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Lavrentev SN, Petrova AS, Serova OF, Vishnyakova P, Kondratev MV, Gryzunova AS, Zakharova NI, Zubkov VV, Silachev DN. Ultrasound Diagnosis and Near-Infrared Spectroscopy in the Study of Encephalopathy in Neonates Born under Asphyxia: Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:591. [PMID: 38790586 PMCID: PMC11119551 DOI: 10.3390/children11050591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.
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Affiliation(s)
- Simeon N. Lavrentev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Anastasia S. Petrova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Olga F. Serova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
| | - Polina Vishnyakova
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Maxim V. Kondratev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Anastasia S. Gryzunova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Nina I. Zakharova
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Victor V. Zubkov
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Denis N. Silachev
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
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Ceran B, Kutman HGK, Beyoğlu R, Şimşek GK, Elbayiyev S, Canpolat FE. Diagnostic role of optic nerve sheath diameter and brain blood flow in neonates with hypoxic-ischemic encephalopathy. Childs Nerv Syst 2023; 39:425-433. [PMID: 36323955 DOI: 10.1007/s00381-022-05731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The primary aim was to study the optic nerve sheath diameter (ONSD) measurements and cerebral blood flows in neonates with hypoxic-ischemic encephalopathy (HIE) who were at risk of cerebral edema and to compare the measurements with healthy neonates. METHODS Neonates diagnosed as Stage II and III HIE patients were enrolled in the study group. ONSD measurements and blood flow Doppler studies in the first 24-48 h of life during hypothermia and following hypothermia treatment. Magnetic resonance imaging (MRI) and transfontanelle ultrasonography were performed within the first 4-7 days of life in all HIE patients. Saved US and MRI images were assessed by a blind pediatric radiologist later on. RESULTS Data from a total of 63 infants (42 in the HIE group and 21 in the control group) were analyzed. Both the right and left ONSD measurements were comparable between HIE and control groups. However, both resistive index (RI) and pulsatility index (PI) of the middle cerebral artery were found to be significantly lower in HIE (0.69 ± 0.09 and 1.14 (0.98-1.30)) group when compared with controls (0.75 ± 0.04 and 1.41 (1.25-1.52)) (p < 0.01). Ultrasonographic ONSD measurements were significant and strongly correlated with MRI ONSD measurements for both sides (r = 0.91 and r = 0.93, p < 0.01). Doppler studies during normothermia were comparable with the control group and significantly increased following therapeutic hypothermia. CONCLUSION Ultrasonographic ONSD measurements can be reliably performed in term neonates with high compatibility to MRI. No significant effect on ONSD measurements was found related to asphyxia and therapeutic hypothermia despite the significant alteration observed in Doppler studies.
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Affiliation(s)
- Burak Ceran
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey.
| | - Hayriye Gözde Kanmaz Kutman
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey
| | - Rana Beyoğlu
- Department of Pediatric Radiology, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey
| | - Gülsüm Kadıoğlu Şimşek
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey
| | - Sarkhan Elbayiyev
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences 06800, Bilkent/Çankaya, Ankara, Turkey
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Transfontanellar duplex brain ultrasonography resistive indices as a prognostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia. J Perinatol 2016; 36:202-6. [PMID: 26609871 PMCID: PMC4767581 DOI: 10.1038/jp.2015.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Prior to therapeutic hypothermia (that is, cooling), transfontanellar duplex brain sonography resistive indices (RI) were studied as a bedside non-invasive measures of cerebral hemodynamics in neonates who suffered from hypoxic-ischemic encephalopathy (HIE). We compared pre- and post-cooling RI values and examined the relationships between RI values and specific long-term neurodevelopmental outcomes. STUDY DESIGN Transfontanellar duplex brain sonography, including RI, were obtained for 28 neonates prior to cooling and for 20 neonates following cooling. All RI values were sampled in the anterior cerebral artery at the beginning of each ultrasound study. Neurodevelopmental assessment was conducted between ages 20-32 months with the Mullen Scale of Early Learning. The relationships between pre- and post-cooling RI and cognitive and motor outcomes were studied. RESULT Neonates with RI values <0.60 prior to and following cooling were more likely to die or have severe neurodevelopmental disability by ages 20-32 months than those with RI>0.60. Lower RI values were associated with specific neurodevelopmental deficits in motor skill attainment. CONCLUSION Pre- and post-cooling transfontanellar duplex brain sonography RI values may be a useful prognostic tool, in conjunction with other clinical information, for neonates diagnosed with HIE. The results of this study suggest that further study of the prognostic value of RI values for short- and long-term outcomes is warranted.
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Stola A, Perlman J. Post-resuscitation strategies to avoid ongoing injury following intrapartum hypoxia-ischemia. Semin Fetal Neonatal Med 2008; 13:424-31. [PMID: 18501692 DOI: 10.1016/j.siny.2008.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The interruption of placental blood flow during labor with redistribution of cardiac output resulting in increased flow to brain, heart, and adrenal glands at the expense of flow to kidney, gut, and skin can result in systemic organ as well as cerebral injury. Thus, post-resuscitation strategies should focus on both the management of potential systemic organ dysfunction and on methods of preventing ongoing brain injury in high-risk infants. General management strategies should include ventilator management to maintain pCO(2) values in the normal range, close attention to blood pressure to avoid hypotension, striving to avoid hypoglycemia, and control of seizures. Modest hypothermia administered within the first 6 hours has been shown to reduce neurodevelopmental deficits and death in those infants at highest-risk infants for developing hypoxic-ischemic brain injury.
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Affiliation(s)
- Anita Stola
- Weill Cornell Medical College, New York 10021, USA
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5
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Abstract
Investigations in animal models of hypoxic-ischemic injury have not translated into clinical trials of success because of the complex pathology of hypoxic-ischemic brain injury in neonates, the difficulty in defining the onset and duration and severity of the injury, the underlying predisposing disorders of the mothers or the infant, the side effects of many of the investigational drugs precluded clinical use, and many of the investigational agents interfered with only one step of the cascade of events that lead to brain injury. It is possible that a combination of therapeutic agents, including those that affect different levels of the cascade to cell death, will have the greatest neuroprotective effects. Modest hypothermia postpones secondary energy failure and can prolong the window while pharmacotherapeutic agents can be used. It is possible that in the future, sequential administration of agents or strategies that are initiated in the intrapartum period and continued postnatally will be the optimum method for treating infants who are at highest risk for brain injury following acute hypoxic-ischemic asphyxia.
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Affiliation(s)
- Seetha Shankaran
- Neonatal-Perinatal Medicine, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
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6
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Abstract
Following critical hypoxia-ischemia during labor and delivery, there is a window of therapeutic opportunity during hypoxic-ischemic encephalopathy. Meta-analysis of three randomized trials of prophylactic barbiturate therapy for neonatal hypoxic-ischemic encephalopathy showed no significant effect on death or disability. One randomized trial of allopurinol showed short-term benefits but was too small to test death or disability. No adequate trials of dexamethasone, calcium channel blockers, or magnesium sulphate have yet been completed, but pilot studies in infants have shown the cardiovascular risks of magnesium sulphate and calcium channel blockers. There is considerable evidence from animal studies that posthypoxic mild hypothermia reduces brain injury. One small randomized trial of mild hypothermia found no adverse effects but was too small to examine death or disability. One large randomized trial of selective head cooling has finished recruitment and a number of large trials of systemic mild hypothermia are ongoing. As time is critical with post-hypoxic interventions, the delay involved in obtaining informed parental consent for such trials might obscure a clinically important therapeutic effect.
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Affiliation(s)
- Andrew Whitelaw
- Division of Child Health, University of Bristol, Bristol, United Kingdom.
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7
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Lingwood BE, Dunster KR, Colditz PB, Ward LC. Noninvasive measurement of cerebral bioimpedance for detection of cerebral edema in the neonatal piglet. Brain Res 2002; 945:97-105. [PMID: 12113956 DOI: 10.1016/s0006-8993(02)02744-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The association of sustained cerebral edema with poor neurological outcome following hypoxia-ischaemia in the neonate suggests that measurement of cerebral edema may allow early prediction of outcome in these infants. Direct measurements of cerebral impedance have been widely used in animal studies to monitor cerebral edema, but such invasive measurements are not possible in the human neonate. This study investigated the ability of noninvasive cerebral impedance measurements to detect cerebral edema following hypoxia-ischaemia. One-day-old piglets were anaesthetized, intubated and ventilated. Hypoxia was induced by reducing the inspired oxygen concentration to 4-6% O(2). Noninvasive cerebral bioimpedance was measured using gel electrodes attached to the scalp. Cerebral bioimpedance was also measured directly by insertion of two silver-silver chloride electrodes subdurally. Noninvasive and invasive measurements were made before, during and after hypoxia. Whole body impedance was measured to assess overall fluid movements. Intracranial pressure was measured continuously via a catheter inserted subdurally, as an index of cerebral edema. There was good agreement between noninvasive and invasive measurements of cerebral impedance although externally obtained responses were attenuated. Noninvasive measurements were also well correlated with intracranial pressure. Whole body impedance changes did not account for increases in noninvasively measured cerebral impedance. Results suggest that noninvasive cerebral impedance measurements do reflect intracranial events, and are able to detect cerebral edema following hypoxia-ischaemia in the neonate.
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Affiliation(s)
- Barbara E Lingwood
- Perinatal Research Centre, The University of Queensland, Royal Women's Hospital, Herston, Queensland 4029, Australia.
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8
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Cornette L, Levene MI. Post-resuscitative management of the asphyxiated term and preterm infant. SEMINARS IN NEONATOLOGY : SN 2001; 6:271-82. [PMID: 11520192 DOI: 10.1053/siny.2001.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Up until the recent past, the treatment for perinatal asphyxia included only supportive measures. Babies were resuscitated and then observed for signs of multi-organ system dysfunction. Apart from standard supportive management, a new arsenal of potential neuroprotective strategies have emerged over the past years, in order to decrease the severity of brain injury following asphyxia. Today, several neuroprotective therapies are being evaluated in human infants.
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Affiliation(s)
- L Cornette
- Division of Paediatrics and Child Health, Leeds General Infirmary, Leeds, UK.
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9
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Whitelaw A. Systematic review of therapy after hypoxic-ischaemic brain injury in the perinatal period. SEMINARS IN NEONATOLOGY : SN 2000; 5:33-40. [PMID: 10802748 DOI: 10.1053/siny.1999.0113] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objectives were to identify and to evaluate controlled trials of interventions for term infants developing hypoxic-ischaemic encephalopathy. Five randomized trials concerning prophylactic anticonvulsant therapy for neonatal HIE were identified. There were methodological problems with all of them, and meta-analysis of barbiturate prophylaxis showed no significant effect on death or disability. One randomized trial of allopurinol showed short-term benfits, but was too small to test death or disability. One small randomized trial of hypothermia found no adverse effects, but was too small to examine death or disability. No adequate trials of dexamethasone, calcium channel blockers, magnesium sulphate, or naloxone have yet been completed, but pilot studies in infants have shown the risks of magnesium sulphate and calcium channel blockers.
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Affiliation(s)
- A Whitelaw
- Division of Child Health, University of Bristol Medical School, Southmead Hospital, Bristol, BS10 5NB, UK.
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10
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Wayenberg JL. Non-invasive measurement of intracranial pressure in neonates and infants: experience with the Rotterdam teletransducer. ACTA NEUROCHIRURGICA. SUPPLEMENT 1998; 71:70-3. [PMID: 9779148 DOI: 10.1007/978-3-7091-6475-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
On the basis of an experience of more than 400 recordings, we demonstrate the usefulness of the anterior fontanelle pressure monitoring (AFP) in several clinical conditions. Main indications for AFP monitoring are the evaluation and the differential diagnosis of neonatal encephalopathy and the assessment of infants with enlarged ventricular spaces, ventriculo-peritoneal derivation or increased head growth rate. Further technical progress is needed to permit AFP recordings in infants with small anterior fontanelle and to reduce the time necessary for the AFP measurement and interpretation procedure. We conclude that it is technically possible and clinically helpful to obtain accurate information about ICP and changes in cerebral compliance in a wide range of clinical conditions without the use of invasive techniques.
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Affiliation(s)
- J L Wayenberg
- Department of Paediatrics, Hôpital Français-Reine Elisabeth, Brussels, Belgium
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11
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Abstract
Perinatal hypoxic-ischemic cerebral injury is a significant cause of neurological morbidity and mortality in childhood. It is often difficult to determine the precise timing of such injury. Data from epidemiological and neuropathological studies have identified several maternal and fetal risk factors that seem to be associated with suspected prenatal brain injury. Hypoxic-ischemic cerebral injury that originates earlier in gestation may result in few, if any, clinical abnormalities during the newborn period. Clinical abnormalities may also be difficult to recognize in the premature newborn, and greater reliance must be placed on other adjunctive investigations, eg, neuroimaging. In contrast, term infants who sustain acute, intrapartum hypoxic-ischemic insult of sufficient magnitude to result in long-term sequelae invariably show recognizable encephalopathy during the newborn period. A combination of clinical data and adjunctive investigations during the neonatal period is a powerful predictive tool for long-term outcome.
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Affiliation(s)
- E H Roland
- Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada
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12
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Hanlo PW, Peters RJ, Gooskens RH, Heethaar RM, Keunen RW, van Huffelen AC, Tulleken CA, Willemse J. Monitoring intracranial dynamics by transcranial Doppler--a new Doppler index: trans systolic time. ULTRASOUND IN MEDICINE & BIOLOGY 1995; 21:613-621. [PMID: 8525552 DOI: 10.1016/0301-5629(94)00147-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Since the introduction of transcranial Doppler sonography (TCD) several investigators have described the relationship between raised intracranial pressure (ICP) and Doppler waveform. This waveform has been expressed by several indices, such as the pulsatility index (PI) and the resistance index (RI). These indices are used to demonstrate the presence of raised ICP. In childhood hydrocephalus this information can be used to indicate the need for shunt implantation. However, PI and RI do prove to have certain disadvantages as both are strongly influenced by the heart rate. Moreover, both indices have a broad range of reference values, especially in children. Therefore, they are not very reliable for detecting insidious changes in the ICP. These drawbacks are due to the fact that these indices are composed of blood flow velocity measurements and do not embody the slope of the TCD waveform itself. An ideal TCD waveform analysis should be performed concerning the time-related changes of the velocities. We present a hydrodynamic model, with its electrical analogue, which shows the effects of raised ICP on the intracranial hemodynamic system. Based on these physical findings we define a new Doppler index, the Trans Systolic Time, reflecting specific changes in the TCD waveform induced by changes in the mean ICP. The applicability of this index, compared with PI and RI, is illustrated by consecutive simultaneous TCD and AFP measurements in three children with hydrocephalus.
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Affiliation(s)
- P W Hanlo
- Department of Neurosurgery, University Hospital, Utrecht, The Netherlands
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13
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Shankaran S, Woldt E, Bedard MP, Delaney-Black V, Zakalik K, Canady A. Feasibility of invasive monitoring of intracranial pressure in term neonates. Brain Dev 1994; 16:121-5. [PMID: 8048699 DOI: 10.1016/0387-7604(94)90047-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seven term neonates with encephalopathy resulting from asphyxia and/or intracranial hemorrhage underwent invasive monitoring of intracranial pressure through the epidural or intracerebral space. The average age (in hours) at insertion of the monitor was 27 h in the 3 neonates with asphyxia and 70 h in the 4 neonates with hemorrhage. Intracranial hypertension was noted in 6 neonates. The management of the hypertension included hyperventilation followed by mannitol for pressures that were sustained above 20 mmHg and pentobarbital for pressures above 30 mmHg. The duration of the hypertension varied in 5 neonates from 4 to 72 h, while in the remaining neonates, the pressure remained elevated until death at 70 h. All 4 survivors with intracranial hemorrhage have minimal neuromotor deficits on follow up and 2 survivors with asphyxia have cognitive deficits and are microcephalic. From this small series, it appears that in the management of term neonates with intracranial hemorrhage, monitoring of intracranial pressure should be considered.
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Affiliation(s)
- S Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit 48201
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14
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Gray PH, Tudehope DI, Masel JP, Burns YR, Mohay HA, O'Callaghan MJ, Williams GM. Perinatal hypoxic-ischaemic brain injury: prediction of outcome. Dev Med Child Neurol 1993; 35:965-73. [PMID: 8224563 DOI: 10.1111/j.1469-8749.1993.tb11578.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Twenty-six term babies with hypoxic-ischaemic brain injury were studied during the neonatal period to evaluate the prediction of outcome to at least one year of age by means of ultrasonography, CT scanning and Doppler ultrasound assessment of cerebral palsy blood flow velocity (CBFV). Adverse outcome was defined as the occurrence of cerebral palsy, developmental delay or death. At follow-up, 17 infants had an adverse outcome (seven died, 10 had disability); the remainder had no detectable impairment. Abnormalities on cranial ultrasound were not, but generalised decreased tissue density on CT scan was, associated with adverse outcome. Abnormal mean CBFV in the middle cerebral artery had no association with outcome, but abnormal mean CBFV in the anterior cerebral artery and a low resistance index in both arteries were significantly associated with adverse outcome. Such information may be used for appropriate counselling of parents of asphyxiated infants.
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Affiliation(s)
- P H Gray
- Mater Mothers' Hospital, South Brisbane QLD, Australia
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15
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Wayenberg JL, Raftopoulos C, Vermeylen D, Pardou A. Non-invasive measurement of intracranial pressure in the newborn and the infant: the Rotterdam teletransducer. Arch Dis Child 1993; 69:493-7. [PMID: 8285752 PMCID: PMC1029591 DOI: 10.1136/adc.69.5_spec_no.493] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Knowledge of intracranial pressure may be important in many clinical situations in neonates and young infants. The best way to obtain this information would be a non-traumatic procedure. In order to test the reliability of a new fontanometer, the Rotterdam teletransducer, 25 simultaneous measurements of cerebrospinal fluid (CSF) pressure and anterior fontanelle pressure (AFP) were performed. Mean (SD) difference between CSF pressure and AFP was -0.2 (1.8) mm Hg (95% confidence interval from -0.48 to -0.88 mm Hg). The AFP was also measured in 60 healthy children (15 premature, 30 term newborn babies, and 15 infants). The different aspects of AFP were analysed and normal values computed. These results suggest that the Rotterdam teletransducer gives reliable continuous information about intracranial pressure and can be used in clinical practice. Interpretation of AFP plots must take the influence of postconceptional age and the physiological occurrence of pressure waves into account.
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Affiliation(s)
- J L Wayenberg
- Department of Paediatrics, Hôpital Français-Reine Elisabeth, Brussels, Belgium
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16
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Affiliation(s)
- M I Levene
- Academic Unit of Paediatrics and Child Health, University of Leeds
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17
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Abstract
In the newborn, structural and functional cerebral abnormalities are described as well as clinical manifestations of neurological distress, change with gestational age, and therefore with the degree of central nervous system maturation. The different maturational stages of the cerebral structure, their vascularization and myelinization from the gestational age of 24-25 weeks to the full-term neonate are briefly reported. The cerebral lesions and mechanisms of hypoxoischemic encephalopathy in the full-term neonate are summarized; an analysis of the various clinical symptoms and additional investigations (in particular the electroencephalogram) allows a precise prognosis to be made. In the premature newborn, there are 2 types of cerebral lesions: intraventricular hemorrhage and periventricular leukomalacia. The latter is primarily responsible for neurological sequelae. Clinical manifestations are poor and atypical; data based on complementary procedures (imaging and electroencephalography) allow an accurate evaluation to be made of the damage and neurological prognosis.
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Affiliation(s)
- A M D'Allest
- Service d'explorations fonctionnelles, Hôpital Antoine-Béclère, Clamart, France
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18
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MESH Headings
- Brain/diagnostic imaging
- Cerebral Hemorrhage/diagnosis
- Cerebral Hemorrhage/diagnostic imaging
- Cerebral Hemorrhage/epidemiology
- Child
- Child, Preschool
- Female
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/epidemiology
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/diagnostic imaging
- Leukomalacia, Periventricular/epidemiology
- Magnetic Resonance Imaging
- Male
- Tomography, X-Ray Computed
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Affiliation(s)
- R N Ichord
- Department of Pediatric Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205
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19
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Lin JP, Goh W, Brown JK, Steers AJ. Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting. Childs Nerv Syst 1992; 8:190-7. [PMID: 1394249 DOI: 10.1007/bf00262843] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus born between 1975 and 1988 was assessed at a mean age of 4.7 years (9 months to 13 years). Two outcomes were determined: 12 patients were either normal (10 or had neurological signs without functional impairments (2), while 21/33 were moderately (16), severely (2), or profoundly impaired (3). Intracranial pressure (ICP) was measured in 26/33 patients (4-40 mm Hg): 2 had normal pressures (< 5.6 mm Hg) and were normal. Raised ICP was not significantly different between outcome groups. Twenty-seven children were shunted; 10/27 had five or more operations (up to 14) and all of these had abnormal neurological outcomes, whereas the number of children with 1-4 shunt procedures was equal in both outcome groups. The rise in morbidity after the fourth shunt procedure may be associated with the ventriculitis suffered by 9 of the 10 patients with more than four shunts (P < 0.01): this compares with 4/14 cases of ventriculitis in the children with 2-4 shunts and no cases of infection in the 3/27 who were shunted once. Outcome was independent of antenatal and perinatal factors including the age at or mode of presentation, and was unrelated to grade of intraventricular haemorrhage or parenchymal changes on ultrasound or CT scanning. CONCLUSION for these small numbers, adverse outcome is statistically related to more than four shunt procedures and ventriculitis but independent of maximum ICP or other perinatal factors.
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Affiliation(s)
- J P Lin
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
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20
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Abstract
Methods for the acqusition and analysis of intracranial pressure (ICP) signals are reviewed from clinical and technical perspectives. The clinical importance of ICP monitoring is presented, and methods for ICP transduction are briefly discussed. These methods include intraventricular catheters, subarachnoid screws, epidural techniques, and the new fiberoptic ICP measurement systems. Approaches to the visual analysis of the ICP waveform are presented, with special emphasis on the relationship between the ICP waveform and the arterial blood pressure signal. Methods of computer-based ICP analysis are also reviewed, including histogram and "systems analysis" methods. Methods to predict ICP pressure rises and to estimate intracranial compliance are also discussed. Finally, ICP monitoring is reviewed from the point of view of patient outcome. It is concluded that advanced ICP waveform analysis methods warrant further clinical evaluation to demonstrate their clinical usefulness.
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Affiliation(s)
- D J Doyle
- Department of Anaesthesia, Toronto General Hospital, Ontario, Canada
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21
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Abstract
Neonatal pathology comprises a large array of cerebral lesions due to ischemic and/or hemorrhagic mechanisms. Pathogenesis, neuropathology, clinical settings in the acute stages as well as short and long-term outcome are discussed.
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Affiliation(s)
- F Guzzetta
- Istituto di Neuropsichiatria Infantile, Policlinico Universitario, Università di Messina, Italy
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22
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Abstract
There is currently no set of evaluations that allows for the accurate prediction of survival or death following severe perinatal asphyxia and the development of hypoxic-ischemic encephalopathy. We hypothesized that low cerebral blood flow velocity, as determined by Doppler ultrasonography, may predict neurologic nonviability in a group of severely asphyxiated infants who exhibited signs of severe encephalopathy. Using the staging system of Sarnat and Sarnat, 11 infants who had had severe perinatal asphyxia were studied at the time that their neurologic examinations met the criteria for stage 3 encephalopathy. Apgar scores, cord or initial blood gases and pH, blood pressure, heart rate, and electroencephalographic findings were similar between those infants who survived (N = 8) and those who died due to cerebral injury (N = 3). Cerebral blood flow velocity, however, was significantly lower in those infants who died (3,288 +/- 884 vs 1,051 +/- 789 planimeter units/min; P less than .005). All infants who died had retrograde diastolic blood flow in the common carotid artery. In the study group the combination of low cerebral blood flow velocity and retrograde diastolic blood flow in the common carotid artery allowed prediction of survival and death with sensitivity and specificity of 100% (P less than .006). Following perinatal asphyxia and the development of severe encephalopathy, the finding of low cerebral blood flow velocity appears to be predictive of neurologic nonviability.
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Affiliation(s)
- T S Rosenkrantz
- Department of Pediatrics, University of Connecticut Health Center, Farmington 06030
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23
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Abstract
Acute perinatal hypoxic-ischemic cerebral injury in the term newborn is a major cause of long-term neurologic abnormalities in childhood. Earlier diagnosis and more precise localization of hypoxic-ischemic cerebral injury has been made possible by optimal timing and the use of new imaging modalities (e.g., magnetic resonance imaging, spectroscopy, computed tomography, cerebral perfusion techniques). Recent concepts on pathogenesis of such injury involves metabolic factors, regional distribution of excitatory (glutamate) synapses, and factors related to active myelination in specific areas at the time of insult. Consideration of these aspects of pathogenesis permit a rational approach to the management of this major neurologic problem in the newborn.
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Affiliation(s)
- A Hill
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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24
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Affiliation(s)
- A Whitelaw
- Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, London
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25
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Affiliation(s)
- A Mehta
- Section of Perinatal and Child Health, MRC Clinical Research Centre, Harrow, Middlesex
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