Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.480
Filtrar
1.
Ther Hypothermia Temp Manag ; 12(2): 90-102, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35675523

RESUMO

Spinal cord injury (SCI) is a devastating neurological condition with no effective treatment. Hypothermia induced by physical means (cold fluid) is established as an effective therapy in animal models of SCI, but its clinical translation to humans is hampered by several constraints. Hypothermia induced pharmacologically may be noninferior or superior to physically induced hypothermia for rapid, convenient systemic temperature reduction, but it has not been investigated previously in animal models of SCI. We used a rat model of SCI to compare outcomes in three groups: (1) normothermic controls; (2) hypothermia induced by conventional physical means; (3) hypothermia induced by intravenous (IV) dihydrocapsaicin (DHC). Male rats underwent unilateral lower cervical SCI and were treated after a 4-hour delay with physical cooling or IV DHC (∼0.60 mg/kg total) cooling (both 33.0 ± 1.0°C) lasting 4 hours; controls were kept normothermic. Telemetry was used to monitor temperature and heart rate during and after treatments. In two separate experiments, one ending at 48 hours, the other at 6 weeks, "blinded" investigators evaluated rats in the three groups for neurological function followed by histopathological evaluation of spinal cord tissues. DHC reliably induced systemic cooling to 32-33°C. At both the time points examined, the two modes of hypothermia yielded similar improvements in neurological function and lesion size compared with normothermic controls. Our results indicate that DHC-induced hypothermia may be comparable with physical hypothermia in efficacy, but more clinically feasible to administer than physical hypothermia.


Assuntos
Hipotermia Induzida , Hipotermia , Traumatismos da Medula Espinal , Animais , Capsaicina/análogos & derivados , Hipotermia/terapia , Hipotermia Induzida/métodos , Masculino , Ratos , Ratos Sprague-Dawley , Medula Espinal/patologia , Traumatismos da Medula Espinal/terapia
2.
Curr Opin Crit Care ; 28(3): 244-249, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35653243

RESUMO

PURPOSE OF REVIEW: Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32-36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients. RECENT FINDINGS: The Targeted Temperature Management 2 (TTM-2) trial documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC vs. targeted normothermia. A systematic review and meta-analysis completed by the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) concluded that temperature control with a target of 32-34 °C did not improve survival or favourable functional outcome after cardiac arrest. Two observational studies have documented an association between predicted moderate hypoxic-ischaemic brain injury and better outcome with temperature control at 33-34 oC compared with 35-36 oC. SUMMARY: We suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Hipotermia Induzida , Coma/etiologia , Coma/terapia , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Humanos , Temperatura
3.
Curr Opin Crit Care ; 28(3): 262-269, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35653246

RESUMO

PURPOSE OF REVIEW: Cardiac arrest centres (CACs) may play a key role in providing postresuscitation care, thereby improving outcomes in out-of-hospital cardiac arrest (OHCA). There is no consensus on CAC definitions or the optimal CAC transport strategy despite advances in research. This review provides an updated overview of CACs, highlighting evidence gaps and future research directions. RECENT FINDINGS: CAC definitions vary worldwide but often feature 24/7 percutaneous coronary intervention capability, targeted temperature management, neuroprognostication, intensive care, education, and research within a centralized, high-volume hospital. Significant evidence exists for benefits of CACs related to regionalization. A recent meta-analysis demonstrated clearly improved survival with favourable neurological outcome and survival among patients transported to CACs with conclusions robust to sensitivity analyses. However, scarce data exists regarding 'who', 'when', and 'where' for CAC transport strategies. Evidence for OHCA patients without ST elevation postresuscitation to be transported to CACs remains unclear. Preliminary evidence demonstrated greater benefit from CACs among patients with shockable rhythms. Randomized controlled trials should evaluate specific strategies, such as bypassing nearest hospitals and interhospital transfer. SUMMARY: Real-world study designs evaluating CAC transport strategies are needed. OHCA patients with underlying culprit lesions, such as those with ST-elevation myocardial infarction (STEMI) or initial shockable rhythms, will likely benefit the most from CACs.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Intervenção Coronária Percutânea , Cuidados Críticos , Humanos , Parada Cardíaca Extra-Hospitalar/terapia
4.
BMC Neurol ; 22(1): 204, 2022 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-35659637

RESUMO

BACKGROUND: It is important to assess the degree of brain injury and predict long-term outcomes in neonates diagnosed with hypoxic-ischemic encephalopathy (HIE). However, routine studies, including magnetic resonance imaging (MRI) and conventional encephalography (EEG) or amplitude-integrated EEG (aEEG), have their own limitations in terms of availability and accuracy of evaluation. Recently, quantitative EEG (qEEG) has been shown to improve the predictive reliability of neonatal HIE and has been further refined with brain mapping techniques. METHODS: We investigated background EEG activities in 29 neonates with HIE who experienced therapeutic hypothermia, via qEEG using a distributed source model. MRI images were evaluated and classified into two groups (normal-to-mild injury vs moderate-to-severe injury), based on a scoring system. Non-parametric statistical analysis using standardized low-resolution brain electromagnetic tomography was performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between the two groups. RESULTS: Electrical neuronal activities were significantly lower in the moderate-to-severe injury group compared with the normal-to-mild injury group. Background EEG activities in moderate-to-severe HIE were most significantly reduced in the temporal and parietal lobes. Quantitative EEG also revealed a decrease in background activity at all frequency bands, with a maximum in decrease in the delta component. The maximum difference in current density was found in the inferior parietal lobule of the right parietal lobe for the delta frequency band. CONCLUSIONS: Our study demonstrated quantitative and topographical changes in EEG in moderate-to-severe neonatal HIE. They also suggest possible implementation and evaluation of conventional EEG and aEEG in neonatal HIE. The findings have implications as biomarkers in the assessment of neonatal HIE.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Encéfalo/diagnóstico por imagem , Eletroencefalografia/métodos , Fenômenos Eletromagnéticos , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Recém-Nascido , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes
5.
J Neuroinflammation ; 19(1): 139, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690757

RESUMO

BACKGROUND: Therapeutic hypothermia significantly improves outcomes after moderate-severe hypoxic-ischemic encephalopathy (HIE), but it is partially effective. Although hypothermia is consistently associated with reduced microgliosis, it is still unclear whether it normalizes microglial morphology and phenotype. METHODS: Near-term fetal sheep (n = 24) were randomized to sham control, ischemia-normothermia, or ischemia-hypothermia. Brain sections were immunohistochemically labeled to assess neurons, microglia and their interactions with neurons, astrocytes, myelination, and gitter cells (microglia with cytoplasmic lipid granules) 7 days after cerebral ischemia. Lesions were defined as areas with complete loss of cells. RNAscope® was used to assess microglial phenotype markers CD86 and CD206. RESULTS: Ischemia-normothermia was associated with severe loss of neurons and myelin (p < 0.05), with extensive lesions, astrogliosis and microgliosis with a high proportion of gitter cells (p < 0.05). Microglial wrapping of neurons was present in both the ischemia groups. Hypothermia improved neuronal survival, suppressed lesions, gitter cells and gliosis (p < 0.05), and attenuated the reduction of myelin area fraction. The "M1" marker CD86 and "M2" marker CD206 were upregulated after ischemia. Hypothermia partially suppressed CD86 in the cortex only (p < 0.05), but did not affect CD206. CONCLUSIONS: Hypothermia prevented lesions after cerebral ischemia, but only partially suppressed microglial wrapping and M1 marker expression. These data support the hypothesis that persistent upregulation of injurious microglial activity may contribute to partial neuroprotection after hypothermia, and that immunomodulation after rewarming may be an important therapeutic target.


Assuntos
Hipotermia Induzida , Hipotermia , Hipóxia-Isquemia Encefálica , Substância Branca , Animais , Gliose/terapia , Hipóxia-Isquemia Encefálica/metabolismo , Inflamação/terapia , Isquemia , Ovinos , Substância Branca/patologia
6.
Sci Rep ; 12(1): 7254, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508580

RESUMO

Existing prognostic models to predict the neurological recovery in patients with cardiac arrest receiving targeted temperature management (TTM) either exhibit moderate accuracy or are too complicated for clinical application. This necessitates the development of a simple and generalizable prediction model to inform clinical decision-making for patients receiving TTM. The present study explores the predictive validity of the Cardiac Arrest Survival Post-resuscitation In-hospital (CASPRI) score in cardiac arrest patients receiving TTM, regardless of cardiac event location, and uses artificial neural network (ANN) algorithms to boost the prediction performance. This retrospective observational study evaluated the prognostic relevance of the CASPRI score and applied ANN to develop outcome prediction models in a cohort of 570 patients with cardiac arrest and treated with TTM between 2014 and 2019 in a nationwide multicenter registry in Taiwan. In univariate logistic regression analysis, the CASPRI score was significantly associated with neurological outcome, with the area under the receiver operating characteristics curve (AUC) of 0.811. The generated ANN model, based on 10 items of the CASPRI score, achieved a training AUC of 0.976 and validation AUC of 0.921, with the accuracy, precision, sensitivity, and specificity of 89.2%, 91.6%, 87.6%, and 91.2%, respectively, for the validation set. CASPRI score has prognostic relevance in patients who received TTM after cardiac arrest. The generated ANN-boosted, CASPRI-based model exhibited good performance for predicting TTM neurological outcome, thus, we propose its clinical application to improve outcome prediction, facilitate decision-making, and formulate individualized therapeutic plans for patients receiving TTM.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Hospitais , Humanos , Hipotermia Induzida/efeitos adversos , Redes Neurais de Computação , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Ressuscitação , Estudos Retrospectivos
7.
Clin Med (Lond) ; 22(3): 285-286, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35584835

RESUMO

INTRODUCTION: We describe a case of olanzapine-induced hypothermia and hand oedema in an older adult with behavioural and psychological symptoms of dementia (BPSD). CASE PRESENTATION: An 82-year-old woman with hypothyroidism and dementia was reviewed by the geriatric team at a nursing home in view of lethargy and an unrecordable oral temperature. She was noted to have a bilateral hand oedema and right basal crackles. Investigations revealed high white cell count and inflammatory markers. She was treated as per hypothermia and communityacquired pneumonia protocols. The patient did not have the expected response to treatment. Olanzapine was tailed down and stopped with good effect as it was suspected to be a contributory cause to both the hypothermia and oedema. DISCUSSION AND CONCLUSION: Potentially inappropriate polypharmacy can be specifically targeted with effective deprescribing. Treatment review should be encouraged on a regular basis, especially in frail older adults with polypharmacy.


Assuntos
Demência , Desprescrições , Hipotermia Induzida , Hipotermia , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Edema , Feminino , Humanos , Hipotermia/induzido quimicamente , Olanzapina , Polimedicação
8.
Am J Emerg Med ; 57: 124-132, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35567900

RESUMO

PURPOSE: Targeted temperature management (TTM) at 32 °C-36 °C improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. METHODS: This multicenter study analyzed nontraumatic OHCA registry data between October 2015 and June 2020 from 29 institutions. Patients were classified into four groups based on targeted temperatures and TFD implementation: TTM at 33 °C with TFD (33TFD), TTM at 36 °C with TFD (36TFD), TTM at 33 °C without TFD (33NTFD), and TTM at 36 °C without TFD (36NTFD). Clinical outcomes were survival till hospital discharge and neurological status at discharge. RESULTS: A total of 938 patients were included in the analysis. There was an independent association between the 33NTFD patients with the least survival and the worst neurological outcomes among the four groups after adjustment for covariates. However, no significant differences were observed in survival and neurological outcomes among the 33TFD, 36TFD, and 36NTFD groups after adjusting for covariates. Compared to 33NTFD, 36NTFD patients exhibited significantly higher adjusted ORs for survival and favorable neurological status at hospital discharge. CONCLUSION: In OHCA patients receiving TTM without TFDs, the adjusted predicted probability of survival and good neurological outcomes at hospital discharge was greater for TTM at 36 °C than that at 33 °C. This suggests that a TTM of 36 °C rather than 33 °C is associated with more favorable clinical outcomes if TFDs are unavailable.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Retroalimentação , Humanos , Hipotermia Induzida/efeitos adversos , Estudos Retrospectivos , Temperatura
10.
Syst Rev ; 11(1): 101, 2022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35606836

RESUMO

BACKGROUND: Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population. METHODS: We will perform a systematic review of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy. We will include randomized, quasi-randomized controlled trials and observational studies. The use of pharmacological or non-pharmacological interventions will be compared to other pharmacological and or non-pharmacological interventions or no intervention/placebo. The primary outcomes for this review will be analgesia and sedation assessed with validated pain scales, circulatory instability, mortality to discharge, and moderate-to-severe neurodevelopmental disability. We will search the following databases: CINAHL, ClinicalTrials.gov , Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Two independent researchers will screen the records for inclusion, extract data using a data extraction form, and assess the risk of bias in the included trials. DISCUSSION: The result of this review will summarize the knowledge regarding the management of pain and sedation in infants treated with therapeutic hypothermia and potentially provide clinicians with guidance on the effective and safe methods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020205755.


Assuntos
Analgesia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Humanos , Hipóxia/terapia , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Dor/etiologia , Revisões Sistemáticas como Assunto
11.
Physiol Rep ; 10(9): e15286, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35510328

RESUMO

Acute respiratory distress syndrome (ARDS) is a lung injury characterized by noncardiogenic pulmonary edema and hypoxic respiratory failure. The purpose of this study was to investigate the effects of therapeutic hypothermia on short-term experimental ARDS. Twenty adult female Yorkshire pigs were divided into four groups (n = 5 each): normothermic control (C), normothermic injured (I), hypothermic control (HC), and hypothermic injured (HI). Acute respiratory distress syndrome was induced experimentally via intrapulmonary injection of oleic acid. Target core temperature was achieved in the HI group within 1 h of injury induction. Cardiorespiratory, histologic, cytokine, and metabolomic data were collected on all animals prior to and following injury/sham. All data were collected for approximately 12 h from the beginning of the study until euthanasia. Therapeutic hypothermia reduced injury in the HI compared to the I group (histological injury score = 0.51 ± 0.18 vs. 0.76 ± 0.06; p = 0.02) with no change in gas exchange. All groups expressed distinct phenotypes, with a reduction in pro-inflammatory metabolites, an increase in anti-inflammatory metabolites, and a reduction in inflammatory cytokines observed in the HI group compared to the I group. Changes to respiratory system mechanics in the injured groups were due to increases in lung elastance (E) and resistance (R) (ΔE from pre-injury = 46 ± 14 cmH2 O L-1 , p < 0.0001; ΔR from pre-injury: 3 ± 2 cmH2 O L-1  s- , p = 0.30) rather than changes to the chest wall (ΔE from pre-injury: 0.7 ± 1.6 cmH2 O L-1 , p = 0.99; ΔR from pre-injury: 0.6 ± 0.1 cmH2 O L-1  s- , p = 0.01). Both control groups had no change in respiratory mechanics. In conclusion, therapeutic hypothermia can reduce markers of injury and inflammation associated with experimentally induced short-term ARDS.


Assuntos
Hipotermia Induzida , Lesão Pulmonar , Síndrome do Desconforto Respiratório , Animais , Biomarcadores , Citocinas , Feminino , Pulmão/patologia , Síndrome do Desconforto Respiratório/terapia , Mecânica Respiratória , Suínos
12.
Actas Dermosifiliogr ; 113(3): 278-283, 2022 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35526920

RESUMO

Chemotherapy-induced hair loss in cancer is usually temporary but can take a significant emotional toll on patients and lead to treatment refusal in many cases. Although hair loss is usually reversible, regrowth can take months, causing greater psychological distress. Recent years have seen the emergence of cold caps, or scalp cooling systems, designed to prevent or at least reduce chemotherapy-induced hair loss. The results to date are encouraging. We review the evidence on the effects and effectiveness of these systems, which are making their way into routine clinical practice.


Assuntos
Antineoplásicos , Neoplasias da Mama , Hipotermia Induzida , Alopecia/induzido quimicamente , Alopecia/prevenção & controle , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Hipotermia Induzida/métodos , Estudos Prospectivos , Couro Cabeludo
13.
Clin Neuropharmacol ; 45(3): 74-77, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35579488

RESUMO

OBJECTIVES: Antipsychotic-induced hypothermia is an uncommon type of secondary hypothermia resulting from neurotransmitter derangements within the nervous system thermoregulation pathway. The most common causative medications include olanzapine, haloperidol, and risperidone, with one published report of aripiprazole. Most individuals who develop antipsychotic-induced hypothermia receive neuroleptic treatment for psychiatric disorder management, with significantly fewer occurrences in those with neurologic disorders. There are currently no reports of antipsychotic-induced hypothermia after a traumatic brain injury (TBI), where antipsychotics are used for the off-label management of posttraumatic agitation. METHODS: A retrospective chart review of the patient's medical record was performed. RESULTS: We present a case of a 56-year-old man with a moderate TBI who developed recurrent episodes of antipsychotic-induced hypothermia after starting aripiprazole for posttraumatic agitation management. CONCLUSIONS: To our knowledge, this is the first publication detailing antipsychotic-induced hypothermia occurring in a TBI patient. Clinicians who initiate antipsychotics for posttraumatic agitation in a TBI patient should be aware of this potential adverse effect, as well as clinical presentation, evaluation, and management strategies.


Assuntos
Antipsicóticos , Hipotermia Induzida , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Benzodiazepinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risperidona/uso terapêutico
14.
Yonsei Med J ; 63(5): 461-469, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512749

RESUMO

PURPOSE: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMA scores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at discharge and 30-day mortality. RESULTS: Increased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI), 1.707-5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196-1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closely associated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841-13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI, 1.675-4.211; p<0.001). CONCLUSION: Increased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM after OHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulation after OHCA.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Microangiopatias Trombóticas , Humanos , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/terapia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Microangiopatias Trombóticas/complicações
15.
Sci Rep ; 12(1): 7945, 2022 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-35562399

RESUMO

This study investigated the 3-year clinical outcomes in relation to the severity of encephalopathy in high-survival infants who underwent therapeutic hypothermia. This retrospective observational study was conducted in level II/III neonatal intensive care units in Japan. The nationwide cohort included 474 infants registered in the Baby Cooling Registry of Japan between January 2012 and December 2016. Clinical characteristics, mortality rate and severe neurological impairment at age 3 years were evaluated. Of the infants, 48 (10.4%), 291 (63.1%) and 122 (26.5%) had mild, moderate and severe encephalopathy, respectively, upon admission. By age 3, 53 (11.2%) infants died, whereas 110 (26.1%) developed major disabilities. The mild group survived up to age 3. In the moderate group, 13 (4.5%) died and 44 (15.8%) developed major disabilities. In the severe group, 39 (32.0%) died by age 3. Adverse outcomes were observed in 100 (82.0%) infants. Mortality was relatively low in all subgroups, but the incidence of major disabilities was relatively high in the severe group. The relatively low mortality and high morbidity may be due to Japanese social and ethical norms, which rarely encourage the withdrawal of intensive life support. Cultural and ethical backgrounds may need to be considered when assessing the effect of therapeutic interventions.


Assuntos
Encefalopatias , Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Doenças do Recém-Nascido , Encefalopatias/etiologia , Pré-Escolar , Estudos de Coortes , Humanos , Hipotermia Induzida/efeitos adversos , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Unidades de Terapia Intensiva Neonatal , Resultado do Tratamento
16.
Medicine (Baltimore) ; 101(20): e29175, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35608418

RESUMO

BACKGROUND: Neonates with moderate to severe encephalopathy benefit significantly from therapeutic hypothermia, with reduced risk of death or disability. However, the need for therapeutic hypothermia for mild neonatal encephalopathy (NE) remains unclear. Therefore, we conducted a protocol for systematic review and meta-analysis to provide evidence supporting therapeutic hypothermia for term or near term neonates with mild NE, including findings of recent long-term outcome studies, as well as novel adjunctive therapies to augment neurodevelopmental outcomes for neonates with NE who receive therapeutic hypothermia. METHODS: Two independent researchers performed a systematic literature search in different electronic databases including PubMed, the Cochrane Center Controlled Trials Register, EMBASE, Medline, Ovid, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database without any restrictions of languages and date. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. Two reviewers will assess the risk of bias of the included studies by the "Risk of Bias Assessment Tool" of the Cochrane Handbook for randomized controlled trials. Statistical analysis will be performed with Review Manager software 5.3. RESULTS: A synthesis of current evidence of therapeutic hypothermia for treating mild NE will be provided in this protocol. CONCLUSION: The results of this study will provide a theoretical basis for the clinical use of therapeutic hypothermia in mild NE.


Assuntos
Encefalopatias , Hipotermia Induzida , Doenças do Recém-Nascido , Encefalopatias/terapia , Humanos , Hipotermia Induzida/métodos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Metanálise como Assunto , Revisões Sistemáticas como Assunto
17.
BMC Pediatr ; 22(1): 290, 2022 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-35581579

RESUMO

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and morbidity. Effective indicators for the early diagnosis of brain injury after HIE and prognosis are lacking. This study aimed to examine the predictive value of serum neuron-specific enolase (NSE), amplitude-integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI), alone and in combination, for the neurological outcomes in neonates with HIE. METHODS: Newborns with HIE born and treated at the Third Affiliated Hospital of An-Hui Medical University were consecutively included in this prospective cohort study (June 2013 to December 2020). Encephalopathy was classified as mild, moderate or severe according to Samat and Sarnat. All patients were assessed serum 1-day NSE and 3-day NSE levels after birth. The children were classified by neurological examination and Bayley Scales of Infant Development II at 18 months of age. ROC analysis was used to evaluate the predictive accuracy of the neurodevelopment outcomes. RESULTS: A total of 50 HIE neonates were enrolled (normal group: 32 (64.0%), moderate delay: 5 (10.0%), severe delay: 30(26.0%)) according to Bayley II scores. Serum 3-day NSE levels increased with worsening neurodevelopment outcomes (normal: 20.52 ± 6.42 µg/L vs. moderate: 39.82 ± 5.92 µg/L vs. severe: 44.60 ± 9.01 µg/L, P < 0.001). The MRI findings at 4-7 days after birth were significantly different among the three groups (P < 0.001). Forty-two (84.0%) children had abnormal aEEG. The combination of the three abnormalities combined together had 100% sensitivity, 97.70% specificity, 98.25% PPV, and 99.98% NPV. CONCLUSIONS: MRI, aEEG, and 3-day NSE can predict the neurological prognosis of newborns with HIE without hypothermia treatment. Their combination can improve the predictive ability for long-term neurobehavioral prognosis.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Criança , Eletroencefalografia/métodos , Eletrofisiologia , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Fosfopiruvato Hidratase , Estudos Prospectivos
18.
Sci Rep ; 12(1): 7795, 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-35551488

RESUMO

Brain injury at birth is an important cause of neurological and behavioral disorders. Hypoxic-ischemic encephalopathy (HIE) is a critical cerebral event occurring acutely or chronically at birth with high mortality and morbidity in newborns. Therapeutic strategies for the prevention of brain damage are still unknown, and the only medical intervention for newborns with moderate-to-severe HIE is therapeutic hypothermia (TH). Although the neurological outcome depends on the severity of the initial insult, emerging evidence suggests that infants with mild HIE who are not treated with TH have an increased risk for neurodevelopmental impairment; in the current clinical setting, there are no specific or validated biomarkers that can be used to both correlate the severity of the hypoxic insult at birth and monitor the trend in the insult over time. The aim of this work was to examine the presence of autophagic and mitophagic proteins in bodily fluids, to increase knowledge of what, early at birth, can inform therapeutic strategies in the first hours of life. This is a prospective multicentric study carried out from April 2019 to April 2020 in eight third-level neonatal intensive care units. All participants have been subjected to the plasma levels quantification of both Parkin (a protein involved in mitophagy) and ATG5 (involved in autophagy). These findings show that Parkin and ATG5 levels are related to hypoxic-ischemic insult and are reliable also at birth. These observations suggest a great potential diagnostic value for Parkin evaluation in the first 6 h of life.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Doenças do Recém-Nascido , Proteína 5 Relacionada à Autofagia , Feminino , Humanos , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/terapia , Gravidez , Estudos Prospectivos , Ubiquitina-Proteína Ligases/genética
19.
Ther Hypothermia Temp Manag ; 12(2): 51-56, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35384724

RESUMO

Neonates are vulnerable to hypothermia in the early postnatal period due to a low temperature environment, physiological function, and many other factors. In this article, the definition, occurrence status, related factors, hazards, and prevention strategies of neonatal hypothermia are reviewed. The interventions for hypothermia are mainly achieved through three processes, that is, intervention in the delivery room before and after birth, intervention on the way from the delivery room to the neonatal intensive care unit (NICU), and intervention after arrival at the NICU. Rewarming is the main intervention measure after the occurrence of hypothermia and slow rewarming is advocated, based on related studies of early neonatal cold injury syndrome and mild hypothermia treatment of hypoxic-ischemic encephalopathy. Rapid rewarming has been proposed in recent years but remains controversial. There are no detailed guidelines yet for rewarming for early neonatal hypothermia, and there is no precise definition of "rapid rewarming" and "slow rewarming" in terms of the rewarming rate.


Assuntos
Hipotermia Induzida , Hipotermia , Hipóxia-Isquemia Encefálica , Humanos , Hipotermia/prevenção & controle , Hipotermia Induzida/efeitos adversos , Hipóxia-Isquemia Encefálica/prevenção & controle , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Reaquecimento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...