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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 »

Practice Points:  Haematological abnormalities are common in neonates with neonatal encephalopathy (NE), including leukocytosis, thrombocytopenia and coagulopathy. nRBCs and EPO may indicate the degree of exposure to hypoxia in neonates with NE. Leukocytes are elevated in NE and associated with systemic inflammation. Consensus on thresholds for intervention are lacking, as there is a relative paucity …

SFNM NE Series: Haematological issues in neonates with neonatal encephalopathy treated with hypothermia Read More »

Practice Points:  Thresholds for hypoglycemia and hyperglycemia remain poorly defined and may vary depending on comorbid conditions and impaired metabolic adaptations. Glycemic levels should be maintained within the broadly accepted physiologic ranges during the early postnatal period in neonates with NE. Hypoglycemia and hyperglycemia in neonates with NE are associated with worse neurodevelopmental outcomes. Optimal …

SFNM NE Series: Nutrition and management of glycemia in neonates with neonatal encephalopathy treated with hypothermia Read More »

    Practice Points: The new International League Against Epilepsy (ILAE) classification of seizures and epilepsies for neonates underscores that the diagnosis of seizures in the neonate relies on an EEG correlate. Stereotyped clinical events without an associated ictal rhythm on EEG are no longer to be treated or diagnosed as neonatal seizures. Neonates with …

SFNM NE Series: Management of seizures in neonates with neonatal encephalopathy treated with hypothermia Read More »

Practice Points:  Fluid and electrolytes management should be individualized to patients’ needs. Initial fluid intake of 60–70 ml/kg/d on the first day of life may be considered for infants with NE. Systemic restriction of fluids and sodium should be avoided. Individualizing the approach based on daily monitoring of fluid and electrolytes at least through the …

SFNM NE Series: Fluid management, electrolytes imbalance and renal management in neonates with neonatal encephalopathy treated with hypothermia Read More »

Practice Points:  During TH: Achieve peripheral oxygen saturation with the least possible fraction of inspired oxygen (FiO2) Minimize ventilation settings if intubated to avoid hypocapnia Heat inspired gas to 37 ◦C and ensure 100% relative humidity Interpret blood gas values corrected for the actual temperature of the infant May use mild sedation to overcome any …

SFNM NE Series: Challenges in respiratory management during therapeutic hypothermia for neonatal encephalopathy Read More »