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  • 1
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    Online Resource
    A Comparison of the Thompson Encephalopathy Score and Amplitude-Integrated Electroencephalography in Infants with Perinatal Asphyxia and Therapeutic Hypothermia
    S. Karger AG ; 2017
    In:  Neonatology Vol. 112, No. 1 ( 2017), p. 24-29
    Details
    In: Neonatology, S. Karger AG, Vol. 112, No. 1 ( 2017), p. 24-29
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In previous studies clinical signs or amplitude-integrated electroencephalography (aEEG)-based signs of encephalopathy were used to select infants with perinatal asphyxia for treatment with hypothermia. 〈 b 〉 〈 i 〉 Aim: 〈 /i 〉 〈 /b 〉 The objective of this study was to compare Thompson encephalopathy scores and aEEG, and relate both to outcome. 〈 b 〉 〈 i 〉 Subjects and Methods: 〈 /i 〉 〈 /b 〉 Thompson scores, aEEG, and outcome were compared in 122 infants with perinatal asphyxia and therapeutic hypothermia. Of these 122 infants, 41 died and 7 had an adverse neurodevelopmental outcome. A receiver operating characteristics (ROC) analysis was also performed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Thompson scores were higher in infants with more abnormal aEEG background patterns (ANOVA, 〈 i 〉 p 〈 /i 〉 〈 0.001). The ROC analysis demonstrated that a Thompson score of 11 or higher or an aEEG background pattern of continuous low voltage or worse was associated with an adverse outcome (AUC 0.84 for both). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 High Thompson scores and a suppressed aEEG background pattern are associated with an adverse outcome after perinatal asphyxia and therapeutic hypothermia. Further studies are needed to identify the best technique with which to select patients for therapeutic hypothermia
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000455819
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 2403535-X
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  • 2
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    Online Resource
    Increased Use of Therapeutic Hypothermia in Infants with Milder Neonatal Encephalopathy due to Presumed Perinatal Asphyxia
    S. Karger AG ; 2020
    In:  Neonatology Vol. 117, No. 4 ( 2020), p. 488-494
    Details
    In: Neonatology, S. Karger AG, Vol. 117, No. 4 ( 2020), p. 488-494
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Adverse outcomes have been reported in infants with mild neonatal encephalopathy (NE). Increasing clinical experience with the application of therapeutic hypothermia (TH) may have resulted in the treatment of newborns with milder NE during recent years. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To determine whether infants treated with TH in the initial years following implementation had a higher degree of NE than infants treated during subsequent years. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Infants with NE treated with TH from February 2008 until July 2017 were included. Thompson and Sarnat scores, amplitude-integrated electroencephalography (aEEG) background patterns before the start of TH, and neurodevelopmental outcome at 2 years were compared between infants treated from February 2008 until October 2012 (period 1) and infants treated from November 2012 until July 2017 (period 2). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 211 newborns with NE were treated with TH (period 1: 〈 i 〉 n 〈 /i 〉 = 109, period 2: 〈 i 〉 n 〈 /i 〉 = 102). Sarnat scores in period 1 and 2 were mild in 7.3 vs. 28.4%, moderate in 66.1 vs. 44.1%, and severe in 26.6 vs. 22.5%, respectively ( 〈 i 〉 p 〈 /i 〉 = 0.008). Thompson scores were lower in period 2 (median = 9, IQR 7–12) than in period 1 (median = 10, IQR 8.5–13.5, 〈 i 〉 p 〈 /i 〉 = 0.018). The aEEGs and neurodevelopmental outcomes were comparable between the periods. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Based on Thompson and Sarnat scores, but not aEEG background patterns, infants treated during the second period had milder NE than infants treated during the first years following implementation of TH. There was no difference in 2 years neurodevelopmental outcome. Further research is necessary to evaluate the value of TH for infants with clinically mild NE.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000508710
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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  • 3
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    Online Resource
    Delay in Treatment of Neonatal Seizures: A Retrospective Cohort Study
    S. Karger AG ; 2020
    In:  Neonatology Vol. 117, No. 5 ( 2020), p. 599-605
    Details
    In: Neonatology, S. Karger AG, Vol. 117, No. 5 ( 2020), p. 599-605
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Neonatal seizures are common and caused by a variety of underlying disorders. There is increasing evidence that neonatal seizures result in further brain damage. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To describe the time interval between diagnosis of amplitude-integrated electroencephalography (aEEG)-confirmed seizures and administration of anti-epileptic drugs (AEDs). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Single-centre retrospective cohort study, with full-term infants ( 〈 i 〉 n 〈 /i 〉 = 106) admitted to a level III neonatal intensive care unit between 2012 and 2017 with seizures confirmed on 2-channel aEEG and corresponding raw electroencephalography traces, treated with AEDs. The time interval between the first seizure on the aEEG registration and AED administration was calculated. Factors associated with early treatment were analysed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The median time interval of initiating treatment of aEEG-confirmed seizures was 01:50 h (interquartile range 00:43–4:30 h). Treatment of aEEG-confirmed seizures was initiated & #x3c;1 h in 34/106 infants (32.1%), between 1 and 2 h in 21/106 infants (19.8%), 2–4 h in 23/106 infants (21.7%), 4–8 h in 14/106 infants (13.2%), and ≥8 h in 14/106 infants (13.2%). Seizures treated & #x3c;1 h were significantly more often recognized by the seizure detection algorithm (SDA) compared to seizures treated & #x3e;1 h (67 vs. 42%, 〈 i 〉 p 〈 /i 〉 = 0.02) and showed more clinical signs (79.4 vs. 37.5%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.01). There was no difference for out-of-office hours (23.5 vs. 22.2%, 〈 i 〉 p 〈 /i 〉 = 0.88). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 With only 32.1% of the seizures being treated & #x3c;1 h, there is room for improvement. Timely treatment occurred more often when seizures were clinical or recognised by the SDA. aEEG is a helpful tool for diagnosing seizures 24/7.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000509282
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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  • 4
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    Online Resource
    Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors
    S. Karger AG ; 2015
    In:  Neonatology Vol. 108, No. 2 ( 2015), p. 130-136
    Details
    In: Neonatology, S. Karger AG, Vol. 108, No. 2 ( 2015), p. 130-136
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Lidocaine is an effective therapy for neonatal seizures; however, it is not widely used, presumably due to the risk of cardiac events. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To investigate the incidence of cardiac events in full-term and preterm infants receiving lidocaine for seizures. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Full-term (n = 368) and preterm (n = 153) infants, admitted to a level 3 neonatal intensive care unit from 1992 to 2012, who received lidocaine for seizures were retrospectively studied. The causal relation between reported cardiac events and lidocaine administration was evaluated based on expected plasma concentrations, symptoms and relevant interactions during cardiac events. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Cardiac events were reported in 11/521 infants (2.1%; 9 full-term, 2 preterm). In 7/11 infants the causal relation was considered plausible, in 3/11 questionable and in 1/11 implausible. The incidence was calculated to be 1.3-1.9% (n = 7-10/521), but was only 0.4% (n = 1/246, p = 0.02) when using reduced-dose regimens. Important risk factors for cardiac events were unstable potassium, (congenital) cardiac dysfunction and concurrent phenytoin use. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Lidocaine-associated cardiac events were rare in our cohort, especially since the introduction of new reduced-dose regimens. This indicates that lidocaine is safe to use as an antiepileptic drug in full-term and preterm infants.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000430767
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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  • 5
    Online Resource
    Online Resource
    Amplitude-Integrated Electroencephalography in Newborns with Inborn Errors of Metabolism
    S. Karger AG ; 2012
    In:  Neonatology Vol. 102, No. 3 ( 2012), p. 203-211
    Details
    In: Neonatology, S. Karger AG, Vol. 102, No. 3 ( 2012), p. 203-211
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The utility of amplitude-integrated electroencephalography (aEEG) monitoring has been established for patients with neonatal hypoxic-ischemic encephalopathy. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To evaluate the role of aEEG in the diagnostic process and treatment of patients with encephalopathy due to inborn errors of metabolism. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Cases collected through an international registry were divided into 5 groups of metabolic disorders. Common aEEG features were sought for each group. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In total, 21/30 (70%) cases had abnormal aEEG background patterns, 18/30 (60%) showed seizure activity. Patients with disorders of energy metabolism, hyperammonemia, and organic/amino acidopathies often showed marked aEEG depression with seizure activity. In contrast, aEEGs of patients with peroxisomal disorders did not show major background abnormalities but seizures were present in 5/6 subjects. We report two features of interest: firstly, two tracings displayed an unusual upward shift of the lower aEEG amplitude margin. Secondly, aEEGs of infants with non-ketotic hyperglycinemia showed a pattern we refer to as ‘high-frequency burst-suppression pattern’. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 aEEG in patients with inborn errors of metabolism frequently reveals abnormalities and assists clinicians in the clinical assessment, management and monitoring of these patients.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000339567
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 2403535-X
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  • 6
    Online Resource
    Online Resource
    Anticonvulsant Effectiveness and Hemodynamic Safety of Midazolam in Full-Term Infants Treated with Hypothermia
    S. Karger AG ; 2015
    In:  Neonatology Vol. 107, No. 2 ( 2015), p. 150-156
    Details
    In: Neonatology, S. Karger AG, Vol. 107, No. 2 ( 2015), p. 150-156
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective was to evaluate the anticonvulsant effectiveness and hemodynamic safety of midazolam in hypothermic newborns and to provide dosing guidance. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Hypothermic newborns with perinatal asphyxia and treated with midazolam were included. Effectiveness was studied using continuous amplitude-integrated electroencephalography. Hemodynamic safety was assessed using pharmacokinetic-pharmacodynamic modeling with plasma samples and blood pressure recordings (mean arterial blood pressure) under hypothermia. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 No effect of therapeutic hypothermia on pharmacokinetics could be identified. Add-on seizure control with midazolam was limited (23% seizure control). An inverse relationship between the midazolam plasma concentration and mean arterial blood pressure could be identified. At least one hypotensive episode was experienced in 64%. The concomitant use of inotropes decreased midazolam clearance by 33%. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Under therapeutic hypothermia, midazolam has limited add-on clinical anticonvulsant effectiveness after phenobarbital administration. Due to occurrence of hypotension requiring inotropic support, midazolam is less suitable as a second-line anticonvulsant drug under hypothermia.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000368180
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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