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Neonatal Brain Injury:
Mechanism, Management and
Prognosis
Charlotte Patterson
4th Year Medical Student
Contents
• Why choose this SSC?
•What is Birth Asphyxia and HIE?
•Prognosis
•Treatment and Management
• Conservative & Sup...
What is Birth
Asphyxia and HIE?
Birth Asphyxia: The result of a critical reduction in O2 delivery
to the fetus either ante...
Pattern of Injury in
HIE
Miller et. al, (2005) Journal of Paediatrics
Neuro-imagery in HIE
Normal HIE
Clinical Presentation
and Prognosis
Mild:
- Irritable
- Excessive response to stimulation
- Hyperventilation
- Impaired fe...
Pathophysiology:
Neuronal Injury
Reduced Oxygen Supply
Cellular Hypoxia
Primary Energy Failure Primary Neuronal Death
Resu...
Management:
Supportive
• Resuscitation
• Respiratory Support
• Seizure Management
• Fluid Restriction
• Hypotension Manage...
Treatment
1. Hypothermia
2. Chemical Therapy
3. Cellular Therapy
1. Hypothermia
Reduced Oxygen Supply
Cellular Hypoxia
Primary Energy Failure Primary Neuronal Death
Resuscitation
Pseudo-n...
1. Hypothermia
Mechanism
• Modifies cells programmed for apoptosis
• Reduces cerebral metabolic rate, therefore production...
1. Hypothermia
Wachtel et. al 2011
1. Hypothermia
2. Chemical Therapy
Reduced Oxygen Supply
Cellular Hypoxia
Primary Energy Failure Primary Neuronal Death
Resuscitation
Pse...
2. Chemical Therapy
Agents that inhibit glutamate release, uptake, or blockage of
glutamate receptors
Blockade of free rad...
3. Cellular Therapy
Stem cells that may help repair ischaemic neuronal tissue
• Neural Stem cells
• Multi-potent adult pro...
3. Cellular Therapy
• 9 day old mice
• HIE artificially induced with R common carotid artery
occlusion.
• MSCs injected in...
Ethics and Law
www.topbraininjurylawyers.com
Legal Action..
Thank you- any
questions?
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Birth asphyxia and Hypoxic-Ischaemic Injury: Prognosis and Management

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Birth asphyxia and Hypoxic-Ischaemic Injury: Prognosis and Management

  1. 1. Neonatal Brain Injury: Mechanism, Management and Prognosis Charlotte Patterson 4th Year Medical Student
  2. 2. Contents • Why choose this SSC? •What is Birth Asphyxia and HIE? •Prognosis •Treatment and Management • Conservative & Supportive • New therapies: -Hypothermia -Chemical Therapy -Cellular Therapy • Evidence Based Medicine? •Disability, Disadvantage and Diversity •Ethics, Law and Medicine •References
  3. 3. What is Birth Asphyxia and HIE? Birth Asphyxia: The result of a critical reduction in O2 delivery to the fetus either antenatally, during labour and/or delivery that is sufficient to produce a lactic acidosis and render the infant in distress at birth. Hypoxic-Ischaemic Encephalopathy (HIE) describes the clinical manifestation of brain injury starting immediately or up to 48hrs post-asphyxia.
  4. 4. Pattern of Injury in HIE Miller et. al, (2005) Journal of Paediatrics
  5. 5. Neuro-imagery in HIE Normal HIE
  6. 6. Clinical Presentation and Prognosis Mild: - Irritable - Excessive response to stimulation - Hyperventilation - Impaired feeding Moderate: - Marked abnormality: tone and movement - Cannot feed - Seizures Severe: - No normal spontaneous movements/ response to pain. - Limb tone fluctuation - Seizures prolonged - Multi-organ failure Complete recovery Variable Recovery Mortality: 30-40% Disability: 80%
  7. 7. Pathophysiology: Neuronal Injury Reduced Oxygen Supply Cellular Hypoxia Primary Energy Failure Primary Neuronal Death Resuscitation Pseudo-normal period Secondary Energy Failure Encephalopathy Delayed Neuronal Death Seizures
  8. 8. Management: Supportive • Resuscitation • Respiratory Support • Seizure Management • Fluid Restriction • Hypotension Management • Treat and Monitor Hypoglycaemia • Restore electrolyte Balance - Anticonvulsants - Continuous Amplitude Integrated EEG (aEEG) -Inotropes -IV Fluids
  9. 9. Treatment 1. Hypothermia 2. Chemical Therapy 3. Cellular Therapy
  10. 10. 1. Hypothermia Reduced Oxygen Supply Cellular Hypoxia Primary Energy Failure Primary Neuronal Death Resuscitation Pseudo-normal period Secondary Energy Failure Encephalopathy Delayed Neuronal Death Seizures
  11. 11. 1. Hypothermia Mechanism • Modifies cells programmed for apoptosis • Reduces cerebral metabolic rate, therefore production of toxic NO and Free Radicals. Who is treated? • Neonates with an abnormal aEEG- fairly predictive What happens? • Aims to lower basal ganglia temperature 32-34°c • Whole body or Just head Disadvantages • Little benefit if severe brain damage • Not yet trialled in pre-term infants
  12. 12. 1. Hypothermia Wachtel et. al 2011
  13. 13. 1. Hypothermia
  14. 14. 2. Chemical Therapy Reduced Oxygen Supply Cellular Hypoxia Primary Energy Failure Primary Neuronal Death Resuscitation Pseudo-normal period Secondary Energy Failure Encephalopathy Delayed Neuronal Death Seizures
  15. 15. 2. Chemical Therapy Agents that inhibit glutamate release, uptake, or blockage of glutamate receptors Blockade of free radical generation or removal- free radical inhibitor Blockade of downstream effects and inhibitors of inflammatory effects Magnesium Xenon Deferoxamine Allupurinol Indomethacin Erythropoetin
  16. 16. 3. Cellular Therapy Stem cells that may help repair ischaemic neuronal tissue • Neural Stem cells • Multi-potent adult progenitor stem cells • Mesenchymal Stem cells (MSCs) • Human Umbilical Cord Stem Cells MSCs can differentiate into neurones and oligodendrocytes, therefore help repair ischaemic neural tissue. May also help with restoration of functional networks via axonal sprouting and synaptogenesis.
  17. 17. 3. Cellular Therapy • 9 day old mice • HIE artificially induced with R common carotid artery occlusion. • MSCs injected into mice: 1st dose 3d, 2nd dose 10d. Velthoven et al. 2010 Journal of Neuroscience
  18. 18. Ethics and Law www.topbraininjurylawyers.com
  19. 19. Legal Action..
  20. 20. Thank you- any questions?

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