and allow for timely intervention. This review summarizes the predictive value of currently available prognostic markers in HIE infants in the therapeutic hypothermia era, including clinical, biochemical, neurophysiological, physiological, and neuroimaging predictors.

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“…Therefore, the presence of SWC on EEG could reflect spared basal ganglia and the absence of SWC may reflect injured basal ganglia. 23 The patients in our study with basal ganglia damage scores of zero on the Barkovich scale (including a patient in the severe group who only had white matter injury) had at least some SWC during the first 96 hours of life. Conversely, patients with the highest score for basal ganglia damage did not show SWC.…”

Section: Discussionmentioning

confidence: 89%

Combined vEEG and Cerebral Oximetry Results to Determine the Severity of Hypoxic–Ischemic Encephalopathy

Pacella

Ghosh

Middlebrook

et al. 2019

Journal of Pediatric Neurology

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The objectives of the study were to evaluate the prognostic utility of bedside monitoring tools for hypoxic–ischemic encephalopathy (HIE) outcome and develop a prognostic predictive model. This retrospective study reviewed neonatal HIE treated with hypothermia between 2013 and 2016. Continuous video electroencephalography (vEEG) recordings scored for background electrocerebral activity, seizure, and sleep–wake cycles, and rSO2 data were stratified by magnetic resonance imaging (MRI) severity. The vEEG and rSO2 were combined in a predictive model. The analysis included 38 patients. The rSO2 was significantly higher in the severe group. vEEG showed early and persistent maximal suppression in the severe group. The predictive correlation of the rSO2 improves when combined with the vEEG.

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Delayed Onset of Sleep-Wake Cycling with Favorable Outcome in Hypothermic-Treated Neonates with Encephalopathy

Cited by 42 publications

References 34 publications

Therapeutic Hypothermia Achieves Neuroprotection via a Decrease in Acetylcholine with a Concurrent Increase in Carnitine in the Neonatal Hypoxia-Ischemia

Therapeutic Hypothermia Achieves Neuroprotection via a Decrease in Acetylcholine with a Concurrent Increase in Carnitine in the Neonatal Hypoxia-Ischemia

Predictors of Long-Term Neurodevelopmental Outcome of Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Combined vEEG and Cerebral Oximetry Results to Determine the Severity of Hypoxic–Ischemic Encephalopathy

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