Effects of mild hypothermia combined EPO therapy on cerebral injury, myocardial injury and oxidative stress of neonatal hypoxic ischemic encephalopathy

Objective:To explore the effects of mild hypothermia combined EPO therapy on cerebral injury, myocardial injury and oxidative stress of neonatal hypoxic ischemic encephalopathy. Methods: A total of 72 children with HIE who were diagnosed and treated in the hospital between December 2015 and June 2017 were chosen as the study subjects and divided into control group (n=36) and EPO group (n=36) by random number table method. Control group received mild hypothermia therapy on the basis of conventional therapy, and EPO group received EPO therapy on the basis of the therapy for control group. The differences in serum levels of cerebral injury indexes, myocardial injury indexes and oxidative stress indexes were compared between the two groups before and after treatment.Results: The differences in serum levels of cerebral injury indexes, myocardial injury indexes and oxidative stress indexes were not statistically significant between the two groups before treatment. After the treatment ended, serum cerebral injury indexes VILIP-1, NPY and NSE levels of EPO group were lower than those of control group whereas IGF-1 level was higher than that of control group;myocardial injury indexes CT-1, Myo and cTnⅠ levels were lower than those of control group;oxidative stress indexes GSH-Px and SOD levels were higher than those of control group whereas AOPP and ROS levels were lower than those of control group.Conclusion: Mild hypothermia combined with EPO therapy can improve the cerebral injury, myocardial injury and oxidative stress of neonatal hypoxic ischemic encephalopathy.

The evaluation value of the quantitative electroencephalogram for the prognosis of neonatal hypoxic ischemic encephalopathy and its relationship with serological indicators

Objective:To study the evaluation value of the quantitative electroencephalogram (qEEG) for the prognosis of neonatal hypoxic ischemic encephalopathy (HIE) and its relationship with serological indicators.Methods: 76 children with HIE who were born and treated in our hospital between April 2013 and February 2017 were collected as observation group, and 50 healthy newborns who were born in our hospital during the same period were collected as normal control group. qEEG parameter values of two groups of children were determined, serum levels of nerve injury indexes, nerve apoptosis indexes and oxidative stress indexes were compared between the two groups, and Pearson test was used to evaluate the inner link between qEEG parameter values and disease severity in children with HIE.Results: qEEG Fp1, Fp2, C3, C4, T3, T4, O1 and O2 loci power spectrum values of observation group were significantly lower than those of normal control group. Serum NSE, NPY, S-100B and MBP contents in observation group were higher than those in normal control group;nerve apoptosis indexes sFas, sFasL and Caspase-3 contents were higher than those in normal control group while Bcl-2 content was lower than that in normal control group;serum oxidative stress indexes AOPP and MDA contents were higher than those in normal control group while SOD content was lower than that in normal control group. Pearson test showed that qEEG Fp1, Fp2, C3, C4, T3, T4, O1 and O2 loci power spectrum values in children with HIE were directly correlated with the contents of nerve injury indexes, nerve apoptosis indexes and oxidative stress indexes. Conclusion: The qEEG parameter values in children with HIE are lower than those in normal children, and the specific values are closely related to the severity of the disease.

Resting-state network complexity and magnitude changes in neonates with severe hypoxic ischemic encephalopathy

Resting-state functional magnetic resonance imaging has revealed disrupted brain network connectivity in adults and teenagers with cerebral palsy. However, the specific brain networks implicated in neonatal cases remain poorly understood. In this study, we recruited 14 termborn infants with mild hypoxic ischemic encephalopathy and 14 term-born infants with severe hypoxic ischemic encephalopathy from Changzhou Children's Hospital, China. Resting-state functional magnetic resonance imaging data showed efficient small-world organization in whole-brain networks in both the mild and severe hypoxic ischemic encephalopathy groups. However, compared with the mild hypoxic ischemic encephalopathy group, the severe hypoxic ischemic encephalopathy group exhibited decreased local efficiency and a low clustering coefficient. The distribution of hub regions in the functional networks had fewer nodes in the severe hypoxic ischemic encephalopathy group compared with the mild hypoxic ischemic encephalopathy group. Moreover, nodal efficiency was reduced in the left rolandic operculum, left supramarginal gyrus, bilateral superior temporal gyrus, and right middle temporal gyrus. These results suggest that the topological structure of the resting state functional network in children with severe hypoxic ischemic encephalopathy is clearly distinct from that in children with mild hypoxic ischemic encephalopathy, and may be associated with impaired language, motion, and cognition. These data indicate that it may be possible to make early predictions regarding brain development in children with severe hypoxic ischemic encephalopathy, enabling early interventions targeting brain function. This study was approved by the Regional Ethics Review Boards of the Changzhou Children's Hospital(approval No. 2013-001) on January 31, 2013. Informed consent was obtained from the family members of the children. The trial was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR1800016409) and the protocol version is 1.0.

Hyperbaric oxygen treatment promotes neural stem cell proliferation in the subventricular zone of neonatal rats with hypoxic-ischemic brain damage

Hyperbaric oxygen therapy for the treatment of neonatal hypoxic-ischemic brain damage has been used clinically for many years, but its effectiveness remains controversial. In addition, the mechanism of this potential neuroprotective effect remains unclear. This study aimed to investigate the influence of hyperbaric oxygen on the proliferation of neural stem cells in the subventricular zone of neonatal Sprague-Dawley rats （7 days old） subjected to hypoxic-ischemic brain damage. Six hours after modeling, rats were treated with hyperbaric oxygen once daily for 7 days. Immunohistochemistry revealed that the number of 5-bromo-2＇-deoxyuridine positive and nestin positive cells in the subventricular zone of neonatal rats increased at day 3 after hypoxic-ischemic brain damage and peaked at day 5. After hyperbaric oxygen treatment, the number of 5-bromo-2＇- deoxyuddine positive and nestin positive cells began to increase at day 1, and was significantly higher than that in normal rats and model rats until day 21. Hematoxylin-eosin staining showed that hyperbaric oxygen treatment could attenuate pathological changes to brain tissue in neonatal rats, and reduce the number of degenerating and necrotic nerve cells. Our experimental findings indicate that hyperbaric oxygen treatment enhances the proliferation of neural stem cells in the subventricular zone of neonatal rats with hypoxic-ischemic brain damage, and has therapeutic potential for promoting neurological recovery following brain injury.

Applications of advanced signal processing and machine learning in the neonatal hypoxic-ischemic electroencephalography

Perinatal hypoxic-ischemic-encephalopathy significantly contributes to neonatal death and life-long disability such as cerebral palsy. Advances in signal processing and machine learning have provided the research community with an opportunity to develop automated real-time identification techniques to detect the signs of hypoxic-ischemic-encephalopathy in larger electroencephalography/amplitude-integrated electroencephalography data sets more easily. This review details the recent achievements, performed by a number of prominent research groups across the world, in the automatic identification and classification of hypoxic-ischemic epileptiform neonatal seizures using advanced signal processing and machine learning techniques. This review also addresses the clinical challenges that current automated techniques face in order to be fully utilized by clinicians, and highlights the importance of upgrading the current clinical bedside sampling frequencies to higher sampling rates in order to provide better hypoxic-ischemic biomarker detection frameworks. Additionally, the article highlights that current clinical automated epileptiform detection strategies for human neonates have been only concerned with seizure detection after the therapeutic latent phase of injury. Whereas recent animal studies have demonstrated that the latent phase of opportunity is critically important for early diagnosis of hypoxic-ischemic-encephalopathy electroencephalography biomarkers and although difficult, detection strategies could utilize biomarkers in the latent phase to also predict the onset of future seizures.

Brainstem tegmental lesions in neonates with hypoxicischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome

Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy(HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supratentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.

Effect of erythropoietin combined with hypothermia on serum tau protein levels and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy

Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promising neuroprotective agents.We hypothesized that erythropoietin combined with hypothermia will improve efficacy of neonatal hypoxic-ischemic encephalopathy treatment.In this study,41 neonates with moderate/severe hypoxic-ischemic encephalopathy were randomly divided into a control group（hypothermia alone for 72 hours,n = 20） and erythropoietin group（hypothermia ＋ erythropoietin 200 IU/kg for 10 days,n = 21）.Our results show that compared with the control group,serum tau protein levels were lower and neonatal behavioral neurological assessment scores higher in the erythropoietin group at 8 and 12 days.However,neurodevelopmental outcome was similar between the two groups at 9 months of age.These findings suggest that erythropoietin combined with hypothermia reduces serum tau protein levels and improves neonatal behavioral neurology outcome but does not affect long-term neurodevelopmental outcome.

Estrogen inhibits lipid peroxidation after hypoxic-ischemic brain damage in neonatal rats

Sprague-Dawley neonatal rats within 7 days after birth were used in this study. The left common carotid artery was occluded and rats were housed in an 8% O2 environment for 2 hours to establish a hypoxic-ischemic brain damage model. 17β-estradiol （1 × 10-5 M） was injected into the rat abdominal cavity after the model was successfully established. The left hemisphere was obtained at 12, 24, 48, 72 hours after operation. Results showed that malondialdehyde content in the left brain of neonatal rats gradually increased as modeling time prolonged, while malondialdehyde content of 17β-estrodial-treated rats significantly declined by 24 hours, reached lowest levels at 48 hours, and then peaked at 72 hours after injury. Nicotinamide-adenine dinucleotide phosphate histochemical staining showed the nitric oxide synthase-positive cells and fibers dyed blue/violet and were mainly distributed in the cortex, hippocampus and medial septal nuclei. The number of nitric oxide synthase-positive cells peaked at 48 hours and significantly decreased after 17β-estrodial treatment. Our experimental findings indicate that estrogen plays a protective role following hypoxic-ischemic brain damage by alleviating lipid peroxidation through reducing the expression of nitric oxide synthase and the content of malondialdehyde.

Relation of nitric oxide and neonate hypoxic- ischemic encephalopathy

Objective To study the changes of the nitric oxide(NO) in process of neonate hypoxic－ ischemic encephalopathy(HIE) and the relations between the concentrations of NO and HIE. Methods Tested the concentrations of NO in CSF of newborn infants suffered HIE the third day and in plasma of newborn infants suffered HIE just attacked instant(within 2 hours), the first day ,the third day and restoring stage and compared with them of normal contrast term. We tried to analyse the reasons and significance of NO change .Results The NO concentration is the highest in plasma of newborn infants suffered HIE the first day. There is significant difference(P<0.01) after comparing the NO concentrations in plasmas of newborn infants suffered HIE just attacked instant, the first day, the third day with of normal contrast team respectively. But there is not significant difference(P >0.05) between NO in plasmas of restoring stage and of normal contrast team. There is positive correlation between the NO concentration in plasma and in CSF of newborn infants suffered HIE the third day. The more serious the disease is, the higher the NO concentration is, the worse the prognosis is. Conclusion NO play along with the course of HIE and play an important role in neonate HIE. Testing the concentration of NO in plasma and in CSF can also help to judge the degree of disease.

Single-nucleotide polymorphism screening and RNA sequencing of key messenger RNAs associated with neonatal hypoxic-ischemia brain damage

A single-nucleotide polymorphism(SNP)is an alteration in one nucleotide in a certain position within a genome.SNPs are associated with disease susceptibility.However,the influences of SNPs on the pathogenesis of neonatal hypoxic-ischemic brain damage remain elusive.Seven-day-old rats were used to establish a hypoxic ischemic encephalopathy model.SNPs and expression profiles of mRNAs were analyzed in hypoxic ischemic encephalopathy model rats using RNA sequencing.Genes exhibiting SNPs associated with hypoxic ischemic encephalopathy were identified and studied by gene ontology and pathway analysis to identify their possible involvement in the disease mechanism.We identified 89 up-regulated genes containing SNPs that were mainly located on chromosome 1 and 2.Gene ontology analysis indicated that the up-regulated genes containing SNPs are mainly involved in angiogenesis,wound healing and glutamatergic synapse and biological processing of calcium-activated chloride channels.Signaling pathway analysis indicated that the differentially expressed genes play a role in glutamatergic synapses,long-term depression and oxytocin signaling.Moreover,intersection analysis of high throughput screening following PubMed retrieval and RNA sequencing for SNPs showed that CSRNP1,DUSP5 and LRRC25 were most relevant to hypoxic ischemic encephalopathy.Significant up-regulation of genes was confirmed by quantitative real-time polymerase chain reaction analysis of oxygen-glucose-deprived human fetal cortical neurons.Our results indicate that CSRNP1,DUSP5 and LRRC25,containing SNPs,may be involved in the pathogenesis of hypoxic ischemic encephalopathy.These findings indicate a novel direction for further hypoxic ischemic encephalopathy research.This animal study was approved on February 5,2017 by the Animal Care and Use Committee of Kunming Medical University,Yunnan Province,China(approval No.kmmu2019038).Cerebral tissue collection from a human fetus was approved on September 30,2015 by the Ethics Committee of Kunming Medical University,China(approval No.2015-9).

Electroencephalography studies of hypoxic ischemia in fetal and neonatal animal models

Alongside clinical achievements,experiments conducted on animal models (including primate or non-primate) have been effective in the understanding of various pathophysiological aspects of perinatal hypoxic/ ischemic encephalopathy (HIE).Due to the reasonably fair degree of flexibility with experiments,most of the research around HIE in the literature has been largely concerned with the neurodevelopmental outcome or how the frequency and duration of HI seizures could relate to the severity of perinatal brain injury,following HI insult.This survey concentrates on how EEG experimental studies using asphyxiated animal models (in rodents,piglets,sheep and non-human primate monkeys) provide a unique opportunity to examine from the exact time of HI event to help gain insights into HIE where human studies become difficult.

Research progress of relationship between hyptoxic ischemic encephalopathy and interleukin in neonates

Hypoxic ischemic encephalopathy (HIE) refers to brain lesions caused by hypoxia in perinatal neonates, usually combined with damage or dysfunction of other organs. The pathogenesis of HIE is very complex, which is still unclear, and it is one of the important subjects of perinatal medicine research. In recent years, the role of immune system in the pathogenesis of HIE has attracted more and more attention, especially interleukin (IL), which plays an important role in the pathogenesis of HIE. Therefore, further study on the immune mechanism of neonatal HIE, to realize early diagnosis and early intervention is of great significance for preventing HIE complications.

Challenges in developing therapeutic strategies for mild neonatal encephalopathy

There is increasing evidence that infants with mild neonatal encephalopathy(NE) have significant risks of mortality, brain injury and adverse neurodevelopmental outcomes. In the era of therapeutic hypothermia, infants need to be diagnosed within 6 hours of birth, corresponding with the window of opportunity for treatment of moderate to severe NE, compared to the retrospective grading over 2 to 3 days, typically with imaging and formal electroencephalographic assessment in the pre-hypothermia era. This shift in diagnosis may have increased the apparent prevalence of brain damage and poor neurological outcomes seen in infants with mild NE in the era of hypothermia. Abnormal short term outcomes observed in infants with mild NE include seizures, abnormal neurologic examination at discharge, abnormal brain magnetic resonance imaging and difficulty feeding. At 2 to 3 years of age, mild NE has been associated with an increased risk of autism, language and cognitive deficits. There are no approved treatment strategies for these infants as they were not included in the initial randomized controlled trials for therapeutic hypothermia. However, there is already therapeutic creep, with many centers treating infants with mild NE despite the limited evidence for its safety and efficacy. The optimal duration of treatment and therapeutic window of opportunity for effective treatment need to be specifically established for mild NE as the evolution of injury is likely to be slower, based on preclinical data. Randomized controlled trials of therapeutic hypothermia for infants with mild NE are urgently required to establish the safety and efficacy of treatment. This review will examine the evidence for adverse outcomes after mild NE and dissect some of the challenges in developing therapeutic strategies for mild NE, before analyzing the evidence for therapeutic hypothermia and other strategies for treatment of these infants.

DWI和SWI联合常规MRI序列与超声在HIE诊断中的对比研究

目的采用Philips 3.0T超导型磁共振扫描仪、美国GE Logiq7超声彩色多普勒诊断仪对HIE患儿进行影像检查及图像分析,探讨颅脑多模态磁共振成像(常规MRI序列联合扩散加权成像DWI及磁敏感加权成像SWI)、颅脑超声在新生儿缺氧缺血性脑病(HIE)诊断中的应用价值及对比研究。方法回顾性研究分析临床诊断为HIE的患儿56例,分别进行颅脑多模态磁共振成像、超声检查,对比两者发现的病灶例数。结果颅脑多模态磁共振成像发现蛛网膜下腔/硬膜下出血、脑实质出血、脑梗死/神经元坏死的病例数较超声多,差异有统计学意义(P<0.05);颅脑多模态磁共振成像发现室管膜下/脑室内出血的病例数较超声少,差异有统计学意义(P<0.05);颅脑多模态磁共振成像发现脑室周围白质软化/囊变的病例数与超声无明显差异。结论在HIE诊断中颅脑多模态磁共振成像较超声有一定优势,两者存在互补性。

DWI扫描联合常规MRI序列检查在新生儿HIE诊断中的临床意义

目的探究弥散加权成像(DWI)扫描联合常规磁共振成像(MRI)序列检查在新生儿缺氧缺血性脑病(HIE)诊断中的临床意义。方法选取2020年1月至2023年10月于西北大学附属医院•西安市第三医院就诊的85例新生儿HIE作为HIE组,同期选取85例健康新生儿作为对照组。HIE组男48例,女37例;胎龄38~40(39.23±0.65)周;出生体重2.21~4.13(3.24±0.41)kg。对照组男43例,女42例;胎龄37~41(39.03±0.84)周;出生体重2.19~4.06(3.11±0.45)kg。分析HIE组DWI扫描联合常规MRI序列检查结果;比较两组DWI参数[丘脑、半卵圆中心、顶叶白质、豆状核、内囊后肢区域脑组织表观扩散系数(ADC)值];分析常规MRI各序列病变检出结果;通过比较DWI扫描、常规MRI序列检查及联合诊断结果,分析其诊断效能。采用独立样本t检验和χ^(2)检验。结果HIE组丘脑[(0.84±0.05)mm^(2)/s]、半卵圆中心[(1.04±0.12)mm^(2)/s]、顶叶白质[(1.14±0.04)mm^(2)/s]、豆状核[(0.76±0.04)mm^(2)/s]、内囊后肢[(0.73±0.03)mm^(2)/s]区域脑组织ADC值均低于对照组[(1.16±0.08)mm^(2)/s、(1.83±0.17)mm^(2)/s、(1.68±0.16)mm^(2)/s、(1.23±0.09)mm^(2)/s、(1.26±0.10)mm^(2)/s](均P<0.05);DWI扫描联合常规MRI序列检查诊断的灵敏度为97.65%(83/85),高于DWI扫描和常规MRI序列检查;漏诊率为2.35%(2/85),低于DWI扫描和常规MRI序列检查(均P<0.05)。结论DWI扫描联合常规MRI序列检查在新生儿HIE诊断中具有较高的诊断灵敏度,漏诊率较低,可为临床诊断HIE提供可靠依据。

多模态磁共振对HIE程度分级及预后评估的临床价值研究

目的通过多模态磁共振获得图像信号特征,观察其在缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿程度分级及预后评估中的临床价值。方法回顾性分析2021年1月—2023年1月在本院确诊为HIE的68例患儿的临床资料,并将其作为HIE组;选取同期的28例健康新生儿为对照组。通过所获取的磁共振(MRI)平扫、弥散、灌注及磁敏感加权图像,进行新生儿颅脑损伤MRI评分,并对临床分度与影像学评分的相关性进行分析;通过观察出血灶及灌注改变情况,评估患儿疾病程度分级及相关预后。结果磁敏感加权成像(susceptibility weighted imaging,SWI)对出血灶的检出率明显高于T1WI序列、T2WI序列及磁共振弥散加权成像(diffusion weighted imaging,DWI)序列(P<0.05);rCBF值在正常组与HIE组间存在差异(P<0.05);不同临床分度HIE患儿不同部位MRI影像学评分及其总评分比较,均为重度组>中度组>轻度组且P<0.05;经Spearman秩相关系数法分析,影像学评分与临床分度呈显著正相关性(r=0.716、0.918、0.939、0.890、0.920,P<0.001)。结论通过头部磁共振常规平扫联合多模态技术手段获取HIE患儿影像学特征,以此对HIE严重程度进行分级,对患儿预后进行综合评估。多模态磁共振对HIE在程度判断及预后评估方面均展示出较高的临床价值,进而为临床提供更全面、准确的临床诊治信息。

脑血流剪切力作用机制下的游泳训练对HIE患儿康复效果分析

目的 通过回顾性分析探讨脑血流剪切力作用机制下游泳训练对新生儿缺血缺氧脑病(hypoxia ischemic encephalopathy,HIE)患儿康复效果.方法 选取64例HIE患儿为研究对象,在常规治疗康复手段基础上参与游泳的患儿为观察组(n=31例),未参与的为对照组(n=33例);对照组采用常规治疗及护理方案,观察组患儿在常规方案基础上,出生7 d后参与保健院的游泳训练,比较两组患儿NBNA评分及DDST筛查结果.结果 与对照组比较,观察组患儿28 d的行为能力、被动肌张力、主动肌张力、原始反射、一般评估和总得分均有所提高;6个月、8个月和12个月的DDST筛查阳性率下降(P<0.05).结论 脑血流剪切力作用机制下游泳训练可在一定程度上改善HIE患儿的神经行为和智能发育.

Semi-quantitative Assessment of Brain Maturation by Conventional Magnetic Resonance Imaging in Neonates with Clinically Mild Hypoxic-ischemic Encephalopathy

Background：Mild hypoxic-ischemic encephalopathy （HIE） injury is becoming the major type in neonatal brain diseases.The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score （TMS） based on conventional magnetic resonance imaging （MRI）.Methods：Totally,45 neonates with clinically mild HIE and 45 matched control neonates were enrolled.Gestated age,birth weight,age after birth and postmenstrual age at magnetic resonance （MR） scan were homogenous in the two groups.According to MR findings,mild HIE neonates were divided into three subgroups：Pattern Ⅰ,neonates with normal MR appearance; Pattern Ⅱ,preterm neonates with abnormal MR appearance; Pattern Ⅲ,full-term neonates with abnormal MR appearance.TMS and its parameters,progressive myelination （M）,cortical infolding （C）,involution of germinal matrix tissue （G）,and glial cell migration bands （B）,were employed to assess brain maturation and compare difference between HIE and control groups.Results：The mean of TMS was significantly lower in mild HIE group than it in the control group （mean ± standard deviation [SD] 11.62 ± 1.53 vs.12.36 ± 1.26,P 〈 0.001）.In four parameters of TMS scores,the M and C scores were significantly lower in mild HIE group.Of the three patterns of mild HIE,Pattern Ⅰ （10 cases） showed no significant difference of TMS compared with control neonates,while Pattern Ⅱ （22 cases）,Ⅲ （13 cases） all had significantly decreased TMS than control neonates （mean ± SD 10.56 ± 0.93 vs.11.48 ± 0.55,P 〈 0.05; 12.59 ± 1.28 vs.13.25 ± 1.29,P 〈 0.05）.It was M,C,and GM scores that significantly decreased in Pattern Ⅱ,while for Pattern Ⅲ,only C score significantly decreased.Conclusions：The TMS system,based on conventional MRI,is an effective method to detect delayed brain maturation in clinically mild HIE.The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.

Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

BACKGROUND Symptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery,most commonly during instrument assistance.Symptomatic subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery techniques.Although the literature is inconclusive,another possible cause of subdural hematomas is therapeutic hypothermia.CASE SUMMARY We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged decelerations.Head ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa.A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive hydrocephalus.CONCLUSION The aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus,particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.

早产与足月HIE的临床危险因素及颅脑MRI对比研究

目的对比分析早产与足月新生儿缺氧缺血性脑病(HIE)的临床危险因素及颅脑MRI表现。方法共纳入我院2016年1月至2020年12月分娩的148例HIE新生儿(包括114例早产儿和34例足月儿)。回顾性分析其临床危险因素和MRI表现的特点,所有婴儿均接受常规MRI和DWI扫描。结果(1)临床高危因素:足月组瘢痕子宫(P=0.042)和羊水污染(P=0.004)发生率较早产组显著增加(P<0.05)。两者在孕期高血压(P=0.854)、剖宫产(P=0.161)、孕期贫血(P=0.308)、孕龄(P=0.590)、前置胎盘(P=0.077)等方面无统计学差异组(P>0.05)。(2)颅脑MRI表现:足月组分水岭损伤发生率(P=0.001)较早产组明显增加(P<0.05)。早产组脑室周围白质损伤(P<0.001)和颅内出血(P=0.026)发生率较足月组明显增加(P<0.05)。两组间基底节/丘脑(P=0.430)、内囊后肢(P=0.324)和胼胝体损伤(P=1.000)差异无统计学意义。结论密切监测不同孕周胎儿发生HIE的危险因素及MRI脑损伤模式可能对HIE预防、早期诊断、干预及改善预后方面具有一定指导价值。