Neurology: Neonatology Questions and Controversies (Neonatology: Questions & Controversies)

Cover
Series Page
Neonatology Questions and Controversies
Copyright
Contributors
Preface
Series Foreword
1 - Cerebral Circulation and Hypotension in the Premature Infant: Diagnosis and Treatment
	Definition of Hypotension
	Pathogenesis and Diagnosis of Pathologic Cerebral Blood Flow
	Monitoring of Blood Pressure, Systemic and Organ Blood Flow, and Cerebral Function
		Doppler Ultrasound
		Impedance Electrical Cardiometry
		Near-Infrared Spectroscopy
		Amplitude-Integrated EEG (Cerebral Function Monitoring)
		Summary of the Monitoring Methods Discussed
	Treatment Strategies
		Systemic Hypotension
		Treatment of Hypotension Associated With PDA
		Treatment of Hypotension Associated With Other Causes Such as Sepsis, Adrenal Insufficiency, and Hypovolemia
		The Impact of Provision of Intensive Care on Systemic and Cerebral Hemodynamics
	Summary and Recommendations
		Diagnosis of Hypotension
		Treatment of Hypotension
	REFERENCES
2 - Intraventricular Hemorrhage and White Matter Injury in the Preterm Infant
	Background
	Neuropathology: Relevance to Clinical Findings
	Pathogenesis
	Periventricular White Matter Injury Associated With IVH
		Clinical Features
		Complications
		Prevention
			Perinatal Strategies
				Antenatal Steroids
			Pregnancy-Induced Hypertension
			Magnesium Sulfate
			Route of Delivery
			Delayed Cord Clamping
			Postnatal Strategies
				Postnatal Factors Associated With an Increased Risk
				Postnatal Administration of Medications to Reduce Severe IVH
	White Matter Injury in the Absence of Hemorrhage
		Periventricular Leukomalacia
		Pathogenesis
			Vascular Factors
			Intrinsic Vulnerability of the Differentiating Oligodendrocyte
				Free Radical Injury
				Excitotoxic Injury (Glutamate)
				Cytokines
	Maternal Fetal Infection and/or Inflammation and White Matter Injury
		Clinical Factors Associated With PVL
			Prevention
	Outcome
		Intraventricular Hemorrhage
		White Matter Injury
	Gaps in Knowledge
	Conclusions
	REFERENCES
3 - Posthemorrhagic Hydrocephalus Management Strategies
	Question 1: What Measurements of Ventricular Size Are Used in Diagnosis of PHVD
	Question 2: How Can Ventricular Dilation Driven By Cerebrospinal Fluid Under Pressure Be Distinguished From Ventricular Dilation...
	Question 3: How Is Excessive Head Enlargement Defined
	Question 4: How Is Raised Intracranial Pressure Recognized
	Question 5: What Is Infant A’s Prognosis
	Question 6: What Is the Mechanism of PHVD
	Question 7: How Can PHVD Injure White Matter
		Raised Intracranial Pressure, Parenchymal Compression, and Ischemia
		Free Radical‒Mediated Injury
		Proinflammatory Cytokines
		Loss of White Matter and Gray Matter
	Question 8: What Interventions Have Been Used in PHVD, and Is There Any Evidence That They Improve Outcome
		Ventriculoperitoneal Shunt Surgery
		Objectives in Treating PHVD
		Repeated Lumbar Punctures or Ventricular Taps
		Drug Treatment to Reduce CSF Production
		Intraventricular Fibrinolytic Therapy
		External Ventricular Drain
		Tapping Via an Ommaya Reservoir
		Ventriculosubgaleal Shunt
		Third Ventriculostomy
		Choroid Plexus Coagulation
		Drainage, Irrigation, and Fibrinolytic Therapy
		Stem Cell Therapy
	Conclusions
	Gaps in Knowledge
	REFERENCES
4 - Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Different Cooling Regimens and Infants Not Included in Prior Trials
	Rationale for Further Investigations of Therapeutic Hypothermia
	What Is the Optimal Temperature and Duration for Therapeutic Hypothermia
	How Late Can Hypothermia be Initiated?
	Should Infants With Mild HIE Receive Hypothermia Therapy?
	Should Hypothermia Be Used in Preterm Infants With HIE?
	How Should Cooling on Transport Be Conducted?
	Is Therapeutic Hypothermia Neuroprotective When Used in Low- and Middle-Income Countries
	Conclusions
	REFERENCES
5 - General Supportive Management of the Term Infant With Neonatal Encephalopathy Following Intrapartum Hypoxia-Ischemia
	Introduction
	Delivery Room Management
	Early Identification of Infants at Highest Risk for Development of Hypoxic-Ischemic Brain Injury
	Supportive Care
		Ventilation
		Maintenance of Adequate Perfusion
		Fluid Status
		Control of Blood Glucose Concentration
		Temperature
		Seizures
			Prophylactic Barbiturates
		Potential Neuroprotective Strategies Aimed at Ameliorating Secondary Brain Injury
		Oxygen Free Radical Inhibitors and Scavengers
		Excitatory Amino Acid Antagonists
		Magnesium
		Xenon
		Erythropoietin
	Gaps in Knowledge
	REFERENCES
6 - Focal Cerebral Infarction
	Perinatal Arterial Ischemic Stroke
		Epidemiology
		Risk Factors
			Maternal Risk Factors
			Antepartum and Intrapartum Risk Factors
			Placental Risk Factors
			Infant Factors
		Clinical Manifestations
			Fetal Ischemic Stroke
			Neonatal Arterial Stroke
		Ischemic Stroke in the Preterm Infant
			Presumed Perinatal Ischemic Stroke
		Imaging Arterial Ischemic Stroke
		Management of Perinatal Arterial Ischemic Stroke
	Cerebral Sinovenous Thrombosis
		Epidemiology
		Risk Factors for CSVT
		Clinical Manifestations
		Imaging CSVT
		Management of CSVT
	Hemorrhagic Stroke
		Clinical Features
		Hemorrhagic Stroke in Preterm Infants
		Imaging Hemorrhagic Stroke
		Management of Perinatal Hemorrhagic Stroke
	Evaluation of Newborns With Suspected Stroke
		History and Physical Examination
		Differential Diagnosis
		Approach to Investigations (Table 6.2)
			Neuroimaging
			Laboratory Investigations
			Electroencephalography
			Placental Pathology
		Neurologic Outcome
		Neuromotor Outcome
			Neonatal Seizures and Epilepsy
		Neurobehavioral Outcome
			Visual Function
			Stroke Recurrence
	Controversies in Neonatal Stroke
		Hematologic Investigations
		Therapeutic Hypothermia for Neonatal Stroke
		Anticoagulation for CSVT
	REFERENCES
7 - Diagnosis and Management of Acute Seizures in Neonates
	Diagnosis
		Classifications
			Focal Clonic Seizures
			Focal Tonic Seizures
			Myoclonic Jerks
			Autonomic Signs
			Spasms
			Subclinical Seizures
		Definition of Seizures
		Definition of Neonatal Status Epilepticus
		Controversies in Definition and Classification of Seizures
	Differential Diagnosis
	Diagnostic Tools and Monitoring
		EEG Characteristics of Neonatal Seizures
		Standard EEG Versus Long-Term or Continuous Monitoring
			Controversies in Monitoring
	Management
		Therapy
		Efficacy and Safety of Antiseizure Medications for Seizures
			Phenobarbital and Phenytoin
			Midazolam
			Lidocaine
			Levetiracetam
			Topiramate
		Antiepileptic Drug Treatment Duration and Discontinuation
			Hypothermia
		Controversies in Therapy
			“Newborn-Tailored” Pharmacotherapy
			Age-Appropriate Antiseizure Therapies
			Timing of Therapy Administration
			Predictors of Response to Antiseizure Medications
			Electrographic-Only Seizures
			Synergistic Effects of Hypothermia and Anticonvulsant Medications
	Conclusions
	REFERENCES
8 - Neonatal-Onset Epilepsies: Early Diagnosis and Targeted Treatment
	The New Chapter of Neonatal Epilepsies
	Landscape of the Neonatal Epilepsies
	KCNQ2/3-Associated Neonatal Epilepsies
	Epilepsy of Infancy With Migrating Focal Seizures Associated With KCNT1
	SCN2A-Associated Neonatal Epilepsies
	The Promise and the Challenge of Precision Medicine in the Nursery
	REFERENCES
9 - Glucose and Perinatal Brain Injury—Questions and Controversies
	Glucose Metabolism in the Fetus and Newborn
		Preterm Infants
		Intrauterine Growth Restriction
	Cerebral Metabolism of Glucose
		Alternate Substrates to Glucose
		Glucose Transporters
	Definitions
		Controversy and Question
	Symptomatic Versus Asymptomatic Hypoglycemia
	Duration of Hypoglycemia
	Causes of Hypoglycemia
		Incidence
	Pathophysiology of Hypoglycemia
		Cerebral Blood Flow, Glucose Utilization, and Cerebral Energy Metabolism
		Cerebral Biochemical Alterations During Hypoglycemia
	Hypoglycemia and Brain Damage
		Neuroimaging Abnormalities
		Controversy and Question
		Hypoglycemia and Hypoxia-Ischemia, Seizures
		Case History
		Outcome
		Treatment
	Conclusions
	REFERENCES
10 - Hyperbilirubinemia and the Risk for Brain Injury
	Definition and Epidemiology
		History of KSD Prevalence
	Pathogenesis of Bilirubin Neurotoxicity
		Active Transport of Bilirubin
		Mechanisms of Bilirubin Damage
		Bilirubin and Calcium Homeostasis
		Mechanisms of Auditory Dysfunction
		Neuroprotective Action of Bilirubin
		Molecular Response to Hyperbilirubinemia
		Developmental Susceptibility
	Diagnosis: Acute Bilirubin Encephalopathy and Kernicterus Spectrum Disorders
		Suggested Improvements to the AAP Guidelines for the Treatment of Hyperbilirubinemia
		Acute Bilirubin Encephalopathy
		ABE and Auditory Nervous System
		ABE and Neuroimaging
		New Strategies in the Diagnosis of ABE
		Kernicterus Spectrum Disorders
		Diagnosis of Kernicterus Spectrum Disorders
	Recommendations for Prevention and Treatment
		Recommendation for the Prevention and Treatment of ABE
	Recommendation for the Diagnosis of KSD and Treatment of Its Clinical Manifestations
		Expanding the Idea of Kernicterus as a Spectrum of Disorders
	Bilirubin Neurotoxicity in the Very Premature Infant
		Difficulties in Assessing Kernicterus in Preterm Infants
	Genetics of KSDs and Susceptibility to Bilirubin Neurotoxicity
	Gaps in Knowledge
	Conclusion
	REFERENCES
11 - Neonatal Meningitis: Current Treatment Options
	Question 1: What Risk Factors Predispose This Infant to Have Early-Onset Bacterial Meningitis?
	Question 2: Do Infants With Meningitis Have Positive Blood Cultures?
	Question 3: What Is the Optimal Evaluation for Possible Late-Onset Sepsis in Preterm Infants in the NICU?
	Question 4: What Is the Empirical Antimicrobial Choice for Possible Late-Onset Sepsis in the NICU?
	Question 5: What Is the Treatment of Meningitis in Neonates, Particularly That Caused by Gram-Negative Bacilli?
	Question 6: Should Other Therapies Be Considered?
	Question 7: What Is the Duration of Treatment for Meningitis in Neonates?
	Question 8: When Should Neuroimaging Be Considered, and What Type of Examination Is Recommended?
	Question 9: Should Other Adjunctive Therapies Be Provided to an Infant With Meningitis?
	Question 10: What If the Infant’s CSF Is Abnormal but Routine Bacterial Cultures of CSF and Blood Are Sterile?
	Question 11: What Is the Outcome of Meningitis in Neonates?
	Conclusion
	REFERENCES
12 - Neonatal Herpes Simplex Virus, Congenital Cytomegalovirus, and Congenital Zika Virus Infections
	Question 1: When Does Infection Occur?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 2: What Are the Risk Factors for Neonatal Infection?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 3: What Are the Clinical Manifestations of Neonatal Infection and Disease?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 4: What Are the Treatments and Outcomes for HSV, CMV, and Zika Virus Infections in Neonates?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 5: Do All Infants With HSV and CMV Infections Have to Be Treated?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 6: What Is the Appropriate Diagnostic Approach to an Infant in Whom HSV, CMV, or Congenital Zika Infection Is Suspected?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 7: How Should You Monitor the Response to Treatment?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Question 8: What Are the Biggest Gaps in Our Current Understanding of the Natural History, Diagnosis, and Management of These Infections?
		Neonatal HSV Disease
		Congenital CMV Infection
		Congenital Zika Infection
	Conclusions
	REFERENCES
13 - Neonatal Hypotonia
	Clinical History Collection
	Clinical Evaluation
	Neurologic Examination of the Hypotonic Infant
	Diagnostic Investigation
	Most Common Neuromuscular Disorders Presenting With Congenital Hypotonia
		Spinal Muscular Atrophies
		Myopathies
		Congenital Muscular Dystrophies
		Congenital Myopathies
		Pompe Disease
		Congenital Myotonic Dystrophy
		Neuromuscular Junction Defects
	REFERENCES
14 - Amplitude-Integrated EEG and Its Potential Role in Augmenting Management Within the NICU
	Amplitude-Integrated EEG
	Assessment of aEEG Background Pattern
	Comparison With Standard EEG
		Background Pattern
			Prognostic Value of aEEG in HIE: Noncooled Situation
		Prognostic Value of aEEG in HIE: Cooled Situation
		aEEG and Seizures
			Seizure Detection
			Should We Treat Subclinical Seizures?
		aEEG in Preterm Infants
	Pitfalls and Artifacts
		Seizure-Like Artifacts
		aEEG in Other Clinical Conditions
	Gaps in Knowledge
	Conclusion
	REFERENCES
15 - Congenital Heart Disease: An Important Cause of Brain Injury and Dysmaturation
	Fetal Brain Injury and Maturation
		Prenatal Diagnosis
		Postnatal Diagnosis
	Malformation Grouping
	Transposition of Great Vessels
		Hypoplastic Left Heart Syndrome
	Brain Injury and Brain Maturation
		Cranial Ultrasound Versus MRI
		Cerebral Ischemia and Stroke
		White Matter Injury
		Cerebral Sinovenous Thrombosis
		Subdural Hemorrhage
		Brain Dysmaturation
	Neuromonitoring
		Intraoperative Monitoring
		Near-Infrared Spectroscopy
		Amplitude-Integrated Electroencephalography
		Continuous Electroencephalography
	Advanced Magnetic Resonance Imaging Techniques in Congenital Heart Disease
		MR Diffusion Tensor Imaging
		Magnetic Resonance Spectroscopy
		Functional MRI
		Other Techniques
	Neurodevelopment of the Infant With CHD
		Predictors of Outcomes
		Preoperative Factors
		Intraoperative Factors
		Postoperative Factors
	New Interventions and Neuroprotection
	Gaps in Knowledge
	REFERENCES
16 - Long-Term Follow-Up of the Very Preterm Graduate
	The Major Sequelae of Very Preterm Birth
		Cerebral Palsy
		Cognitive Impairment in Infancy
		Sensory Outcomes
		Behavior
		Classification of Impairment
	Learning Points
	Transition to School
		Starting School
		Emerging Impairments at Early School Age
		Cognitive Function
		School Attainment
		Behavior
		Motor Problems
		Changes Over Time for Individual Children
		Learning Points
	Transition to Young Adult Life
		Learning Points
	Components of a Follow-Up Program
	Gaps in Knowledge
	Conclusions
	REFERENCES