Placental Tissue Stem Cells and their role in Neonatal Diseases
Neonatal diseases such as hypoxic ischemic encephalopathy, diseases of prematurity and congenital disorders carry increased morbidity and mortality. Despite technological advancements, their incidence remains largely unabated. Stem cell (SC) interventions are novel therapies in the neonatal world. In pre-clinical models of neonatal diseases, SC applications have shown encouraging results. SC sources vary, with the bone marrow being the most utilized. However, the ability to harvest bone marrow SCs from neonates is limited. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - December 20, 2021 Category: Perinatology & Neonatology Authors: Andreas Damianos, Kui Xu, Gregory T. Kalin, Vladimir V. Kalinichenko Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 23, 2021 Category: Perinatology & Neonatology Source Type: research

Neuroimaging in the term newborn with neonatal encephalopathy
Neuroimaging is widely used to aid in the diagnosis and clinical management of neonates with neonatal encephalopathy (NE). Yet, despite widespread use clinically, there are few published guidelines on neuroimaging for neonates with NE. This review outlines the primary patterns of brain injury associated with hypoxic-ischemic injury in neonates with NE and their frequency, associated neuropathological features, and risk factors. In addition, it provides an overview of neuroimaging methods, including the most widely used scoring systems used to characterize brain injury in these neonates and their utility as predictive bioma...
Source: Seminars in Fetal and Neonatal Medicine - October 26, 2021 Category: Perinatology & Neonatology Authors: Jessica L. Wisnowski, Pia Wintermark, Sonia L. Bonifacio, Christopher D. Smyser, A. James Barkovich, A. David Edwards, Linda S. de Vries, Terrie E. Inder, Vann Chau, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Proposing a Care Practice Bundle for Neonatal Encephalopathy during Therapeutic Hypothermia
Neonates with neonatal encephalopathy (NE) often present with multi-organ dysfunction that requires multidisciplinary specialized management. Care of the neonate with NE is thus complex with interaction between the brain and the various organ systems. Illness severity during the first days of birth, and not only during the initial hypoxia-ischemia event, is a significant predictor of adverse outcomes in neonates with NE treated with therapeutic hypothermia (TH). We thus propose a care practice bundle dedicated to support the injured neonatal brain that is based on the current best evidence for each organ system. (Source: S...
Source: Seminars in Fetal and Neonatal Medicine - October 15, 2021 Category: Perinatology & Neonatology Authors: Pia Wintermark, Khorshid Mohammad, Sonia L. Bonifacio, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Advantages and disadvantages of mandibular distraction in Robin sequence
Robin sequence (RS) is diagnosed in infants born with micrognathia, glossoptosis and varying degrees of upper airway obstruction (UAO)1. RS is the result of a sequence of disruptions to embryonic development that is believed to begin with hypoplasia of the neonatal mandible. Micrognathia can be initiated by extrinsic, intrinsic, or neurologic/neuromuscular causes2,3. The heterogeneity of the RS phenotype can be explained by these different etiologies. A classification can be made into “isolated RS” - infants without any concomitant anomalies, and “RS-plus”-infants, in whom additional malformations a...
Source: Seminars in Fetal and Neonatal Medicine - September 20, 2021 Category: Perinatology & Neonatology Authors: Corstiaan C. Breugem, Robrecht JH. Logjes, Jitske W. Nolte, Roberto L. Flores Source Type: research

The role of upper airway endoscopy in craniofacial malformations
To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 18, 2021 Category: Perinatology & Neonatology Authors: Denise Manica, Cl áudia Schweiger Source Type: research

A parent's view on the care of their baby with Robin sequence
A Robin sequence parent presents the view that Robin sequence healthcare providers are engaging in practices which may be outdated, excessively invasive, and unnecessarily detrimental to quality of life, and proposes possible areas of research to improve patient outcomes. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Philippe Pakter Source Type: research

Quality of life in children undergoing treatment for Robin Sequence in infancy
Over the last decades, due to improvements in diagnostic techniques, operative and post-operative care, the focus in pediatrics has shifted from mortality as the main outcome to long-term morbidity outcomes relevant to daily life. In children, recovery and morbidity after treatment or an intervention are related to growth and development in the following three domains: physical, mental, and social development [1]. After hospital discharge, recovery in these three domains runs simultaneously, resulting in a ‘new normal’ for the child and its parents (for readability, the term parents includes both parents and ca...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Karolijn Dulfer, Koen Joosten Source Type: research

Feeding Considerations for Infants with Craniofacial Malformations
Approximately 5% of children experience difficulty with the complex coordination of sucking, swallowing and breathing required for feeding. Infants with craniofacial malformations may have anatomic and neurologic contributions to feeding problems. Examples include cleft lip and/or palate, micrognathia, maxillary hypoplasia, and pharyngeal dysfunction. Interventions may facilitate weight gain and avoid failure-to-thrive in these infants. An interdisciplinary approach to address feeding challenges in children with craniofacial differences is necessary. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Mark A. Green, Cory M. Resnick Source Type: research

Evidence and practical aspects of treatment with the T übingen palatal plate
The T übingen therapy concept centered on an individual orthodontic palatal plate with a spur-like velar extension (Tübingen Palatal or Epiglottic Baton Plate, TPP or PEBP) and intensive feeding training. It was primarily developed for infants with Robin sequence, but has since also be used successfully in infants with other craniofacial malformations. TPP improves not only upper airway obstruction, but also feeding problems, thriving, mandibular growth and was associated with intact neurocognitive outcome. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Cornelia Wiechers, J örg Arand, Bernd Koos, Christian F. Poets Source Type: research

Positioning as a Conservative Treatment Option in Infants with micrognathia and/or cleft
Evaluation and management of airway obstruction in prone position were reviewed from studies in infants with micrognathia and/or cleft palate, using polysomnography (PSG) or similar measures, and comparing prone against other positions. Most studies identified were case series from specialist referral centres. Airway obstruction appears more severe on PSG than clinical assessment, but there is no consensus for PSG definitions of mild, moderate or severe airway obstruction. Infants show individual variability in responses to positioning; sleep quality tends to improve when prone, but 22-25% have better respiratory outcomes ...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Karen A. Waters Source Type: research

Using continuous nasal airway pressure in infants with craniofacial malformations
Obstructive sleep apnea (OSA) is common in infants and children with craniofacial malformations. Continuous positive airway pressure (CPAP) represents an effective noninvasive treatment for severe upper airway obstruction in these children, reducing the need of surgery or a tracheostomy. The decision to start CPAP should be discussed by a multidisciplinary team in order to decide the optimal individualized treatment strategy. CPAP initiation depends on patients ’ clinical characteristics and local practices, with an increase tendency towards an outpatient program. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Alessandro Amaddeo, Lucie Griffon, Brigitte Fauroux Source Type: research

The role of the nasopharyngeal prong in craniofacial disorders in particular the Pierre Robin Sequence
There are a wide range of surgical and maxillofacial options to alleviate upper airway obstruction in children with craniofacial disorders. The nasopharyngeal prong (NPP) is a simple idea where the airway obstruction arising from the posteriorly placed tongue secondary to a small mandible can be overcome quickly and without resorting to more invasive surgical procedures.The role of the NPP is of particular interest in Robin sequence (RS). RS describes a congenital anomaly with retrognathia and U-shaped palate where in some children the tongue and small jaw can significantly impact on airway patency with upper airway obstru...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Francois Abel, Colin Wallis Source Type: research

Developmental outcome of children with Robin Sequence: how does the question arise?
Robin sequence (RS) is a heterogeneous congenital condition characterized by retrognathia, glossoptosis, upper airway obstruction, and very often, posterior U-shape cleft palate. Half the children with RS have an underlying syndrome, either identified (syndromic RS) or not (RS+). Long-term intellectual developmental outcome first depends on the underlying diagnosis and is often poor in syndromic cases. On the contrary, the rare studies that analysed the long-term developmental outcome of children with isolated RS who received effective treatment of their respiratory and feeding difficulties early in life, showed intellectu...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: A. Fleurance, C. Poets, C. Chalouhi, B. Thouvenin, V. Abadie Source Type: research

Quality of life in children undergoing treatment for Pierre Robin Sequence in infancy
Over the last decades, due to improvements in diagnostic techniques, operative and post-operative care, the focus in pediatrics has shifted from mortality as the main outcome to long-term morbidity outcomes relevant to daily life. In children, recovery and morbidity after treatment or an intervention are related to growth and development in the following three domains: physical, mental, and social development (1). After hospital discharge, recovery in these three domains runs simultaneously, resulting in a ‘new normal’ for the child and its parents (for readability, the term parents includes both parents and ca...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Karolijn Dulfer, Koen Joosten Source Type: research

A parent ’s view on the care of their baby with Robin Sequence
A Robin Sequence parent presents the view that Robin Sequence healthcare providers are engaging in practices which may be outdated, excessively invasive, and unnecessarily detrimental to quality of life, and proposes possible areas of research to improve patient outcomes. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Philippe Pakter Source Type: research

Fetal markers for the detection of infants with craniofacial malformation
Facial clefts and Robin sequence (RS) share the timing of the diagnosis during the course of pregnancy, their association with genetic diseases and the subsequent management following the initial diagnosis. If a suspicion of a facial cleft or RS is made, a detailed anatomical examination of the fetus should be carried out to identify further anomalies. This may also involve genetic testing including a microarray or an exome analysis. Interdisciplinary counseling, including pre- and postnatal experts with sufficient experience in the management of such neonates, should be involved in this counseling. (Source: Seminars in Fe...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: Cornelia Wiechers, Karl Oliver Kagan Source Type: research

Diagnostic Approaches to Respiratory Abnormalities in Craniofacial Syndromes
Craniofacial syndromes are a complex cluster of genetic conditions characterized by embryonic perturbations in the developmental trajectory of the upper airway and related structures. The presence of reduced airway size and maladaptive neuromuscular responses, particularly during sleep, leads to significant alterations in sleep architecture and overall detrimental gas exchange abnormalities that can be life-threatening. The common need for multi-stage therapeutic interventions for these craniofacial problems requires careful titration of anatomy and function, and the latter is currently evaluated by overnight polysomnograp...
Source: Seminars in Fetal and Neonatal Medicine - September 17, 2021 Category: Perinatology & Neonatology Authors: David Gozal Source Type: research

Supporting families in their child's journey with neonatal encephalopathy and therapeutic hypothermia
Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 16, 2021 Category: Perinatology & Neonatology Authors: Betsy Pilon, Alexa K. Craig, Monica E. Lemmon, Annie Goeller, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Managing infants with craniofacial malformations – where to go next?
Treatment of infants with craniofacial malformations, e.g. Robin sequence, is characterized by considerable heterogeneity and a lack of randomized trials to identify an optimal approach. We propose to establish an international register using a common minimal dataset that will better allow for a comparison between key determinants and outcomes in these patients. In infants, this should include an assessment of mandibular micrognathia, glossoptosis, upper airway obstruction, weight gain and mode of feeding. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 16, 2021 Category: Perinatology & Neonatology Authors: Christian F. Poets, Veronique Abadie, Corstiaan Breugem, Colin Wallis, Francois Abel, Christel Chalouhi, Frea Kruisinga, Anna-Lisa Sorg, Cornelia Wiechers Source Type: research

Genetics of Craniofacial Malformations
The field of craniofacial malformations is comprehensive and does not allow to discuss all craniofacial malformations which have been described as single entities. Many of the syndromes with craniofacial malformations are ultrarare. In this review we have chosen craniofacial malformation syndromes which are of relevance for the pediatrician, especially neonatologist: different types of craniosynostoses, oculo-auriculo-vertebral spectrum, Pierre Robin sequence and Treacher Collins syndrome. These syndromes will be described in detail. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 16, 2021 Category: Perinatology & Neonatology Authors: Ariane Schmetz, Jeanne Amiel, Dagmar Wieczorek Source Type: research

Supporting families in their child's journey with therapeutic hypothermia
Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 16, 2021 Category: Perinatology & Neonatology Authors: Betsy Pilon, Alexa K. Craig, Monica E. Lemmon, Annie Goeller Source Type: research

Management of Seizures in Neonates with Neonatal Encephalopathy Treated with Hypothermia
Neonatal encephalopathy (NE) is the most common etiology of acute neonatal seizures – about half of neonates treated with therapeutic hypothermia for NE have EEG-confirmed seizures. These seizures are best identified with continuous EEG monitoring, as clinical diagnosis leads to under-diagnosis of subclinical seizures and over-treatment of events that are not seizures. High seizu re burden, especially status epilepticus, is thought to augment brain injury. Treatment, therefore, is aimed at minimizing seizure burden. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - September 15, 2021 Category: Perinatology & Neonatology Authors: Oscar DeLaGarza-Pineda, Janette A. Mailo, Geraldine Boylan, Vann Chau, Hannah C. Glass, Amit M. Mathur, Renee Shellhaas, Janet S. Soul, Courtney J. Wusthoff, Taeun Chang, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Hemodynamic optimization for neonates with neonatal encephalopathy caused by a hypoxic ischemic event: Physiological and therapeutic considerations
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measures used to assess circulatory adequacy have multiple confounders. Comprehensive, quantitative echocardiography may be used to delineate the relative contribution of lung parenchymal, pulmonary vascular, and cardiac disease to hypotension and/or hypoxemic respiratory failure. (So...
Source: Seminars in Fetal and Neonatal Medicine - August 12, 2021 Category: Perinatology & Neonatology Authors: Danielle R. Rios, Anie Lapointe, Georg M. Schmolzer, Khorshid Mohammad, Krisa P. VanMeurs, Roberta L. Keller, Arvind Sehgal, Satyan Lakshminrusimha, Regan E. Giesinger, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Hemodynamic optimization for neonates with neonatal encephalopathy caused by hypoxic ischemic event: Physiological and therapeutic considerations
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measures used to assess circulatory adequacy have multiple confounders. Comprehensive, quantitative echocardiography may be used to delineate the relative contribution of lung parenchymal, pulmonary vascular, and cardiac disease to hypotension and/or hypoxemic respiratory failure. (So...
Source: Seminars in Fetal and Neonatal Medicine - August 12, 2021 Category: Perinatology & Neonatology Authors: Danielle R. Rios, Anie Lapointe, Georg M. Schmolzer, Khorshid Mohammad, Krisa P. VanMeurs, Roberta L. Keller, Arvind Sehgal, Satyan Lakshminrusimha, Regan E. Giesinger, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Placental contribution to neonatal encephalopathy
Placental assessment, although currently underused, can inform our understanding of the etiology and timing of Neonatal Encephalopathy (NE). We review our current understanding of the links between placental dysfunction and NE and how this information may inform clinical decisions, now and in the future, emphasizing the four major placental lesions associated with NE. In addition, we discuss maternal and fetal factors that are hypothesized to contribute to specific placental pathologies, especially innate or acquired thrombophilias. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 9, 2021 Category: Perinatology & Neonatology Authors: Penn AA, Wintermark P, Chalak LF, Armstrong J, Redline R, M.S. Scher, Nelson KB, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy
Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 3, 2021 Category: Perinatology & Neonatology Authors: Sandoval Karamian AG, S. Mercimek-Andrews, Mohammad K, Molloy E, Chang T, Chau V, D.M. Murray, Wusthoff CJ, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - August 1, 2021 Category: Perinatology & Neonatology Source Type: research

Bedside and Laboratory Neuromonitoring in Neonatal Encephalopathy
Several bedside and laboratory neuromonitoring tools are currently used in neonatal encephalopathy (NE) to assess 1) brain function [amplitude-integrated electroencephalogram (aEEG) and EEG], 2) cerebral oxygenation delivery and consumption [near-infrared spectroscopy (NIRS)] and 3) blood and cerebrospinal fluid biomarkers. The aim of the review is to provide the role of neuromonitoring in understanding the development of brain injury in these newborns and better predict their long-term outcome. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 27, 2021 Category: Perinatology & Neonatology Authors: Chalak L, L. Hellstrom-Westas, Bonifacio S, Tsuchida T, Chock V, M. El-Dib, Massaro AN, A. Garcia-Alix, Newborn Brain Society Guidelines and Publications Source Type: research

Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia
In randomised trials, therapeutic hypothermia is associated with reduced prevalence of the composite outcome mortality or neurodevelopmental morbidity in neonates with neonatal encephalopathy (NE). Following systematic review, the reduction in prevalence of both mortality and infant neuromorbidity is clear. Among three trials reporting school age outcomes, the effects of NE and TH suggest that such benefit persists into middle childhood, but none of the major trials were powered to detect differences in these outcomes. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 25, 2021 Category: Perinatology & Neonatology Authors: Neil Marlow, Seetha Shankaran, Elizabeth E. Rogers, Nathalie L. Maitre, Christopher D. Smyser, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action
Although low- and middle-income countries (LMICs) shoulder 90% of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in t...
Source: Seminars in Fetal and Neonatal Medicine - July 23, 2021 Category: Perinatology & Neonatology Authors: Vaisakh Krishnan, Vijay Kumar, Gabriel Variane, Waldemar A. Carlo, Zulfiqar A. Bhutta, St éphane Sizonenko, Anne Hansen, Seetha Shankaran, Sudhin Thayyil, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Haematological issues in neonates with neonatal encephalopathy treated with hypothermia
Neonatal encephalopathy (NE) is associated with abnormality of neurological function and involves multiorgan dysfunction. There are long-term complications such as cerebral palsy and developmental delay. Cardiac, renal, neurological and other organ dysfunctions are well described. Haematological dysfunction is relatively common and includes anaemia, thrombocytopenia, monocyte and neutrophil activation, hypofibrinogenemia and coagulopathy. There is a lack of consensus definitions of hematological parameters and optimal levels for intervention due to the lack of interventional studies in term neonates and the lack of knowled...
Source: Seminars in Fetal and Neonatal Medicine - July 22, 2021 Category: Perinatology & Neonatology Authors: Eman Isweisi, Carmel Maria Moore, Tim Hurley, Martha Sola-Visner, Naomi McCallion, Fionnuala Ni Ainle, Zunera Zareen, Deirdre U. Sweetman, Anna E. Curley, Eleanor J. Molloy, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Neonatal encephalopathy: Focus on epidemiology and underexplored aspects of etiology
Neonatal Encephalopathy (NE) is a neurologic syndrome in term and near-term infants who have depressed consciousness, difficulty initiating and maintaining respiration, and often abnormal tone, reflexes and neonatal seizures in varying combinations. Moderate/severe NE affects 0.5-3/1000 live births in high-income countries, more in low- and middle-income countries, and carries high risk of mortality or disability, including cerebral palsy. Reduced blood flow and/or oxygenation around the time of birth, as with ruptured uterus, placental abruption or umbilical cord prolapse can cause NE. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 14, 2021 Category: Perinatology & Neonatology Authors: McIntyre S, Nelson KB, Mulkey SB, Lechpammer M, Molloy E, Badawi N, Newborn Brain Society Guidelines and Publications Committee* Source Type: research

Subcutaneous Fat Necrosis associated with hypercalcemia in neonates with neonatal encephalopathy treated with therapeutic hypothermia
Subcutaneous fat necrosis of the newborn (SFNN) is a rare, self-resolving panniculitis. The onset of skins lesions occurs within the first week of life, with a median age of onset around day 6 of life (range 1-70). About 50 % of neonates with SFNN will develop hypercalcemia in the first month though some present later. Typically, SFNN develops prior to hypercalcemia. Only half of the neonates have classic symptoms of hypercalcemia; routine screening for hypercalcemia is recommended for neonates with SFNN or at-risk. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 14, 2021 Category: Perinatology & Neonatology Authors: Celia Rodd, Agnes Schwieger, Cornelia Hagmann, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Nutrition and management of glycemia in neonates with neonatal encephalopathy treated with hypothermia
Adequate nutrition and glycemic homeostasis are increasingly recognized as potentially neuroprotective for the developing brain. In the context of hypoxia-ischemia, evidence is scarce regarding optimal nutritional support and administration route, as well as the short- and long-term consequences of such interventions. In this review, we summarize current knowledge on disturbances of brain metabolism of glucose and substrates by hypoxia-ischemia, and compound effects of these mechanisms on brain injury characterized by specific patterns on EEG and MRI. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 12, 2021 Category: Perinatology & Neonatology Authors: Pinchefsky EF, Schneider J, Basu S, Tam EWY, Gale C, Newborn Brain Society Guidelines and Publications Committee* Source Type: research

Update on Mechanisms of the Pathophysiology of Neonatal Encephalopathy
Therapeutic hypothermia is now well established to significantly improve survival without disability after neonatal encephalopathy (NE). To further improve outcomes, we need to better understand the mechanisms of brain injury. The central finding, which offers the potential for neuroprotective and neurorestorative interventions, is that brain damage after perinatal hypoxia-ischemia evolves slowly over time. Although brain cells may die during profound hypoxia-ischemia, even after surprisingly severe insults cells may show transient recovery of oxidative metabolism during a "latent" phase characterized by actively...
Source: Seminars in Fetal and Neonatal Medicine - July 7, 2021 Category: Perinatology & Neonatology Authors: Joanne O. Davidson, Fernando Gonzalez, Pierre Gressens, Alistair J. Gunn, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Medico-Legal Considerations in the Context of Neonatal Encephalopathy and Therapeutic Hypothermia
Neonatal encephalopathy (NE) is a significant complication of the peripartum period. It can lead to lifelong neurologic disabilities, including cerebral palsy, cognitive impairments, developmental delays, and epilepsy. Induced hypothermia is the first therapy, which has shown promise in improving the outcomes for neonates with moderate to severe NE following a presumed intrapartum insult.NE is also a frequent source of medical malpractice litigation. In this paper, we will review salient features of the American Tort System as it pertains to medical malpractice. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - July 7, 2021 Category: Perinatology & Neonatology Authors: Jonathan M. Fanaroff, Michael G. Ross, Steven M. Donn, Newborn Brain Society Guidelines and Publications Committee* Source Type: research

Management of Comfort and Sedation in Neonates with Neonatal Encephalopathy Treated with Therapeutic Hypothermia
Ensuring comfort for neonates undergoing therapeutic hypothermia (TH) after neonatal encephalopathy (NE) exemplifies a vital facet of neonatal neurocritical care. Physiologic markers of stress are frequently present in these neonates. Non-pharmacologic comfort measures form the foundation of care, benefitting both the neonate and parents. Pharmacological sedatives may also be indicated, yet have the potential to both mitigate and intensify the neurotoxicity of a hypoxic-ischemic insult. Morphine represents current standard of care with a history of utilization and extensive pharmacokinetic data to guide safe and effective ...
Source: Seminars in Fetal and Neonatal Medicine - June 22, 2021 Category: Perinatology & Neonatology Authors: Christopher McPherson, Adam Frymoyer, Cynthia M. Ortinau, Steven P. Miller, Floris Groenendaal Source Type: research

Optimizing Initial Neonatal Resuscitation To Reduce Neonatal Encephalopathy Around the World
One million two hundred thousand neonatal lives are lost each year due to intrapartum-related events; 99% of these deaths occur in low- and lower middle-income countries. Neonates exposed to intrapartum-related events present with failure to breathe at birth. Quick and effective delivery room management of these neonates is critical in the prevention of brain injury. Given the prominent role of lung aeration in the cardiopulmonary transition at birth, the mainstay of neonatal resuscitation is effective ventilation. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 21, 2021 Category: Perinatology & Neonatology Authors: Jackie Patterson, Krysten North, Eugene Dempsey, Daniel Ishoso, Daniele Trevisanuto, Anne CC. Lee, Beena D. Kamath-Rayne, Beena D. Kamath-Rayne, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Challenges in respiratory management during therapeutic hypothermia for Neonatal Encephalopathy
Neonatal encephalopathy (NE) is a serious condition with devastating neurological outcomes that can impact oxygenation and ventilation. The currently recommended therapeutic hypothermia (TH) for these infants may also has several respiratory implications. It decreases metabolic rate and oxygen demands; however, it increases oxygen solubility in the blood and impacts its release to peripheral tissue including the brain. Respiratory management of infants treated with TH should aim for minimizing exposure to hypocapnia or hyperoxia. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 19, 2021 Category: Perinatology & Neonatology Authors: Mohamed El-Dib, Eniko Szakmar, Ela Chakkarapani, Hany Aly, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Unanswered Questions in Neonates with NE
This manuscript has been contributed to, seen, and approved by all the authors. All the authors fulfill the authorship credit requirements. No conflict of interest exists. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 14, 2021 Category: Perinatology & Neonatology Authors: Pia Wintermark, Mohamed El Dib, Sonia Bonifacio, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Therapies for Neonatal Encephalopathy: Targeting the Latent, Secondary and Tertiary Phases of Evolving Brain Injury
In term and near-term neonates with neonatal encephalopathy, therapeutic hypothermia protocols are well established. The current focus is on how to improve outcomes further and the challenge is to find safe and complementary therapies that confer additional protection, regeneration or repair in addition to cooling. Following hypoxia-ischemia, brain injury evolves over three main phases (latent, secondary and tertiary), each with a different brain energy, perfusion, neurochemical and inflammatory milieu. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 12, 2021 Category: Perinatology & Neonatology Authors: Aravanan A. Chakkarapani, Hany Aly, Manon Benders, C. Michael Cotten, Mohamed El-Dib, Pierre Gressens, Henrik Hagberg, Hemmen Sabir, Pia Wintermark, Nicola J. Robertson, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Unanswered questions regarding therapeutic hypothermia for neonates with neonatal encephalopathy
Therapeutic hypothermia (TH) is now well established to improve intact survival after neonatal encephalopathy (NE). However, many questions could not be addressed by the randomized controlled trials. Should late preterm newborns with NE be cooled? Is cooling beneficial for mild NE? Is the current therapeutic time window optimal, or could it be shortened or prolonged? Will either milder or deeper hypothermia be effective? Does infection/inflammation exposure in the perinatal period in combination with NE offer potentially beneficial preconditioning or might it obviate hypothermic neuroprotection? In the present review, we d...
Source: Seminars in Fetal and Neonatal Medicine - June 12, 2021 Category: Perinatology & Neonatology Authors: Hemmen Sabir, Sonia L. Bonifacio, Alistair J. Gunn, Marianne Thoresen, Lina F. Chalak Source Type: research

Issues in the Daily Management of Neonates with NE
This manuscript has been contributed to, seen, and approved by all the authors. All the authors fulfill the authorship credit requirements. No conflict of interest exists. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 12, 2021 Category: Perinatology & Neonatology Authors: Pia Wintermark, Mohamed El Dib, Sonia Bonifacio, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia
Engaging with ethical issues is central to the management of neonatal encephalopathy (NE). As treatment for these neonates evolves, new ethical issues will arise and many existing challenges will remain. We highlight three key ethical issues that arise in the care of neonates with NE treated with therapeutic hypothermia: facilitating shared decision making, understanding futility, and defining the boundaries between standard of care and research. Awareness of these issues will help clinicians counsel families in light of evolving treatments and outcomes. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 11, 2021 Category: Perinatology & Neonatology Authors: Monica E. Lemmon, Courtney J. Wusthoff, Renee D. Boss, Lisa Anne Rasmussen, Newborn Brain Society Guidelines and Publications Committee* Source Type: research

Perinatal asphyxia from the obstetric standpoint
Perinatal asphyxia remains one of the major causes of morbidity and mortality for term newborns. Though access to health care and birth attendants have decreased the rate, Neonatal encephalopathy (NE) has not been eliminated. Worldwide, women at socioeconomic disadvantage have the highest risk of delivering a neonate with NE. Neonates that will experience perinatal asphyxia cannot be easily identified prospectively and the intrapartum testing available is not specific enough to clearly indicate the best course of action in most cases. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - June 11, 2021 Category: Perinatology & Neonatology Authors: Meghan G. Hill, Kathryn L. Reed, Richard Brown, Newborn Brain Society Guidelines and Publications Committee* Source Type: research

Fluid management, electrolytes imbalance and renal management in neonates with neonatal encephalopathy treated with hypothermia
Kidney dysfunction and acute kidney injury (AKI) frequently accompanies neonatal encephalopathy and contributes to neonatal morbidity and mortality. While there are currently no proven therapies for the treatment of AKI, understanding the pathophysiology along with early recognition and treatment of alterations in fluid, electrolyte and metabolic homeostasis that accompany AKI offer opportunity to reduce associated morbidity. Promising new tests and technologies, including urine and serum biomarkers and renal near-infrared spectroscopy offer opportunities to improve diagnosis and monitoring of neonates at risk for kidney i...
Source: Seminars in Fetal and Neonatal Medicine - June 11, 2021 Category: Perinatology & Neonatology Authors: Jeffrey L. Segar, Valerie Y-L. Chock, Matthew W. Harer, David T. Selewski, David J. Askenazi, Newborn Brain Society Guidelines and Publications Committee Source Type: research

Editorial Board
(Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - May 27, 2021 Category: Perinatology & Neonatology Source Type: research

Translational insights into mechanisms and preventive strategies after renal injury in neonates
Adverse perinatal circumstances can cause acute kidney injury (AKI) and contribute to chronic kidney disease (CKD). Accumulating evidence indicate that a wide spectrum of perinatal conditions interferes with normal kidney development and ultimately leads to aberrant kidney structure and function later in life. The present review addresses the lack of mechanistic knowledge with regard to perinatal origins of CKD and provides a comprehensive overview of pre- and peri-natal insults, including genetic predisposition, suboptimal nutritional supply, obesity and maternal metabolic disorders, placental insufficiency leading to int...
Source: Seminars in Fetal and Neonatal Medicine - May 7, 2021 Category: Perinatology & Neonatology Authors: Jenny Voggel, Jasmine Mohr, Kai D. N üsken, Jörg Dötsch, Eva Nüsken, Miguel A. Alejandre Alcazar Source Type: research

Cooling in mild encephalopathy: Costs and perils of therapeutic creep
Increasing confidence in therapeutic hypothermia and ambiguity of cooling guidelines has led to many clinicians extending its use to untested populations like mild encephalopathy, or even no encephalopathy. Poor quality clinical neurological examination for encephalopathy staging coupled with a fear of litigation if a baby with mild encephalopathy progress to moderate or severe encephalopathy appears to be the primary driver for this therapeutic creep. Recent data suggesting increased apoptosis with cooling uninjured brains, and lack of hypothermic neuroprotection in partial prolonged hypoxia, implies that such therapeutic...
Source: Seminars in Fetal and Neonatal Medicine - April 8, 2021 Category: Perinatology & Neonatology Authors: Vijay Kumar, Mani Singla, Sudhin Thayyil Source Type: research