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Brain PD > week 5 part 2 > Flashcards

week 5 part 2 Flashcards

1
Q

What is Perinatal asphyxia (PA) characterised by?

A

Impairment of exchange of respiratory gases (oxygen and carbon dioxide)

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2
Q

What does PA result in?

A

Hypoxia

Hypercapnia

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3
Q

What is the incidence of PA?

A

1 to 6 per 1,000 live full-term births

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4
Q

What plays a role in the way in which the baby positions themselves to come out in the best way?

A
  1. Condition of the uterus

2. Condition of the mother

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5
Q

Define Hypoxia

A

Diminished amount of oxygen in the blood supply

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6
Q

Define cerebral ischemia

A

Diminished amount of blood perfusing the brain

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7
Q

What is HIE?

A

Encephalopathy due to hypoxia and cerebral ischaemia

Resulting in death or subsequent cerebral palsy

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8
Q

What are babies able to sustain?

A

withstand stress of labour

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9
Q

When can you only call those who have hypoxic ischaemic Encephalopathy?

A
  • Diminished amount of oxygen
  • Have evidence of being affected by lack of perfusion
  • The baby should have encephalopathy because it has both hypoxia and cerebral ischemia
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10
Q

What are the History/Etiology/Risk Factors of PA?

A
  1. Pre-conceptual
  2. Antepartum
  3. Intra partum
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11
Q

What is example of Pre-conceptual?

A
  1. IDDM
  2. Maternal medical illness
  3. Sepsis
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12
Q

What is Antepartum?

A
  1. Infection
  2. IUGR
  3. Pre-eclampsia
  4. APH
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13
Q

What is an example of Intra-partum?

A
  1. Breech
  2. Shoulder dystocia
  3. cord prolapse
  4. Cord around the neck
  5. Uterine rupture
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14
Q

what is the consequence of cord tighten around the neck?

A

Interrupts blood flow and therefore get acidosis with hypoxia or hypercapnia

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15
Q

What is HIE?

A

major cause of death and disability in a well grown term baby

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16
Q

Where is HIE seen?

A

around 2-3 per 1000 live births in developed countries

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17
Q

What does HIE account for?

A

6% neonatal deaths and a combined mortality/morbidity of around 23% developed countries

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18
Q

What is the criteria for HIE?

A
  1. Need for prolonged resuscitation beyond 10 minutes after birth
  2. Perinatal acidosis in a blood gas in the first hour with PH < 7.0

Base deficit > 16mmol/L

  1. High lactate
  2. APGAR score of < 5 at 10 mins
  3. Abnormal neurological examination or presence of seizures
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19
Q

What is the APGAR score?

A

Devised by DR Virginia Apgar in 1952 and comprises 5 components

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20
Q

What are the 5 components of APGAR score?

A
  1. Appearance
  2. Pulse rate
  3. Grimace or reflexes
  4. Activity or muscle tone
  5. Respiration
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21
Q

What will recover with normal neurological examination?

A

APGAR score of > 7 at 5 minutes

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22
Q

What do babies with very poor score of 0-3 at 5 minutes have?

A

High chance of death/disability

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23
Q

20% of those with an APGAR score of 0 at 10 minutes

A

still survive with no disability at 6-7 years

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24
Q

What are the 5 characteristic of APGAR score

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respiration
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25
Q

When is the score done?

A

At first minute, 5 minutes and 10 minutes of life during resuscitations

26
Q

Good score

A

the baby didn’t need any help and therefore had a normal delivery and normal pregnancy

27
Q

What happens when there is an insult?

A

there is a lack of blood supply, lack of oxygen, and therefore lack of ATP production provided by the mitochondria

28
Q

What is the cellular level changes in HIE?

A

Disruption in the ATP=dependent pathway

29
Q

What are the neurological examination?

A
  1. state of mind/consciousness
  2. Movement - Eyes, limbs
  3. Tone
  4. Posture
  5. Reflexes
  6. Presence or absence of abnormal movement or seizures
30
Q

What is Sarnat & Sarnat Grading of HIE?

A

is a classification scale for hypoxic-ischaemic encephalopathy of the newborn (HIE), a syndrome caused by a lack of adequate oxygenation around the time of birth which manifests as altered consciousness, altered muscle tone, and seizures

31
Q

Baby on the ventilator

A

it is having nitric oxide because of pulmonary hypertension

32
Q

What are the Multi-organ involvement in HIE?

A
  1. Heart
  2. lungs
  3. Renal
  4. Liver
  5. GI
  6. Hematologic
33
Q

Heat

A

Myocardial contractility

severe hypotension

passive cardiac dilatation

tricuspid regurgitation

34
Q

Lungs

A

Severe pulmonary hypertension requiring assisted ventilation

35
Q

Renal

A

Renal failure presenting as oliguria

36
Q

Liver

A

Elevated liver function tests and coagulopathy

37
Q

GI

A

poor peristalsis and delayed gastric emptying

rarely necrotising enterocoloitis

38
Q

Hematologic

A 
Increased nucleated RBC 
neutropenia
Neutrophilia 
Thrombocytopenia
Coagulopathy
39
Q

What are the other factors that baby can have?

A
  • Birth trauma, maternal drug toxins, infections/sepsis, meningitis and loads of other neurological and neuromuscular problems
40
Q

What are DD’s for HIE?

A
  1. Metabolic encephalopathy
  2. Neuromuscular disorders including neonatal myopathies
  3. Congenital brain disorders
  4. Infections
  5. Truma
  6. Toxins (Maternal drug use)
41
Q

What is the specific scan for brains?

A

Cranial ultrasound scan

42
Q

What is aEEG?

A

this is the bedside cerebral function monitor – it gives you a pattern recognition to know if it is a normal pattern or more relatively suppressed abnormal pattern and the last one is no activity in the brain

43
Q

What is currently the best available biomarker for HIE?

A

MRI

44
Q

When is MRI done?

A

around 7-10 days of age

45
Q

What are the pattern of injury score?

A
  1. posterior limb of the internal capsule (PLIC)
  2. Basal ganglia and thalamic (BGT) score
  3. White matter (WM) score
  4. Cortical involvement
46
Q

What are the supportive treatment?

A
  1. Manage ventilation
  2. Multi-organ support: Inotropes, fluid management, feeding, coagulopathy
  3. Avoidance of hypoglycaemia, hypocarbia
  4. Seizure management
47
Q

What is the only definitive treatment currently available for hypoxic ischemic encephalopathy?

A

Total body cooling

48
Q

When should you start the treatment?

A

treatment during re-perfusion window to try and avoid damage from subsequent on-going injury

49
Q

total forest plot favoured hypothermia

A

∆ CoolCap was done in Australia and NIHCD was done in America and Toby was done in Europe by putting them together

50
Q

What is one of the biggest landmarks in neonatal world

A

hypothermia therapy

51
Q

What is the Therapeutic Hypothermia?

A

Total body hypothermia for term infants

initiate as early as possible within 6 hours

33.5 to 34.5 degrees - active cooling, rectal temperature

Duration - 72 hours

Gradual rewarming period for 14 hours

only in level 3 neonatal intensive care units

can be initiated while transfer to NICU using mobile cooling equipment

52
Q

What are the novel adjunct therapies?

A
  1. Xenon/Argon
  2. Melatonin
  3. Erythropoietin
53
Q

What is Xenon/Argon?

A
  1. Toby-Xe - feasible and safe, but is unlikely to enhance the neuroprotective effect of cooling
  2. inhibitor of NMDA glutamate receptors
  3. Reduces apoptosis by activation of anti-apoptotic factors
54
Q

What is melatonin?

A
  1. anti-inflammatory, anti-apoptotic, and antioxidant processes through nuclear and cell membrane receptors
  2. Boosts glial and neuronal development
55
Q

What is Erythropoietin?

A
  1. Reduces apoptosis due to less NO/glutamate toxicity, anti-inflammatory, anti-oxidative role
  2. Modulates NO synthase and improves perfusion - Erythropoiesis, Neurogenesis and Angiogenesis
56
Q

What is poor prognosis?

A
  1. Lack of spontaneous respiration within 20-30 mins ago age
  2. Presence of seizures
  3. Abnormal clinical examination beyond 7-10 days
  4. Absence of suck by 7-10 days
  5. Poor head growth during post natal and first year of life
57
Q

What is the follow up care?

A
  1. Monitoring as out-patient for development, head growth - regularly until 2 years of age
  2. 18 months to 2 years - detailed developmental assessment to quantify long term disability
  3. Support from community services - Sppech and language, physiotherapist, occupational therapist and community paediatrician
  4. portage services - home visiting educational service for pre-school children with SEND and their families
58
Q

What are the various scales to develop a neurological outcomes at 2 years?

A
  1. Denver Scale
  2. Schedule of growing skills
  3. Griffiths mental developmental scales
  4. Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III)
59
Q

What are the 5 domains of Bayley III?

A
  1. Cognitive
  2. Receptive language
  3. Expressive language
  4. Fine motor
  5. Gross motor
60
Q

What does Bayley III separate?

A
  1. separates cognitive and language

2. widely used

61
Q

What is the availavle Biomarker for HIE - Injury/prognosis

A
  1. Clinical examination - Evolves with time - birth until 2 year corrected age for developmental check
  2. MRI imaging at 7-14 days

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