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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 suppresse...
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