Interventions for Perinatal Hypoxic–Ischemic Encephalopathy

Vannucci, Robert C.; Perlman, Jeffrey M.

doi:10.1542/peds.100.6.1004

Cited by 446 publications

(307 citation statements)

References 149 publications

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“…Even when a successful therapy may allow the recovery of the affected patients as a requirement prior to therapy initiation, the hypoxic situation needs to be clearly and efficiently detected. Moreover, the time window between insult and start of therapy appears to be narrow (Vannucci andPerlman 1997, Roelfsema et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Spectroscopy study of the dynamics of the transencephalic electrical impedance in the perinatal brain during hypoxia

Seoane¹,

Lindecrantz²,

Olsson³

et al. 2005

Physiol. Meas.

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Hypoxia/ischaemia is the most common cause of brain damage in neonates. Thousands of newborn children suffer from perinatal asphyxia every year. The cells go through a response mechanism during hypoxia/ischaemia, to maintain the cellular viability and, as a response to the hypoxic/ischaemic insult, the composition and the structure of the cellular environment are altered. The alterations in the ionic concentration of the intra-and extracellular and the consequent cytotoxic oedema, cell swelling, modify the electrical properties of the constituted tissue. The changes produced can be easily measured using electrical impedance instrumentation. In this paper, we report the results from an impedance spectroscopy study on the effects of the hypoxia on the perinatal brain. The transencephalic impedance, both resistance and reactance, was measured in newborn piglets using the four-electrode method in the frequency range from 20 kHz to 750 kHz and the experimental results were compared with numerical results from a simulation of a suspension of cells during cell swelling. The experimental results make clear the frequency dependence of the bioelectrical impedance, confirm that the variation of resistance is more sensitive at low than at high frequencies and show that the reactance changes substantially during hypoxia. The resemblance between the experimental and numerical results proves the validity of modelling tissue as a suspension of cells and confirms the importance of the cellular oedema process in the alterations of the electrical properties of biological tissue. The study of the effects of hypoxia/ischaemia in the bioelectrical properties of tissue may lead to the development of useful clinical tools based on the application of bioelectrical impedance technology.

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Section: Introductionmentioning

confidence: 99%

Spectroscopy study of the dynamics of the transencephalic electrical impedance in the perinatal brain during hypoxia

Seoane¹,

Lindecrantz²,

Olsson³

et al. 2005

Physiol. Meas.

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“…The need for early prediction of outcome is particularly important because of brief therapeutic window and possible side effects of neuroprotective interventions. 8 Based on animal studies and preliminary clinical experience, the therapeutic window in human neonates seems to be within 1 to 6 hours after birth. 9 Thus, it is important to look for useful predictors early in the course of disease, preferably within the first 6 hours after birth.…”

Section: Introductionmentioning

confidence: 99%

Postnatal Lactate as an Early Predictor of Short-Term Outcome after Intrapartum Asphyxia

2003

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OBJECTIVES:To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN:We retrospectively reviewed the records of 61 full-term neonates (Z37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001.The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS:The initial lactate levels were significantly higher (p ¼ 0.001) in neonates with moderate-to-severe HIE (mean±SD ¼ 11.09±4.6) as compared to those with mild or no HIE (mean±SD ¼ 7.1±4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5±mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS:The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.

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“…Multiple therapies that have shown promise in animal models include magnesium, inhibitory glutamate receptor antagonists, nitric oxide inhibitors, calcium channel blockers, platelet-activating factor antagonists, adenosinergic agents, growth factors, monosialoganglioside GM1, minocycline, xenon and erythropoietin. 11,18,[55][56][57][58][59] Despite initial promise shown in animal models, none of these therapies have shown utility in human trials. Whether therapeutic hypothermia functions synergistically with other therapies or provides an opportunity for these or other therapies to work is unknown.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

“…16,17 It is this time during transition from the recovery period into the secondary phase of injury that allows for a potential window for neuroprotection or diminution of injury. 18 This therapeutic window of opportunity exists during the period of time following resuscitation of infants injured by hypoxic-ischemic insults but before the secondary phase of injury.…”

Section: Introductionmentioning

confidence: 99%