Neurological Disorders

Hi Netter, I had couple of patients (27 and 29 weekers) who have had grade III IVH in the first week of life, they had roller coaster course, where they had severe RDS, ventilated, received surfactant therapy, and clinically septic (septic shock). They have developed BPD (moderate - severe) and healthcare associated BSI down the road. we were following IVH-III with serial cranial ultrasound, and it was showing evidence of progressive ventricular dilatation till the stage that pediatric neurosurgeon was involved. At 7- 8 weeks of PMA everything disappeared totally. How frequent did you witnessed such a scenario? Regards

It would be nice to find out practices around the world regarding Head Cooling / Total Body Cooling for Birth Asphyxia. I have added a poll for this post. As for us, we do have the Olympus Head cooling apparatus but use it rarely. Maybe it is because we (the doctors and nurses ) are not comfortable with it. Seems to be related more to initial resistance while adopting a new technology rather than the equipment itself...which is remarkably simple to use.

Prophylactic treatment with indomethacin was shown to reduce the risk of severe IVH in the 1990s. (http://www.ncbi.nlm.nih.gov/pubmed/8134206) However, follow-up studies later showed that indomethacin prophylaxis did not improve mortality or neurodevelopmental outcomes. These findings are summarized in a Cochrane review from 2010. (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000174.pub2/abstract) The 99nicu Poll for June and July is about such NSAID prophylaxis and whether you have and/or still use it.

Hi Netters, I would like to explore the head cooling criteria. the criteria of the three largiest clinical trial of hypothermia are basically evidence of fetal acidemia, low apgar scores, the need for active resuscitation and clinical signs of encephalopathy +/- CFM monitoring. Although we are following these criteria but we may miss cases of moderate HIE. for example there is an evidence of perinatal sentinle event, cord pH 7.0 and BE -12, Apgar scores 6 & 8 @ 1 and 5 minutes. no active resuscitation required but at 10 hours of age the baby developed clinical seizure ( we missed the theraputic window for head cooling) and the work up R/O the common causes of seizurs.…

What is evidence based recommendation in treating large SDH/EDH/ICH in a new born ? Surgical or medical? comparision of results? thanks

Check this link : http://www.nemo-europe.com/

In a case with with stage 2 { moderate } Hypoxic ischemic encephalopathy (HIE) and seizures in 1 st day of life controlled by Phenobarbital , Phenytion and Midazolam. How and when should these drugs be withdrawed? ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Mohamad Ismail neonatology resident Mansoura Egypt

Read an interesting news article LINK Any comments? Some related reading Cilio MR, Ferriero DM. Synergistic neuroprotective therapies with hypothermia. Semin Fetal Neonatal Med. 2010 Mar 6. [Epub ahead of print] PubMed PMID: 20207600. LINK Cattano D, Williamson P, Fukui K, Avidan M, Evers AS, Olney JW, Young C. Potential of xenon to induce or to protect against neuroapoptosis in the developing mouse brain. Can J Anaesth. 2008 Jul;55(7):429-36. PubMed PMID: 18591700. LINK TO DOWNLOAD Ma D, Hossain M, Chow A, Arshad M, Battson RM, Sanders RD, Mehmet H, Edwards AD, Franks NP, Maze M. Xenon and hypothermia combine to provide neuroprotect…

Is anyone trying hypothermia, systemic or cranial, to minimize the effects of HIE? Candidates for this form of therapy must first be placed on aEEG to determine if any brain activity is present. Sustained cranial or systemic hypothermia needs to be initiated by 6 hours from birth to be effective.

Does anyone have experience in using Keppra/Levetiracetam in neonatal seizures ?