Preclinical neurorehabilitation with environmental enrichment confers cognitive and histological benefits in a model of pediatric asphyxial cardiac arrest.

Pediatric asphyxial cardiac arrest (ACA) often leaves children with physical, cognitive, and emotional disabilities that affect overall quality of life, yet rehabilitation is neither routinely nor systematically provided. Environmental enrichment (EE) is considered a preclinical model of neurorehabilitation and thus we sought to investigate its efficacy in our established model of pediatric ACA. Male Sprague-Dawley rat pups (post-natal day 16-18) were randomly assigned to ACA (9.5 min) or Sham injury. After resuscitation, the rats were assigned to 21 days of EE or standard (STD) housing during which time motor, cognitive, and anxiety-like (i.e., affective) outcomes were assessed. Hippocampal CA1 cells were quantified on post-operative day-22. Both ACA + STD and ACA + EE performed worse on beam-balance vs. Sham controls (p < 0.05) and did not differ from one another overall (p > 0.05); however, a single day analysis on the last day of testing revealed that the ACA + EE group performed better than the ACA + STD group (p < 0.05) and did not differ from the Sham controls (p > 0.05). Both Sham groups performed better than ACA + STD (p < 0.05) but did not differ from ACA + EE (p > 0.05) in the open field test. Spatial learning and declarative memory were improved and CA1 neuronal loss was attenuated in the ACA + EE vs. ACA + STD group (p < 0.05). Collectively, the data suggest that providing rehabilitation after pediatric ACA can reduce histopathology and improve motor and cognitive ability.

La ausencia de evidencia no constituye evidencia de la ausencia / Absence of evidence is not evidence of absence

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Aire frente a oxígeno al 100 % en reanimación neonatal. En la práctica un dilema con varias opciones / Room air versus 100 % oxygen in neonatal resuscitation. In practice, a dilemma with various options

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Dados epidemiológicos sobre anóxia neonatal em um hospital público de Dourados, MS, Brasil / Epidemiological data about neonatal anoxia from a public hospital in Dourados, MS, Brazil

A anóxia neopnatal é considerada a agressão desencadeada pela deficiência de oxigênio ao feto ou recém-nascido. Pode ser causada por diferentes fatores pré ou peri parto (maternos, placentários, fetais, ou do trabalho de parto) que reduzem o intercâmbio de oxigênio materno à criança. Tal situação pode resultar em hipercapnia e acidose, quando o recém-nascido inicia mecanismos adaptativos com desvio sanguíneo a órgãos nobres, a fim de evitar o desenvolvimento de lesões. A abordagem precoce é de extrema importância, porque as seqüelas podem ser variadas, dependendo da extensão do acometimento, da tolerância do recém-nascido à de hipóxia, do desenvolvimento maturacional. A presente pesquisa objetivou o levantamento de dados epidmiológicos em prontuários, entre janeiro e junho 2003, de um Hospital Público de Dourados – MS, destacando a ocorrência e causa da anóxia, e evolução entre neonatos neste período. Entre 54 casos, 3,92 apresentou algum grau de anóxia. Destes 18,52 apresentam complicações após o nascimento; 62,96 nasceram de parto vaginas e 37,04 de parto cesariana; 22,22 apresentaram relato de trabalho de parto prolongado; 44,44 apresentaram patologias maternas prévias; 14,81 foram internardos em UTI neonatal com 50 necessitando de uso de ventilação mecânica. Deste total, 3,70 evoluíram para óbito e 96, 30 tiveram melhora do quadro. O comprometimento do desenvolvimento neuronatal pode resultar em déficits cognitivos e motores importantes, a longo prazo, comprometendo a sicialização do indivíduo na sociedade. A abordagem fisioterápica, diante do recém-nascido anoxiado, estimula o desenvolvimento neuropsicomotor e obtém resultados favoráveis e significativos, pelo alto desenvolvimento maturacional e pela plasticidade neural.

Suporte de vida neonatal / Neonatal life suport

Em neonatologia, ressuscitaçäo identifica duas situaçöes: a primeira relaciona-se à assistência ao recém-nascido em sua transiçäo de vida fetal para a vida extra-uterina; a segunda, a situaçöes de emergência, em que ocorre parada respiratória ou cardíaca durante a permanência do recém-nascido na unidade neonatal. O recém-nascido humano é particularmente vulnerável; à asfixia. Esse processo, embora progressivo, é reversível desde que suas causas sejam removidas em tempo hábil. O feto de termo normal, acha-se provido de uma gama de mecanismos adaptativos que lhe permitem sobreviver à privaçäo de oxigênio devido a deficientes trocas placentárias. As lesöes ocorrem quando a intensidade da asfixia é tal que ultrapassa a capacidade de o organismo manter o metabolismo celular. Certas condiçöes que ocorrem durante a gestaçäo, o trabalho de parto e o parto apresentam risco aumentado de asfixia para o feto e para o recém-nascido. Identificados antes do nascimento, permitiräo que o recém-nascido seja adequadamente atendido. A ressuscitaçäo após tais preparaçöes necessárias deve ser feita em meio ambiente adequado, respeitando-se o aquecimento e a posiçäo do recém-nascido. Após aspiraçäo e estimulaçäo útil, a avaliaçäo precisa levar em conta: esforços respiratórios, frequência cardíaca, cor e boletim de Apgar. Após limpeza das vias aéreas superiores e estimulaçäo efetiva, devem ser realizadas ventilaçäo e massagem cardíaca em situaçöes de bradicardia e eventual parada cardiorrespiratória. Sequencialmente, deve-se proceder à infusäo de medimentos e líquidos, em caso de colapso circulatório ou falta de resposta à oxigenaçäo e massagem cardíacas sem efeitos satisfatórios.

Swallowing difficulties and early CNS injuries: correlation with the presence of axial skeletal deformities.

We reviewed the neurological findings in 36 adults with history of perinatal brain injury that required gastrostomy due to progressive swallowing difficulties in a population of 624 institutionalized patients. A stereotypic pattern of progression of deficits was observed. Risk factors that correlated with increased risk of swallowing disorders included: presence of multiple handicaps; progressive deformities of the spine and extremities; decreased range of motion of mandible, laterognathism and other mandibular asymmetries. These findings suggest that spinal deformities and swallowing difficulties are part of a spectrum of impaired function of paired axial muscles in this population. The identification of these risk factors may help in the long-term care plan of severely impaired patients whose survival is extended by the use of feeding tubes.

Influence of medical history on assessment of at-risk infants.

The influence of knowledge of their medical history on the assessment of at-risk infants was examined. Two at-risk infants, one with a high-risk medical history and one with a low-risk history, were assessed and videotaped using the Movement Assessment of Infants. 41 physical therapists were randomly assigned to assess the videotaped examinations in four groups with different knowledge of the infants' histories (high-risk infant with actual or low-risk history; low-risk infant with actual or high-risk history). The clinical significance of the difference in total risk scores between knowledge conditions of a high-risk history and a low-risk history was greater for the low-risk infant. The higher mean total risk score for the low-risk infant assessed with a high-risk history suggests that false positive results could occur which may alter parents' perceptions and interactions with the infants and consequently influence their development.

Clinical profile of severe birth asphyxia.

In this retrospective analysis, 56 babies with Apgar score 3 and less were studied. In 33, successful bag-mask ventilation was carried out. Seventeen babies received endotracheal IPPV. In 9 out of them bag-mask ventilation was never tried whereas in 8 bag-mask ventilation had failed. In 6 babies physical stimulation and blast of oxygen on the face was adequate. Following this experience, in the subsequent years, endotracheal intubation was required mainly in extremely low birth weight babies or babies with Apgar score 0 at birth. During the study period, drugs were used in about 50% babies. In subsequent years this figure has come down to 10%, that too in special situations. This study helped us to evolve a policy in resuscitations severely asphyxiated babies. Bag-mask ventilation is the first choice. Failure to achieve progressively improving Apgar score by 1 minute, usually 4-5, is an indication for endotracheal intubation. Drugs are required in special situations only.