Early Retinal Findings Following Cooling in Neonatal Encephalopathy.

BACKGROUND AND AIM: Perinatal HI (hypoxia-ischemia)-related visual defects including blindness are known to be associated with ischemic lesions in intracerebral visual pathways and ischemic retinal damage (IRD). Intraocular hemorrhages (IOH) such as retinal hemorrhage (RH), which may result from perinatal HI, can cause IRD by various mechanisms. We aimed to evaluate the early retinal findings in neonates with moderate-to-severe neonatal encephalopathy (NE) who underwent TH and its relationship between coagulation status, amplitude-integrated electroencephalography (aEEG) patterns, and magnetic resonance imaging-magnetic resonance spectroscopy (MRI-MRS) findings. METHOD AND PATIENTS: A total of 31 newborn infants who underwent moderate-to-severe NE and TH included in the study. Coagulation parameters were taken immediately before starting TH, and daily during TH period. aEEG records were obtained during TH and rewarming period.Binocular indirect ophthalmoscopic examination (BIOE) and MRI-MRS scanning were performed when TH protocol completed. RESULTS: Total 13 (41.9%) patients had abnormal BIOE findings. Ten of them were (77%) IOH, other findings are as follows: RH (n = 7), optic disc hemorrhage (n = 2), and vitreous hemorrhage (n = 1). Initial coagulation status was not related to IOH. Worsened aEEG and MRI-MRS results were not related to BIOE findings. CONCLUSION: Frequency of IOH is high in newborns with NE who underwent TH being independent from severity of MRS-MRI findings, aEEG pattern, and disturbed coagulation status.

Therapeutic hypothermia for neonatal encephalopathy implications for neonatal units in India.

Therapeutic hypothermia has recently emerged from bench to bedside. Three large multicenter trials from industrialized countries and three independent meta-analyses have shown its efficacy in reducing death and disability following neonatal encephalopathy due a perinatal hypoxic event. Many neonatal units in well-resourced settings now offer hypothermia as standard care in neonatal encephalopathy. However, these results cannot be extrapolated to low resource settings due to differences in population, risk benefits and high cost. Use of therapeutic hypothermia in low resource settings should be considered experimental and should therefore be restricted to well equipped level 2 and 3 neonatal units. The safety and efficacy of hypothermia using novel low technology methods need to be examined in rigorously controlled multicenter randomized controlled trials in these neonatal units before it can be offered as a standard care, as the risks may outweigh the benefits. The current practice of maintaining normothermia should continue, until such evidence is available.

Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy.

This is a case report and a descriptive study demonstrating that artifacts are common during long-term recording of amplitude-integrated electroencephalograms and may lead to erroneous classification of the amplitude-integrated electroencephalogram trace. Artifacts occurred in 12% of 200 hours of recording time sampled from a representative sample of 20 infants with neonatal encephalopathy. Artifacts derived from electrical or movement interference occurred with similar frequency; both types of artifacts influenced the voltage and width of the amplitude-integrated electroencephalogram band. This is important knowledge especially if amplitude-integrated electroencephalogram is used as a selection tool for neuroprotection intervention studies.