Difficulties at Birth: Long Term Developmental Outcomes
|
|
- Rodger Barnett
- 5 years ago
- Views:
Transcription
1 Difficulties at Birth: Long Term Developmental Outcomes Alan D. Bedrick MD Division of Neonatology and Developmental Biology Department of Pediatrics University of Arizona Tucson, Arizona
2 DISCLOSURE I have no vested interest or intention to discuss off-label and/or investigational use of pharmaceuticals or devices I have no financial or other relationship with anymanufacturer or commercial product or servicesdiscussed in this presentation (other than the U of A which I love dearly)
3 OBJECTIVES Understand some aspects of labor and delivery which might result in perinatal brain injury Distinguish between those infants whose neurologic problems originated before birth vs. during birth Understand some of the long term neurologic outcomes of infants who sustained brain damage during birth Understand some of the medical-legal issues which result in referrals to vocational experts
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19 Case Report 3,060 gm full-term female infant born to 37 y.o. hospital administrator. Uncomplicated pregnancy. Mother presents with decreased fetal movement x 24 hours which resolved two days before delivery. Labor remarkable for failure to descend. Forceps assisted vaginal delivery. Apgar scores 4/8. Resuscitated with T- Piece resuscitator x few breaths. UA cord ph = 7.25.? Jittery at birth. D/C home after 48 hours. After 6 months, pediatrician notes failure to achieve normal major motor milestones and mild hypertonia, all extremities. Pediatrician reviews birth history. Comments to mother that maybe something happened at birth since forceps were used.
20 3,060 gm full-term female infant born to 37 y.o. hospital administrator. Uncomplicated pregnancy. Mother presents with decreased fetal movement x 24 hours which resolved two days before delivery. Labor remarkable for failure to descend. Forceps assisted vaginal delivery. Apgar scores 4/8. Resuscitated with T-Piece resuscitator x few breaths. UA cord ph = 7.25.? Jittery at birth. D/C home after 48 hours. After 6 months, pediatrician notes failure to achieve normal major motor milestones and mild hypertonia, all extremities. Pediatrician reviews birth history. Comments to mother that maybe something happened at birth since forceps were used years later, delivering obstetrician is sued for breach of the standard of care and failing to perform a timely Caesarean Section. Allegation is that had a Caesarean Section been performed, baby would not have cerebral palsy and would be normal. Vocational Rehabilitation Expert consulted re future capabilities, etc.
21 Definition: Cerebral Palsy Cerebral Palsy A general descriptive condition which is characterized by sustained, non-progressive neurologic disability characterized by abnormal control of movement and posture. The type (spastic diplegia/ quadriplegia; hemiplegia, etc.) is determined by the location of the lesion within the central nervous system, and the timing of its occurrence.
22 Definition: CognitiveImpairment Cognitive Impairment (MR) IQ score < 2 S.D. below the mean. The etiology of cognitive impairment generally occurs prenatally or during the early developmental years, and impairs the individual s ability to adapt to the environment. Average IQ = 100; MR IQ < 70 Etiologies: genetic, infectious, teratogenic, metabolic social factors (mild delay)
23 The Continuum of Influences Conception Labor and Delivery Infancy Childhood
24 *
25 Perinatal Asphyxia is NOT a Diagnosis!! It is a physiological and biochemical state secondary to a known or unknown condition. Perinatal asphyxia may be due to specific clinical conditions which have pathophysiology evidenced by abnormal gas exchange (such as placenta previa, abruption, cord prolapse).
26 Rhesus Monkey Model Dawes (1964) Term Rhesus Monkeys Prior to delivery: - catheters placed in fetal vessels Delivery by Caesarean Section - head placed in saline filled rubber bag - umbilical cords immediately clamped Followed the course of selected physiological parameters during 10 minutes of total asphyxia followed by resuscitation
27
28
29 Circulatory Changes During Asphyxia Redistribution of Cardiac Output (Selective Circulatory Ischemia) TO: FROM: Brain, Heart, Adrenal Glands Kidneys, Lungs, Mesentery, Muscle
30 PERINATAL ASPHYXIA AND CEREBRAL PALSY Is there a causal (or associative) relationship between antenatal/perinatal events and subsequent development of mental retardation or cerebral palsy? Are cerebral palsy and mental retardation preventable? Does perinatal asphyxia cause brain injury?
31 Causes of Cerebral Palsy Most ataxic/dyskinetic CP w/ MR is genetic in etiology Up to 50% of spastic CP in term infants is due to recognizable prenatal disorders cerebral dysgenesis / maldevelopment prenatal strokes [MCA] TORCH infections Other: Asphyxia : * Infection chorioamnionitis (FIRS) * Coagulation factors / auto-immune factor V Leiden; APA syndrome
32 Neuropathological Correlates Cerebral Palsy: damage to basal ganglia (extrapyramidal system) and surrounding white matter. Pathologically: scarring and cavitation in the basal ganglia with loss of periventricular tissue ---> hydrocephalus ex- vacuo [cystic periventricular leukomalacia] Cognitive Impairment: assoc. w/ cerebral cortical damage. Acutely: cortical cerebral edema and cell necrosis. Chronically: scarring and fibrosis Timing During Gestation: preterm, term Severity of Insult: chronic, acute
33
34
35 Pathogenesis and Etiology of Perinatal Brain Damage Mechanisms of brain injury identified from pathologic studies can be corroborated in clinical studies. NIH Collaborative Perinatal Project, 1957 Cerebral palsy is not related to the events of delivery in term pregnancies, i.e. it does not occur as the result of complications during term delivery.
36 Temporal Spectrum of Perinatal Asphyxial Insults Infants may be born with subacute, old cerebral lesions The fetus subjected to ongoing adverse conditions during intra-uterine life may accrue subacute cerebral damage. If the fetus survives, acute lesions become subacute, heal, and scar. The presence of latent subacute lesions at birth may account for many cases of CNS dysfunction that develop after uncomplicated term delivery. e.g. Cellular Migration Disorders: lissencephaly, polymicrogyria
37 Acute vs. Chronic Injury: Clinical Patterns Depression of vital functions may occur in an infant with subacute brain damage which occurred long before the onset of labor. Acute vs. chronic damage may be clinically similar in first minutes of life; subsequent clinical pattern is different. Acute: coma, recurrent apnea, seizures, multi-system involvement Chronic: depressed; responds to resuscitation, goes to the regular nursery, and then home.
38 Neonatal Encephalopathy Clinically defined syndrome of disturbed neurologic function in an infant appearing early after delivery. Manifested by difficulty initiating and maintaining respiration; depression of tone and reflexes (hypotonia -> hypertonia) Profound alteration of consciousness, and often seizures Does not imply etiology [hypoxic ischemic encephalopathy] (vs metabolic, infectious) Perinatal Depression = Perinatal Asphyxia
39 Neonatal Encephalopathy: Etiology Hypoxia/Ischemia 40% Cerebro Vascular 11% Infection / Meningitis 11% Metabolic 10% Genetic 3% Unknown 25%
40 Is Perinatal Brain Injury Related to Obstetric Care?
41 Perinatal Events and Brain Damage YES THAT CAN HAPPEN!! Only for certain types of brain injury are perinatal asphyxial events possibly related to later outcome. Despite this: Techniques are not perfect for identifying the fetus at risk What severity and duration of acute or chronic asphyxia warrants aggressive obstetrical intervention?
42 Identification of At Risk Pregnancies Ante-partum Care - Risk Assessment: Biophysical profile - Serial U/S to document fetal growth Electronic Fetal Monitoring --> C - Sections If any of the screening tests are abnormal, one can suspect that a potentially compromised fetus may not withstand labor and may undergo a loss of capacity to tolerate labor. All our tools to assess fetal well-being during pregnancy and labor cannot prognosticate neurologic impairment
43 Perinatal Events and Outcome While some infants with evident perinatal asphyxia do poorly, most do well. Most newborn infants with objective clinical signs of perinatal asphyxia in the first days of life do well, and show no signs of permanent brain dysfunction (mild, moderate, severe encephalopathy) Whole Body Cooling for acute neonatal encephalopathy In the absence of specific clinical signs, perinatal asphyxia can seldom be ascribed as the cause of brain damage.
44 Perinatal Events and Outcome If the incidence of CP was related to suboptimal obstetrical care (failure to perform timely C-S), then its prevalence should be decreasing. IT HAS NOT DONE SO! (Incr. CS -> No decr. CP!) The rate of cerebral palsy parallels substantial increases in survival in very low birth weight infants. The rate of CP is many times higher among infants < 1500 g at birth versus full-term infants.
45 When is Severe Fetal Asphyxia Followed by Brain Damage? Usually see: severe metabolic acidosis multi-system derangement - CV, GI, Renal stormy newborn neurologic course - A fetus compromised by an earlier prenatal event is more likely to exhibit evidence of asphyxia than a normal fetus. - Fetal distress may be followed by brain damage, but the obstetrician may be unable to interrupt that relationship. Spastic quadriplegia is the most prevalent type of cerebral palsy in term infants
46 Can Asphyxia ---> Brain Injury? Best Evidence Identifiable sequence of events Identified cause of fetal oxygen interruption Early neonatal signs w/ subsequent encephalopathy Consistent neuroimaging studies: early: edema; no prenatal lesions later: atrophy / destruction [global; diffuse] Static motor disorder: spastic quadriplegia w/ dyskinesia
47 What Suggests a Cause of Cerebral Palsy OTHER than Acute Perinatal Asphyxia? Intrauterine growth retardation Umbilical cord ph > 7.0; base deficit < 12 mmol/l Systemic infection Neuroimaging: long-standing abnormalities Decreased FHR variability at onset of monitoring Microcephaly Extensive chorioamnionitis Congenital coagulopathy Other risk factors: prematurity; multiple births
48 Relationships between time course of asphyxial insult, site(s) of brain injury, and type of disability TIME COURSE SITE OF BRAIN INJURY DISABILITY Acute Near Total Moderate Basal Ganglia/Thalami Athetoic/Dystonic CP Impaired Cognitive Development Severe BG/T + Cerebral Cortex Severe spastic QP, cortical, visual impairment, cognitive, microcephaly Prolonged Moderate Watershed Regions Moderate Spastic QP, cognitive deficit cognitive impairment, Severe Extensive Cortical Pathology Spastic QP, severe impairment, visual microcephaly
49 Follow Up and Intervention Detectability of Impairment 1 st year: Severe Motor / Sensory Loss 2 nd year: Low Developmental Quotient 2-4 years: Fine/Gross MotorDysfunction 4-7 years: Cognitive Abnormalities 7-9 years: Learning Disbalities
50 Follow Up and Intervention Intensive Follow Up for Those at High Risk for Disability Vision Loss: pediatric ophthalmology Hearing Loss: brain stem evoked response, audiologist Seizures: pediatric neurology Nutrition: nutritionist; gastrostomy tube
51 Follow Up and Intervention 4 8 Month Neurodevelopmental Follow Up Feeding/Nutrition Head Growth Visual Awareness Oral Motor Function (salivary control Early Vocalization Physical Therapy Assessment
52 Follow Up and Intervention Month Neurodevelopmental Follow-Up Pediatric Rehabilitation Ongoing Multidisciplinary Follow Up Speech Pathology Physical Therapy Occupation Therapy Bayley III Testing
53
54
55 Physicians and nurses need to accept the notion that error is an inevitable accompaniment of the human condition, even among conscientious professionals with high standards. Errors must be accepted as evidence of system flaws not character flaws.
56
57
58 Reasons Why People Sue Their Doctors Percent Expressing Concern Advised to sue by influential other 32 Needed money 24 Believed there was a cover-up 24 Child would have no future 23 Needed information 20 Wanted revenge, license 19 Source - Hickson, 1992
59
60
61
62
63
64
65
66 ? Perinatal Events -> CP 1. Despite advances in perinatal care, the societal burden of cerebral palsy has not decreased. Advanced NICU technology has permitted survival of tinier, more premature infants resulting in more children with CP 2. Cerebral palsy in children born at term often reflects phenomena which preceded the onset of labor. 3. Most cerebral palsy is not preceded by severe intrapartum asphyxia.
67 ? PerinatalEvents -> CP 4. Most severely asphyxiated infants who survive are later clinically normal, and DO NOT develop cerebral palsy or mental retardation. 5. The diagnosis of fetal asphyxia is imprecise. 6. Fetal asphyxia may follow fetal brain damage. 7. Efforts to prevent evident perinatal brain injury will require a focus on factors and events during pregnancy, especially those which result in preterm delivery.
68
69
70
71
72
Objectives. Birth Depression Management. Birth Depression Terms
Objectives Birth Depression Management Regional Perinatal Outreach Program 2016 Understand the terms and the clinical characteristics of birth depression. Be familiar with the evidence behind therapeutic
More informationHYPOXIC ISCHEMIC ENCEPHALOPATHY AND THE OBSTETRICIAN
HYPOXIC ISCHEMIC ENCEPHALOPATHY AND THE OBSTETRICIAN DISCLOSURE I have nothing to disclose and have no real or potential conflicts with this presentation and its content. Michael P. Nageotte, M.D. CASE:
More informationETIOLOGY AND PATHOGENESIS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY
ETIOLOGY AND PATHOGENESIS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY HYPOXIC-ISCHEMIC ENCEPHALOPATHY Hypoxic-İschemic Encephalopathy Encephalopathy due to hypoxic-ischemic injury [Hypoxic-ischemic encephalopathy
More informationStudy of role of MRI brain in evaluation of hypoxic ischemic encephalopathy
Original article: Study of role of MRI brain in evaluation of hypoxic ischemic encephalopathy *Dr Harshad Bhagat, ** Dr Ravindra Kawade, ***Dr Y.P.Sachdev *Junior Resident, Department Of Radiodiagnosis,
More informationBirth Asphyxia - Summary of the previous meeting and protocol overview
Birth Asphyxia - Summary of the previous meeting and protocol overview Dr Ornella Lincetto, WHO Geneve Milano, 11June 2007 Vilka är Personality egenskaper med den astrologiska Tvillingarna? Objective of
More informationDOWNLOAD OR READ : PERINATAL EVENTS AND BRAIN DAMAGE IN SURVIVING CHILDREN BASED ON PAPERS PRESENTED AT AN INTERNATIONA PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : PERINATAL EVENTS AND BRAIN DAMAGE IN SURVIVING CHILDREN BASED ON PAPERS PRESENTED AT AN INTERNATIONA PDF EBOOK EPUB MOBI Page 1 Page 2 perinatal events and brain damage in surviving
More informationNational follow-up program CPUP Pediatric Neurology paper form
National follow-up program CPUP Pediatric Neurology paper form 110206 1 National Follow-Up program- CPUP Pediatric Neurology Personal nr (unique identifier): Last name: First name: Region child belongs
More informationNeonatal Therapeutic Hypothermia. A Wasunna Professor of Neonatal Medicine and Pediatrics School of Medicine, University of Nairobi
Neonatal Therapeutic Hypothermia A Wasunna Professor of Neonatal Medicine and Pediatrics School of Medicine, University of Nairobi Definition of Perinatal Asphyxia *No agreed universal definition ACOG/AAP
More informationThese signs should lead to the administration of high concentrations of
Hypoxic-ischemic encephalopathy (HIE); (cont.) Clinical manifestations; *Intrauterine; growth restriction and increased vascular resistances may be the st manifestation of fetal hypoxia. *During labor;
More informationFetal Heart Rate Monitoring Myths and Misperceptions s: Electronic Fetal Heart Rate Monitoring (EFM): Baseline Assumptions.
Can FHR Monitoring Prevent Hypoxic-Ischemic Encephalopathy in the Newborn? Fetal Heart Rate Monitoring Myths and Misperceptions 1. Yes 2. No 72% Tekoa L. King CNM, MPH June 6, 2008 28% Yes No Objectives
More informationHypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic
More informationCerebral Palsy. By:Carrie Siders and Kelsey Hampsey. 3rd hour.
Cerebral Palsy By:Carrie Siders and Kelsey Hampsey 3rd hour. What is Cerebral Palsy? Cerebral palsy is a physical disability It affects movement and posture It is a permanent life-long condition does not
More informationCorrelation of Neurodevelopmental Outcome and brain MRI/EEG findings in term HIE infants
Correlation of Neurodevelopmental Outcome and brain MRI/EEG findings in term HIE infants Ajou University School of Medicine Department of Pediatrics Moon Sung Park M.D. Hee Cheol Jo, M.D., Jang Hoon Lee,
More informationNeonatal Seizure. Dr.Nawar Yahya. Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan. Supervised by:
Neonatal Seizure Supervised by: Dr.Nawar Yahya Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan Objectives: What is neonatal seizure Etiology Clinical presentation Differential diagnosis
More informationStudy of renal functions in neonatal asphyxia
Original article: Study of renal functions in neonatal asphyxia *Dr. D.Y.Shrikhande, **Dr. Vivek Singh, **Dr. Amit Garg *Professor and Head, **Senior Resident Department of Pediatrics, Pravara Institute
More informationThe high risk neonate
The high risk neonate Infant classification by gestational (postmenstrual) age Preterm. Less than 37 completed weeks (259 days). Term. Thirty-seven to 416/7 weeks (260-294 days). Post-term. Forty-two weeks
More informationHistorical Perspectives on the Etiology of Cerebral Palsy 233 Tonse N.K. Raju
PERINATAL CAUSES OF CEREBRAL PALSY Preface Marcus C. Hermansen xv Historical Perspectives on the Etiology of Cerebral Palsy 233 Tonse N.K. Raju This essay presents the early history on the evolution of
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Hypoxic Ischemic Encephalopathy. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationGuslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara
Guslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara 1 Definition Perinatal asphyxia is a fetus/newborn, due to: is an insult to the Lack
More informationIn the first edition of this report, the Task Force on Neonatal
Neonatal Encephalopathy and Neurologic Outcome, Second Edition Report of the American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy Executive Summary In the first edition
More informationBirth Asphyxia. Perinatal Depression. Birth Asphyxia. Risk Factors maternal. Risk Factors fetal. Risk Factors Intrapartum 2/12/2011
Birth Asphyxia Perinatal Depression Sara Brown, ARNP Children s Hospital and Regional Medical Center May occur in utero, during labor/delivery or during the neonatal period Condition of impaired blood
More informationThe child with hemiplegic cerebral palsy thinking beyond the motor impairment. Dr Paul Eunson Edinburgh
The child with hemiplegic cerebral palsy thinking beyond the motor impairment Dr Paul Eunson Edinburgh Content Coming to a diagnosis The importance of understanding the injury MRI scans Role of epilepsy
More informationTalking About The Facts: Stroke In Children
Talking About The Facts: Stroke In Children AWARENESS LEADS TO A QUICKER RESPONSE AND LIFESAVING OUTCOMES FOR CHILDREN. Pediatric Stroke Warriors continues to strengthen communities by providing support
More informationFigure removed due to copyright restrictions.
Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz IN SUMMARY HST 071 An Example of a Fetal Heart Rate Tracing Figure removed
More informationBabies First and CaCoon Risk Factors (A Codes and B Codes)
Babies First and Risk Factors (A Codes and B Codes) (Birth through 4 years of age) Medical Risk Factors A1. Drug exposed infant (See A29) A2. Infant HIV positive A3. Maternal PKU or HIV positive A4. Intracranial
More informationLectures 4 Early fetal assessment, screening, ultrasound and treatment modalities during pregnancy. II. Asphyxia and Resuscitation (3 lectures)...
Outline of a 2 year Neonatology educational course (80 lectures) PLUS 2 graduate level courses (GENETICS and BIOSTATISTICS & EPIDEMIOLOGY Approximate Percent in Examination I. Maternal-Fetal Medicine (6
More informationOriginal article: Evaluation of hypoxic-ischaemic events in preterm neonates using trans cranial ultrasound
Original article: Evaluation of hypoxic-ischaemic events in preterm neonates using trans cranial ultrasound Priyanka Upadhyay *, Ketki U Patil 1, Rajesh Kuber 2, Vilas Kulkarni 3, Amarjit Singh 4 * Chief
More informationCerebral palsy? Cerebral palsies? Cerebral palsy spectrum disorder?
Teamwork makes the dream work Nationaal symposium van Belgische CP-centra 18/02/2019 Cerebral palsy? Cerebral palsies? Cerebral palsy spectrum disorder? Faes Franny Dienst Kinderneurologie UZ Gent Centrum
More informationBIRTH TRAUMA LITIGATION: PROVING THE CAUSE OF NEWBORN NEUROLOGIC INJURY 1 By Richard C. Halpern
BIRTH TRAUMA LITIGATION: PROVING THE CAUSE OF NEWBORN NEUROLOGIC INJURY 1 By Richard C. Halpern Proving the cause of newborn neurologic injury in birth trauma litigation, an essential step to a successful
More informationWhat does an EEG show?
EEG Video EEG Ambulatory EEG There s a whole lot of Shakin going on Vagus Nerve Stimulators Division of Child Neurology, Developmental Pediatrics and Genetics Intrathecal Baclofen Pumps EEG first used
More informationTLC March 27, Shawn Hollinger-Neonatal Fellow CHEO
TLC March 27, 2013 Presented/Prepared by: Shawn Hollinger, PGY5 Neonatal-Perinatal Medicine Resident - University of Ottawa With slides/images from Dr. Brigitte Lemyre Associate Professor of Pediatrics
More informationNeonatal Encephalopathy and Neurologic Outcome, Second Edition
Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children STATEMENT OF ENDORSEMENT Neonatal Encephalopathy and Neurologic Outcome, Second Edition
More informationShould infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants?
Should infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants? Shoshana Revel-Vilk, MD MSc Pediatric Hematology Center, Pediatric Hematology/Oncology Department,
More informationSubspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level
Subspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level Prerequisites: Any prior pediatric rotations and experience Primary Goals for this
More informationEarly Accurate Diagnosis & Early Intervention for Cerebral Palsy INTERNATIONAL RECOMMENDATIONS
Early Accurate Diagnosis & Early Intervention for Cerebral Palsy INTERNATIONAL RECOMMENDATIONS Professor Iona Novak Cerebral Palsy Alliance Australia Neuroplasticity is fundamentally why we believe in
More informationNEONATOLOGY Healthy newborn. Neonatal sequelaes
NEONATOLOGY Healthy newborn. Neonatal sequelaes Ágnes Harmath M.D. Ph.D. senior lecturer 11. November 2016. Tasks of the neonatologist Prenatal diagnosed condition Inform parents, preparation of necessary
More informationPerlman J, Clinics Perinatol 2006; 33: Underlying causal pathways. Antenatal Intrapartum Postpartum. Acute near total asphyxia
Perlman J, Clinics Perinatol 2006; 33:335-353 Underlying causal pathways Antenatal Intrapartum Postpartum Acute injury Subacute injury Associated problem Reduced fetal movements Placental insufficiency
More informationInsults to the Developing Brain & Effect on Neurodevelopmental Outcomes
Insults to the Developing Brain & Effect on Neurodevelopmental Outcomes Ira Adams-Chapman, MD Assistant Professor of Pediatrics Director, Developmental Progress Clinic Emory University School of Medicine
More informationToo Cool? Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia. Lauren Sacco DNP, ARNP, NNP-BC
Too Cool? Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia Lauren Sacco DNP, ARNP, NNP-BC Pathophysiology of HIE Occurs in two energy failure phases: First phase happens during the initial insult
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article A Study on Serum Calcium Level in Birth Asphyxia Amrita Vamne 1*, Ramesh Chandra Thanna 2*,
More informationCerebral Palsy 4.0 Contact Hours Presented by: CEU Professor
Cerebral Palsy 4.0 Contact Hours Presented by: CEU Professor www.ceuprofessoronline.com Copyright 2009 The Magellan Group, LLC. All Rights Reserved. Reproduction and distribution of these materials is
More informationBenefits of Caffeine Citrate: Neurodevelopmental Outcomes of ELBW Infants
St. Catherine University SOPHIA Master of Arts in Nursing Theses Nursing 12-2011 Benefits of Caffeine Citrate: Neurodevelopmental Outcomes of ELBW Infants Teri Johnson St. Catherine University Follow this
More informationEarly seizures indicate quality of perinatal care
Archives of Disease in Childhood, 1985, 6, 89-813 Early seizures indicate quality of perinatal care R J DERHAM, T G MATTHEWS, AND T A CLARKE Rotunda Hospital, Dublin, Ireland SUMMARY An analysis of antepartum,
More informationSwings... Page 15 BTLG Newsletter July 2015
Page 15 BTLG Newsletter July 2015 Swings... By James P. Fitzgerald, John M. Daly, Randy B. Nassau, and Margaret Johnson-Pertet, Yonkers, New York Introduction In March 2014, the American College of Obstetrics
More informationRESEARCH ARTICLE EVALUATION OF NEUROIMAGING IN CEREBRAL PALSY. S.H. Hasanpour avanji MD
RESEARCH ARTICLE EVALUATION OF NEUROIMAGING IN CEREBRAL PALSY S.H. Hasanpour avanji MD Assistant Professor of Child Neurology, Iran University of Medical Sciences Corresponding Author: S.H. Hasanpour avanji
More informationNeurological outcome after perinatal asphyxia at term
Section 1 Chapter 1 Scientific background Neurological outcome after perinatal asphyxia at term David Odd and Andrew Whitelaw Introduction It was nearly 150 years ago that an association between perinatal
More informationCALIFORNIA STATE UNIVERSITY, SACRAMENTO
COLLEGE OF EDUCATION DEPARTMENT OF SPECIAL EDUCATION, REHABILITATION AND SCHOOL PSYCHOLOGY CALIFORNIA STATE UNIVERSITY, SACRAMENTO School Psychology Diagnostic Clinic 6000 J Street Sacramento, California
More informationHypoglycaemia of the neonate. Dr. L.G. Lloyd Dept. Paediatrics
Hypoglycaemia of the neonate Dr. L.G. Lloyd Dept. Paediatrics Why is glucose important? It provides 60-70% of energy needs Utilization obligatory by red blood cells, brain and kidney as major source of
More informationNo social problems noted No past med hx Mother had spontaneous rupture of fetal membranes SB born on Needed to be resuscitated at birth
No social problems noted No past med hx Mother had spontaneous rupture of fetal membranes SB born on 9-16-2011 Needed to be resuscitated at birth (included assisted vent) Had generalized edema and possible
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening
More informationAdmission/Discharge Form for Infants Born in Please DO NOT mail or fax this form to the CPQCC Data Center. This form is for internal use ONLY.
Selection Criteria Admission/Discharge Form for Infants Born in 2016 To be eligible, you MUST answer YES to at least one of the possible criteria (A-C) A. 401 1500 grams o Yes B. GA range 22 0/7 31 6/7
More informationSWISS SOCIETY OF NEONATOLOGY. Severe apnea and bradycardia in a term infant
SWISS SOCIETY OF NEONATOLOGY Severe apnea and bradycardia in a term infant October 2014 2 Walker JH, Arlettaz Mieth R, Däster C, Division of Neonatology, University Hospital Zurich, Switzerland Swiss Society
More informationGUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA
GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA The newborn is not an adult, nor a child. In people of all ages, death can occur from a failure of breathing and / or circulation. The interventions required to aid
More informationList of Chapters. 5. Care of the sick child Evidence-based pediatrics (page 77 to 80)
Illustrated Textbook of Paediatrics, 4th Edition Tom Lissauer, and Graham Clayden, 2012 List of Chapters 1. The child in society 2. History and examination 3. Normal child development, hearing and vision
More informationTable 1: The major changes in AHA / AAP neonatal resuscitation guidelines2010 compared to previous recommendations in 2005
Table 1: The major changes in AHA / AAP neonatal guidelines2010 compared to previous recommendations in 2005 Resuscitation step Recommendations (2005) Recommendations (2010) Comments/LOE 1) Assessment
More informationEpilepsy in children with cerebral palsy
Seizure 2003; 12: 110 114 doi:10.1016/s1059 1311(02)00255-8 Epilepsy in children with cerebral palsy A.K. GURURAJ, L. SZTRIHA, A. BENER,A.DAWODU & V. EAPEN Departments of Paediatrics, Community Medicine
More informationQueen Charlotte Hospital
Queen Charlotte Hospital Neuroprotection for neonatal encephalopathy Neonatal encephalopathy accounts for 1 million deaths worldwide and even greater numbers of disabled survivors In countries with
More informationPrenatal Prediction of The Neurologically Impaired Neonate By Ultrasound
Prenatal Prediction of The Neurologically Impaired Neonate By Ultrasound Robert H. Debbs, D.O.,F.A.C.O.O.G. Professor of OB-GYN Perelman School of Medicine, University of Pennsylvania Director, Pennsylvania
More informationInfection. Risk factor for infection ACoRN alerting sign with * Clinical deterioration. Problem List. Respiratory. Cardiovascular
The ACoRN Process Baby at risk Unwell Risk factors Post-resuscitation requiring stabilization Resuscitation Ineffective breathing Heart rate < 100 bpm Central cyanosis Support Infection Risk factor for
More informationNeonatal Hypoglycemia
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Neonatal Hypoglycemia. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationWhat is symptomatic? Neonatal hypoglycemia: how low can you go? Hypoglycemia and MRI. Conflicts. What s the problem? Hypoglycemia and MRI
Neonatal hypoglycemia: how low can you go? Kristi Watterberg, MD Professor of Pediatrics, UNM What is symptomatic? Jitteriness Cyanosis Poor feeding Weak, high-pitched cry Seizures Apnea Lethargy, low
More informationRunning head: THERAPEUTIC HYPOTHERMIA AND TRANSPORT 1
Running head: THERAPEUTIC HYPOTHERMIA AND TRANSPORT 1 Therapeutic Hypothermia for Neonatal Encephalopathy: Preparation for Transport to Cooling Center Teresa Z. Baker, DNP-S Annie L. Addison, FNP-S NURS
More informationTOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO
TOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO DISCLOSURE I have no relationships with commercial companies
More informationApproach to the Child with Developmental Delay
Approach to the Child with Developmental Delay Arwa Nasir Department of Pediatrics University of Nebraska Medical Center DISCLOSURE DECLARATION Approach to the Child with Developmental Delay Arwa Nasir
More informationNEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY
Background NEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY A perinatal hypoxic-ischaemic insult may present with varying degrees of neonatal encephalopathy, neurological disorder and
More informationSerum creatine kinase and lactic dehydrogenase levels as useful markers of immediate and long-term outcome of perinatal asphyxia
Serum creatine kinase and lactic dehydrogenase levels as useful markers of immediate and long-term outcome of perinatal asphyxia D H Karunatilaka 1, G W D S Amaratunga 2, K D N I Perera 3, V Caldera 4
More informationToo or Too Cold. Too Cold...Too Hot...Just Right. Temperature Control in Newborns. Temperature Balance in Newborns. Basics in the Delivery Room
Too or Too Cold Neonatology Rediscovers Temperature Control Advances and Controversies in Clinical Pediatrics May 31, 2007 Terri A. Slagle Neonatology, CPMC Too Cold...Too Hot...Just Right Too Cold = Issues
More informationADMISSION/DISCHARGE FORM FOR INFANTS BORN IN 2019 DO NOT mail or fax this form to the CPQCC Data Center. This form is for internal use ONLY.
1 Any eligible inborn infant who dies in the delivery room or at any other location in your hospital within 12 hours after birth and prior to admission to the NICU is defined as a "Delivery Room Death."
More informationNeonatal Hypoglycemia. Presented By : Kamlah Olaimat 25\7\2010
Neonatal Hypoglycemia Presented By : Kamlah Olaimat 25\7\2010 Definition The S.T.A.B.L.E. Program defines hypoglycemia as: Glucose delivery or availability is inadequate to meet glucose demand (Karlsen,
More informationSWISS SOCIETY OF NEONATOLOGY. Peripartal management of a prenatally diagnosed large oral cyst
SWISS SOCIETY OF NEONATOLOGY Peripartal management of a prenatally diagnosed large oral cyst May 2007 2 Fontana M, Berger TM, Winiker H, Jöhr M, Nagel H, Neonatal and Pediatric Intensive Care Unit (FM,
More informationAMERICAN ACADEMY OF PEDIATRICS
AMERICAN ACADEMY OF PEDIATRICS The Role of the Primary Care Pediatrician in the Management of High-risk Newborn Infants ABSTRACT. Quality care for high-risk newborns can best be provided by coordinating
More informationTRAINING NEONATOLOGY SILVANA PARIS
TRAINING ON NEONATOLOGY SILVANA PARIS RESUSCITATION IN DELIVERY ROOM INTRODUCTION THE GLOBAL RESUSCITATION BURDEN IN NEWBORN 136 MILL NEWBORN BABIES EACH YEAR (WHO WORLD REPORT) 5-8 MILL NEWBORN INFANTS
More informationPerinatal/Neonatal Case Presentation
Perinatal/Neonatal Case Presentation & & & & & & & & & & & & & & Bilateral Thalamic Lesions in a Newborn with Intrauterine Asphyxia After Maternal Cardiac Arrest a Case Report with Literature Review Maya
More informationDevelopmental delay Poor School Progress. I Smuts Department of Paediatrics
Developmental delay Poor School Progress I Smuts Department of Paediatrics References Normal development: Handbook of Neurology: Paediatric clinical examination guideline How do children present Children
More informationRetrospectıve analysıs for newborn ınfants wıth hypoxıc-ıschemıc encephalopathy
Basic Research Journal of Medicine and Clinical Sciences ISSN 2315-6864 Vol. 1(2) pp. 19-24 September 2012 Available online http//www.basicresearchjournals.org Copyright 2012 Basic Research Journal Full
More informationSWISS SOCIETY OF NEONATOLOGY. Bart s syndrome with severe newborn encephalopathy: a delayed diagnosis
SWISS SOCIETY OF NEONATOLOGY Bart s syndrome with severe newborn encephalopathy: a delayed diagnosis May 2003 2 Buettiker V, Hogan P, Badawi N, Department of Neonatology (BV, NB), Department of Dermatology
More informationAddendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context
Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context A subcommittee of the Canadian Neonatal Resuscitation Program (NRP) Steering Committee
More informationSeverity of Hypoxic Ischaemic Encephalopathy in Neonates with Birth Asphyxia
Journal of Rawalpindi Medical College (JRMC); 2007; (): 8-22 Severity of Hypoxic Ischaemic Encephalopathy in Neonates with Birth Asphyxia Rubina Zulfiqar, Samiya Naeemullah Department of Paediatrics, Holy
More informationSummary of Changes: References/content updated to reflect most current standards of practice.
Alaska Native Medical Center: Mother Baby Unit Guideline: Neonatal Hypoglycemia Subject: Neonatal Hypoglycemia REVISION DATE: Jan 2015,12/2011, 02/2009, 11, 2007, 07/2007,04/2001, 04/1999 REPLACES: NSY:
More informationMedical Conditions Resulting in High Probability of Developmental Delay and DSCC Screening Information
Jame5. L.Jma5, ~reuiry Medical Conditions Medical Conditions Resulting in High Probability of Developmental Delay and DSCC Screening Information I Not Listed later Children with medical conditions which
More informationPrognosis in. Encephalopathy. Hypoxic-Ischemic. Özge Aydemİr MD
Prognosis in Hypoxic-Ischemic Encephalopathy Özge Aydemİr MD Major problems we have to face while caring infants with HIE are; Øto provide families with reliable information about outcome. Øto decide how
More informationDemographic and clinical characteristic of Cerebral Palsy Among Children in Diyala Province Iraq
Demographic and clinical characteristic of Cerebral Palsy Among Abstract Background: Cerebral palsy (CP) is defined as non-progressive disorder of movement and posture due to brain insult or injury occurring
More informationPrematurity as a Risk Factor for ASD. Disclaimer
Prematurity as a Risk Factor for ASD Angela M. Montgomery, MD, MSEd Assistant Professor of Pediatrics (Neonatology) Director, Yale NICU GRAD Program Suzanne L. Macari, PhD Research Scientist, Child Study
More informationUNIVERSITY OF WASHINGTON
UNIVERSITY OF WASHINGTON THE FETAL ALCOHOL SYNDROME DIAGNOSTIC AND PREVENTION NETWORK (FAS DPN) Center for Human Development and Disability Dear Sir or Madam, Thank you very much for your request for an
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationHypoxic ischemic brain injury in neonates - early MR imaging findings
Hypoxic ischemic brain injury in neonates - early MR imaging findings Poster No.: C-1208 Congress: ECR 2015 Type: Authors: Keywords: DOI: Educational Exhibit E.-M. Heursen, R. Reina Cubero, T. Guijo Hernandez,
More informationNewborn Screen & Development Facts about the genetic diseases new since March 2006 (Excluding Cystic Fibrosis)
Newborn Screen & Development Facts about the genetic diseases new since March 2006 (Excluding Cystic Fibrosis) 1) Argininosuccinic acidemia (ASA) a) Incidence: ~1 in 70,000 b) Deficiency in an enzyme of
More informationHypoxic-Ischemic Encephalopathy. TW de Witt University of Pretoria Department of Paediatrics Neonatology
Hypoxic-Ischemic Encephalopathy TW de Witt University of Pretoria Department of Paediatrics Neonatology Background HIE remains a serious condition that causes significant mortality and longterm morbidity.
More informationFrom NICU to the Community. General Practitioners Study Day October 18 th 2014
From NICU to the Community General Practitioners Study Day October 18 th 2014 News in Neonatology Therapeutic hypothermia CPAP vs ventilation Palivizumab RSV prophylaxis Feeding post discharge Universal
More informationPaediatrica Indonesiana. Echocardiographic patterns in asphyxiated neonates. Maswin Masyhur, Idham Amir, Sukman Tulus Putra, Alan Roland Tumbelaka
Paediatrica Indonesiana VOLUME 49 July NUMBER 4 Original Article Echocardiographic patterns in asphyxiated neonates Maswin Masyhur, Idham Amir, Sukman Tulus Putra, Alan Roland Tumbelaka Abstract Background
More informationNeonatal infections and neonatal seizures. Mohamed Waheed Elsharief Dept. of paediatrics Faculty of medicine Jazan University KSA
Neonatal infections and neonatal seizures Mohamed Waheed Elsharief Dept. of paediatrics Faculty of medicine Jazan University KSA objectives By the end of this lecture the student should Define neonatal
More informationNeonatal Hypoxic-Ischemic Injury: Ultrasound and Dynamic Color Doppler Sonography perfusion of the Brain and Abdomen with pathologic correlation.
Neonatal Hypoxic-Ischemic Injury: Ultrasound and Dynamic Color Doppler Sonography perfusion of the Brain and Abdomen with pathologic correlation. Ricardo Faingold,MD Montreal Children s Hospital Medical
More informationTHE VEGETATIVE STATE IN INFANCY AND CHILDHOOD
THE VEGETATIVE STATE IN INFANCY AND CHILDHOOD Stephen Ashwal MD, Professor of Pediatrics and Neurology, Chief, Division of Child Neurology, Department of Pediatrics, Loma Linda University School of Medicine,
More informationAshley Robson Canyon Creek Dr. Mckinney, TX 75070
1 Ashley Robson 2212 Canyon Creek Dr. Mckinney, TX 75070 September 2 nd 2014 Debra Brandon PhD, RN, CCNS, FAAN Duke University School of Nursing Durham, NC Dear Mrs. Brandon- I would like the opportunity
More informationStudy of correlation severity of hypoxic ischemic encephalopathy on MRI brain with clinical findings
Radiology and Imaging Special Issue December 2017: Vol-7, Issue- 1, P 34-41 Original article: Study of correlation severity of hypoxic ischemic encephalopathy on MRI brain with clinical findings *Dr Ramaa
More informationNeurodevelopmental Risk?
Normal Newborn During transitional hypoglycemia normal newborns have an enhanced ketogenic response to fasting. Newborn brains have enhanced capability to use ketone bodies for fuel Allows newborns to
More information5 Diagnosis. Timely diagnosis. Back to contents
5 5 Diagnosis Back to contents Study Advisory Group questions: Are there delays in diagnosis? Is there variation in how the cerebral palsies are described? signs can fluctuate, to avoid over-diagnosis
More informationPALLIATIVE C ARE CARE F OR FOR PEDIATRIC PATIENTS
PALLIATIVE CARE FOR PEDIATRIC PATIENTS INTRODUCTION In Sub-Saharan Africa 16% of children born alive die before their 5 th birthday. AIDS and cancer are two most commonest incurable childhood d diseases
More informationEQUIPMENT: Nitrous Oxygen Delivery System:
Policy: Nitrous Oxide Use in the Intrapartum and Immediate Postpartum Period for Obstetrical Patients in the Family Birth Place Approvers: CEO. CNO, Medical Staff President, Anesthesia Chair, OB Medical
More information