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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 …

SFNM NE Series: Medico-legal considerations in the context of neonatal encephalopathy and therapeutic hypothermia Read More »

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 …

SFNM NE Series: Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia Read More »

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 …

SFNM NE Series: Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia Read More »

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 …

SFNM NE Series: Neuroimaging in the term newborn with neonatal encephalopathy Read More »

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 …

SFNM NE Series: Bedside and laboratory neuromonitoring in neonatal encephalopathy Read More »

Practice Points:  Communication amidst therapeutic hypothermia is challenging; parents desire timely, transparent, and consistent communication with clinicians. Parents value opportunities to participate in their infant’s clinical care. Programs should work to integrate parents into clinical care in the acute period and empower them to lead clinical care and rehabilitation as they prepare for life at …

SFNM NE Series: Supporting families in their child’s journey with neonatal encephalopathy and therapeutic hypothermia Read More »

Practice Points:  The evolution of injury following hypoxic-ischemic injury involves multiple mechanisms and progresses over a prolonged period of time. Cell death often presents as a continuum between early necrosis and later apoptosis, involving a balance between early biophysical damage and failure of oxidative metabolisms and activation of pro- grammed cell death pathways. Very delayed …

SFNM NE Series: Update on mechanisms of the pathophysiology of neonatal encephalopathy Read More »

Practice Points:  Clinicians looking after neonates with NE treated with TH must be aware of SFNN and must be assessed the neonates routinely for SFNN Routine clinical and biochemical monitoring for hypercalcemia in those with SFNN or at-risk is critical Hypercalcemia is typically detected at a month of age; half the neonates are asymptomatic Prompt …

SFNM NE Series: Subcutaneous fat necrosis associated with hypercalcemia in neonates with neonatal encephalopathy treated with therapeutic hypothermia Read More »

Practice Points:  Non-pharmacologic approaches form the foundation for providing comfort for neonates with NE receiving TH Benzodiazepines should be avoided for sedation Morphine 50 μg/kg followed by a continuous infusion of 5 μg/kg/hour currently represents the approach to pharmacologic sedation with the strongest basis in evidence Low-dose dexmedetomidine infusion may be considered as an alternative …

SFNM NE Series: Management of comfort and sedation in neonates with neonatal encephalopathy treated with therapeutic hypothermia Read More »