| 1. |
- Feet, B A, et al.
(author)
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Cerebral excitatory amino acids and Na+,K+-ATPase activity during resuscitation of severely hypoxic newborn piglets
- 1998
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In: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 87:8, s. 889-895
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Journal article (peer-reviewed)abstract
- We tested the hypothesis that early brain recovery in hypoxic newborn piglets is improved by resuscitating with an O2 supply close to the minimum level required by the newborn piglet brain. Severely hypoxic 2-5-d-old anaesthetized piglets were randomly divided into three resuscitation groups: hypoxaemic (n = 8), 21% O2 (n = 8), and 100% O2 groups (n = 8). The hypoxaemic group was mechanically ventilated with 12-18% O2 adjusted to achieve a cerebral venous O2 saturation of 17-23% (baseline; 45 +/- 1%, mean +/- SEM). During the 2h resuscitation period, extracellular aspartate and glutamate concentrations in the cerebral striatum were higher during hypoxaemic resuscitation (p = 0.044 and p = 0.055, respectively) than during resuscitation with 21% O2 or 100% O2, suggesting an unfavourable accumulation of potent excitotoxins during hypoxaemic resuscitation. The cell membrane Na+,K+-ATPase activity of cerebral cortical tissue after 2 h resuscitation was similar in the three groups (p = 0.30). In conclusion, hypoxaemic resuscitation did not normalize early cerebral metabolic recovery as efficiently as resuscitation with 21% O2 or 100% O2. Resuscitation with 21% O2 was as efficient as resuscitation with 100% O2 in this newborn piglet hypoxia model.
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| 2. |
- Feet, B A, et al.
(author)
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Early cerebral metabolic and electrophysiological recovery during controlled hypoxemic resuscitation in piglets
- 1998
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In: Journal of Applied Physiology. - 1522-1601. ; 84:4, s. 1208-1216
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Journal article (peer-reviewed)abstract
- We tested the hypothesis that controlled hypoxemic resuscitation improves early cerebral metabolic and electrophysiological recovery in hypoxic newborn piglets. Severely hypoxic anesthetized piglets were randomly divided into three resuscitation groups: hypoxemic, 21% O2, and 100% O2 groups (8 in each group). The hypoxemic group was mechanically ventilated with 12-18% O2 adjusted to achieve a cerebral venous O2 saturation of 17-23% (baseline; 45 +/- 1%). Base excess (BE) reached -22 +/- 1 mM at the end of hypoxia. During a 2-h resuscitation period, no significant differences in time to recovery of electroencephalography (EEG), quality of EEG at recovery, or extracellular hypoxanthine concentrations in the cerebral cortex and striatum were found among the groups. BE and plasma hypoxanthine, however, normalized significantly more slowly during controlled hypoxemic resuscitation than during resuscitation with 21 or 100% O2. We conclude that early brain recovery during controlled hypoxemic resuscitation was as efficient as, but not superior to, recovery during resuscitation with 21 or 100% O2. The systemic metabolic recovery from hypoxia, however, was delayed during controlled hypoxemic resuscitation.
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| 3. |
- Hellström-Westas, Lena, et al.
(author)
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Low risk of seizure recurrence after early withdrawal of antiepileptic treatment in the neonatal period
- 1995
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In: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 72:2, s. 97-101
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Journal article (peer-reviewed)abstract
- The risk of seizure recurrence within the first year of life was evaluated in infants with neonatal seizures diagnosed with a combination of clinical signs, amplitude-integrated electroencephalogram (EEG) monitoring, and standard EEG. Fifty eight of 283 (4.5%) neonates in tertiary level neonatal intensive care had seizures. The mortality in the infants with neonatal seizures was 36.2%. In 31 surviving infants antiepileptic treatment was discontinued after one to 65 days (median 4.5 days). Three infants received no antiepileptic treatment, two continued with prophylactic antiepileptic treatment. Seizure recurrence was present in only three cases (8.3%)--one infant receiving prophylaxis, one treated for 65 days, and in one infant treated for six days. Owing to the small number of infants with seizure recurrence, no clinical features could be specifically related to an increased risk of subsequent seizures. When administering antiepileptic treatment, one aim was to abolish both clinical and electrographical seizures. Another goal was to minimise the duration of treatment and to keep the treatment as short as possible. It is suggested that treating neonatal seizures in this way may not only reduce the risk of subsequent seizure recurrence, but may also minimise unnecessary non-specific prophylactic treatment for epilepsy.
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| 4. |
- Hellström-Westas, Lena, et al.
(author)
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Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants
- 1995
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In: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 72:1, s. 34-38
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Journal article (peer-reviewed)abstract
- The background pattern in single channel amplitude integrated EEG recordings (aEEG) was recorded in 47 infants within the first six hours after birth to see if this could predict outcome after birth asphyxia. The aEEG background pattern during the first six hours of life was continuous and of normal voltage in 26 infants. All these infants survived; 25 were healthy, one had delayed psychomotor development. A continuous but extremely low voltage pattern was present in two infants, both of whom survived with severe handicap. Five infants had flat (mainly isoelectric) tracings during the first six hours of life; four died in the neonatal period, and one survived with severe neurological handicap. Burst-suppression pattern was identified in 14 infants, of whom five died, six survived with severe handicap, and three were healthy at follow up. The type of background pattern recorded within the first six postnatal hours in the aEEG tracings predicted outcome correctly in 43 of 47 (91.5%) infants. Use of aEEG monitoring can predict outcome, with a high degree of accuracy, after birth asphyxia, within the first six hours after birth. The predictive value of a suppression-burst pattern was, however, somewhat lower than the other background patterns. The aEEG seems to be a feasible technique for identifying infants at high risk of subsequent brain damage who might benefit from interventionist treatment after asphyxia.
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| 5. |
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| 6. |
- Svenningsen, N W, et al.
(author)
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OSCILLO-oscillating air mattress in neonatal care of very preterm babies
- 1995
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In: Technology and Health Care. - 0928-7329. ; 3:1, s. 43-46
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Journal article (peer-reviewed)abstract
- In this pilot study a new device for respiratory stimulation with undulating oscillations and high frequency vibrations via an air mattress was tested as an additional therapy in 12 preterm infants with recurrent apnoeic episodes. The mean birthweight of the study population was 1760 g and gestational age 31.1 weeks. it was shown that an oscillating air mattress is an effective additional mode of treatment for apnoeic episodes in preterm infants. There was a clear reduction in rate of apnoeas in all 12 infants being transitory in 2 and more persistent in 10 infants. Besides restlessness in a few cases no side effects were observed. Whether this mode of treatment could lessen the need for drug medication with xanthines will require a larger randomized investigation.
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| 7. |
- Toet, M C, et al.
(author)
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Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy
- 1999
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In: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 81:1, s. 19-23
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Journal article (peer-reviewed)abstract
- AIM: To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. METHODS: Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. RESULTS: Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. CONCLUSION: aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.
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