Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy

Azzopardi, D; Strohm, Brenda; Edwards, A. David; Dyet, Leigh; Halliday, Henry L.; Juszczak, Edmund; Kapellou, Olga; Levene, Malcolm I.; Marlow, Neil; Porter, E; Thoresen, Marianne; Whitelaw, Andrew; Brocklehurst, Peter

doi:10.1056/nejmoa0900854

Cited by 1,542 publications

(1,313 citation statements)

References 24 publications

Supporting

Mentioning

1,198

Contrasting

Unclassified

Order By: Relevance

“…On each ROI, the mean value of the resistivity and its standard deviation Effect of Therapeutic Hypothermia (for Hypoxo Ischemic Encephalopathy) and Rewarming on the Cerebral Resistivity As a clinical illustration of the capability of resistivity maps to give easily readable clinical information on the resistivity of the vascular network, serial examinations have been performed on a full-term infant subjected to therapeutic hypothermia after neonatal hypoxo ischemic encephalopathy. 27,28 The patient was maintained under mild whole-body hypothermia (33.51C) from 6 hours of life and for 72 hours. When the period of cooling concluded, rewarming was cautiously conducted and the servocontrolled rectal temperature was allowed to rise by no more than 0.51C per hour, to a maximum of 36.5±0.21C.…”

Section: Quantitative Data Mapping With Ultrafast Doppler Imagingmentioning

confidence: 99%

Ultrafast Doppler Reveals the Mapping of Cerebral Vascular Resistivity in Neonates

Demené

Pernot

Biran

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

In vivo mapping of the full vasculature dynamics based on Ultrafast Doppler is showed noninvasively in the challenging case of the neonatal brain. Contrary to conventional pulsed-wave (PW) Doppler Ultrasound limited for 440 years to the estimation of vascular indices at a single location, the ultrafast frame rate (5,000 Hz) obtained using plane-wave transmissions leads to simultaneous estimation of full Doppler spectra in all pixels of wide field-of-view images within a single cardiac cycle and high sensitivity Doppler imaging. Consequently, 2D quantitative maps of the cerebro-vascular resistivity index (RI) are processed and found in agreement with local measurements obtained on large arteries of healthy neonates using conventional PW Doppler. Changes in 2D resistivity maps are monitored during recovery after therapeutic whole-body cooling of full-term neonates treated for hypoxic ischemic encephalopathy. Arterial and venous vessels are unambiguously differentiated on the basis of their distinct hemodynamics. The high spatial (250 Â 250 mm 2 ) and temporal resolution (o1 ms) of Ultrafast Doppler imaging combined with deep tissue penetration enable precise quantitative mapping of deep brain vascular dynamics and RI, which is far beyond the capabilities of any other imaging modality.

show abstract

Section: Quantitative Data Mapping With Ultrafast Doppler Imagingmentioning

confidence: 99%

Ultrafast Doppler Reveals the Mapping of Cerebral Vascular Resistivity in Neonates

Demené

Pernot

Biran

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…Rapid initiation of therapeutic hypothermia is optimal since earlier initiation results in better outcomes. 10,11 Cooling on transport is feasible and safe, and results in quicker time to therapeutic temperature than when initiated at the referral center. 12 Although therapeutic hypothermia has significantly improved outcomes among neonates with HIE, the neuroprotective effect is incomplete, with death and severe disability rates at approximately 50% among those who received treatment in the clinical trials.…”

Section: Resuscitation and Supportive Carementioning

confidence: 99%

Interdisciplinary Approach to Neurocritical Care in the Intensive Care Nursery

Glass

Rogers

Peloquin

et al. 2014

Seminars in Pediatric Neurology

View full text Add to dashboard Cite

Neurocritical care is a multidisciplinary subspecialty that combines expertise in critical care medicine, neurology, and neurosurgery, and has led to improved outcomes in adults who have critical illnesses. Advances in resuscitation and critical care have led to high rates of survival among neonates with life-threatening conditions such as perinatal asphyxia, extreme prematurity, and congenital malformations. The sequelae of neurologic conditions arising in the neonatal period include lifelong disabilities such as cerebral palsy and epilepsy, as well as intellectual and behavioral disabilities. Centers of excellence have adapted the principles of neurocritical care to reflect the needs of the developing newborn brain, including early involvement of a neurologist for recognition and treatment of neurologic conditions, attention to physiology to help prevent secondary brain injury, a protocol-driven approach for common conditions like seizures and hypoxic-ischemic encephalopathy, and education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function and development. Semin Pediatr Neurol 21:241-247 C 2014 Published by Elsevier Inc.

show abstract

“…Finally, in the 1990s laboratory studies demonstrated the benefit of mild hypothermia in dogs after cardiac arrest [14]. In the last decade, pivotal randomized clinical trials have provided direct evidence of a benefit of mild hypothermia to improve neurological outcome after cardiac arrest and perinatal asphyxia [1,2,[4][5][6][7].…”

Section: Historical Aspectsmentioning

confidence: 99%

“…Until the last decade, management of a newborn with HIE had consisted largely of supportive care. In the last 6 years, 3 large, randomized, placebo-controlled trials have shown that TH initiated within 6 h of birth reduces death and disability in these infants [5][6][7].…”

Section: Perinatal Asphyxiamentioning

confidence: 99%

“…Experts favor the following definitions: mild hypothermia (T c 34°C to 35.9°C), moderate hypothermia (T c 32°C to 33.9°C), moderate-deep hypothermia (T c 30°C to 31.9°C), and deep hypothermia (T c <30°C) [3]. Despite the lack of consensus in terminology, previous studies demonstrated that body temperature does not need to be less than 32°C to achieve neuroprotection [1,2,[4][5][6][7]. In fact, induced hypothermia to temperatures below 32°C has been associated with significant side effects, such as refractory cardiac arrhythmias and coagulopathies that can be very difficult to manage [8,9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic Hypothermia for Acute Neurological Injuries

2012

View full text Add to dashboard Cite

Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

show abstract

Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy

Abstract: Induction of moderate hypothermia for 72 hours in infants who had perinatal asphyxia did not significantly reduce the combined rate of death or severe disability but resulted in improved neurologic outcomes in survivors. (Current Controlled Trials number, ISRCTN89547571.)

Cited by 1,542 publications

References 24 publications

Ultrafast Doppler Reveals the Mapping of Cerebral Vascular Resistivity in Neonates

Ultrafast Doppler Reveals the Mapping of Cerebral Vascular Resistivity in Neonates

Interdisciplinary Approach to Neurocritical Care in the Intensive Care Nursery

Therapeutic Hypothermia for Acute Neurological Injuries

Contact Info

Product

Resources

About