Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Krishnan, Vaisakh; Kumar, Vijay; Variane, Gabriel Fernando Todeschi; Carlo, Waldemar A.; Bhutta, Zulfiqar Ahmed; Sizonenko, Stéphane; Hansen, Anne; Shankaran, Seetha; Thayyil, Sudhin

doi:10.1016/j.siny.2021.101271

Cited by 24 publications

(15 citation statements)

References 76 publications

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“…Because intrauterine hypoxia is the most common final pathway leading to preterm neonatal death, prevention and treatment of this condition should be a major focus of efforts to reduce preterm neonatal mortality. 26 Improvements in both obstetric care and neonatal resuscitation will probably be required to reduce mortality from this condition. 27 …”

Section: Discussionmentioning

confidence: 99%

The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study

Kusagur

Reza

Goudar

et al. 2022

The Lancet Global Health

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Section: Discussionmentioning

confidence: 99%

The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study

Kusagur

Reza

Goudar

et al. 2022

The Lancet Global Health

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“…Centralized systems can reach a large number of centers in real-time, with educational activities, consultation, and monitoring to leverage the quality of care. After proving the value of aEEG monitoring in a LMIC [24], such a system has successfully been implemented by Protecting Brains and Saving Futures (PBSF) in over 30 hospitals across all regions of Brazil [48]. Babies are monitored with EEG or aEEG and assisted by a team in a remote monitoring center, with encrypted data of EEG transmitted to a secure cloudbased server.…”

Section: Eeg Monitoring Systems and The Future In Lmicsmentioning

confidence: 99%

Neonatal Seizures—Perspective in Low-and Middle-Income Countries

Vegda

Krishnan

Variane³

et al. 2022

Indian J Pediatr

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Neonatal seizures are the commonest neurological emergency and are associated with poor neurodevelopmental outcome. While they are generally difficult to diagnose and treat, they pose a significant clinical challenge for physicians in low- and middle-income countries (LMIC). They are mostly provoked seizures caused by an acute brain insult such as hypoxic–ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the central nervous system, or acute metabolic disturbances. Early onset epilepsy syndromes are less common. Clinical diagnosis of seizures in the neonatal period are frequently inaccurate, as clinical manifestations are difficult to distinguish from nonseizure behavior. Additionally, a high proportion of seizures are electrographic-only without any clinical manifestations, making diagnosis with EEG or aEEG a necessity. Only focal clonic and focal tonic seizures can be diagnosed clinically with adequate diagnostic certainty. Prompt diagnosis and timely treatment are important, with evidence suggesting that early treatment improves the response to antiseizure medication. The vast majority of published studies are from high-income countries, making extrapolation to LMIC impossible, thus highlighting the urgent need for a better understanding of the etiologies, comorbidities, and drug trials evaluating safety and efficacy in LMIC. In this review paper, the authors present the latest data on etiology, diagnosis, classification, and guidelines for the management of neonates with the emphasis on low-resource settings.

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“…Birth asphyxia leading to HIE affects 1–2 in every 1000 infants in the United Kingdom and far more in low resource countries [ 73 , 74 ]. The consequences for babies severely affected are significant including long-lasting neurological impairments (cerebral palsy, epilepsy) and death.…”

Section: Energy Metabolism Fails In Neonates After Birth Asphyxiamentioning

confidence: 99%

Mitochondrial dynamics in the neonatal brain – a potential target following injury?

Jones

Thornton

2022

Bioscience Reports

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The impact of birth asphyxia and its sequelae, hypoxic–ischaemic (HI) brain injury, is long-lasting and significant, both for the infant and for their family. Treatment options are limited to therapeutic hypothermia, which is not universally successful and is unavailable in low resource settings. The energy deficits that accompany neuronal death following interruption of blood flow to the brain implicate mitochondrial dysfunction. Such HI insults trigger mitochondrial outer membrane permeabilisation leading to release of pro-apoptotic proteins into the cytosol and cell death. More recently, key players in mitochondrial fission and fusion have been identified as targets following HI brain injury. This review aims to provide an introduction to the molecular players and pathways driving mitochondrial dynamics, the regulation of these pathways and how they are altered following HI insult. Finally, we review progress on repurposing or repositioning drugs already approved for other indications, which may target mitochondrial dynamics and provide promising avenues for intervention following brain injury. Such repurposing may provide a mechanism to fast-track, low-cost treatment options to the clinic.

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Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Cited by 24 publications

References 76 publications

The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study

The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study

Neonatal Seizures—Perspective in Low-and Middle-Income Countries

Mitochondrial dynamics in the neonatal brain – a potential target following injury?

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