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Vega-del-Val C, Arnaez J, Ochoa-Sangrador C, Garrido-Barbero M, García-Alix A. Incidence of encephalopathy and comorbidity in infants with perinatal asphyxia: a comparative prospective cohort study. Front Pediatr 2024; 12:1363576. [PMID: 38601274 PMCID: PMC11004398 DOI: 10.3389/fped.2024.1363576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Programs that aim to improve the detection hypoxic-ischemic encephalopathy (HIE) should establish which neonates suffering from perinatal asphyxia need to be monitored within the first 6 h of life. Method An observational prospective cohort study of infants with gestational age ≥35 weeks, and above 1,800g, were included according to their arterial cord pH value (ApH): ≤7.00 vs. 7.01-7.10. Data was collected including obstetrical history, as well as neonatal comorbidities, including the presence of HIE, that happened within 6 h of life. A standardized neurological exam was performed at discharge. Results There were 9,537 births; 176 infants with ApH 7.01-7.10 and 117 infants with ApH ≤7.00. All 9 cases with moderate-to-severe HIE occurred among infants with ApH ≤7.00. The incidence of global and moderate-severe HIE was 3/1,000 and 1/1,000 births, respectively. Outcome at discharge (abnormal exam or death) showed an OR 12.03 (95% CI 1.53, 94.96) in infants with ApH ≤7.00 compared to ApH 7.01-7.10 cohort. Ventilation support was 5.1 times (95% CI 2.87, 9.03) more likely to be needed by those with cord ApH ≤7.00 compared to those with ApH 7.01-7.10, as well as hypoglycemia (37% vs. 25%; p = 0.026). In 55%, hypoglycemia occurred despite oral and/or intravenous glucose administration had been already initiated. Conclusions Cord pH 7.00 might be a safe pH cut-off point when developing protocols to monitor infants born with acidemia in order to identify infants with moderate or severe HIE early on. There is non-negligible comorbidity in the ApH ≤7.00 cohort, but also in the 7.01-7.10 cohort.
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Affiliation(s)
| | - Juan Arnaez
- Neonatology Unit, Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
| | - Carlos Ochoa-Sangrador
- Department of Investigation Unit, Hospital Virgen de la Concha, Zamora, Spain
- Ciencias de la Salud, Escuela Universitaria de Enfermería, Zamora, Spain
| | | | - Alfredo García-Alix
- Neonatal Neurology, Nene Foundation, Madrid, Spain
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Florham Park, NJ, United States
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2
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Alarcón A, de Vries LS, Parodi A, Arnáez J, Cabañas F, Steggerda SJ, Rebollo M, Ramenghi L, Dorronsoro I, López-Azorín M, Schneider J, Noguera-Julian A, Ríos-Barnés M, Recio M, Bickle-Graz M, Martínez-Biarge M, Fortuny C, García-Alix A, Truttmann AC. Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities. Arch Dis Child Fetal Neonatal Ed 2024; 109:151-158. [PMID: 37739774 PMCID: PMC10894834 DOI: 10.1136/archdischild-2023-325790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs). METHODS Multicentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability. RESULTS Neuroimaging scoring was associated with outcome (p<0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p<0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia. CONCLUSIONS Categorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis.
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Affiliation(s)
- Ana Alarcón
- Department of Neonatology, Hospital Sant Joan de Déu and Neonatal Brain Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Linda S de Vries
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Juan Arnáez
- Neonatal Unit, Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology NeNe Foundation, Madrid, Spain
- Sociedad Iberoamericana de Neonatología (SIBEN), New Jersey, New Jersey, USA
| | - Fernando Cabañas
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Research Foundation, Hospital Universitario La Paz, Madrid, Spain
| | - Sylke J Steggerda
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mónica Rebollo
- Radiology Department, Paediatric Radiology Unit, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Diagnostic and Therapeutic Imaging Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Luca Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Università di Genova, Genoa, Italy
| | - Izaskun Dorronsoro
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Manuela López-Azorín
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Juliane Schneider
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
| | - Antoni Noguera-Julian
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnés
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Myriam Bickle-Graz
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
| | | | - Clàudia Fortuny
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Alfredo García-Alix
- Neonatal Neurology NeNe Foundation, Madrid, Spain
- Sociedad Iberoamericana de Neonatología (SIBEN), New Jersey, New Jersey, USA
| | - Anita C Truttmann
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
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Garrido-Barbero M, Arnaez J, Martín-Ancel A, González H, García-Alix A. Thrombin, protein C, and protein S values in mother-infant dyads in the postpartum period. An Pediatr (Barc) 2023; 98:338-343. [PMID: 37076369 DOI: 10.1016/j.anpede.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/17/2022] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION The objective of the study was to establish the normal range for the levels of antithrombin (AT), protein C (PC), and protein S (PS) in the first week post birth in mother-infant pairings, adjusting for obstetric and perinatal factors, based on 2 different laboratory methods. METHODS Determinations were carried out in 83 healthy term neonates and their mothers, establishing 3 postpartum age groups: 1-2 days, 3 days, and 4-7 days. RESULTS There were no differences in the levels of any of the proteins between the different age groups in neonates or mothers in the first week post birth. The adjusted analysis found no association with obstetric or perinatal factors. The AT and PC levels were higher in mothers compared to infants (P < .001), while the PS levels were similar in both. Overall, the correlation of maternal and infant protein values was poor, except for the levels of free PS in the first 2 days after delivery. Although we found no differences based on which of the 2 laboratory methods was applied, the absolute values did differ.
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Affiliation(s)
| | - Juan Arnaez
- Unidad de Neonatología, Complejo Asistencial Universitario de Burgos, Burgos, Spain; Fundación NeNe, Madrid, Spain; Profesor Sociedad Iberoamericana de Neonatología, Nueva Yersey, EE.UU.
| | - Ana Martín-Ancel
- Unidad de Neonatología, Centro de Medicina Maternofetal y Neonatal de Barcelona (BCNatal), Hospital Sant Joan de Déu y Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alfredo García-Alix
- Fundación NeNe, Madrid, Spain; Profesor Sociedad Iberoamericana de Neonatología, Nueva Yersey, EE.UU
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4
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Núñez C, García-Alix A, Arca G, Agut T, Carreras N, Portella MJ, Stephan-Otto C. Breastfeeding duration is associated with larger cortical gray matter volumes in children from the ABCD study. J Child Psychol Psychiatry 2023. [PMID: 36946606 DOI: 10.1111/jcpp.13790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Despite the numerous studies in favor of breastfeeding for its benefits in cognition and mental health, the long-term effects of breastfeeding on brain structure are still largely unknown. Our main objective was to study the relationship between breastfeeding duration and cerebral gray matter volumes. We also explored the potential mediatory role of brain volumes on behavior. METHODS We analyzed 7,860 magnetic resonance images of children 9-11 years of age from the Adolescent Brain Cognitive Development (ABCD) dataset in order to study the relationship between breastfeeding duration and cerebral gray matter volumes. We also obtained several behavioral data (cognition, behavioral problems, prodromal psychotic experiences, prosociality, impulsivity) to explore the potential mediatory role of brain volumes on behavior. RESULTS In the 7,860 children analyzed (median age = 9 years and 11 months; 49.9% female), whole-brain voxel-based morphometry analyses revealed an association mainly between breastfeeding duration and larger bilateral volumes of the pars orbitalis and the lateral orbitofrontal cortex. In particular, the association with the left pars orbitalis and the left lateral orbitofrontal cortex proved to be very robust to the addition of potentially confounding covariates, random selection of siblings, and splitting the sample in two. The volume of the left pars orbitalis and the left lateral orbitofrontal cortex appeared to mediate the relationship between breastfeeding duration and the negative urgency dimension of the UPPS-P Impulsive Behavior Scale. Global gray matter volumes were also significant mediators for behavioral problems as measured with the Child Behavior Checklist. CONCLUSIONS Our findings suggest that breastfeeding is a relevant factor in the proper development of the brain, particularly for the pars orbitalis and lateral orbitofrontal cortex regions. This, in turn, may impact impulsive personality and mental health in early puberty.
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Affiliation(s)
- Christian Núñez
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alfredo García-Alix
- Neonatal Neurology, NeNe Foundation, Madrid, Spain
- Iberoamerican Society of Neonatology (SIBEN), NJ, United States
| | - Gemma Arca
- Neonatal Neurology, NeNe Foundation, Madrid, Spain
- Department of Neonatology, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Thais Agut
- Neonatal Neurology, NeNe Foundation, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Nuria Carreras
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Maria J Portella
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Networking Research Center on Mental Health (CIBERSAM), Madrid, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Networking Research Center on Mental Health (CIBERSAM), Madrid, Spain
- Pediatric Computational Imaging Group (PeCIC), Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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García-Alix A, Saenz de Pipaon M, Argente J. IN MEMORIAM José Quero Jiménez, M.D., Ph.D. Full Professor of pediatrics & neonatology. Pediatr Res 2023:10.1038/s41390-023-02516-2. [PMID: 36944723 DOI: 10.1038/s41390-023-02516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Alfredo García-Alix
- Nene Foundation, Barcelona, Catalunya, Spain
- Professor of Neonatology, Iberic American Society of Neonatology (SIBEN), Wellington, FL, USA
| | - Miguel Saenz de Pipaon
- La Paz University Hospital Children Hospital, Neonatology, IdiPaz, Madrid, Spain.
- Universidad Autonoma de Madrid, Department of Pediatrics, Madrid, Spain.
| | - Jesús Argente
- Universidad Autonoma de Madrid, Department of Pediatrics, Madrid, Spain
- Hospital Infantil Universitario Nino Jesus, Department of Pediatrics & Endocrinology, Madrid, Spain
- Instituto de Investigación del Hospital de La Princesa, Madrid, Spain
- Instituto de Salud Carlos III, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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García-Alix A, Arca G. Stem cells in the horizon of the treatment of the neonatal arterial ischemic infraction. An Pediatr (Barc) 2022; 97:373-374. [PMID: 36270945 DOI: 10.1016/j.anpede.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Gemma Arca
- Fundación NeNe, Spain; Departamento de Neonatología, Hospital Clínic, IDIBAPS, Barcelona, Spain
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García-Alix A, Arca G. Las células madre en el horizonte del tratamiento del infarto arterial cerebral del neonato. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Schuler-Faccini L, Del Campo M, García-Alix A, Ventura LO, Boquett JA, van der Linden V, Pessoa A, van der Linden Júnior H, Ventura CV, Leal MC, Kowalski TW, Rodrigues Gerzson L, Skilhan de Almeida C, Santi L, Beys-da-Silva WO, Quincozes-Santos A, Guimarães JA, Garcez PP, Gomes JDA, Vianna FSL, Anjos da Silva A, Fraga LR, Vieira Sanseverino MT, Muotri AR, Lopes da Rosa R, Abeche AM, Marcolongo-Pereira C, Souza DO. Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects. Front Genet 2022; 13:758715. [PMID: 35350244 PMCID: PMC8957982 DOI: 10.3389/fgene.2022.758715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.
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Affiliation(s)
- Lavínia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Miguel Del Campo
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Liana O Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | - Camila V Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | - Thayne Woycinck Kowalski
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,CESUCA-Centro Universitário, Cachoeirinha, Brazil
| | | | | | - Lucélia Santi
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Walter O Beys-da-Silva
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Jorge A Guimarães
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | | | - Fernanda Sales Luiz Vianna
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - André Anjos da Silva
- School of Medicine, Graduate Program in Medical Sciences-Universidade do Vale do Taquari-UNIVATES, Lajeado, Brazil.,School of Medicine, Universidade do Vale do Rio dos Sinos-UNISINOS, São Leopoldo, Brazil
| | - Lucas Rosa Fraga
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Alysson R Muotri
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Alberto Mantovani Abeche
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Diogo O Souza
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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Núñez C, Stephan-Otto C, Arca G, Agut T, Arnaez J, Cordeiro M, Benavente-Fernández I, Boronat N, Lubián-López SP, Valverde E, Hortigüela M, García-Alix A. Neonatal arterial stroke location is associated with outcome at 2 years: a voxel-based lesion-symptom mapping study. Arch Dis Child Fetal Neonatal Ed 2022; 107:45-50. [PMID: 33990386 DOI: 10.1136/archdischild-2020-320400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In contrast to motor impairments, the association between lesion location and cognitive or language deficits in patients with neonatal arterial ischaemic stroke remains largely unknown. We conducted a voxel-based lesion-symptom mapping cross-sectional study aiming to reveal neonatal arterial stroke location correlates of language, motor and cognitive outcomes at 2 years of age. DESIGN Prospective observational multicentre study. SETTING Six paediatric university hospitals in Spain. PARTICIPANTS We included 53 patients who had a neonatal arterial ischaemic stroke with neonatal MRI and who were followed up till 2 years of age. MAIN OUTCOME MEASURES We analysed five dichotomous clinical variables: speech therapy (defined as the need for speech therapy as established by therapists), gross motor function impairment, and the language, motor and cognitive Bayley scales. All the analyses were controlled for total lesion volume. RESULTS We found that three of the clinical variables analysed significantly correlated with neonatal stroke location. Speech therapy was associated with lesions located mainly at the left supramarginal gyrus (p=0.007), gross motor function impairment correlated with lesions at the left external capsule (p=0.044) and cognitive impairment was associated with frontal lesions, particularly located at the left inferior and middle frontal gyri (p=0.012). CONCLUSIONS The identification of these susceptible brain areas will allow for more precise prediction of neurological impairments on the basis of neonatal brain MRI.
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Affiliation(s)
- Christian Núñez
- Departament de Psiquiatria, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Gemma Arca
- Departament de Neonatologia, Hospital Clínic, IDIBAPS, Barcelona, Spain.,NeNe Foundation, Madrid, Spain
| | - Thais Agut
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,NeNe Foundation, Madrid, Spain.,Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Juan Arnaez
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario de Burgos, Burgos, Spain
| | - Malaika Cordeiro
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Nuria Boronat
- Departamento de Neonatología, Hospital Universitario y Politécnico La Fe. Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Simón Pedro Lubián-López
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Puerta del Mar, Cádiz, Spain
| | - Eva Valverde
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
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Fasce J, Novoa JM, Toso P, García-Alix A. [Current status of Therapeutic Hypothermia in Hypoxic-Ischemic Encephalopathy]. Andes Pediatr 2021; 92:831-837. [PMID: 35506793 DOI: 10.32641/andespediatr.v92i6.4024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
Therapeutic hypothermia (TH) has been the standard treatment for neonatal Hypoxic-Ischemic En cephalopathy (HIE) for more than a decade. This therapy has been one of the best studied treatments in neonatal medicine, moving from preclinical models to patient application. Its implementation has been accompanied by the development of neuromonitoring, neonatal neurology as a specific area of expertise, and the intense search for new neuroprotective strategies. This article provides an update on the clinical scope of this therapy, with emphasis on the problems of our geographic region. In addition, some additional strategies that can improve the therapeutic efficacy of TH are reviewed, as well as controversial aspects in its application and some future perspectives in the care of neonates with HIE.
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Affiliation(s)
- Juan Fasce
- Hospital Clínico Regional Guillermo Grant Benavente, Universidad de Concepción, Concepción, Chile
| | | | - Paulina Toso
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Arnaez J, García-Alix A. [Neuromonitoring of the extremely preterm infant]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00242-3. [PMID: 34340940 DOI: 10.1016/j.anpedi.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Complejo Asistencial Universitario de Burgos, Burgos, España; Neurología Neonatal, Fundación NeNe, España.
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Domínguez-Dieppa F, Cardetti M, Rodríguez S, García-Alix A, Sola A. Hypoxic Ischemic Encephalopathy in Units Reporting to the Ibero-American Society of Neonatology Network: Prevalence and Mortality. MEDICC Rev 2021; 23:30-34. [PMID: 33780420 DOI: 10.37757/mr2021.v23.n1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Hypoxic ischemic encephalopathy is a neurological condition occurring immediately after birth following a perinatal asphytic episode. Therapeutic hypothermia is a safe and effective intervention to reduce mortality and major disability in survivors. In Latin America, perinatal asphyxia is a major problem, but no data are available characterizing its current situation in the region or the impact of hypoxic ischemic encephalopathy on its management. OBJECTIVE Understand the prevalence, mortality and use of therapeutic hypothermia in newborns at ≥36 weeks gestational age with hypoxic ischemic encephalopathy admitted to neonatal units reporting to the Ibero-American Society of Neonatology Network. METHODS The Ibero-American Society of Neonatology Network groups various neonatology centers in Latin America that share information and collaborate on research and medical care. We evaluated data on newborns with ≥36 weeks gestational age reported during 2019. Each unit received a guide with definitions and questions based on the Society's 7th Clinical Consensus. Evaluated were encephalopathy frequency and severity, Apgar score, need for resuscitation at birth, use of therapeutic hypothermia and clinical evolution at discharge. Our analysis includes descriptive statistics and comparisons made using the chi-square test. RESULTS We examined reports of 2876 newborns from 33 units and 6 countries. In 2849 newborns with available data, hypoxic encephalopathy prevalence was 5.1% (146 newborns): 27 (19%) mild, 36 (25%) moderate, 43 (29%) severe, and 40 (27%) of unknown intensity. In those with moderate and severe encephalopathy, frequencies of Apgar scores ≤3 at the first minute (p = 0.001), Apgar scores ≤3 at the fifth minute (p ⟨0.001) and advanced resuscitation (p = 0.007) were higher. Therapeutic hypothermia was performed in only 13% of newborns (19). Neonatal mortality from encephalopathy was 42% (61). CONCLUSIONS Hypoxic ischemic encephalopathy is a neonatal condition that results in high mortality and severe neurological sequelae. In this study, the overall prevalence was 5.1% with a mortality rate of 42%. Although encephalopathy was moderate or severe in 54% of reported cases, treatment with hypothermia was not performed in 87% of newborns. These data reflect a regional situation that requires urgent action.
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Affiliation(s)
| | - Marcelo Cardetti
- Clinical Neonatology and Maternity Services at the Endocrinology and Human Reproduction Center, San Luis, Argentina
| | | | - Alfredo García-Alix
- Sant Joan de Deu Pediatric Research Institute, Nene Foundation, University of Barcelona, Barcelona, Spain
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13
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Núñez C, Arca G, Agut T, Stephan-Otto C, García-Alix A. Precise neonatal arterial ischemic stroke classification with a three-dimensional map of the arterial territories of the neonatal brain. Pediatr Res 2020; 87:1231-1236. [PMID: 31835270 DOI: 10.1038/s41390-019-0724-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Data regarding neonatal arterial ischemic stroke (NAIS) topography are still sparse and inaccurate. Despite the importance of locating NAIS to predict the long-term outcome of neonates, a map of arterial territories is not yet available. Our aim was therefore to generate the first three-dimensional map of arterial territories of the neonatal brain (ATNB) and test its usefulness. METHODS Three-dimensional time-of-flight magnetic resonance angiography images were acquired from four neonates without NAIS. Arteries were semi-automatically segmented to build a symmetric arterial template. This allowed us to delineate the volumetric extension of each arterial territory, giving rise to the ATNB map, which is publicly available. Its applicability was tested on a sample of 34 neonates with NAIS. RESULTS After applying the ATNB map to the neonatal sample, the posterior trunk of the middle cerebral artery, followed by its anterior trunk, were identified as the most affected arterial territories. When comparing the results obtained employing the map with the original diagnoses made during the standard clinical evaluation of NAIS, major diagnostic errors were found in 18% of cases. CONCLUSION The ATNB map has been proven useful to precisely identify the arterial territories affected by an NAIS, as well as to increase the accuracy of clinical diagnoses.
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Affiliation(s)
- Christian Núñez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Gemma Arca
- Hospital Clínic, Barcelona, Spain.,Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,NeNe Foundation, Barcelona, Spain
| | - Thais Agut
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,NeNe Foundation, Barcelona, Spain.,Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Alfredo García-Alix
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,NeNe Foundation, Barcelona, Spain.,Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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14
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Fasce J, Calbacho M, Oyarzun M, Reinbach K, Daza A, García-Alix A. [Cerebral sinovenous thrombosis in a newborn with mutation of MTHFR C677T treated with enoxaparin]. Rev Chil Pediatr 2020; 91:417-423. [PMID: 32730524 DOI: 10.32641/rchped.v91i3.1270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Neonatal cerebral sinovenous thrombosis (CSNT) is a rare and generally serious con dition about which there is little knowledge of the responsible pathophysiological mechanisms and, although controversial, it has been suggested that genetic thrombophilia may play a role in its patho genesis. Out of concern for intracranial bleeding, the anticoagulant treatment with low-molecular- weight heparin is controversial. CLINICAL CASE Full-term newborn who presented at eight days of life breastfeeding rejection, clonic seizures, and locomotor hypoactivity. The MRI neuroimaging showed a CSNT involving multiple venous sinuses, a right thalamic hemorrhagic infarction, and venous con gestion in frontal white matter. Thrombophilia study highlighted a homozygous MTHFR C677T mutation. Treatment with low-molecular-weight heparin was associated with repermeabilization of the superior sagittal sinus after 23 days of starting therapy. CONCLUSIONS The clinical presentation of CSNT in the neonate is nonspecific, probably related to the extent and severity of the injury and the development of associated complications, such as venous hemorrhagic infarctions and intraparenchymal or intraventricular hemorrhage. These complications are detected through ultrasound or MRI, and they should make us suspect a CSNT. In this experience, the anticoagulant treatment proved to be safe and prevents thrombus propagation.
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Affiliation(s)
- Juan Fasce
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Marcela Calbacho
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - María Oyarzun
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Katya Reinbach
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Ariadna Daza
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
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15
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Soriano-Arandes A, Frick MA, García López-Hortelano M, Sulleiro E, Rodó C, Sánchez-Seco MP, Cabrera-Lafuente M, Suy A, De la Calle M, Santos M, Antolin E, Viñuela MDC, Espiau M, Salazar A, Guarch-Ibáñez B, Vázquez A, Navarro-Morón J, Ramos-Amador JT, Martin-Nalda A, Dueñas E, Blázquez-Gamero D, Reques-Cosme R, Olabarrieta I, Prieto L, De Ory F, Thorne C, Byrne T, Ades AE, Ruiz-Burga E, Giaquinto C, Mellado-Peña MJ, García-Alix A, Carreras E, Soler-Palacín P. Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain. Pathogens 2020; 9:pathogens9050352. [PMID: 32392815 PMCID: PMC7281364 DOI: 10.3390/pathogens9050352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4–6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4–39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.
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Affiliation(s)
- Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
- Correspondence: ; Tel.: +34-93-4893-140
| | - Marie Antoinette Frick
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | | | - Elena Sulleiro
- Departament of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlota Rodó
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | | | | | - Anna Suy
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - María De la Calle
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | - Mar Santos
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Eugenia Antolin
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | | | - María Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Ainara Salazar
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Borja Guarch-Ibáñez
- Department of Paediatrics, Hospital Universitari Josep Trueta, 17007 Girona, Spain;
| | - Ana Vázquez
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | | | | | - Andrea Martin-Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Eva Dueñas
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | | | | | - Luis Prieto
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | - Fernando De Ory
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Thomas Byrne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | | | - Elisa Ruiz-Burga
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35122 Padova, Italy;
| | - María José Mellado-Peña
- Department of Paediatrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.G.L.-H.); (M.J.M.-P.)
| | | | - Elena Carreras
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - Pere Soler-Palacín
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
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Arnaez J, Herranz-Rubia N, Garcia-Alix A, Diez-Delgado J, Benavente-Fernández I, Tofé I, Jerez A, Hurtado J, Ceballos J, Millán M, Esquivel M, Ruiz C, Baca M, Tapia E, Losada M, Torres E, Pavón A, Jiménez P, Jiménez F, Ventura M, Rite S, González T, Arias R, Balliu P, Lloreda-García J, Alcaráz J, Tapia C, de la Morena A, Centelles I, Güemes I, Estañ J, Alberola A, Aparici S, López R, Beceiro J, García B, Martínez L, González E, Arruza L, Blanco M, Moral M, Arias B, Mar F, Jiménez J, Romera G, Cuñarro A, Muñóz C, Cabañas F, Valverde E, Montero R, Tejedor J, Santana C, Reyes B, Romero S, Orizaola A, Baquero M, Hernández D, Pantoja A, Vega-del-Val C, Castañón L, Gutiérrez E, Benito M, Caserío S, Arca G, García M, López-Vílchez M, Castells L, Domingo M, Coroleu W, Boix H, Porta R, García-Alix A, Martínez-Nadal S, Jiménez E, Sole E, Albújar M, Fernández E, Barrio A, Piñán E, Avila-Alvarez A, Vázquez M, Balado N, Crespo P, Couce M, Concheiro-Guisán A, Esteban I, Lavilla A, Alzina V, Aguirre A, Loureiro B, Echániz I, Elorza M, Euba A. Atención integral del neonato con encefalopatía hipóxico-isquémica en España. An Pediatr (Barc) 2020; 92:286-296. [DOI: 10.1016/j.anpedi.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
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Arca G, Arnaez J, Agut T, Núñez C, Stephan-Otto C, Valls A, García-Alix A. Neuron-specific enolase is correlated with lesion topology, relative infarct volume and outcome of symptomatic NAIS. Arch Dis Child Fetal Neonatal Ed 2020; 105:132-137. [PMID: 31201253 DOI: 10.1136/archdischild-2018-316680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/27/2019] [Accepted: 05/12/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To correlate neuron-specific enolase (NSE) levels in cerebrospinal fluid (CSF) in neonate infants with symptomatic neonatal arterial ischaemic stroke (NAIS) with the arterial distribution of infarct, infarct volume and outcome. DESIGN Prospective observational multicentre cohort. SETTING Three paediatric university hospitals in Spain. SUBJECTS Thirty-eight neonates with more than 35 weeks' gestational age between 2006 and 2016 were studied. They were diagnosed with NAIS by MRI. They underwent a lumbar puncture to measure CSF-NSE concentrations within 96 hours after the onset of symptoms. Sixty-seven neonates admitted with suspected infections served as controls. We used a classification based on the arterial distribution, and the lesions were segmented with ITK-Snap software to determine their volume. Neurodevelopment was assessed at 24 months using the Bayley-III, Gross Motor Function Classification System and Bimanual Fine Motor Function. RESULTS CSF-NSE levels were higher in patients with symptomatic NAIS when compared with controls. Neonates with multifocal NAIS and with NAIS located in middle cerebral artery (MCA)-M1 arterial territory showed higher CSF-NSE levels when compared with cases with MCA-M2-M3-M4 territories (p<0.001). A significant correlation was found between CSF-NSE and relative infarction volume (rs=0.597; p<0.001). CSF-NSE values were higher in those infants with symptomatic NAIS with adverse outcome compared with infants with good development (p=0.020). Infants with CSF-NSE values above 55 ng/mL had an OR of adverse outcome of 6.48 (95% CI 1.48 to 28.33). CONCLUSIONS CSF-NSE is a potential early prognostic biomarker after an NAIS due to the relation between volume, topology and neurodevelopment at 2 years of age.
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Affiliation(s)
- Gemma Arca
- Department of Neonatology, Clinic Maternitat University Hospital, Barcelona, Spain.,Fundación NeNe, Madrid, Spain
| | - Juan Arnaez
- Fundación NeNe, Madrid, Spain.,Department of Neonatology, Burgos University Hospital, Burgos, Spain
| | - Thais Agut
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Department of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Christian Núñez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Anna Valls
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Alfredo García-Alix
- Fundación NeNe, Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
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Martinez-Monseny AF, Casas-Alba D, Arjona C, Bolasell M, Casano P, Muchart J, Ramos F, Martorell L, Palau F, García-Alix A, Serrano M. Okur-Chung neurodevelopmental syndrome in a patient from Spain. Am J Med Genet A 2019; 182:20-24. [PMID: 31729156 DOI: 10.1002/ajmg.a.61405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
Abstract
Okur-Chung neurodevelopmental syndrome (OCNS, MIM#617062) is a rare autosomal dominant syndrome related to CSNK2A1 mutations. It is characterized by intellectual disability, hypotonia, feeding and speech difficulties, dysmorphic features, and multisystem involvement. To date, less than 30 patients with OCNS have been described in detail in the literature, primarily in Asian populations. Here, we report a 5-year-old Spanish female with OCNS arising from a novel CSNK2A1 mutation c.149A>G, p.Tyr50Cys. Although her clinical features were compatible with OCNS syndrome, magnetic resonance imaging unexpectedly showed a duplication of the pituitary gland, a clinical finding not previously related to any known genetic condition. Other novel signs were an absence of the olfactory bulbs and multiple duplications of cervical vertebrae. We suggest that the midline abnormalities may be a significant part of this condition and lead to diagnostic suspicion. However, further descriptions are needed.
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Affiliation(s)
- Antonio F Martinez-Monseny
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Dídac Casas-Alba
- Pediatric Neurology Department, Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain
| | - César Arjona
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Mercè Bolasell
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Paula Casano
- Endocrinology Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Jordi Muchart
- Radiology Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Federico Ramos
- Pediatric Neurology Department, Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Loreto Martorell
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Francesc Palau
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Division of Pediatrics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Clinic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
| | - Alfredo García-Alix
- Department of Genetic and Molecular Medicine IPER, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Division of Pediatrics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Clinic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
| | - Mercedes Serrano
- Pediatric Neurology Department, Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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Olivé G, Agut T, Echeverría-Palacio CM, Arca G, García-Alix A. Usefulness of Cranial Ultrasound for Detecting Neonatal Middle Cerebral Artery Stroke. Ultrasound Med Biol 2019; 45:885-890. [PMID: 30642660 DOI: 10.1016/j.ultrasmedbio.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Magnetic resonance imaging is the gold standard technique in establishing the diagnosis of neonatal arterial ischemic stroke (NAIS). The diagnostic value of cranial ultrasound scanning in this clinical context is controversial. We aimed to assess the current sensitivity of the cranial ultrasound scan (CUS) in detecting NAIS, as this issue has not been well described in the literature. Newborns with NAIS diagnosed by magnetic resonance imaging between 2010 and 2016 were included. All CUSs were blindly analyzed retrospectively by a neonatologist expert in neuroimaging and compared with the findings of non-expert evaluators recorded on medical charts immediately after performing the evaluation. The overall sensitivity of CUS in detecting an imaging finding suggestive of NAIS was 87% (95% confidence interval (CI): 79%-95%) for an expert evaluator, but declined to 72% (61%-83%) when performed by a non-expert evaluator (p 0.002). Sensitivity was 83% and 61% in the first 24 h and 86% and 66% at 24-48 h for expert and non-expert evaluators, respectively (p < 0.05). CUS has higher sensitivity than previously reported in the detection of a NAIS, for both expert and non-expert evaluators. These findings may be explained by the advanced technology of new ultrasound equipment. Expertise in performing CUS is useful, particularly in the first 48 h after clinical debut.
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Affiliation(s)
- Gemma Olivé
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Thais Agut
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.
| | | | - Gemma Arca
- Department of Neonatology, Agrupació Sanitaria Hospital Clinic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Alfredo García-Alix
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), U724, Madrid, Spain
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Abstract
There is mounting experimental evidence that therapeutic hypothermia (TH) mitigates secondary mechanisms of spinal cord injury (SCI). There is a potential synergistic neuroprotective effect for SCI through the combination of TH and other promising therapies. The treatment of TH for SCI has promising results in adults, but its use is anecdotal in newborns with SCI. SCI is a rare, serious, and often fatal complication of instrumental delivery. For the first time, we describe the case of a male newborn infant with upper SCI who was born at term age and was offered whole-body cooling and erythropoietin treatment with unsuccessful outcome. There are still many unresolved issues related to TH in the SCI, some of them specific to the neonatal patient. Accurately establishing the diagnosis and its severity is crucial to redirect care for SCI and to indicate potential neuroprotective therapies. Considering the lack of therapeutic options, the extremely poor outcomes associated with acute SCI, and the extensive experience in safe use of whole-body cooling in newborn infants, we feel that moderate whole-body cooling should be offered as soon as possible after birth to the newborn infant with SCI.
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Affiliation(s)
- Juan Arnaez
- 1 Neonatal Unit, Hospital Universitario de Burgos, Burgos, Spain.,2 Fundación NeNe, Spain
| | - María Miranda
- 1 Neonatal Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - Ester Riñones
- 3 Neuroradiology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Alfredo García-Alix
- 2 Fundación NeNe, Spain.,4 Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.,5 Universitat de Barcelona, Barcelona, Spain
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21
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García-Muñoz Rodrigo F, García Cruz L, Galán Henríquez G, Urquía Martí L, Rivero Rodríguez S, García-Alix A, Figueras Aloy J. Variations in the number of births by day of the week, and morbidity and mortality in very-low-birth-weight infants. J Pediatr (Rio J) 2019; 95:41-47. [PMID: 29197224 DOI: 10.1016/j.jped.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. METHODS This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. RESULTS Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p<0.001), but differences were no longer significant after adjusting for confounding factors. CONCLUSIONS The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
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Affiliation(s)
- Fermín García-Muñoz Rodrigo
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain.
| | - Loida García Cruz
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Gloria Galán Henríquez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Lourdes Urquía Martí
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Sonia Rivero Rodríguez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
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Casas-Alba D, Martínez-Monseny A, Pino-Ramírez RM, Alsina L, Castejón E, Navarro-Vilarrubí S, Pérez-Dueñas B, Serrano M, Palau F, García-Alix A. Hyaline fibromatosis syndrome: Clinical update and phenotype-genotype correlations. Hum Mutat 2018; 39:1752-1763. [PMID: 30176098 DOI: 10.1002/humu.23638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/11/2022]
Abstract
Hyaline fibromatosis syndrome (HFS) is the unifying term for infantile systemic hyalinosis and juvenile hyaline fibromatosis. HFS is a rare autosomal recessive disorder of the connective tissue caused by mutations in the gene for anthrax toxin receptor-2 (ANTXR2). It is characterized by abnormal growth of hyalinized fibrous tissue with cutaneous, mucosal, osteoarticular, and systemic involvement. We reviewed the 84 published cases and their molecular findings, aiming to gain insight into the clinical features, prognostic factors, and phenotype-genotype correlations. Extreme pain at minimal handling in a newborn is the presentation pattern most frequently seen in grade 4 patients (life-limiting disease). Gingival hypertrophy and subcutaneous nodules are some of the disease hallmarks. Though painful joint stiffness and contractures are almost universal, weakness and hypotonia may also be present. Causes of death are intractable diarrhea, recurrent infections, and organ failure. Median age of death of grade 4 cases is 15.0 months (p25-p75: 9.5-24.0). This review provides evidence to reinforce the previous hypothesis that missense mutations in exons 1-12 and mutations leading to a premature stop codon lead to the severe form of the disease, while missense pathogenic variants in exons 13-17 lead to the mild form of the disease. Multidisciplinary team approach is recommended.
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Affiliation(s)
- Dídac Casas-Alba
- Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Antonio Martínez-Monseny
- Department of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Rosa M Pino-Ramírez
- Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Laia Alsina
- Department of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, University of Barcelona, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Esperanza Castejón
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Sergi Navarro-Vilarrubí
- Department of Pediatric Palliative Care, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Belén Pérez-Dueñas
- Department of Pediatric Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Pediatric Neurology, Vall d'Hebron Hospital and Research Institute, Barcelona, Spain
| | - Mercedes Serrano
- Department of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Pediatric Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain
| | - Francesc Palau
- Department of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain
- Laboratory of Neurogenetics and Molecular Medicine, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Division of Pediatrics, University of Barcelona School of Medicine, Barcelona, Spain
| | - Alfredo García-Alix
- Department of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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Arnaez J, Garcia-Alix A, Calvo S, Lubián-López S, Diez-Delgado J, Benavente I, Tofé I, Jerez A, Hurtado J, Ceballos J, Millán M, Esquivel M, Ruiz C, Baca M, Tapia E, Losada M, Torres E, Pavón A, Jiménez P, Jiménez F, Ventura M, Rite S, González T, Arias R, Balliu P, Lloreda-García J, Alcaráz J, Tapia C, de la Morena A, Centelles I, Güemes I, Estañ J, Alberola A, Aparici S, López R, Beceiro J, García B, Martínez L, González E, Arruza L, Blanco M, Moral M, Arias B, Mar F, Jiménez J, Romera G, Cuñarro A, Muñóz C, Cabañas F, Valverde E, Montero R, Tejedor J, Santana C, Reyes B, Romero S, Orizaola A, Baquero M, Hernández D, Pantoja A, Vega C, Castañón L, Gutiérrez E, Benito M, Caserío S, Arca G, García M, López-Vílchez M, Castells L, Domingo M, Coroleu W, Boix H, Porta R, García-Alix A, Martínez-Nadal S, Jiménez E, Sole E, Albújar M, Fernández E, Barrio A, Piñán E, Avila-Alvarez A, Vázquez M, Balado N, Crespo P, Couce M, Concheiro-Guisán A, Esteban I, Lavilla A, Alzina V, Aguirre A, Loureiro B, Echániz I, Euba MEA. Care of the newborn with perinatal asphyxia candidate for therapeutic hypothermia during the first six hours of life in Spain. Anales de Pediatría (English Edition) 2018. [DOI: 10.1016/j.anpede.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Palau F, García-Alix A. Genoma humano y medicina. An Pediatr (Barc) 2018; 89:1-2. [DOI: 10.1016/j.anpedi.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022] Open
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain. Anales de Pediatría (English Edition) 2018. [DOI: 10.1016/j.anpede.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Carreras N, Alsina M, Alarcon A, Arca-Díaz G, Agut T, García-Alix A. Efficacy of passive hypothermia and adverse events during transport of asphyxiated newborns according to the severity of hypoxic-ischemic encephalopathy. J Pediatr (Rio J) 2018; 94:251-257. [PMID: 28822711 DOI: 10.1016/j.jped.2017.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/16/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine if the efficacy of passive hypothermia and adverse events during transport are related to the severity of neonatal hypoxic-ischemic encephalopathy. METHODS This was a retrospective study of 67 infants with hypoxic-ischemic encephalopathy, born between April 2009 and December 2013, who were transferred for therapeutic hypothermia and cooled during transport. RESULTS Fifty-six newborns (84%) were transferred without external sources of heat and 11 (16%) needed an external heat source. The mean temperature at departure was 34.4±1.4°C and mean transfer time was 3.3±2.0h. Mean age at arrival was 5.6±2.5h. Temperature at arrival was between 33 and 35°C in 41 (61%) infants, between 35°C and 36.5°C in 15 (22%) and <33°C in 11 (16%). Infants with severe hypoxic-ischemic encephalopathy had greater risk of having an admission temperature<33°C (OR: 4.5; 95% CI: 1.1-19.3). The severity of hypoxic-ischemic encephalopathy and the umbilical artery pH were independent risk factors for a low temperature on admission (p<0.05). Adverse events during transfer, mainly hypotension and bleeding from the endotracheal tube, occurred in 14 infants (21%), with no differences between infants with moderate or severe hypoxic-ischemic encephalopathy. CONCLUSION The risk of overcooling during transport is greater in newborns with severe hypoxic-ischemic encephalopathy and those with more severe acidosis at birth. The most common adverse events during transport are related to physiological deterioration and bleeding from the endotracheal tube. This observation provides useful information to identify those asphyxiated infants who require closer clinical surveillance during transport.
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Affiliation(s)
- Nuria Carreras
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Alsina
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Ana Alarcon
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Oxford University Hospitals NHS Foundation Trust, Neonatal Unit, Oxford, United Kingdom
| | - Gemma Arca-Díaz
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Fundación NeNe, Spain
| | - Thais Agut
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Alfredo García-Alix
- Institut de Recerca Pediatrica Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Fundación NeNe, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), U724, Madrid, Spain.
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García-Muñoz Rodrigo F, Figueras Aloy J, Saavedra Santana P, García-Alix A. Crecimiento posnatal hasta el alta hospitalaria en recién nacidos extremadamente prematuros españoles. An Pediatr (Barc) 2017; 87:301-310. [DOI: 10.1016/j.anpedi.2016.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 11/25/2022] Open
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Arnaez J, Tejedor JC, Caserío S, Montes MT, Moral MT, González de Dios J, García-Alix A. Bioethics in end-of-life decisions in neonatology: Unresolved issues. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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García-Muñoz Rodrigo F, Figueras Aloy J, Saavedra Santana P, García-Alix A. Postnatal growth at hospital discharge in extremely premature newborns in Spain. Anales de Pediatría (English Edition) 2017. [DOI: 10.1016/j.anpede.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Arnaez J, García-Alix A, Arca G, Caserío S, Valverde E, Moral MT, Benavente-Fernández I, Lubián-López S. Population-Based Study of the National Implementation of Therapeutic Hypothermia in Infants with Hypoxic-Ischemic Encephalopathy. Ther Hypothermia Temp Manag 2017; 8:24-29. [PMID: 28800288 DOI: 10.1089/ther.2017.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Data on the incidence of hypoxic-ischemic encephalopathy (HIE) in the first 6 hours of life together with the implementation of therapeutic hypothermia (TH) are relevant to delineate actions to achieve the lowest rates of neonatal mortality, morbidity, and long-term impact on health associated with HIE. This is population-based national survey study, including newborns ≥35 weeks of gestation with moderate-to-severe HIE from all level III neonatal care units, to provide the incidence of HIE for the period 2012-2013, and the implementation of TH up to June 2015 in Spain. Incidence rate was 0.77 per 1000 live births (95% confidence interval 0.72-0.83). By June 2015, 63% (57/90) of the units had implemented TH; 95% of them performed servo-controlled whole-body TH. For the 2-year period, 86% of the newborns diagnosed with moderate-to-severe HIE received TH. Active TH increased in use from 78% in 2012 to 85% in 2013 (p = 0.01). The main reasons for not cooling were a delay in the diagnosis (31/682) and the fact that the treatment was not offered (20/682). Interhospital patient transfer was performed using passive hypothermia, by appropriately trained personnel in 61% of centers. Eighteen percent of newborns with moderate or severe HIE died, without significant differences between the 2 years. Up-to-date knowledge of the national coverage of neonatal care of infants with HIE in developed countries is a prerequisite to reducing the load of HIE in this area and to facilitating coordinated, eliminate investigation.
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Affiliation(s)
- Juan Arnaez
- 1 Unidad de Neonatología, Hospital Universitario de Burgos , Burgos, España, Fundación NeNe, España
| | - Alfredo García-Alix
- 2 Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu , Universitat de Barcelona, Barcelona, España, Fundación NeNe, España
| | - Gemma Arca
- 3 Unidad de Neonatología, Hospital Universitario Clinic (Sede Maternitat) , Barcelona, España, Fundación NeNe, España
| | - Sonia Caserío
- 4 Unidad de Neonatología, Hospital Universitario Río Hortega , Valladolid, España, Fundación NeNe, España
| | - Eva Valverde
- 5 Servicio de Neonatología. Hospital Universitario La Paz , Madrid, España, Fundación NeNe, España
| | - M Teresa Moral
- 6 Servicio de Neonatología, Hospital Universitario 12 de Octubre , Madrid, España, Fundación NeNe, España
| | | | - Simón Lubián-López
- 7 Unidad de Neonatología, Hospital Universitario Puerta del Mar , Cádiz, España, Fundación NeNe, España
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Arnaez J, García-Alix A, Arca G, Valverde E, Caserío S, Moral MT, Benavente-Fernández I, Lubián-López S. [Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain]. An Pediatr (Barc) 2017; 89:12-23. [PMID: 28764944 DOI: 10.1016/j.anpedi.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres.
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Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, España; Fundación NeNe, Madrid, España.
| | - Alfredo García-Alix
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Universitat de Barcelona, Barcelona, España; Fundación NeNe, Madrid, España
| | - Gemma Arca
- Unidad de Neonatología, Hospital Universitario Clínic (Sede Maternitat), Barcelona, España; Fundación NeNe, Madrid, España
| | - Eva Valverde
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España; Fundación NeNe, Madrid, España
| | - Sonia Caserío
- Unidad de Neonatología, Hospital Universitario Río Hortega, Valladolid, España; Fundación NeNe, Madrid, España
| | - M Teresa Moral
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España; Fundación NeNe, Madrid, España
| | - Isabel Benavente-Fernández
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
| | - Simón Lubián-López
- Unidad de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España; Fundación NeNe, Madrid, España
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Arnaez J, Tejedor JC, Caserío S, Montes MT, Moral MT, González de Dios J, García-Alix A. [Bioethics in end-of-life decisions in neonatology: Unresolved issues]. An Pediatr (Barc) 2017; 87:356.e1-356.e12. [PMID: 28476218 DOI: 10.1016/j.anpedi.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/07/2017] [Accepted: 03/16/2017] [Indexed: 11/19/2022] Open
Abstract
This document is the result of previous work carried out by different expert groups and submitted to multidisciplinary debate at a Conference about controversial, deficient, or new aspects in the field of neonatal palliative care, such as: 1) the deliberative decision-making process, 2) hospital and domiciliary palliative care, 3) donation after controlled cardiac death, and 4) moral stress in professionals. The most relevant conclusions were: the need to instruct professionals in bioethics and in the deliberative method to facilitate thorough and reasonable decision-making; the lack of development in the field of perinatal palliative care and domiciliary palliative care in hospitals that attend newborns; the need to provide neonatal units with resources that help train professionals in communication skills and in the management of moral distress, as well as delineate operational procedure and guidelines for neonatal organ donation.
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Affiliation(s)
- Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Fundación NeNe, Burgos, España.
| | | | - Sonia Caserío
- Unidad de Neonatología, Hospital Universitario Rio Hortega, Fundación NeNe, Valladolid, España
| | | | - María Teresa Moral
- Servicio de Neonatología, Hospital 12 de Octubre, Fundación NeNe, Red Samid, Universidad Complutense de Madrid, Madrid, España
| | - Javier González de Dios
- Servicio de Pediatría, Hospital General Universitario de Alicante, Departamento de Pediatría, Universidad Miguel Hernández, Alicante, España
| | - Alfredo García-Alix
- Institut de Recerca Pediàtrica, Universitat de Barcelona Hospital Sant Joan de Déu, Fundación NeNe, Barcelona, España
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Pérez-Cerdá C, Girós ML, Serrano M, Ecay MJ, Gort L, Pérez Dueñas B, Medrano C, García-Alix A, Artuch R, Briones P, Pérez B. A Population-Based Study on Congenital Disorders of Protein N- and Combined with O-Glycosylation Experience in Clinical and Genetic Diagnosis. J Pediatr 2017; 183:170-177.e1. [PMID: 28139241 DOI: 10.1016/j.jpeds.2016.12.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/18/2016] [Accepted: 12/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the clinical, biochemical, and genetic features of patients with congenital disorders of glycosylation (CDG) identified in Spain during the last 20 years. STUDY DESIGN Patients were selected among those presenting with multisystem disease of unknown etiology. The isoforms of transferrin and of ApoC3 and dolichols were analyzed in serum; phosphomannomutase and mannosephosphate isomerase activities were measured in fibroblasts. Conventional or massive parallel sequencing (customized panel or Illumina Clinical-Exome Sequencing TruSight One Gene Panel) was used to identify genes and mutations. RESULTS Ninety-seven patients were diagnosed with 18 different CDG. Eighty-nine patients had a type 1 transferrin profile; 8 patients had a type 2 transferrin profile, with 6 of them showing an alteration in the ApoC3 isoform profile. A total of 75% of the patients had PMM2-CDG presenting with a heterogeneous mutational spectrum. The remaining patients showed mutations in any of the following genes: MPI, PGM1, GFPT1, SRD5A3, DOLK, DPGAT1, ALG1, ALG6, RFT1, SSR4, B4GALT1, DPM1, COG6, COG7, COG8, ATP6V0A2, and CCDC115. CONCLUSION Based on literature and on this population-based study of CDG, a comprehensive scheme including reported clinical signs of CDG is offered, which will hopefully reduce the timeframe from clinical suspicion to genetic confirmation. The different defects of CDG identified in Spain have contributed to expand the knowledge of CDG worldwide. A predominance of PMM2 deficiency was detected, with 5 novel PMM2 mutations being described.
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Affiliation(s)
- Celia Pérez-Cerdá
- Center of Molecular Biology-Severo Ochoa, University Autonomous of Madrid-Spanish National Research Council, La Paz Institute for Health Research, Center for Biomedical Research on Rare Diseases, Madrid, Spain.
| | - Ma Luisa Girós
- Inborn Errors of Metabolism, Biochemical and Molecular Genetics Serv., Biomedical Diagnostic Center, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Mercedes Serrano
- Department of Pediatric Neurology, Institute of Pediatric Research-Hospital Sant Joan de Déu, Center for Biomedical Research on Rare Diseases, Barcelona, Spain; Department of Clinical Biochemistry, Institute of Pediatric Research-Hospital Sant Joan de Déu, Centre for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - M Jesús Ecay
- Center of Molecular Biology-Severo Ochoa, University Autonomous of Madrid-Spanish National Research Council, La Paz Institute for Health Research, Center for Biomedical Research on Rare Diseases, Madrid, Spain
| | - Laura Gort
- Inborn Errors of Metabolism, Biochemical and Molecular Genetics Serv., Biomedical Diagnostic Center, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Belén Pérez Dueñas
- Department of Pediatric Neurology, Institute of Pediatric Research-Hospital Sant Joan de Déu, Center for Biomedical Research on Rare Diseases, Barcelona, Spain; Department of Clinical Biochemistry, Institute of Pediatric Research-Hospital Sant Joan de Déu, Centre for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Celia Medrano
- Center of Molecular Biology-Severo Ochoa, University Autonomous of Madrid-Spanish National Research Council, La Paz Institute for Health Research, Center for Biomedical Research on Rare Diseases, Madrid, Spain
| | - Alfredo García-Alix
- Division of Neonatology, Institute of Pediatric Research-Hospital San Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Rafael Artuch
- Department of Pediatric Neurology, Institute of Pediatric Research-Hospital Sant Joan de Déu, Center for Biomedical Research on Rare Diseases, Barcelona, Spain; Department of Clinical Biochemistry, Institute of Pediatric Research-Hospital Sant Joan de Déu, Centre for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Paz Briones
- Inborn Errors of Metabolism, Biochemical and Molecular Genetics Serv., Biomedical Diagnostic Center, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Belén Pérez
- Center of Molecular Biology-Severo Ochoa, University Autonomous of Madrid-Spanish National Research Council, La Paz Institute for Health Research, Center for Biomedical Research on Rare Diseases, Madrid, Spain
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Del Campo M, Feitosa IML, Ribeiro EM, Horovitz DDG, Pessoa ALS, França GVA, García-Alix A, Doriqui MJR, Wanderley HYC, Sanseverino MVT, Neri JICF, Pina-Neto JM, Santos ES, Verçosa I, Cernach MCSP, Medeiros PFV, Kerbage SC, Silva AA, van der Linden V, Martelli CMT, Cordeiro MT, Dhalia R, Vianna FSL, Victora CG, Cavalcanti DP, Schuler-Faccini L. The phenotypic spectrum of congenital Zika syndrome. Am J Med Genet A 2017; 173:841-857. [PMID: 28328129 DOI: 10.1002/ajmg.a.38170] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 12/24/2022]
Abstract
In October 2015, Zika virus (ZIKV) outbreak the Brazilian Ministry of Health (MoH). In response, the Brazilian Society of Medical Genetics established a task force (SBGM-ZETF) to study the phenotype of infants born with microcephaly due to ZIKV congenital infection and delineate the phenotypic spectrum of this newly recognized teratogen. This study was based on the clinical evaluation and neuroimaging of 83 infants born during the period from July, 2015 to March, 2016 and registered by the SBGM-ZETF. All 83 infants had significant findings on neuroimaging consistent with ZIKV congenital infection and 12 had confirmed ZIKV IgM in CSF. A recognizable phenotype of microcephaly, anomalies of the shape of skull and redundancy of the scalp consistent with the Fetal Brain Disruption Sequence (FBDS) was present in 70% of infants, but was most often subtle. In addition, features consistent with fetal immobility, ranging from dimples (30.1%), distal hand/finger contractures (20.5%), and feet malpositions (15.7%), to generalized arthrogryposis (9.6%), were present in these infants. Some cases had milder microcephaly or even a normal head circumference (HC), and other less distinctive findings. The detailed observation of the dysmorphic and neurologic features in these infants provides insight into the mechanisms and timings of the brain disruption and the sequence of developmental anomalies that may occur after prenatal infection by the ZIKV.
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Affiliation(s)
- Miguel Del Campo
- Division of Dysmorphology and Teratology, Department of Pediatrics, UCSD, San Diego, California
| | - Ian M L Feitosa
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Medicina Clínica, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Dafne D G Horovitz
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Alfredo García-Alix
- Institut de Recerca Pediàtrica Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Maria V T Sanseverino
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - João M Pina-Neto
- Faculdade de Medicina de Ribeirao Preto, Departamento de Genetica, Universidade de Sao Paolo, Ribeirao Preto, Brazil
| | | | - Islane Verçosa
- Centro de Aperfeiçoamento Visual Ver a Esperança Renascer/CAVIVER, Fortaleza, Brazil
| | - Mirlene C S P Cernach
- Departamento de Genetica Medica, Universidade Federal de Sao Paolo (UNIFESP), Sao Paolo, Brazil
| | | | | | - André A Silva
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- UNIVATES University, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Marli T Cordeiro
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Rafael Dhalia
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Fernanda S L Vianna
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- SIAT-Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cesar G Victora
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Denise P Cavalcanti
- Departamento de Genetica Medica, Universidade de Campinas UNICAMP, Campinas, Brazil
| | - Lavinia Schuler-Faccini
- Departamento de Genetica, Universidade Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Potiguar, Natal, Brazil
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Stephan-Otto C, Núñez C, Arca G, Agut T, García-Alix A. Three-Dimensional Map of Neonatal Arterial Ischemic Stroke Distribution From Early Multimodal Brain Imaging. Stroke 2017; 48:482-485. [DOI: 10.1161/strokeaha.116.014186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/28/2016] [Accepted: 11/11/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although neonatal arterial ischemic stroke (NAIS) location has considerable impact on long-term outcome, a map showing spatial distribution of NAIS is lacking. Our aim was to generate this distribution map, based on early magnetic resonance imaging data.
Methods—
Lesions from 34 consecutive neonates with NAIS from a single center were segmented using multimodal magnetic resonance imaging (median age at acquisition =5 days). Lesion masks for all subjects were registered onto a standard neonatal brain and then overlaid to generate a 3D map of NAIS distribution.
Results—
The region posterior to the central sulcus is the most frequently affected in neonates, with 24 of the 34 neonates (71%) showing lesions in this region in at least one hemisphere. Moreover, NAIS frequency is markedly higher in the left hemisphere.
Conclusions—
This is the first report of an NAIS distribution map. Regions posterior to the central sulcus present increased vulnerability. Our findings suggest that motor areas are not as frequently affected as has been previously reported. By contrast, we find high NAIS vulnerability in functional areas related to language. The distribution of ischemic strokes in neonates seems to be different from that seen in adults.
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Affiliation(s)
- Christian Stephan-Otto
- From the Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain (C.S.-O., C.N.); Hospital Clínic, Barcelona, Spain (G.A.); and Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Spain (T.A., A.G.-A.)
| | - Christian Núñez
- From the Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain (C.S.-O., C.N.); Hospital Clínic, Barcelona, Spain (G.A.); and Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Spain (T.A., A.G.-A.)
| | - Gemma Arca
- From the Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain (C.S.-O., C.N.); Hospital Clínic, Barcelona, Spain (G.A.); and Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Spain (T.A., A.G.-A.)
| | - Thais Agut
- From the Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain (C.S.-O., C.N.); Hospital Clínic, Barcelona, Spain (G.A.); and Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Spain (T.A., A.G.-A.)
| | - Alfredo García-Alix
- From the Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain (C.S.-O., C.N.); Hospital Clínic, Barcelona, Spain (G.A.); and Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Spain (T.A., A.G.-A.)
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del Río R, Ochoa C, Alarcon A, Arnáez J, Blanco D, García-Alix A. Amplitude Integrated Electroencephalogram as a Prognostic Tool in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review. PLoS One 2016; 11:e0165744. [PMID: 27802300 PMCID: PMC5089691 DOI: 10.1371/journal.pone.0165744] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/16/2016] [Indexed: 02/03/2023] Open
Abstract
Introduction Perinatal management and prognostic value of clinical evaluation and diagnostic tools have changed with the generalization of therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy (HIE) Aim to ascertain the prognostic value of amplitude integrated electroencephalogram (aEEG) in neonates with HIE considering hours of life and treatment with TH. Methods A systematic review was performed. Inclusion criteria were studies including data of neonates with HIE, treated or not with TH, monitored with aEEG and with neurodevelopmental follow-up of at least 12 months. The period of bibliographic search was until February 2016. No language restrictions were initially applied. Consulted databases were MEDLINE, Scopus, CINHAL and the Spanish language databases GuiaSalud and Bravo. Article selection was performed by two independent reviewers. Quality for each individual paper selected was evaluated using QUADAS-2. Review Manager (RevMan) version 5.3 software was used. Forest plots were constructed to graphically show sensitivity and specificity for all included studies, separating patients treated or not with hypothermia. Summary statistics were estimated using bivariate models and random effects approaches with the R package MADA from summary ROC curves. Meta-regression was used to estimate heterogeneity and trends. Results from the 403 articles initially identified, 17 were finally included and critically reviewed. In infants not treated with hypothermia the maximum reliability of an abnormal aEEG background to predict death or moderate/severe disability was at 36 hours of life, when a positive post-test probability of 97.90% was achieved (95%CI 88.40 to 99.40%). Positive likelihood ratio (+LR) at these hours of life was 26.60 (95%CI 4.40 to 94.90) and negative likelihood ratio (-LR) was 0.23 (95%CI 0.10 to 0.44). A high predictive value was already present at 6 hours of life in this group of patients, with a positive post-test probability of 88.20% (95%CI 79.80 to 93%) and a +LR of 4.34 (95%CI 2.31 to 7.73). In patients treated with TH the maximum predictive reliability was achieved at 72 hours of life (post-test probability of 95.70%, 95%CI 84.40 to 98.50%). +LR at this age was 24.30 (95%CI 5.89 to 71.30) and–LR was 0.40 (95%CI 0.25 to 0.57). Predictive value of aEEG at 6 hours of life was low in these patients (59.10%, 95%CI 55.70 to 63%). Conclusion This study confirms that aEEG´s background activity, as recorded during the first 72 hours after birth, has a strong predictive value in infants with HIE treated or not with TH. Predictive values of traces throughout the following 72 hours are a helpful guide when considering and counselling parents about the foreseeable long-term neurological outcome
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Affiliation(s)
- Ruth del Río
- Department of Neonatology, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- * E-mail:
| | - Carlos Ochoa
- Research Unit, Hospital Virgen de la Concha, Zamora, Spain
| | - Ana Alarcon
- Department of Neonatology, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Neonatology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Juan Arnáez
- Department of Neonatology, Hospital Universitario Burgos, Burgos, Spain
| | - Dorotea Blanco
- Department of Neonatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Alfredo García-Alix
- Department of Neonatology, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
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García-Muñoz Rodrigo F, García Hernández JÁ, García-Alix A. Characterization of mothers at risk of delivery at the limit of viability and factors related to infant survival. J Matern Fetal Neonatal Med 2016; 30:2198-2203. [PMID: 27690708 DOI: 10.1080/14767058.2016.1243095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the sociodemographic and clinical characteristics of mothers of infants at the limit of viability and to know the perinatal factors associated to infants' survival. METHOD Single-center cohort study of mothers and newborns assisted in our tertiary care center (2004-2010). Demographic and perinatal variables were compared between mothers who gave birth ≤26 weeks GA and the general population. The association between perinatal factors and neonatal survival was studied by Cox regression analysis. RESULTS Mothers of newborns ≤26 weeks (n = 136) had less education and pregnancy control. They had more frequently assisted reproductive technologies (ART) (5.2% versus 2.3%; p< 0.05), multiple gestations (16.6% versus 2.1%; p < 0.05), pregnancy complications and C-section (39.7% versus 13.4%; p < 0.001). After correcting for confounders, the perinatal factors independently associated with a variation in the risk of mortality were the administration of antenatal steroid [aHR (95%CI): 0.465 (0.254-0.853), p = 0.013], singleton pregnancy [aHR (95%CI): 0.482 (0.279-0.834), p = 0.009], infant's temperature on admission [aHR (95%CI): 0.642 (0.426-0.968), p = 0.035] and CRIB score [aHR (95%CI): 1.151 (1.058-1.251), p = 0.001]. CONCLUSIONS Mothers of preterm infants at the limit of viability had more ART, multiple pregnancies, obstetrical complications and C-section. Infants' survival was independently associated to antenatal steroids, singleton pregnancy, temperature on admission and CRIB score.
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Affiliation(s)
- Fermín García-Muñoz Rodrigo
- a Neonatal Unit, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria , Las Palmas de Gran Canaria , Spain
| | - José Ángel García Hernández
- b Obstetric and Gynecology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria , Las Palmas, de Gran Canaria , Spain , and
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Alarcon A, Martinez-Biarge M, Cabañas F, Quero J, García-Alix A. A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection. Neonatology 2016; 110:277-285. [PMID: 27344149 DOI: 10.1159/000446690] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT). OBJECTIVE The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV. METHODS Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders. RESULTS Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT. CONCLUSIONS A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.
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Affiliation(s)
- Ana Alarcon
- Neonatal Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Martín-Ancel A, Balaguer A, García-Alix A. Duración de la reanimación en neonatos con Apgar a los 10 min menor de 3 en la era de la hipotermia. An Pediatr (Barc) 2015; 82:129-30. [DOI: 10.1016/j.anpedi.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022] Open
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Arnáez J, Vega C, García-Alix A, Gutiérrez E, Caserío S, Jiménez M, Castañón L, Esteban I, Hortelano M, Hernández N, Serrano M, Prada T, Diego P, Barbadillo F. Multicenter programme for the integrated care of newborns with perinatal hypoxic-ischaemic insult (ARAHIP). An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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García-Alix A, Demestre X. Claudine Amiel-Tison. An Pediatr (Barc) 2014; 81:e74-5. [DOI: 10.1016/j.anpedi.2014.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Agut T, Muchart J, Delgadillo V, García-Alix A. [Rhombencephalosynapsis, a rare congenital abnormality easy to diagnose]. An Pediatr (Barc) 2014; 81:e3-4. [PMID: 24560496 DOI: 10.1016/j.anpedi.2013.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- T Agut
- Servicio de Neonatología, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
| | - J Muchart
- Servicio de Diagnóstico por la imagen, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - V Delgadillo
- Servicio de Neuropediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - A García-Alix
- Servicio de Neonatología, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
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Arca G, García-Alix A, Arnáez J, Blanco D. [Sedation in term or near-term newborns with hypoxic-ischemic encephalopathy who require therapeutic hypothermia]. An Pediatr (Barc) 2014; 82:52-3. [PMID: 24907864 DOI: 10.1016/j.anpedi.2014.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- G Arca
- Servicio de Neonatología, Sede Maternidad, Hospital Clínic, Barcelona, España.
| | - A García-Alix
- Servicio de Neonatología, Sede Maternidad, Hospital Clínic, Barcelona, España
| | - J Arnáez
- Servicio de Neonatología, Sede Maternidad, Hospital Clínic, Barcelona, España
| | - D Blanco
- Servicio de Neonatología, Sede Maternidad, Hospital Clínic, Barcelona, España
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Pereira E, Polo MR, López JM, Quijano TA, García-Alix A, Fons C. Agenesis of the corpus callosum in a newborn with turner mosaicism. Pediatr Rep 2014; 6:5112. [PMID: 24987509 PMCID: PMC4076649 DOI: 10.4081/pr.2014.5112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/15/2013] [Accepted: 12/12/2013] [Indexed: 11/23/2022] Open
Abstract
The agenesis of the corpus callosum results from a failure in the development of the largest fiber bundle that connects cerebral hemispheres. Patient's outcome is influenced by etiology and associated central nervous system malformations. We describe a child with Turner syndrome (TS) mosaicism, with particular phenotype features and a complete agenesis of the corpus callosum. To our knowledge, this is the second case report of TS mosaicism associated with complete agenesis of the corpus callosum. Anatomical brain magnetic resonance imaging and diffusion tensor imaging were useful to confirm the complete absence of the corpus callosum, evaluate associated central nervous system malformations, visualize abnormal white matter tracts (Probst bundles) and assess the remaining commissures.
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Affiliation(s)
- Ester Pereira
- Department of Pediatrics, Centro Hospitalar de Leiria-Pombal EPE , Leiria, Portugal ; Department of Neurology, Hospital Sant Joan De Déu , Barcelona, Spain
| | | | | | | | | | - Carmen Fons
- Department of Neurology, Hospital Sant Joan De Déu , Barcelona, Spain
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Martínez-Biarge M, Blanco D, García-Alix A, Salas S. [Follow-up of newborns with hypoxic-ischaemic encephalopathy]. An Pediatr (Barc) 2013; 81:52.e1-14. [PMID: 24290154 DOI: 10.1016/j.anpedi.2013.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
Hypothermia treatment for newborn infants with hypoxic-ischemic encephalopathy reduces the number of neonates who die or have permanent neurological deficits. Although this therapy is now standard of care, neonatal hypoxic-ischaemic encephalopathy still has a significant impact on the child's neurodevelopment and quality of life. Infants with hypoxic-ischaemic encephalopathy should be enrolled in multidisciplinary follow-up programs in order to detect impairments, to initiate early intervention, and to provide counselling and support for families. This article describes the main neurodevelopmental outcomes after term neonatal hypoxic-ischaemic encephalopathy. We offer recommendations for follow-up based on the infant's clinical condition and other prognostic indicators, mainly neonatal neuroimaging. Other aspects, such as palliative care and medico-legal issues, are also briefly discussed.
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Affiliation(s)
- M Martínez-Biarge
- Department of Paediatrics, Hammersmith Hospital, Imperial College, Londres, Reino Unido.
| | - D Blanco
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - A García-Alix
- Servicio de Neonatología, Hospital Sant Joan de Déu, Barcelona, España
| | - S Salas
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
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46
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García-Alix A, Jimenez-Espejo FJ, Lozano JA, Jiménez-Moreno G, Martinez-Ruiz F, García Sanjuán L, Aranda Jiménez G, García Alfonso E, Ruiz-Puertas G, Anderson RS. Anthropogenic impact and lead pollution throughout the Holocene in Southern Iberia. Sci Total Environ 2013; 449:451-60. [PMID: 23454707 DOI: 10.1016/j.scitotenv.2013.01.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 05/04/2023]
Abstract
Present day lead pollution is an environmental hazard of global proportions. A correct determination of natural lead levels is very important in order to evaluate anthropogenic lead contributions. In this paper, the anthropogenic signature of early metallurgy in Southern Iberia during the Holocene, more specifically during the Late Prehistory, was assessed by mean of a multiproxy approach: comparison of atmospheric lead pollution, fire regimes, deforestation, mass sediment transport, and archeological data. Although the onset of metallurgy in Southern Iberia is a matter of controversy, here we show the oldest lead pollution record from Western Europe in a continuous paleoenvironmental sequence, which suggests clear lead pollution caused by metallurgical activities since ~3900 cal BP (Early Bronze Age). This lead pollution was especially important during Late Bronze and Early Iron ages. At the same time, since ~4000 cal BP, an increase in fire activity is observed in this area, which is also coupled with deforestation and increased erosion rates. This study also shows that the lead pollution record locally reached near present-day values many times in the past, suggesting intensive use and manipulation of lead during those periods in this area.
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Affiliation(s)
- A García-Alix
- Instituto Andaluz de Ciencias de la Tierra (IACT-CSIC-UGR), Consejo Superior de Investigaciones Científicas-Universidad de Granada, Avenida de las Palmeras no 4, 18100 Granada, Spain.
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47
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Tenorio V, Alarcón A, García-Alix A, Arca G, Camprubí M, Agut T, Figueras J. Hipotermia cerebral moderada en la encefalopatía hipóxico-isquémica. Experiencia en el primer año de su puesta en marcha. An Pediatr (Barc) 2012; 77:88-97. [DOI: 10.1016/j.anpedi.2012.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/05/2011] [Accepted: 01/03/2012] [Indexed: 01/12/2023] Open
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48
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Abstract
Valproate overdose, extensively described in adults and older children, has been reported in only 1 newborn: a 26-day-old female who developed a severe cerebral edema leading to a fatal outcome. Therefore, the consequences of valproate overdose are largely unknown in the neonatal period. Here, we present the clinical evolution of a 6-day-old newborn who developed hyperammonemic encephalopathy after the accidental administration of 310 mg/kg of oral valproate in a single dose. Despite the very high valproate and blood ammonia levels, he did not develop life-threatening complications and he completely recovered without sequels. His brain magnetic resonance imaging showed symmetric focal T1 prolonged signals in both globi pallidi that completely resolved over time, a neuroimaging pattern that was not previously described in valproate overdose. Our case report suggests that valproate overdose in newborns can be completely reversible even when the valproate and ammonium blood levels are very high.
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Affiliation(s)
- Anna Grynnerup
- Department of Neonatology, Hospital Sant Joan de Déu, Universidad de Barcelona, Spain
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49
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León M, Muchart J, García-Alix A. Hipoplasia adenohipofisiaria congénita aislada. An Pediatr (Barc) 2012; 76:165-6. [DOI: 10.1016/j.anpedi.2011.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/07/2011] [Indexed: 10/17/2022] Open
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50
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Blanco D, García-Alix A, Valverde E, Tenorio V, Vento M, Cabañas F. [Neuroprotection with hypothermia in the newborn with hypoxic-ischaemic encephalopathy. Standard guidelines for its clinical application]. An Pediatr (Barc) 2011; 75:341.e1-20. [PMID: 21925984 DOI: 10.1016/j.anpedi.2011.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 07/18/2011] [Accepted: 07/18/2011] [Indexed: 01/24/2023] Open
Abstract
Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is supported by current scientific evidence. The following document was prepared by the authors on request of the Spanish Society of Neonatology and is intended to be a guide for the proper implementation of this therapy. We discuss the difficulties that may arise when moving from the strict framework of clinical trials to clinical daily care: early recognition of clinical encephalopathy, inclusion and exclusion criteria, hypothermia during transport, type of hypothermia (selective head or systemic cooling) and side effects of therapy. The availability of hypothermia therapy has changed the prognosis of children with hypoxic-ischaemic encephalopathy and our choices of therapeutic support. In this sense, it is especially important to be aware of the changes in the predictive value of the neurological examination and the electroencephalographic recording in cooled infants. In order to improve neuroprotection with hypothermia we need earlier recognition of to recognise earlier the infants that may benefit from cooling. Biomarkers of brain injury could help us in the selection of these patients. Every single infant treated with hypothermia must be included in a follow up program in order to assess neurodevelopmental outcome.
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Affiliation(s)
- D Blanco
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, España.
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