Therapeutic hypothermia as a neuroprotective strategy in newborns with perinatal asphyxia—case report

Oliveira, Nayara Rodrigues Gomes de; Teixeira, Gustavo Gonçalves; Fernandes, Kathlen Terezinha Montes Soares; Avelar, Marla Moreira; Medeiros, Maja; Formiga, Cibelle Kayenne Martins Roberto

doi:10.3389/fresc.2023.1132779

Cited by 3 publications

References 22 publications

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Time to death and its predictors among neonates with perinatal asphyxia at a tertiary hospital in southern Ethiopia

Bekele,

Kara,

Kerbo

et al. 2024

Preprint

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Background: Perinatal asphyxia (PNA) remains a leading, yet preventable, cause of neonatal death, disproportionately affecting low-resource settings like Ethiopia. Despite its significance, data on the burden and factors influencing survival among asphyxiated neonates in this region are scarce. This study aims to address this gap by investigating the time to death and its associated predictors in this vulnerable population. Methods: A retrospective cohort study was conducted at Wolaita Sodo University Comprehensive Specialized Hospital's Neonatal Intensive Care Unit (NICU) in southern Ethiopia. Medical records of 404 neonates diagnosed with PNA between January 2019 and December 2023 were reviewed. The study followed these neonates for a total of 2889 person-days to assess their survival outcomes. Kaplan-Meier analysis estimated the median time to death, and a Weibull regression model identified independent predictors of mortality. Results: The findings revealed the incidence density of PNA-related mortality of 30.8 per 1,000 person-days (95% CI: 25.0-37.9). Notably, nearly 72% of deaths occurred within the first critical week of life, with a median survival time of 20 days. The multivariable Weibull regression analysis identified several factors significantly associated with shorter time to death at p 0.05. These are presence of meconium-stained amniotic fluid (MSAF), low fifth-minute Apgar score (less than 7), birth weight greater than 4000gm, low admission oxygen saturation level, treatment with anticonvulsant, the use of Continuous Positive Airway Pressure (CPAP) for oxygen administration, and need for resuscitation with chest compression. Conclusion: This study highlights the significant burden of PNA-related mortality, particularly during the first week of life, in a resource-limited setting. The findings underscore the urgent need for improved PNA management strategies. Furthermore, specific treatment decisions, including the use of anticonvulsants, oxygen therapy methods, and resuscitation techniques, emerged as crucial factors influencing survival outcomes. These results call for further investigation into these specific interventions and potentially revising PNA management protocols to optimize the chances of survival for asphyxiated neonates in low-resource settings like Ethiopia.

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Time to death and its predictors among neonates with perinatal asphyxia at a tertiary hospital in southern Ethiopia

Bekele,

Kara,

Kerbo

et al. 2024

Preprint

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Low Fetal Resistance to Hypoxia as a Cause of Stillbirth and Neonatal Encephalopathy

Shabanov,

Samorodov,

Urakova

et al. 2024

Clin. Exp. Obstet. Gynecol.

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Objective: Low fetal resistance to hypoxia is a factor in stillbirth and neonatal encephalopathy. This review examines fetal movement patterns in response to hypoxia as a predictor of the likelihood of stillbirth. Monitoring the dynamics of fetal movements during maternal apnea could allow the assessment of fetal resistance to hypoxia. The goal of this study is to describe the practical application of this method by doctors and pregnant women. Mechanism: We searched relevant keywords in the international scientific literature databases Scopus and Web of Science, as well as databases for patents granted in China, India, USA, Japan, Germany, Russia and other countries. Devices, drugs and medical technologies that provide diagnosis, modeling, prevention and treatment of intrauterine fetal hypoxia, stillbirth and neonatal encephalopathy were considered. Findings in Brief: During apnea by a pregnant woman in the second half of normal pregnancy, if the maximum duration of fetal immobility exceeds 30 seconds from the onset of breath-holding, then the fetus is considered to show good resistance to hypoxia, thus preserving its health and life during vaginal delivery. On the other hand, excessive fetal movements <10 seconds after the onset of apnea in a pregnant woman indicates low fetal resistance to hypoxia. When fetal resistance to hypoxia is low, there is no alternative to immediate cesarean section for the preservation of fetal life and health. Conclusions: The monitoring of fetal movements during apnea in pregnant women allows real-time assessment of fetal resistance to intrauterine hypoxia. Obtaining timely information on fetal resistance to hypoxia is critical for determining the optimal timing and type of delivery in order to prevent encephalopathy and stillbirth.

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Relationship between Maternal Stress and Neurobehavioral Indicators of Preterm Infants in the Neonatal Intensive Care Unit

Ramos,

Formiga,

Oliveira

et al. 2024

Children

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Background: Preterm birth and prolonged neonatal hospitalization are potential sources of stress for mothers of preterm and low birth weight infants. Aim: To evaluate maternal stress and its association with neurobehavioral indicators of preterm infants during hospitalization in the neonatal intensive care unit. Methods: A cross-sectional study was conducted in a neonatal intensive care unit of a hospital in Goiânia, Brazil. The study included preterm and low birth weight infants of both genders and their mothers. The Parental Stressor Scale: Neonatal Intensive Care Unit and the Neurobehavioral Assessment of the Preterm Infant were respectively applied to mothers and infants in the neonatal intensive care unit. Results: The study involved 165 premature infants and their mothers. The mean age of the mothers was 26.3 years and most had a high school education level (57.6%). Mothers perceived the experience of having an infant in the neonatal intensive care unit as moderately stressful (2.96 ± 0.81). The parental role alteration (4.11 ± 1.03) and sights and sounds (2.15 ± 0.90) subscales exhibited the highest and lowest stress levels, respectively. Significant correlations (rho < −0.3; p < 0.05) were found between maternal stress and neurobehavioral indicators of infants. In the multivariate analysis, low leg tone was a predictor of higher maternal stress. Low tone and limited arm movement were predictors of higher maternal stress in the maternal role item. Conclusions: The experience of having a preterm infant hospitalized was considered moderately stressful for mothers. Maternal stress levels were significantly correlated with low scores on neonatal neurobehavioral indicators.

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Therapeutic hypothermia as a neuroprotective strategy in newborns with perinatal asphyxia—case report

Cited by 3 publications

References 22 publications

Time to death and its predictors among neonates with perinatal asphyxia at a tertiary hospital in southern Ethiopia

Time to death and its predictors among neonates with perinatal asphyxia at a tertiary hospital in southern Ethiopia

Low Fetal Resistance to Hypoxia as a Cause of Stillbirth and Neonatal Encephalopathy

Relationship between Maternal Stress and Neurobehavioral Indicators of Preterm Infants in the Neonatal Intensive Care Unit

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