அவசர மருத்துவம்: திறந்த அணுகல்
திறந்த அணுகல்

சுருக்கம்

Predictors of neurodevelopmental outcome in newborn treated with hypothermia therapy

Minkyo Chun

Predictors of neurodevelopmental outcome in newborn treated with hypothermia therapy

Minkyo Chun

The Catholic University of Korea, South Korea

Abstract

Hypothermia therapy significantly reduces the mortality rate of neonates with moderate or severe hypoxic ischemic encephalopathy due to perinatal hypoxia and the incidence of severe disorders at 18 months of age in large-scale, multicenter, randomized controlled trials. It is the only proven effective neuroprotective therapy. This treatment has been used internationally since it was proposed as a standard treatment for neonates with hypoxia ischemic encephalopathy in 2010 and has been introduced in Korea since 2012. However, despite the development and implementation of hypothermic therapy, the morbidity rate of neonates with moderate to low-oxygen ischemic encephalopathy at birth is still high and remains the most important cause of neuro-developmental disorders and death in infants and young children. With the proliferation of hypothermic therapy, the need for an objective prognostic factor that can confirm the therapeutic effect and predict long-term neurological prognosis for patients who have undergone hypothermic treatment with hypoxic ischemia immediately after birth is emerging.  Currently, studies are being conducted to confirm the prognostic factors such as blood tests and amplitude-integrated electroencephalography (aEEG). The discovery of factors that can predict the extent of nerve damage or neurodevelopmental disorders during the initial course of treatment will help to effectively implement access to treatment plans and adjuvant treatment schedules for specific treatment groups.

The present study was conducted on neonatal patients who had undergone hypothermia treatment, including clinical characteristics related to delivery and birth, clinical symptoms during treatment, blood and biochemical results before and after treatment, and brain magnetic resonance imaging (MRI). We tried to find out if any of the results were related to the prognosis of neurodevelopment.

Target and method: This study was approved by the Institutional Bioethics Committee of the Yeouido St. Mary's Hospital of the Catholic University of Korea. Between August 2013 and May 2016, of 29 newborns who were hospitalized for hypoxic ischemic encephalopathy in the neonatal intensive care center at Yeouido St. Mary's Hospital, Catholic University of Korea, 3 of whom died before neurodevelopmental testing and 2 who were not followed up The medical records were retrospectively analyzed in 24 patients who were able to follow the neurological examination at 18 to 24 months of age.

The subjects are whole body hypothermia protocol of the National Institute of Child Health and Human Development (NICHD) [4According to], among children with gestational age of 36 weeks or more and birth weight of 1,800 g or more, metabolic acidosis, low afghan score, and neurological examination of moderate to severe hypoxia ischemic encephalopathy, use a low-temperature whole body mat within 6 hours of life Hypothermia treatment was performed to lower the central body temperature of the newborn to 33.5 ° C and maintain it for 72 hours. The gestational period, birth weight, sex, neonatal hypoxia ischemic encephalopathy, delivery method, mother's age, major risk events that can cause fetal brain damage during delivery, presence of amniotic fluid, and postnatal hypothermia Time, surfactant administration, lowest blood pressure during hypothermia, lowest pulse rate, booster administration, steroid administration, pneumothorax, pulmonary hemorrhage, persistent pulmonary hypertension, convulsions, electroencephalography (EGG) results, and other major factors related to perinatal or delivery Factors were analyzed. The hematological test was conducted to compare and analyze the results of hematology, blood gas, blood chemistry, and bleeding factors before and after treatment. All subject children were taken with brain MRI on the 7th and 14th days of birth, with both conventional and diffuse emphasis images. The captured images were read by a pediatric radiology specialist.

The evaluation of cranial nerve development was performed by Korean Developmental Screening Test for infants and children (K-DST), Bayley Scales of Infant Development (BSID-II) Or, among neurological tests by pediatric rehabilitation medicine specialists, criteria were determined and evaluated according to the tests performed on each target child. K-DST conducted the appropriate K-DST every 4 months after birth, and follow-up was performed by all pediatric rehabilitation specialists. K-DST receives the parents' answers to the five developmental areas of infants and toddlers (communication, large muscle exercise, small muscle exercise, problem solving, and personal-sociality). It was compared with the star cut score. If a score lower than the cutoff score was obtained in one or more developmental areas, it was judged as 'suspect development delay' and then referred to the Rehabilitation Medicine Department. BSID-II was diagnosed as having significant developmental delay if the mental developmental index was less than 70 or the psychomotor developmental index was less than 70 when the corrected age was 18–24 months. A neurological examination performed by a pediatric neurologist and a rehabilitation clinician who diagnoses cerebral palsy if one of the limbs has non-progressive spastic or dystonic muscle contractions, or postural maintenance disorders and movement disorders Did. All subjects were subjected to brain evoked response audiometry before discharge and, if abnormal, additionally 2-3 times until 6 months of age, and then diagnosed with sensorineural hearing loss when persistent abnormality occurred. Visual development was defined as having severe visual impairment with vision better than 20/200 with better vision correction. Delayed development, cerebral palsy, sensorineural hearing loss, and visual impairment were defined as having poor neurodevelopmental outcome.

In this study, clinical features related to delivery and birth, clinical symptoms and test results during treatment, blood before and after treatment, to investigate factors that can predict the prognosis of neural development after systemic hypothermia treatment in hypoxic ischemic encephalopathy neonates And biochemical results were analyzed and it was confirmed that brain MRI was the most sensitive and specific test as a factor related to the prognosis of neurodevelopment. However, there is a limitation that MRI results are viewed and predicted after treatment rather than before or during treatment. In the future, large-scale prospective randomized comparative studies are needed to find early neurological predictors of hypoxic ischemic encephalopathy.

Note: This work is partly presented at 26th International Conference on Neonatology and Perinatology on November 15-17, 2018 held at Edinburgh, Scotland