How well does neonatal neuroimaging correlate with neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy?

Pediatric Research, Journal Year: 2023, Volume and Issue: 94(3), P. 1018 - 1025

Published: March 1, 2023

Abstract Background In newborns with hypoxic-ischemic encephalopathy (HIE), the correlation between neonatal neuroimaging and degree of neurodevelopmental impairment (NDI) is unclear. Methods Infants HIE enrolled in a randomized controlled trial underwent MRI/MR spectroscopy (MRS) using harmonized protocol at 4–6 days age. The severity brain injury was measured validated scoring system. Using proportional odds regression, we calculated adjusted ratios (aOR) for associations MRI/MRS measures primary ordinal outcome (i.e., normal, mild NDI, moderate severe or death) age 2 years. Results Of 451 infants median 5 (IQR 4.5–5.8), outcomes were normal (51%); (12%), (14%), NDI (13%); death (9%). MRI score (aOR 1.06, 95% CI 1.05, 1.07), 39.6, 16.4, 95.6), MRS lactate/n-acetylaspartate (NAA) ratio 1.6, 1.4,1.8) associated worse outcomes. mild/moderate had similar BSID-III cognitive, language, motor scores as no injury. Conclusion absence injury, does not accurately discriminate NDI. Given diagnostic uncertainty, families need to be counseled regarding range possible Impact Half all (HIE) large clinical either died years despite receiving therapeutic hypothermia. Severe global pattern on both strongly impairment. mean MRI. prognostic uncertainty among less degrees should

Language: Английский

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Neonatal encephalopathy and hypoxic–ischemic encephalopathy: moving from controversy to consensus definitions and subclassification

Pediatric Research, Journal Year: 2023, Volume and Issue: 94(6), P. 1860 - 1863

Published: Aug. 12, 2023

Language: Английский

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Variations in care of neonates during therapeutic hypothermia: call for care practice bundle implementation

Pediatric Research, Journal Year: 2023, Volume and Issue: 94(1), P. 321 - 330

Published: Jan. 9, 2023

Language: Английский

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The ALIGN Framework

Neurology, Journal Year: 2022, Volume and Issue: 100(8)

Published: Dec. 1, 2022

Background and Objectives

Clinicians often communicate complex, uncertain, distressing information about neurologic prognosis to parents of critically ill infants. Although communication tools have been developed in other disciplines settings, none address the unique needs neonatal pediatric neurology context. We aimed develop a parent-informed framework guide clinicians communicating prognosis.

Methods

Parents infants with conditions intensive care unit were enrolled longitudinal study shared decision-making from 2018 2020. completed semistructured interviews following recorded family meetings health team, at hospital discharge, 6 months after discharge. All targeted parent preferences for prognostic disclosure. analyzed data using conventional content analysis approach. Two team members independently coded all interview transcripts, discrepancies resolved consensus. used NVIVO 12 qualitative software index organize codes.

Results

Fifty-two 37 123 interviews. predominantly mothers (n = 37/52, 71%) median age 31 (range 19–46) years. Half Black 26/52, 50%), minority reported Hispanic ethnicity 2/52, 4%). Inductive resulted emergence 5 phases (Approach, Learn, Inform, Give support, Next steps: ALIGN): (1) Approach: appreciated receiving consistent their child9s outcome who knew child well. (2) Learn: valued when asked them how they preferred what already prior delivery. (3) Inform: honest, thorough, balanced that disclosed uncertainty acknowledged room hope. (4) support: empathic offered real-time emotional support. (5) connected resources, including peer

Discussion

The ALIGN offers novel, strategy effectively represents key elements conversation prognosis, each clinician can adapt this own Future work will assess effectiveness on quality understanding.

Language: Английский

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Families as partners in neonatal neuro-critical care programs

Pediatric Research, Journal Year: 2024, Volume and Issue: unknown

Published: June 17, 2024

Language: Английский

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Quality improvement and outcomes for neonates with hypoxic-ischemic encephalopathy: obstetrics and neonatal perspectives

Seminars in Perinatology, Journal Year: 2024, Volume and Issue: 48(3), P. 151904 - 151904

Published: April 1, 2024

Despite significant improvement in perinatal care and research, hypoxic ischemic encephalopathy (HIE) remains a global healthcare challenge. From both published research reports of QI initiatives, we have identified number distinct opportunities that can serve as targets quality (QI) initiatives focused on reducing HIE. Specifically, (i) implementation interventions to anticipate timely manage high-risk deliveries; (ii) enhancement team training communication; (iii) optimization early HIE diagnosis management referring centers during transport; (iv) standardization the approach when managing neonates with therapeutic hypothermia; (v) establishment protocols for family integration follow-up, been important successful initiatives. We also provide framework examples tools be used support work discuss some perceived challenges future targeting

Language: Английский

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The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis

Midwifery, Journal Year: 2023, Volume and Issue: 125, P. 103771 - 103771

Published: July 10, 2023

Language: Английский

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Improving UK data on avoidable perinatal brain injury: review of data dictionaries and consultation

Pediatric Research, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 30, 2025

Abstract Background High quality data is important to understanding epidemiology and supporting improvement efforts in perinatal brain injury. It not clear which items relevant injury are captured across UK sources of routinely collected data, nor what needs be done ensure that those fit for purpose improving care. Methods We reviewed dictionaries four main consulted a multi-professional group ( N = 27) with expertise neonatal/maternity care, statistics, clinical negligence. Results None the we currently captures, on its own, range Data lack common definitions ongoing linkage different sources. Our consultation identified need standardising definition avoidable injury, resolving inconsistencies capturing existing sources, co-designing strategy meaningful use data. Conclusions Limited standardisation key problems using guide aimed at reducing risk A programme involving co-design healthcare professionals families improve capture now needed. Impact challenge as basis reduce harmonisation professionals, families, other specialists needed enable better this area. There standardise resolve

Language: Английский

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A Pilot Randomized Control Trial of Holding During Hypothermia and Effects on Maternal and Infant Salivary Cortisol Levels

Advances in Neonatal Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 6, 2025

The lack of physical contact during therapeutic hypothermia (TH) is challenging for parents newborns with hypoxic ischemic encephalopathy. Holding often avoided due to concerns effects on infant temperature and dislodging equipment. We assessed the effect holding TH maternal salivary cortisol levels vital signs. Prospective crossover study infants randomized a 30-minute session day-2 versus day-3 TH. "No-holding" occurred alternate day at same time. Pre- post-holding were compared between no-holding conditions. Vital signs collected 2-minute intervals. Data was analyzed using mixed-effects models. Thirty-four mothers recruited. median gestational age 39 weeks, 16 (94%) had moderate encephalopathy all morphine Salivary decreased after (P = .02) .01). Infants held day-2, but not day-3, lower heart rates, respiratory mean arterial pressures. Temperature oxygen saturations stable both days. demonstrate positive as evidenced by mother rate, blood pressure day-2. Further research needed replicate these results, understand response assess correlation cumulative exposure.

Language: Английский

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Parental closeness during infant therapeutic hypothermia: Nurses’ experiences and reflections

Journal of Neonatal Nursing, Journal Year: 2025, Volume and Issue: 31(3), P. 101656 - 101656

Published: March 14, 2025

Language: Английский

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