Effect of longer, deeper cooling for newborns with neurological condition

 As a neonatal neurologist involved in the program at The Womans Hospital, its amazing to care for these babies in the NICU and to see them later in the office.

Sadly, there is a limit to the efficiacy of the treatment.

JR

Effect of longer, deeper cooling for newborns with neurological condition

Date:

December 23, 2014

Source:

JAMA - Journal of the American Medical Association

Among full-term newborns with moderate or severe hypoxic ischemic encephalopathy (damage to cells in the central nervous system from inadequate oxygen), receiving deeper or longer duration cooling did not reduce risk of neonatal intensive care unit death, compared to usual care, according to a study in the December 24/31 issue of JAMA.

Hypoxic ischemic encephalopathy is an important cause of childhood neurodevelopmental deficits among infants born at full-term. Hypothermia (reduced body temperature) at 33.5°C for 72 hours reduces death or disability, according to background information in the article. Longer cooling and deeper cooling has been found to be neuroprotective in animal models.

Seetha Shankaran, M.D., of Wayne State University, Detroit, and colleagues conducted a study in which full-term infants were randomly assigned to four hypothermia groups: 33.5°C for 72 hours, 32.0°C for 72 hours, 33.5°C for 120 hours, and 32.0°C for 120 hours, to examine if longer duration and deeper cooling would improve outcomes at 18 to 22 months. Infants admitted to the neonatal intensive care until within 6 hours of birth were candidates for the study when seizures or moderate or severe encephalopathy was present. The trial was closed for safety and futility issues and included 364 infants (of 726 planned).

Mortality in the neonatal intensive care unit (NICU) was 7 percent for the 33.5°C for 72 hours group, 14 percent for the 32.0°C for 72 hours group, 16 percent for the 33.5°C for 120 hours group, and 17 percent for the 32.0°C for 120 hours group.

Among neonates with moderate hypoxic ischemic encephalopathy, death in the NICU occurred in 4 percent in the 72 hours group; 8 percent in the 120 hours group; 7 percent in the 33.5°C group; and in 5 percent in the 32.0°C group. Among neonates with severe hypoxic ischemic encephalopathy, deaths in the NICU occurred in 34 percent in the 72 hours group; 42 percent in the 120 hours group; 31 percent in the 33.5°C group; and in 44 percent in the 32.0°C group.

Safety outcomes were similar between the 120 hours group vs 72 hours group and the 32.0°C group vs 33.5°C group, except major bleeding occurred among 1 percent in the 120 hours group vs 3 percent in the 72 hours group. Futility analysis determined that the probability of detecting a statistically significant benefit for longer cooling, deeper cooling, or both for NICU death was less than 2 percent.

Full article here

Potential causes of ADD and ADHD

This article discusses possible causes of ADD and ADHD compiled from different sources. Causes include genetic factors, premature birth, and other complications. ADD/ ADHD is a complex illness with few simple solutions. JR

A study in the British Medical Journal, Lancet, has reported for the first time, direct evidence of a genetic link with ADHD. Another study published in the medical journal, Pediatrics, has suggested that increased exposure to pesticides may also be linked to ADHD. Other causes may include premature birth, complications during childbirth such as hypoxia (lack of oxygen), and prolonged exposure to anesthesia at early ages.

The study on the genetic link with ADHD, even more so, makes it increasingly clear that ADHD is not caused by bad parenting or high sugar diets. There has been too much misunderstanding about the causes of ADHD with the child and the parents being unfairly stigmatised. Misconceptions such as if the parents did a better job of parenting or if the child tried harded and wasn't lazy, then the child would not have ADHD. These are all misconceptions that only do harm to the child's self esteem as well as the parents' self esteem.

It needs to be understood that ADHD or ADD is a neurophysiologic disorder, not a result of parenting.....

The most important point is that early intervention for the child's ADHD or ADD is likely to produce the best clinical outcome. Parenting a child with ADD or ADHD is a much more challenging child rearing experience than parenting a child without ADHD or ADD. Normal parenting methods frequently are not adequate as the parents are likely to experience increased frustrations with normal parenting methods not having the impact that they desire. 

The child is more vulnerable to developing low self esteem as they feel they are not as smart as their peers, or that it will never get better for them academically,or why try hard if it doesn't make a difference. If they are impulsive, then they will trigger a lot of disapproval from adults and may get rejected by peers.

Neurologically, the ADHD or ADD child's concentration or attentional system is underfunctioning so they are unable to successfully meet their academic and even sometimes day to day challenges. When their self esteem suffers, the parent's self esteem may also suffer. Again, the earliest intervention can produce the best clinical outcome and prevent psychological problems as they get older.

Read more here