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An N Massaro - One of the best experts on this subject based on the ideXlab platform.
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high dose erythropoietin population pharmacokinetics in neonates with Hypoxic Ischemic Encephalopathy receiving hypothermia
Pediatric Research, 2017Co-Authors: Adam Frymoyer, An N Massaro, Sandra E Juul, Theo K BammlerAbstract:High-dose erythropoietin (Epo) is a promising neuroprotective treatment in neonates with Hypoxic–Ischemic Encephalopathy (HIE) receiving hypothermia. We evaluated the pharmacokinetics and dose–exposure relationships of high-dose Epo in this population to inform future dosing strategies. We performed a population pharmacokinetic analysis of 47 neonates with HIE treated with hypothermia who received up to six doses of Epo in two previous clinical trials. We compared the ability of different dosing regimens to achieve the target neuroprotective Epo exposure levels determined from animal models of Hypoxic–ischemia (i.e., area under the curve during the first 48 h of treatment (AUC48 h) 140,000 mU*h/ml). Birth weight scaled via allometry was a significant predictor of Epo clearance and volume of distribution (P < 0.001). After accounting for birth weight, variation in Epo pharmacokinetics between neonates was low (CV% 20%). All 23 neonates who received 1,000 U/kg every 24 h for the first 2 d of therapy achieved the target AUC48 h 140,000 mU*h/ml. No neonate who received a lower dosing regimen achieved this target. In neonates with HIE receiving hypothermia, Epo 1,000 U/kg every 24 h for the first 2 d of therapy resulted in consistent achievement of target exposures associated with neuroprotection in animal models.
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impaired cerebral autoregulation and brain injury in newborns with Hypoxic Ischemic Encephalopathy treated with hypothermia
Journal of Neurophysiology, 2015Co-Authors: An N Massaro, Rathinaswamy B Govindan, Gilbert Vezina, Taeun Chang, Nickie Andescavage, Yunfei Wang, Tareq Alshargabi, Marina Metzler, Kari Harris, Adre J Du PlessisAbstract:Impaired cerebral autoregulation may contribute to secondary injury in newborns with Hypoxic-Ischemic Encephalopathy (HIE). Continuous, noninvasive assessment of cerebral pressure autoregulation ca...
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short term outcomes after perinatal Hypoxic Ischemic Encephalopathy a report from the children s hospitals neonatal consortium hie focus group
Journal of Perinatology, 2015Co-Authors: An N Massaro, Karna Murthy, Isabella Zaniletti, Noah Cook, Robert Digeronimo, Maria L V Dizon, Shannon E G Hamrick, Victor J Mckay, Girija Natarajan, Rakesh RaoAbstract:Short-term outcomes after perinatal Hypoxic Ischemic Encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group
Jon E Tyson - One of the best experts on this subject based on the ideXlab platform.
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effect of therapeutic hypothermia initiated after 6 hours of age on death or disability among newborns with Hypoxic Ischemic Encephalopathy a randomized clinical trial
JAMA, 2017Co-Authors: Abbot R Laptook, Seetha Shankaran, Jon E Tyson, Breda Munoz, Edward F Bell, Ronald N Goldberg, Nehal A Parikh, Namasivayam Ambalavanan, Claudia Pedroza, Athina PappasAbstract:Importance Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with Hypoxic-Ischemic Encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with Hypoxic-Ischemic Encephalopathy. Design, Setting, and Participants A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe Hypoxic-Ischemic Encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of Encephalopathy and age at randomization. Results Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate Encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance Among term infants with Hypoxic-Ischemic Encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. Trial Registration clinicaltrials.gov Identifier:NCT00614744
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effect of depth and duration of cooling on death or disability at age 18 months among neonates with Hypoxic Ischemic Encephalopathy a randomized clinical trial
Publisher, 2017Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Athina Pappas, Scott A Mcdonald, Abhik Das, Brenda B Poindexter, Kurt Schibler, Edward F BellAbstract:Importance Hypothermia for 72 hours at 33.5°C for neonatal Hypoxic-Ischemic Encephalopathy reduces death or disability, but rates continue to be high. Objective To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with Hypoxic-Ischemic Encephalopathy. Design, Setting, and Participants Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks’ gestation) with Hypoxic-Ischemic Encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. Interventions A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). Main Outcomes and Measures The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of Encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. Results The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, −1.0% [95% CI, −10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, −3.1% [95% CI, −12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed ( P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Conclusions and Relevance Among term neonates with moderate or severe Hypoxic-Ischemic Encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. Trial Registration clinicaltrials.gov Identifier:NCT01192776
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effect of depth and duration of cooling on deaths in the nicu among neonates with Hypoxic Ischemic Encephalopathy a randomized clinical trial
JAMA, 2014Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Edward F Bell, Athina Pappas, Scott A Mcdonald, Abhik Das, Brenda B Poindexter, Kurt Schibler, Roy J HeyneAbstract:Importance Hypothermia at 33.5°C for 72 hours for neonatal Hypoxic Ischemic Encephalopathy reduces death or disability to 44% to 55%; longer cooling and deeper cooling are neuroprotective in animal models. Objective To determine if longer duration cooling (120 hours), deeper cooling (32.0°C), or both are superior to cooling at 33.5°C for 72 hours in neonates who are full-term with moderate or severe Hypoxic Ischemic Encephalopathy. Design, Setting, and Participants A randomized, 2 × 2 factorial design clinical trial performed in 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network between October 2010 and November 2013. Interventions Neonates were assigned to 4 hypothermia groups; 33.5°C for 72 hours, 32.0°C for 72 hours, 33.5°C for 120 hours, and 32.0°C for 120 hours. Main Outcomes and Measures The primary outcome of death or disability at 18 to 22 months is ongoing. The independent data and safety monitoring committee paused the trial to evaluate safety (cardiac arrhythmia, persistent acidosis, major vessel thrombosis and bleeding, and death in the neonatal intensive care unit [NICU]) after the first 50 neonates were enrolled, then after every subsequent 25 neonates. The trial was closed for emerging safety profile and futility analysis after the eighth review with 364 neonates enrolled (of 726 planned). This report focuses on safety and NICU deaths by marginal comparisons of 72 hours’ vs 120 hours’ duration and 33.5°C depth vs 32.0°C depth (predefined secondary outcomes). Results The NICU death rates were 7 of 95 neonates (7%) for the 33.5°C for 72 hours group, 13 of 90 neonates (14%) for the 32.0°C for 72 hours group, 15 of 96 neonates (16%) for the 33.5°C for 120 hours group, and 14 of 83 neonates (17%) for the 32.0°C for 120 hours group. The adjusted risk ratio (RR) for NICU deaths for the 120 hours group vs 72 hours group was 1.37 (95% CI, 0.92-2.04) and for the 32.0°C group vs 33.5°C group was 1.24 (95% CI, 0.69-2.25). Safety outcomes were similar between the 120 hours group vs 72 hours group and the 32.0°C group vs 33.5°C group, except major bleeding occurred among 1% in the 120 hours group vs 3% in the 72 hours group (RR, 0.25 [95% CI, 0.07-0.91]). Futility analysis determined that the probability of detecting a statistically significant benefit for longer cooling, deeper cooling, or both for NICU death was less than 2%. Conclusions and Relevance Among neonates who were full-term with moderate or severe Hypoxic Ischemic Encephalopathy, longer cooling, deeper cooling, or both compared with hypothermia at 33.5°C for 72 hours did not reduce NICU death. These results have implications for patient care and design of future trials. Trial Registration clinicaltrials.gov Identifier:NCT01192776
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phenobarbital and temperature profile during hypothermia for Hypoxic Ischemic Encephalopathy
Journal of Child Neurology, 2012Co-Authors: Guilherme M Santanna, Abbot R Laptook, Seetha Shankaran, Jon E Tyson, Scott A Mcdonald, Rosemary D Higgins, Richard A Ehrenkranz, Abhik Das, Rebecca Bara, Ronald N GoldbergAbstract:Data from the whole-body hypothermia trial was analyzed to examine the effects of phenobarbital administration prior to cooling (+PB) on the esophageal temperature (Te) profile, during the induction phase of hypothermia. A total of 98 infants were analyzed. At enrollment, +PB infants had a higher rate of severe Hypoxic-Ischemic Encephalopathy and clinical seizures and lower Te and cord pH than infants that have not received phenobarbital (–PB). There was a significant effect of phenobarbital itself and an interaction between phenobarbital and time in the Te profile. Mean Te in the +PB group was lower than in the –PB group, and the differences decreased over time. In +PB infants, the time to surpass target Te of 33.5°C and to reach the minimum Te during overshoot were shorter. In conclusion, the administration of phenobarbital before cooling was associated with changes that may reflect a reduced thermogenic response associated with barbiturates.
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temperature profile and outcomes of neonates undergoing whole body hypothermia for neonatal Hypoxic Ischemic Encephalopathy
Pediatric Critical Care Medicine, 2012Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Ronald N Goldberg, Scott A Mcdonald, Rosemary D Higgins, Richard A Ehrenkranz, Abhik Das, Guilherme M Santanna, Rebecca BaraAbstract:BACKGROUND Decreases below target temperature were noted among neonates undergoing cooling in the NICHD Neonatal Research Network Trial of whole body hypothermia for neonatal Hypoxic-Ischemic Encephalopathy.
Seetha Shankaran - One of the best experts on this subject based on the ideXlab platform.
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effect of therapeutic hypothermia initiated after 6 hours of age on death or disability among newborns with Hypoxic Ischemic Encephalopathy a randomized clinical trial
JAMA, 2017Co-Authors: Abbot R Laptook, Seetha Shankaran, Jon E Tyson, Breda Munoz, Edward F Bell, Ronald N Goldberg, Nehal A Parikh, Namasivayam Ambalavanan, Claudia Pedroza, Athina PappasAbstract:Importance Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with Hypoxic-Ischemic Encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with Hypoxic-Ischemic Encephalopathy. Design, Setting, and Participants A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe Hypoxic-Ischemic Encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of Encephalopathy and age at randomization. Results Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate Encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance Among term infants with Hypoxic-Ischemic Encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. Trial Registration clinicaltrials.gov Identifier:NCT00614744
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effect of depth and duration of cooling on death or disability at age 18 months among neonates with Hypoxic Ischemic Encephalopathy a randomized clinical trial
Publisher, 2017Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Athina Pappas, Scott A Mcdonald, Abhik Das, Brenda B Poindexter, Kurt Schibler, Edward F BellAbstract:Importance Hypothermia for 72 hours at 33.5°C for neonatal Hypoxic-Ischemic Encephalopathy reduces death or disability, but rates continue to be high. Objective To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with Hypoxic-Ischemic Encephalopathy. Design, Setting, and Participants Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks’ gestation) with Hypoxic-Ischemic Encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. Interventions A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). Main Outcomes and Measures The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of Encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. Results The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, −1.0% [95% CI, −10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, −3.1% [95% CI, −12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed ( P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Conclusions and Relevance Among term neonates with moderate or severe Hypoxic-Ischemic Encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. Trial Registration clinicaltrials.gov Identifier:NCT01192776
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effect of depth and duration of cooling on deaths in the nicu among neonates with Hypoxic Ischemic Encephalopathy a randomized clinical trial
JAMA, 2014Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Edward F Bell, Athina Pappas, Scott A Mcdonald, Abhik Das, Brenda B Poindexter, Kurt Schibler, Roy J HeyneAbstract:Importance Hypothermia at 33.5°C for 72 hours for neonatal Hypoxic Ischemic Encephalopathy reduces death or disability to 44% to 55%; longer cooling and deeper cooling are neuroprotective in animal models. Objective To determine if longer duration cooling (120 hours), deeper cooling (32.0°C), or both are superior to cooling at 33.5°C for 72 hours in neonates who are full-term with moderate or severe Hypoxic Ischemic Encephalopathy. Design, Setting, and Participants A randomized, 2 × 2 factorial design clinical trial performed in 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network between October 2010 and November 2013. Interventions Neonates were assigned to 4 hypothermia groups; 33.5°C for 72 hours, 32.0°C for 72 hours, 33.5°C for 120 hours, and 32.0°C for 120 hours. Main Outcomes and Measures The primary outcome of death or disability at 18 to 22 months is ongoing. The independent data and safety monitoring committee paused the trial to evaluate safety (cardiac arrhythmia, persistent acidosis, major vessel thrombosis and bleeding, and death in the neonatal intensive care unit [NICU]) after the first 50 neonates were enrolled, then after every subsequent 25 neonates. The trial was closed for emerging safety profile and futility analysis after the eighth review with 364 neonates enrolled (of 726 planned). This report focuses on safety and NICU deaths by marginal comparisons of 72 hours’ vs 120 hours’ duration and 33.5°C depth vs 32.0°C depth (predefined secondary outcomes). Results The NICU death rates were 7 of 95 neonates (7%) for the 33.5°C for 72 hours group, 13 of 90 neonates (14%) for the 32.0°C for 72 hours group, 15 of 96 neonates (16%) for the 33.5°C for 120 hours group, and 14 of 83 neonates (17%) for the 32.0°C for 120 hours group. The adjusted risk ratio (RR) for NICU deaths for the 120 hours group vs 72 hours group was 1.37 (95% CI, 0.92-2.04) and for the 32.0°C group vs 33.5°C group was 1.24 (95% CI, 0.69-2.25). Safety outcomes were similar between the 120 hours group vs 72 hours group and the 32.0°C group vs 33.5°C group, except major bleeding occurred among 1% in the 120 hours group vs 3% in the 72 hours group (RR, 0.25 [95% CI, 0.07-0.91]). Futility analysis determined that the probability of detecting a statistically significant benefit for longer cooling, deeper cooling, or both for NICU death was less than 2%. Conclusions and Relevance Among neonates who were full-term with moderate or severe Hypoxic Ischemic Encephalopathy, longer cooling, deeper cooling, or both compared with hypothermia at 33.5°C for 72 hours did not reduce NICU death. These results have implications for patient care and design of future trials. Trial Registration clinicaltrials.gov Identifier:NCT01192776
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phenobarbital and temperature profile during hypothermia for Hypoxic Ischemic Encephalopathy
Journal of Child Neurology, 2012Co-Authors: Guilherme M Santanna, Abbot R Laptook, Seetha Shankaran, Jon E Tyson, Scott A Mcdonald, Rosemary D Higgins, Richard A Ehrenkranz, Abhik Das, Rebecca Bara, Ronald N GoldbergAbstract:Data from the whole-body hypothermia trial was analyzed to examine the effects of phenobarbital administration prior to cooling (+PB) on the esophageal temperature (Te) profile, during the induction phase of hypothermia. A total of 98 infants were analyzed. At enrollment, +PB infants had a higher rate of severe Hypoxic-Ischemic Encephalopathy and clinical seizures and lower Te and cord pH than infants that have not received phenobarbital (–PB). There was a significant effect of phenobarbital itself and an interaction between phenobarbital and time in the Te profile. Mean Te in the +PB group was lower than in the –PB group, and the differences decreased over time. In +PB infants, the time to surpass target Te of 33.5°C and to reach the minimum Te during overshoot were shorter. In conclusion, the administration of phenobarbital before cooling was associated with changes that may reflect a reduced thermogenic response associated with barbiturates.
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temperature profile and outcomes of neonates undergoing whole body hypothermia for neonatal Hypoxic Ischemic Encephalopathy
Pediatric Critical Care Medicine, 2012Co-Authors: Seetha Shankaran, Abbot R Laptook, Jon E Tyson, Ronald N Goldberg, Scott A Mcdonald, Rosemary D Higgins, Richard A Ehrenkranz, Abhik Das, Guilherme M Santanna, Rebecca BaraAbstract:BACKGROUND Decreases below target temperature were noted among neonates undergoing cooling in the NICHD Neonatal Research Network Trial of whole body hypothermia for neonatal Hypoxic-Ischemic Encephalopathy.
Ernest M Graham - One of the best experts on this subject based on the ideXlab platform.
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perinatal inflammation infection and its association with correction of metabolic acidosis in Hypoxic Ischemic Encephalopathy
Journal of Perinatology, 2016Co-Authors: Clark T Johnson, Irina Burd, R Raghunathan, Frances J Northington, Ernest M GrahamAbstract:Perinatal inflammation/infection and its association with correction of metabolic acidosis in Hypoxic-Ischemic Encephalopathy
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neonatal brain imaging and the identification of metabolic acidemia and Hypoxic Ischemic Encephalopathy
Journal of Maternal-fetal & Neonatal Medicine, 2009Co-Authors: Kristy A Ruis, Frances J Northington, Christoph U Lehmann, Ernest M GrahamAbstract:Objective. To determine the precision with which intrapartum metabolic acidemia and Hypoxic–Ischemic Encephalopathy (HIE) in term and near-term infants can be identified by neonatal brain imaging.Study design. This is a case–control study whose inclusion criteria were neonates born at ≥34 weeks gestation with a cord gas at delivery, suspected neurological abnormalities, and computed tomography (CT) or magnetic resonance (MR) imaging of the brain. Neonates with chromosomal and major congenital malformations were excluded. Brain imaging for neonates with and without metabolic acidemia (pH 12 mM) at birth and HIE were retrospectively reviewed by a neuroradiologist blinded to their clinical course and compared.Results. There were 54 neonates admitted to the NICU at a single university hospital between 1992 and 2006 that met these inclusion criteria of which 27 had metabolic acidemia at birth. There were 16 diagnosed clinically as having HIE at the time of neonatal discharge, 13 from t...
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intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and Hypoxic Ischemic Encephalopathy
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Joel Larma, Anadir Silva, Cynthia J Holcroft, Richard E Thompson, Pamela Donohue, Ernest M GrahamAbstract:Objective The purpose of this study was to determine whether electronic fetal monitoring can identify fetuses with metabolic acidosis and Hypoxic-Ischemic Encephalopathy. Study Design The cases were 107 nonanomalous chromosomally normal fetuses with an umbilical arterial pH Results Cases had a significant increase in late and prolonged decelerations/hour and late decelerations/contractions. Those fetuses with Hypoxic-Ischemic Encephalopathy had significant increases in bradycardia, decreased variability, and nonreactivity but no difference in late or variable decelerations/hour. For the identification of Hypoxic-Ischemic Encephalopathy, the sensitivity, specificity, and positive and negative predictive values were 15.4%, 98.9%, 66.7%, and 89.4%, respectively, for bradycardia; 53.8%, 79.8%, 26.9%, and 92.6%, respectively, for decreased variability; 92.3%, 61.7%, 2.7%, and 82.9%, respectively, for nonreactivity; and 7.7%, 98.9%, 50.0%, and 88.6%, respectively, for all 3 abnormalities combined. Conclusion Fetal metabolic acidosis and Hypoxic-Ischemic Encephalopathy are associated with significant increases in electronic fetal monitoring abnormalities, but their predictive ability to identify these conditions is low.
L I Guofen - One of the best experts on this subject based on the ideXlab platform.
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the clinical analysis of sodium cytidine triphosphate therapy on neonatal Hypoxic Ischemic Encephalopathy and the influence of neuroendocrine
The Journal of Medical Theory and Practice, 2011Co-Authors: L I GuofenAbstract:Objective:To observe the effect of Sodium Cytidine Triphosphate therapy on neonatal Hypoxic-Ischemic Encephalopathy and the influence of neuroendocrine.Methods:From June 2009 to June 2010,106 cases with Hypoxic Ischemic Encephalopathy were randomly devided into two groups,the control group given routine treatment,while the treatment group was given routine treament and Sodium Cytidine Triphosphate therapy.compared with two groups of clinical efficacy,main signs,and neuroendocrine indexes.Results:Recovering consciousness,reflex restore and muscle tension recovery time of the treatment group were significantly shorter than the control group,the difference showed statistically significant(P0.05).Two groups of COR and NE level after the treatment was decreased obviously before treatment,The difference was statistically significant(P0.01).After treatment COR and NE level of the treatment group was obviously lower than those of the control group after treatment level.The difference was statistically significant(P0.01).Conclusion:The Sodium Cytidine Triphosphate treatment of Hypoxic Ischemic Encephalopathy,can shorten the recovering consciousness,reflex restore and muscle tension recovery time,and obviously improved neuroendocrine,It's worthy of clinic application.