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Practice Points:  Neonates with NE often present with multi-organ dysfunction that requires multidisciplinary specialized management. Care of the neonates with NE is thus complex with interaction between the brain and the various organ systems. Illness severity during the first days of life, and not only during the initial asphyxia event, is a significant predictor of […]

Practice Points:  Therapeutic hypothermia alongside optimal supportive care increases mortality and does not provide neuroprotection after NE in tertiary neonatal intensive care units in south Asia. Meticulous attention to supportive care, including avoidance of hyperthermia, hyperoxia, hypocarbia, hypoglycemia, and appropriate seizure management, remain the most important steps to reduce brain injury. PubMed Link To view

Practice Points:  Assessment of therapies across a range of animal models, with careful safety and pharmacokinetic studies, is vital before clinical translation. Clinical neuroprotection trials in neonates with NE need careful planning, with adequate power and pharmacokinetic information built into the protocols. Determination of optimal dose and timing of each agent will be important as

Practice Points:  Cool to a central body temperature of 33.5 ◦C for 72 h as soon as possible in term and near-term neonates with moderate and severe NE. TH for term and near-term newborns with mild NE remains debated with insufficient systematic evidence proving improved neuro- developmental outcome with treatment, and without a clear picture

Practice Points:  Therapeutic hypothermia has become a standard care for treating qualifying neonates with neonatal encephalopathy. Criteria for cooling generally include evidence of an intrapartum sentinel event, significant metabolic acidosis on an umbilical cord or immediate neonatal blood gas specimen, and evidence of neonatal encephalopathy. They should meet the criteria from published clinical trials. Clinicians

Practice Points:  A shared decision making approach should be used in decision making for encephalopathic neonates treated with therapeutic hypothermia. Clinicians and parents must balance complementary ethical justifications, including the best interest standard, harm principle, and relational potential standard. The estimation and communication of prognosis is complex and requires preparation, reflection, and humility. Clinicians must

Practice Points:  Neonatal encephalopathy (NE) is a clinical diagnosis which may arise from numerous etiologies HIE may be distinguished from NE due to other causes using the history, physical and neurological exam, and investigations PubMed Link To view the full text and an associated presentation, become a NBS member here

Practice Points:  Therapeutic Hypothermia is a safe and effective treatment which reduces the impact of neural injury following hypoxia ischaemia and moderate/severe neonatal encephalopathy. Despite TH, a high proportion of survivors still develop moderate/ severe disability necessitating close follow up into childhood designed to identify neuromotor, cognitive and behavioural prob- lems. Early referral to child

Practice Points:  Neuroimaging in the term neonates with neonatal encephalopathy (NE) is useful to identify patterns consistent with hypoxic-ischemic brain injury, to inform management decisions, to prognosticate long-term outcome, and to rule out other etiologies than hypoxic- ischemic brain injury. Magnetic resonance imaging is the preferred imaging technique for examining the brain of term neonates

Practice Points:  EEG/aEEG While aEEG is helpful to monitor trends at the bedside and can diagnose most seizures, cEEG remains the gold standard for seizure detection. Because of the wide range of start time and frequency of seizures, it is recommended to use either cEEG/aEEG throughout therapeutic hypo- thermia and rewarming, with a minimum of