Journal ArticleDOI
Whole-Body Hypothermia for Neonates With Hypoxic???Ischemic Encephalopathy
Seetha Shankaran,Abbot R. Laptook,Richard A. Ehrenkranz,Jon E. Tyson,Scott A. McDonald,Edward F. Donovan,Avroy A. Fanaroff,W. Kenneth Poole,Linda L. Wright,Rosemary D. Higgins,Neil N. Finer,Waldemar A. Carlo,Shahnaz Duara,William Oh,C. Michael Cotton,David K. Stevenson,Barbara J. Stoll,James A. Lemons,Ronnie Guillet,Alan H. Jobe +19 more
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Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy and causes no increase in major disability among survivors.Abstract:
This randomized, controlled trial had as its goal to determine whether whole-body cooling, begun within 6 hours of birth and continuing for 72 hours, reduces disability and mortality in term infants with moderate or severe encephalopathy. Infants entered into the study had a gestational age of 36 weeks or longer, were admitted with either severe acidosis or perinatal complications, and required resuscitation at birth. They were randomized to usual care or whole-body cooling and were reassessed neurodevelopmentally at age 18 to 22 months. The 102 infants assigned to hypothermia were placed on a blanket precooled to 5°C and the esophageal temperature, measured with a probe, was reduced to 33.5°C. A second blanket then was attached to the cooling system decrease variability in esophageal temperature. A skin probe monitored the temperature of the abdominal-wall skin. At both sites, temperature was monitored continuously and recorded every 15 minutes for 4 hours and then hourly for 8 hours. After 72 hours, the set point of the automatic control on the cooling system was increased by 0.5°C per hour. After 6 hours, the esophageal probe was removed and warming continued until the set point of the warmer reached 36.5°C. The 106 control infants were exposed to an overhead radiant warmer to maintain an abdominal-wall skin temperature of 36.5°C to 37.0°C. The incidence of death or moderate/severe disability was 44% in treated infants and 62% of control infants (risk ratio [RR], 0.72; 95% confidence interval [CI], 0.54-0.95). Approximately one fourth of actively treated infants (24%) and 37% of control infants died (RR, 0.68; 95% CI, 0.44-1.05). No increase in major disability was observed in surviving infants. Cerebral palsy occurred in 19% of the hypothermia group and 30% of control infants (RR, 0.68; 95% CI, 0.38-1.22). These results suggest that whole-body cooling, or hypothermia, is a safe and effective means of limiting mortality and reducing disability in newborn infants with moderate or severe encephalopathy.read more
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Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Mary Ann Peberdy,Clifton W. Callaway,Robert W. Neumar,Romergryko G. Geocadin,Janice L. Zimmerman,Michael W. Donnino,Andrea Gabrielli,Scott M. Silvers,Arno Zaritsky,Raina M. Merchant,Terry L. Vanden Hoek,Steven L. Kronick +11 more
TL;DR: The goal of immediate post-cardiac arrest care is to optimize systemic perfusion, restore metabolic homeostasis, and support organ system function to increase the likelihood of intact neurological survival.
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Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Monica E. Kleinman,Leon Chameides,Stephen M. Schexnayder,Ricardo A. Samson,Mary Fran Hazinski,Dianne L. Atkins,Marc D. Berg,Allan R. de Caen,Ericka L. Fink,Eugene B. Freid,Robert W. Hickey,Bradley S. Marino,Vinay M. Nadkarni,Lester T. Proctor,Faiqa Qureshi,Kennith Sartorelli,Alexis A. Topjian,Elise W. van der Jagt,Arno Zaritsky +18 more
TL;DR: In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause, more often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest.
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.
Jerry P. Nolan,Jasmeet Soar,David Zideman,Dominique Biarent,Leo Bossaert,Charles D. Deakin,Rudolph W. Koster,Jonathan Wyllie,Bernd W. Böttiger +8 more
TL;DR: This book discusses Anaesthesia and Intensive Care Medicine, neonatology and Paediatrics, and any Anasthesiologie und Operative Intensivmedizin, which may apply to these fields.
Journal ArticleDOI
Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Jeffrey M. Perlman,Jonathan Wyllie,John Kattwinkel,Dianne L. Atkins,Jay P. Goldsmith,Ruth Guinsburg,Mary Fran Hazinski,Colin J Morley,Sam Richmond,Wendy M. Simon,Nalini Singhal,Edgardo Szyld,Masanori Tamura,Sithembiso Velaphi +13 more
TL;DR: This work states that Neonatal Resuscitation and Emergency Cardiovascular Care Science With Treatment Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary is the most likely cause of sudden death in newborns aged under six weeks.
Journal ArticleDOI
Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review.
Michael K Mwaniki,Maurine Atieno,Joy E Lawn,Charles R. Newton,Charles R. Newton,Charles R. Newton +5 more
TL;DR: Intrauterine and neonatal insults have a high risk of causing substantial long-term neurological morbidity, and comparable cohort studies in resource-poor regions should be done to properly assess the burden of these conditions, and long- term outcomes, such as chronic disease, and to inform policy and programme investments.
References
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Development and reliability of a system to classify gross motor function in children with cerebral palsy
Robert J. Palisano,Peter Rosenbaum,Stephen D. Walter,Dianne J Russell,Ellen Wood,Barbara Galuppi +5 more
TL;DR: A five‐level classification system analogous to the staging and grading systems used in medicine, which has application for clinical practice, research, teaching, and administration is developed.
Journal ArticleDOI
Small Differences in Intraischemic Brain Temperature Critically Determine the Extent of Ischemic Neuronal Injury
Raul Busto,W. Dalton Dietrich,Mordecai Y.-T. Globus,I. Valdes,Peritz Scheinberg,Myron D. Ginsberg +5 more
TL;DR: Results demonstrate that rectal temperature unreliably reflects brain temperature during ischemia, and that despite severe depletion of brain energy metabolites at all temperatures, small increments of intraischemic brain temperature markedly accentuate histopathological changes following 3-day survival.
Journal ArticleDOI
Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs.
TL;DR: Selective head cooling, maintained throughout the secondary phase of injury, is noninvasive and safe and shows potential for improving neonatal outcome after perinatal asphyxia.
Journal ArticleDOI
Moderate hypothermia in neonatal encephalopathy: efficacy outcomes.
Dorothea J. Eicher,Carol L. Wagner,Lakshmi P. Katikaneni,Thomas C. Hulsey,W. Thomas Bass,David A. Kaufman,Michael J. Horgan,Sheila Languani,Jatinder Bhatia,Lawrence M. Givelichian,Koravangatta Sankaran,Jerome Y. Yager +11 more
TL;DR: Although these results need to be validated in a large clinical trial, this pilot trial provides important data for clinical trial design of hypothermia treatment in neonatal hypoxic-ischemic injury.