bims-hylehe 2018-09-02 papers

Issue of 2018–09–02
seven papers selected by
Richard James, University of Pennsylvania

J Pediatr. 2018 Aug 22. pii: S0022-3476(18)30873-4. [Epub ahead of print]

Amplitude-Integrated Electroencephalography for Early Recognition of Brain Injury in Neonates with Critical Congenital Heart Disease.

Nathalie H P Claessens, Lotte Noorlag, Lauren C Weeke, Mona C Toet, Johannes M P J Breur, Selma O Algra, Antonius N J Schouten, Felix Haas, Floris Groenendaal, Manon J N L Benders, Nicolaas J G Jansen, Linda S de Vries.

OBJECTIVE: To study perioperative amplitude-integrated electroencephalography (aEEG) as an early marker for new brain injury in neonates requiring cardiac surgery for critical congenital heart disease (CHD).
STUDY DESIGN: This retrospective observational cohort study investigated 76 neonates with critical CHD who underwent neonatal surgery. Perioperative aEEG recordings were evaluated for background pattern (BGP), sleep-wake cycling (SWC), and ictal discharges. Spontaneous activity transient (SAT) rate, inter-SAT interval (ISI), and percentage of time with an amplitude <5 µV were calculated. Routinely obtained preoperative and postoperative magnetic resonance imaging of the brain were reviewed for brain injury (moderate-severe white matter injury, stroke, intraparenchymal hemorrhage, or cerebral sinovenous thrombosis).
RESULTS: Preoperatively, none of the neonates showed an abnormal BGP (burst suppression or worse) or ictal discharges. Postoperatively, abnormal BGP was seen in 18 neonates (24%; 95% CI, 14%-33%) and ictal discharges was seen in 13 neonates (17%; 95% CI, 8%-26%). Abnormal BGP and ictal discharges were more frequent in neonates with new postoperative brain injury (P = .08 and .01, respectively). Abnormal brain activity (ie, abnormal BGP or ictal discharges) was the single risk factor associated with new postoperative brain injury in multivariable logistic regression analysis (OR, 4.0; 95% CI, 1.3-12.3; P = .02). Postoperative SAT rate, ISI, or time <5 µV were not associated with new brain injury.
CONCLUSION: Abnormal brain activity is an early, bedside marker of new brain injury in neonates undergoing cardiac surgery. Not only ictal discharges, but also abnormal BGP, should be considered a clear sign of underlying brain pathology.

Keywords: MRI; brain abnormalities; brain activity; brain function; cardiac surgery; heart defect; newborns

DOI: https://doi.org/10.1016/j.jpeds.2018.06.048

Clin Perinatol. 2018 Sep;pii: S0095-5108(18)31373-3. [Epub ahead of print]45(3): 453-466

Necrotizing Enterocolitis and Neurodevelopmental Outcome.

Ira Adams-Chapman.

Necrotizing enterocolitis is a serious complication of prematurity that is associated with an increased risk for adverse neurodevelopmental outcome secondary to a complex relationship between various morbidities that increase the risk for central nervous system injury. Affected infants are exposed to a variety of circulating cytokines known to be associated with white matter injury. These infants also have an increased risk of secondary blood stream infections and nutritional compromise.

Keywords: Follow-up; Necrotizing enterocolitis; Neurodevelopment; Sepsis

DOI: https://doi.org/10.1016/j.clp.2018.05.014

Semin Fetal Neonatal Med. 2018 Aug 17. pii: S1744-165X(18)30096-9. [Epub ahead of print]

The cost of necrotizing enterocolitis in premature infants.

Meredith E Mowitz, Dmitry Dukhovny, John A F Zupancic.

Necrotizing enterocolitis (NEC), a common morbidity of prematurity, affects 5-10% of premature infants with a birthweight <1500 g. The added cost remains unclear. Multiple studies report the cost of care for an infant with NEC as higher than that of well premature infants, but these studies are fraught with limitations. Surgical intervention and type of surgery appear to impact overall costs. Health care resource utilization extends beyond the birth hospitalization, particularly in those infants requiring surgery, and persists to at least three years of age. This narrative review of the literature reveals a paucity of studies and significant methodological deficiencies in most included studies. Further studies of the cost of NEC need to address the issues of significant confounding in this complex population.

Keywords: Costs; Necrotizing enterocolitis; Premature infant

DOI: https://doi.org/10.1016/j.siny.2018.08.004

Semin Fetal Neonatal Med. 2018 Aug 17. pii: S1744-165X(18)30097-0. [Epub ahead of print]

Neurodevelopmental outcomes following necrotizing enterocolitis.

Marie Hickey, Michael Georgieff, Sara Ramel.

Necrotizing enterocolitis (NEC), a gastrointestinal emergency predominantly affecting premature infants, is associated with increased risk for poor neurodevelopmental outcomes. NEC often strikes during a period of rapid and dynamic neurologic development when the brain is particularly vulnerable to insults and nutrient deficits. The pathogenesis of neurodevelopmental impairment following NEC is likely multifactorial, with both nutritional and non-nutritional factors at play. Follow-up testing that ensures early detection and intervention for impairments is crucial to optimize neurodevelopmental outcomes following NEC. A multifaceted approach to follow-up after NEC is necessary, with close monitoring of growth, serial developmental assessments, neurologic examinations, hearing and vision testing and neuroimaging. Further research is needed to understand the pathogenesis of neurodevelopmental impairment following NEC, to identify more targeted follow-up tests, and to discover interventions aimed at optimizing neurodevelopmental outcomes following NEC.

Keywords: Gastrointestinal microbiota; Inflammation; Necrotizing enterocolitis; Neurodevelopment; Nutrition; Outcomes; Prematurity

DOI: https://doi.org/10.1016/j.siny.2018.08.005

Clin Perinatol. 2018 Sep;pii: S0095-5108(18)31374-5. [Epub ahead of print]45(3): xvii-xviii

Neurodevelopmental Outcomes of the Preterm Infant.

Ira Adams-Chapman, Sara B DeMauro.

DOI: https://doi.org/10.1016/j.clp.2018.06.001

Clin Perinatol. 2018 Sep;pii: S0095-5108(18)31360-5. [Epub ahead of print]45(3): 377-392

Neurodevelopmental Outcomes in Early Childhood.

Andrea F Duncan, Melissa A Matthews.

Technological advances in neonatal-perinatal medicine have led to a steady increase in the survival of preterm infants. Although the increase in survival is a remarkable success, children born preterm remain at high risk for brain injury and long-term neurodevelopmental deficits. Children born preterm may have abnormal muscle tone or movements, cognitive deficits, language impairments, and behavioral problems. This article reviews neurodevelopmental outcomes and factors that influence outcomes in preterm children during early childhood.

Keywords: Developmental outcomes; Early childhood; Neurodevelopment; Preterm

DOI: https://doi.org/10.1016/j.clp.2018.05.001