Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis

Hakobyan, Mariam; Dijkman, Koen P.; Laroche, Sabrina; Naulaers, Gunnar; Rijken, Monique; Steiner, Katerina; Straaten, H.L.M. van; Swarte, Renate; Horst, Hendrik J. ter; Zecic, Alexandra; Zonnenberg, Inge A.; Groenendaal, Floris

doi:10.1159/000493358

Cited by 45 publications

(47 citation statements)

References 29 publications

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“…A single-center study reported that TH was not neuroprotective in asphyxiated newborns with proven bacterial chorioamnionitis, despite antibiotic treatment (Wintermark et al, 2010). Recently, a retrospective analysis from the Netherlands and Belgium reported that outcome in newborns with perinatal asphyxia and proven culture-positive sepsis did not significantly differ from outcome of infants with perinatal asphyxia without sepsis (Hakobyan et al, 2018). However, the number of infants with culture-positive sepsis involved in both studies was very low.…”

Section: Discussionmentioning

confidence: 99%

Early Pro-inflammatory Microglia Activation After Inflammation-Sensitized Hypoxic-Ischemic Brain Injury in Neonatal Rats

Serdar

Kempe

Rizazad

et al. 2019

Front. Cell. Neurosci.

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Background: Perinatal asphyxia, leading to neonatal encephalopathy, is one of the leading causes for child mortality and long-term morbidities. Neonatal encephalopathy rates are significantly increased in newborns with perinatal infection. Therapeutic hypothermia is only neuroprotective in 50% of cooled asphyxiated newborns. As shown experimentally, cooling has failed to be neuroprotective after inflammation-sensitized hypoxic ischemic (HI) brain injury. Microglia are thought to be key players after inflammation-sensitized HI brain injury. We performed this study investigating early microglia phenotype polarization in our newborn animal model of inflammation-sensitized HI brain injury, better understanding the underlying pathophysiological processes. Methods: Seven days old Wistar rat pups were injected with either vehicle (NaCl 0.9%) or E. coli lipopolysaccharide (LPS), followed by left carotid ligation combined with global hypoxia inducing a mild unilateral hypoxic-ischemic injury. Pups were randomized to (1) Sham group ( n = 41), (2) LPS only group ( n = 37), (3) Veh/HI group ( n = 56), and (4) LPS/HI group ( n = 79). On postnatal days 8 and 14 gene-expression analysis or immunohistochemistry was performed describing early microglia polarization in our model. Results: We confirmed that LPS pre-sensitization significantly increases brain area loss and induced microglia activation and neuronal injury after mild hypoxia-ischemia. Additionally, we show that microglia upregulate pro-inflammatory genes involving NLRP-3 inflammasome gene expression 24 h after inflammation-sensitized hypoxic-ischemic brain injury. Conclusion: These results demonstrate that microglia are early key mediators of the inflammatory response following inflammation-sensitized HI brain injury and that they polarize into a predominant pro-inflammatory phenotype 24 h post HI. This may lead to new treatment options altering microglia phenotype polarization early after HI brain injury.

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Section: Discussionmentioning

confidence: 99%

Early Pro-inflammatory Microglia Activation After Inflammation-Sensitized Hypoxic-Ischemic Brain Injury in Neonatal Rats

Serdar

Kempe

Rizazad

et al. 2019

Front. Cell. Neurosci.

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“…Medical files were reviewed for demographics. Some data of these infants have been published in previous studies [11][12][13][14][15][16]. The severity of NE was assessed by analysis of the aEEG background patterns in the hour before start of hypothermia and clinical grading tools documented in the electronic health care system, and a comparison was made between infants treated from February 2008 until October 2012 (period 1) and those treated from November 2012 until July 2017 (period 2).…”

Section: Data Collectionmentioning

confidence: 99%

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

et al. 2020

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Introduction: Adverse outcomes have been reported in infants with mild neonatal encephalopathy (NE). Increasing clinical experience with the application of therapeutic hypothermia (TH) may have resulted in the treatment of newborns with milder NE during recent years. Objective: To determine whether infants treated with TH in the initial years following implementation had a higher degree of NE than infants treated during subsequent years. Methods: Infants with NE treated with TH from February 2008 until July 2017 were included. Thompson and Sarnat scores, amplitude-integrated electroencephalography (aEEG) background patterns before the start of TH, and neurodevelopmental outcome at 2 years were compared between infants treated from February 2008 until October 2012 (period 1) and infants treated from November 2012 until July 2017 (period 2). Results: 211 newborns with NE were treated with TH (period 1: n = 109, period 2: n = 102). Sarnat scores in period 1 and 2 were mild in 7.3 vs. 28.4%, moderate in 66.1 vs. 44.1%, and severe in 26.6 vs. 22.5%, respectively (p = 0.008). Thompson scores were lower in period 2 (median = 9, IQR 7–12) than in period 1 (median = 10, IQR 8.5–13.5, p = 0.018). The aEEGs and neurodevelopmental outcomes were comparable between the periods. Conclusions: Based on Thompson and Sarnat scores, but not aEEG background patterns, infants treated during the second period had milder NE than infants treated during the first years following implementation of TH. There was no difference in 2 years neurodevelopmental outcome. Further research is necessary to evaluate the value of TH for infants with clinically mild NE.

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“…Anaerobic glycolysis and lactic acidosis will ensue. Neonatal hypoxic ischemic encephalopathy refers to the neurologic sequelae of perinatal asphyxia [2,3].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Associated Factors of Perinatal Asphyxia in Neonates Admitted to Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Cross-Sectional Study

Gebregziabher

Hadgu

Abebe

2020

International Journal of Pediatrics

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Background. Perinatal asphyxia is defined as the inability of the newborn to initiate and sustain enough respiration after delivery and is characterized by a marked impairment of gas exchange. It is one of the most common causes of neonatal mortality and morbidity. There are very few studies on perinatal asphyxia in Tigray, and so this study is aimed at assessing the prevalence and associated factors of perinatal asphyxia in Ayder Comprehensive Specialized Hospital NICU, Tigray, Ethiopia. Methods. An institution-based cross-sectional study design was conducted among neonates admitted to Ayder Comprehensive Specialized Hospital from January 1, 2016, to December 30, 2017. Medical records of 267 neonates admitted to the neonatal intensive care unit were selected by a systematic sampling method, and relevant information was collected using a checklist. The data was analyzed using SPSS version 20. Descriptive statistics were computed to determine the prevalence of birth asphyxia and sociodemographic and obstetrics data. Binary logistic regression was used to test associations between the associated factors and perinatal asphyxia. First bivariate analysis was performed to assess the association without controlling the effect of other independent variables. Variables with P value < 0.25 were fitted to the multivariable binary logistic regression model. Finally, variables with P value < 0.05 were expressed as associated factors of perinatal asphyxia. Results. Of the 267 neonates, 48 neonates had perinatal asphyxia, giving a prevalence of 18%. Prolonged labor (AOR=5.19, 95% CI: 1.73-15.63, P=0.003), presence of meconium (AOR=4.17, 95% CI: 1.34-12.98, P=0.014), and preeclampsia (AOR=7.94, 95% CI: 2.22-28.37, P=0.001) were important determinant factors for birth asphyxia. The case fatality rate of perinatal asphyxia was 37.5%. Conclusion and Recommendations. Prevalence and mortality of asphyxia were high. Prolonged labor, presence of meconium, and preeclampsia were determinant factors for birth asphyxia. Early detection and intervention of high-risk mothers should be carried out by health care providers, and mothers should be monitored with partograph during labor.

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Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis

Cited by 45 publications

References 29 publications

Early Pro-inflammatory Microglia Activation After Inflammation-Sensitized Hypoxic-Ischemic Brain Injury in Neonatal Rats

Early Pro-inflammatory Microglia Activation After Inflammation-Sensitized Hypoxic-Ischemic Brain Injury in Neonatal Rats

Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia

Prevalence and Associated Factors of Perinatal Asphyxia in Neonates Admitted to Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Cross-Sectional Study

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