While waiting: early recognition and initial management of neonatal hypoxic-ischemic encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) occurring during the perinatal period is one of the primary causes of severe, long-term neurological deficits in children. Initial systemic supportive therapy remains a critical aspect of HIE management. In addition to support therapy, the widespread use of hypothermia has demonstrated a reduction in death and neurodevelopmental disability in infants with moderate to severe HIE. Neonates with HIE born outside of tertiary care centers must be rapidly identified as hypothermia candidates and have emergent transport arranged. While waiting for the transport team to arrive, these neonates often require intensive stabilization, including meticulous temperature management. This article examines the need for HIE outreach teaching programs, assists in the identification of a neonate for hypothermia therapy, and supplies evidence-based recommendations for the initial stabilization and care of neonates delivered at nontertiary care facilities. The guidelines and materials supplied represent the outreach model used by our regional hypothermia center and disseminated to the surrounding referral hospitals.

Neonatal gastric lactobezoar: management with N-acetylcysteine.

Gastric lactobezoars (GLBs) are the most common form of bezoars in neonates and consist of aggregations of undigested milk constituents. GLB can present with a variety of intra-abdominal clinical symptoms, and occasionally, extra-abdominal symptoms. Conservative management, with a period of bowel rest and intravenous fluids, is the most common treatment regimen for uncomplicated GLB. Surgical measures are reserved for the rare complications of obstruction and/or perforation. Although limited, utilization of the protein-cleaving enzyme N-acetylcysteine has been described for the disintegration of GLB in toddlers. In this paper, we discuss the first documented use of N-acetylcysteine for a neonatal GLB. Supporting literature, the infant's unusual presentation, and details of the treatment regimen are discussed.

Photoacoustic tomography can detect cerebral hemodynamic alterations in a neonatal rodent model of hypoxia-ischemia.

Hypoxic-Ischemic Encephalopathy (HIE) is one of the most recognized causes of neurological deficits in children. Cerebral blood flow (CBF) reductions, as seen with HIE, resulting in neuronal injury have not been evaluated in real-time. Photoacoustic Tomography (PAT) is a form of optical imaging which can detect cerebral hemodynamic alterations in a noninvasive, non-ionizing fashion via changes in hemoglobin optical absorption. Further, this technology has the potential to capture cerebral blood volume (CBV) fluctuations and perhaps CBF changes in real-time. We hypothesized that PAT can detect a reduction in cerebral hemoglobin optical absorption, and therefore CBF, in a neonatal model of hypoxia-ischemia. To investigate, P7 rats underwent right carotid artery ligation and exposure to 8 percent oxygen for 60 minutes while imaged with PAT every 20 minutes. Cerebral hemodynamic alterations, as measured by mean optical absorption (MOA), were calculated as a change from baseline. Global and regional MOA was analyzed using a linear mixed model. Global MOA was reduced within the right hemisphere as compared to the left during hypoxia. Regional differences in MOA were detected between the left and right sides for the middle and posterior cortical regions. Injury was confirmed using immunohistochemistry. We conclude that a reduction in global and regional MOA, and hence CBF, could be identified by PAT in a neonatal rat model of HIE. This is the first study described in the literature utilizing a neonatal rat model of HIE to demonstrate in vivo alterations in cerebral hemodynamics in a non-invasive and near real-time fashion.