Hypothermia for neonatal encephalopathy – a refinement – documents severe anoxic brain injury

Hypothermia for neonatal

Encephalopathy – a refinement

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Changes in incidence of cystic fibrosis

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There have now been two large trials demonstrating that 72h

Hypothermia may improve the neurodevelopment outcomes of

Ants with neonatal encephalopathy. Only infants with moderate

Ephalopathy after birth seem to benefit. Few infants with mild

Ephalopathy have long-term deficits and the severe cases appear

Have no benefit.


There are ongoing trials, which will better inform

About this therapy, but multiple questions will remain.Severe anoxic brain injury for ex-

Ple, there is no information in humans about the interval from

Th to initiation of cooling that can protect the brain, the optimal

Perature, or the optional duration of cooling. Trials of cooling for

Natal encephalopathy are very difficult. Most of these infants are

N outside level 3 units capable of providing hypothermia, and the

Ical assessments for the hypothermia, consent, and initiation of

Rapy within 6h of birth limits enrollment in trials. Careful in-

Th analysis of the limited available data can provide some infor-

Tion to guide clinical care. In this issue of the journal, gunn et al

Vide a secondary analysis of the cool cap trial, which demon-

Tes that the degree of encephalopathy is not altered by hypother-

severe anoxic brain injury

A on day 4. This information indicates that a therapeutic response

Not be evaluated by the clinical exam. As previously reported,

Ants with moderate encephalopathy are most likely to benefit.

€”alan H. Jobe, MD, phd

Page 55 (article)

He role of EKG in identification of

Ngenital cardiac defects

Some congenital cardiac defects may go unrecognized in the

Ical setting. This is particularly true of atrial septal defects. It is

Clear if more routine use of EKG as a screening tool in children

Uld be beneficial in detecting those abnormalities. In this issue of

E journal, chiu et al report on a school-based study using a

Plified 4 lead EKG in first and fourth grade elementary and

Ior high school students in taiwan.Severe anoxic brain injury after excluding those with

Wn heart disease, the prevalence of conduction defects was

5%. Among those students with conduction defects, 39 students

H previously undetected atrial septal defects were found. An

Itional 15 students were found to have potentially important

Diac rhythm disturbance. These results confirm that there are

Diagnosed cardiac abnormalities among school children. However,

Do not yet have sufficient evidence to support using EKG as a

Tine screening test in children. Further studies will be necessary to

Elop on evidence base to support this.

€”stephen R. Daniels, MD, phd

Page 85 (article)

Journal of pediatrics

Idence of cystic fibrosis in two regions of europe—brittany and

Rtheastern italy—over the time period 1990 to 2005.Severe anoxic brain injury the goal

S to study the impact of newborn screening for cystic fibrosis. The

Ual birth incidence in the two regions was similar; however,

Natal diagnosis has been more commonly utilized in brittany.

Ere was a higher rate of termination of pregnancy in brittany, so

Re has been approximately a 30% reduction in the birth incidence.

E impact of newborn screening and the effects of population

Xing are discussed. The general question of how much prenatal

Eening can prevent birth defects is discussed in an editorial by

Itz.

€”robert W. Wilmott, MD

Page 15 (article)

Page 20 (article)

Page 25 (article)

Page 3 (editorial)

January 2008 A3

Hypothermia for neonatal encephalopathy – a refinement