Management and investigation of neonatal encephalopathy: 2017 update.
Management and investigation of neonatal encephalopathy: 2017 update.
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DOI：
10.1136/archdischild-2015-309639
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Robertson NJ
中科院分区：
文献类型：
--
作者：
Martinello K;Hart AR;Yap S;Mitra S;Robertson NJ
这篇综述讨论了确定新生儿脑病病因的方法，以及缺氧缺血性脑病（HIE）复苏和后续管理的现有证据。新生儿脑病除缺氧缺血外，还可由多种病因引起。结合仔细的历史，检查和明智地使用调查可以帮助确定原因。在过去的7年中，中度至重度HIE的婴儿受益于常规治疗性低温的引入;需要治疗额外有益结局的人数为7人（95% CI 5至10）。 最近的研究集中在心肺抑制婴儿的最佳复苏实践上，例如在建立通气和空气复苏后延迟脐带夹紧。大约四分之一的婴儿在出生后10分钟时心搏停止，随后冷却，结果正常，这表明需要根据进入强化治疗单元和早期冷却的情况，对停止复苏做出个性化的决定。 在我们目前的33.5°C下72小时的治疗方案中，冷却的全部益处似乎已经被利用;更深和更长的冷却显示出不利的结果。 未来5-10年的挑战将是评估哪些辅助疗法是安全的，并在I期和II期试验中优化低温脑保护。 最佳护理可能需要根据性别，遗传风险，损伤严重程度和炎症状态进行定制治疗。
This review discusses an approach to determining the cause of neonatal encephalopathy, as well as current evidence on resuscitation and subsequent management of hypoxic-ischaemic encephalopathy (HIE). Encephalopathy in neonates can be due to varied aetiologies in addition to hypoxic-ischaemia. A combination of careful history, examination and the judicious use of investigations can help determine the cause. Over the last 7 years, infants with moderate to severe HIE have benefited from the introduction of routine therapeutic hypothermia; the number needed to treat for an additional beneficial outcome is 7 (95% CI 5 to 10). More recent research has focused on optimal resuscitation practices for babies with cardiorespiratory depression, such as delayed cord clamping after establishment of ventilation and resuscitation in air. Around a quarter of infants with asystole at 10 min after birth who are subsequently cooled have normal outcomes, suggesting that individualised decision making on stopping resuscitation is needed, based on access to intensive treatment unit and early cooling. The full benefit of cooling appears to have been exploited in our current treatment protocols of 72 hours at 33.5°C; deeper and longer cooling showed adverse outcome. The challenge over the next 5–10 years will be to assess which adjunct therapies are safe and optimise hypothermic brain protection in phase I and phase II trials. Optimal care may require tailoring treatments according to gender, genetic risk, injury severity and inflammatory status.
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DOI：
10.1016/j.jpeds.2013.11.036
发表时间：
2014-05
期刊：
The Journal of pediatrics
影响因子：
--
作者：
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通讯作者：
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