Neuroprotection in the newborn:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2008
|
| Schriftenreihe: | Clinics in perinatology
35,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, S. [609]-831 Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Neuroprotection in the newborn |c guest ed. Alan R. Spitzer ... |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2008 | |
| 300 | |a XII, S. [609]-831 |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
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| adam_text | Contents
Preface xi
Alan R. Spitzer and Robert D. White
Physiology of Brain Injury
Cerebrovascular Injury in Premature Infants: Current Understanding and Challenges
for Future Prevention 609
Adre J. du Plessis
Cerebrovascular insults are a leading cause of brain injury in premature in¬
fants, contributing to the high prevalence of motor, cognitive, and behav¬
ioral deficits. Understanding the complex pathways linking circulatory
immaturity to brain injury in premature infants remains incomplete. These
mechanisms are significantly different from those causing injury in the
mature brain. The gaps in knowledge of normal and disturbed cerebral
vasoregulation need to be addressed. This article reviews current under¬
standing of cerebral perfusion, in the sick premature infant in particular,
and discusses challenges that lie ahead.
Cytokines and Perinatal Brain Damage 643
Olaf Dammann and T. Michael O Shea
Perinatal brain damage has been implicated in the pathogenesis of neuro-
developmental impairments and psychiatric illnesses. This article reviews
evidence that infection outside of the brain can damage the brain, and dis¬
cusses specific cytokines and pathomechanisms that probably mediate
the putative effect of remote infection on the developing brain. Events as¬
sociated with increased circulating inflammatory cytokines, chemokines,
and immune cells are described. Finally, studies of genetic variation in sus¬
ceptibility to cytokine-related brain damage are reviewed.
Detection of Brain Injury
The Use of Amplitude Integrated Electroencephalography for Assessing
Neonatal Neurologic Injury 665
Mona C. Toet, Linda G.M. van Rooij, and Linda S. de Vries
Amplitude-integrated electroencephalography (aEEG) plays an important
role in integrated care of the full-term infant with neonatal encephalopathy.
The three main features that are provided with aEEG are the background
pattern on admission and the rate of recovery seen during the first 24 to
48 hours after birth, the presence of most electrographic discharges,
and the effect of antiepileptic drugs.
Anatomic Changes and Imaging in Assessing Brain injury in the Term Infant 679
Russell K. Lawrence and Terrie E. Inder
Encephalopathy from hypoxic-ischemic injury is a major cause of morbidity
and mortality in term infants. MRI is the gold standard in evaluating the nature
and extent of injury. Although imaging this population is challenging, impor¬
tant information can be obtained safely. Patterns of injury and the likely mech¬
anisms that cause them are reviewed. Conventional images combined with
additional techniques provide clues to cause, timing, and long-term progno¬
sis. As altering acute neurologic damage with interventions in the acute period
becomes a reality, MRI will play a crucial role in delineating which infants have
the most to gain and act as a biomarker to gauge response.
Proteomics- and Metabolomics-Based Neonatal Diagnostics in Assessing
and Managing the Critically III Neonate 695
Alan R. Spitzer and Donald Chace
The use of proteomic-based neonatal screening has been relatively limited
until the present era and has focused primarily on the evaluation of newborns
for inborn errors of metabolism. The future of proteomic-based screening
seems to be much more encompassing, however. Tandem mass spectrom-
etry and other related technologies are highly likely to be used in the evalua¬
tion of acute disease processes. Proteomics has the advantage over
genomics of permitting a more direct look at an evolving disease process, be¬
cause genomics primarily relates only the potential for a disease or abnormal¬
ity to express itself. This article reviews the current uses of proteomics-based
newborn evaluation and evaluates how this rapidly evolving area of medicine
may be used to assess the fetus and the neonate in the near future.
Protection and Treatment of Brain Injury—Hypothermia
Hypothermia for Hypoxic-ischemic Encephalopathy 717
Rakesh Sahni and Ulana M. Sanocka
We are entering an era in which hypothermia will be used in combination
with other novel neuroprotective interventions. The targeting of multiple
sites in the cascade leading to brain injury may prove to be a more effective
treatment strategy after hypoxic-ischemic encephalopathy in newborn in¬
fants than hypothermia alone.
Brain Cooling for Preterm Infants 735
Alistair Jan Gunn and Laura Bennet
There is strong evidence that prolonged, moderate cerebral hypothermia
initiated within a few hours after severe hypoxia-ischemia and continued
until resolution of the acute phase of delayed cell death can reduce neuro-
nal loss and improve behavioral recovery in term infants and adults after
cardiac arrest. This review examines the evidence that mild to moderate
hypothermia is protective after hypoxia-ischemia in models of preterm
brain injury and evaluates the potential risks. Induced hypothermia likely
has potential to significantly reduce disability. Cautious, systematic trials
are essential before hypothermia can be used in these vulnerable infants.
Supportive Care During Neuroprotective Hypothermia in theTerm Newborn:
Adverse Effects and their Prevention 749
Marianne Thoresen
Hypothermia as neuroprotective treatment requires significant knowledge
of how temperature affects all organ systems and interventions used in in¬
tensive care. Education and training in resuscitation, including avoidance
of hyperthermia, early diagnosis of eligible infants, and initiation of early
cooling followed by safe transport of cooled infants to the cooling center
seems to be an optimal approach. This article suggests clinical manage¬
ment and shows examples of potential adverse effects of clinical hypo¬
thermia. The practical cooling recommendations suggested herein are
therefore likely to develop and change over time as more experience is
gained.
Technical Aspects of Starting a Neonatal Cooling Program 765
John D.E. Barks
Clinicians who are convinced by the available evidence that cooling is
a safe and effective treatment of hypoxic-ischemic encephalopathy in
the term or near-term infant are now faced with a series of decisions
around implementation of therapeutic hypothermia in their neonatal
ICU or region. There is currently uncertainty about the efficacy of cooling
or at least the magnitude of the effect, and precise estimates of the ben¬
efit of cooling must await the publication of the results of the several
pending trials. This article assumes that clinicians are sufficiently con¬
vinced by the available evidence of safety and efficacy to proceed to
the implementation step and offers guidelines for starting a neonatal
cooling program.
Pharmacologic Methods of Neuroprotection
The Diagnosis, Management, and Postnatal Prevention of Intraventricular
Hemorrhage in the Preterm Neonate 777
Heather J. McCrea and Laura R. Ment
Intraventricular hemorrhage (IVH) occurs in 20% to 25% of very low birth-
weight preterm neonates and may be associated with significant sequelae.
Infants who have IVH are at risk for posthemorrhagic hydrocephalus and
periventricular leukomalacia; as many as 75% of those who have parenchy-
mal involvement of hemorrhage suffer significant neurodevelopmental dis¬
ability. Because of the prevalence of IVH and the medical and societal
impact of this disease, many postnatal pharmacologic prevention strategies
have been explored. Randomized clinical prevention trials should provide
long-term neurodevelopmental follow-up to assess the impact of preterm
birth, injury, and pharmacologic intervention on the developing brain.
Inhaled Nitric Oxide and Neuroprotection in Preterm Infants 793
Jeremy D. Marks and Michael D. Schreiber
Although inhaled nitric oxide-mediated decreases in chronic lung disease
and severe intraventricular hemorrhage/periventricular leukomalacia un¬
doubtedly contribute to improved neurodevelopmental outcomes, inhaled
nitric oxide has an independent neuroprotective effect. Although these data
are encouraging, additional studies are required before recommending the
routine use of inhaled nitric oxide for neuroprotection in preterm infants.
Neuroprotection in Infant Heart Surgery 809
Robert Ryan Clancy
Neonatal hypoxic-ischemic encephalopathy, prematurity, sepsis-meningi¬
tis, and serious forms of complex congenital heart disease requiring infant
heart surgery are just a few examples of disorders that share high mortality
and morbidity rates. Newborn heart surgery represents a period of planned
and deliberate ischemia-reperfusion injury, which is obliged to occur to
cure or palliate complex forms of congenital heart disease. Advances in
cardiothoracic surgical and anesthetic techniques, including cardiopulmo-
nary bypass and deep hypothermic circulatory arrest, have substantially
decreased mortality, expanding the horizon to address functional neuro¬
logic and cardiac outcomes in long-term survivors. Interest in the func¬
tional status of survivors now stretches beyond the newborn period to
childhood, adolescence, and adulthood.
Index 823
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| spelling | Neuroprotection in the newborn guest ed. Alan R. Spitzer ... Philadelphia [u.a.] Saunders 2008 XII, S. [609]-831 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in perinatology 35,4 Neuroprotektivum (DE-588)4675103-8 gnd rswk-swf Neugeborenes (DE-588)4041781-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Neuroprotektivum (DE-588)4675103-8 s Neugeborenes (DE-588)4041781-5 s DE-604 Spitzer, Alan R. Sonstige oth Clinics in perinatology 35,4 (DE-604)BV000003382 35,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017077094&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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