News

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 […]

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

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

    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

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

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

Practice Points:  Neonatal transition is dependent on aeration of the lungs. Neonatal resuscitation programs are based on evidence-based recommendations from the International Liaison Committee on Resuscitation and adapted for regional differences. Bag-mask ventilation is the critical, life-saving skill of neonatal resuscitation. Beyond initial trainings, optimizing resuscitation can be accomplished through regular simulation practice and continuous

Practice Points:  Placental pathologies are a frequent finding in the context of NE A combination of acute and chronic placental lesions are more likely to be seen in NE Defined histopathological criteria using the 2016 Amsterdam consensus document should be used whenever the placenta is assessed Efficacy of therapeutic hypothermia may be influenced by antenatal

Practice Points:  Neonatal encephalopathy due to a hypoxic ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension Therapeutic hypothermia and rewarming modify loading conditions and blood flow and careful adjustment of inotropic agents is recommended. Delineating the physiology during therapeutic hypothermia clinically is difficult Comprehensive, quantitative echocardiography can assist with delineating pulmonary

Practice Points: The rates of birth asphyxia are the lowest in developed countries. Access to prenatal care and the social determinants of health are the most important factors related to birth asphyxia. The pregnancy-related risk factors for birth asphyxia are common and generally not informative as to which foetuses are likely to be affected at