Additional Information
Book Details
Abstract
Neurology, a volume in Dr. Polin’s Neonatology: Questions and Controversies Series, offers expert authority on the toughest neurological challenges you face in your practice. This medical reference book will help you provide better evidence-based care and improve patient outcomes with research on the latest advances.
- Reconsider how you handle difficult practice issues with coverage that addresses these topics head on and offers opinions from the leading experts in the field, supported by evidence whenever possible.
- Find information quickly and easily with a consistent chapter organization.
- Get the most authoritative advice available from world-class neonatologists who have the inside track on new trends and developments in neonatal care.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Pin page | fm2 | ||
| Half-titile page | i | ||
| Series page | ii | ||
| Neurology: Neonatology Questions and Controversies | iii | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Series Foreword | ix | ||
| Preface | xi | ||
| Table Of Contents | xiii | ||
| 1 Introduction | 1 | ||
| 2 Cerebral Circulation and Hypotension in the Premature Infant: Diagnosis and Treatment | 3 | ||
| Definition of Hypotension | 4 | ||
| Pathogenesis and Diagnosis of Pathologic Cerebral Blood Flow | 8 | ||
| Doppler Ultrasound | 11 | ||
| Impedance Electrical Cardiometry | 12 | ||
| Near-Infrared Spectroscopy | 12 | ||
| Amplitude-Integrated EEG (Cerebral Function Monitoring) | 13 | ||
| Summary | 14 | ||
| Treatment Strategies | 14 | ||
| Systemic Hypotension | 15 | ||
| Treatment of Hypotension Associated with PDA | 16 | ||
| Treatment of Hypotension Associated with Other Causes | 17 | ||
| Impact of Provision of Intensive Care on Systemic and Cerebral Hemodynamics | 18 | ||
| Summary and Recommendations | 19 | ||
| Diagnosis of Hypotension | 19 | ||
| Treatment of Hypotension | 20 | ||
| References | 22 | ||
| 3 Intraventricular Hemorrhage and White Matter Injury in the Preterm Infant | 27 | ||
| Periventricular-Intraventricular Hemorrhage | 28 | ||
| Background | 28 | ||
| Neuropathology: Relevance to Clinical Findings | 28 | ||
| Pathogenesis | 28 | ||
| Periventricular White Matter Injury Associated with IVH | 30 | ||
| Clinical Features | 30 | ||
| Complications | 31 | ||
| Prevention | 31 | ||
| Perinatal Strategies | 31 | ||
| Route of Delivery | 31 | ||
| Postnatal Strategies | 32 | ||
| Postnatal Factors Associated with an Increased Risk | 33 | ||
| Postnatal Administration of Medications to Reduce Severe IVH | 33 | ||
| White Matter Injury in the Absence of Hemorrhage | 33 | ||
| Periventricular Leukomalacia | 34 | ||
| Pathogenesis | 35 | ||
| Vascular Factors | 35 | ||
| Intrinsic Vulnerability of the Differentiating Oligodendrocyte | 35 | ||
| Free Radical Injury | 35 | ||
| Excitotoxic Injury (Glutamate) | 36 | ||
| Cytokines | 36 | ||
| Maternal Fetal Infection and/or Inflammation and White Matter Injury | 37 | ||
| Clinical Factors Associated with PVL | 37 | ||
| Prevention | 37 | ||
| Outcome | 38 | ||
| Intraventricular Hemorrhage | 38 | ||
| PVL | 38 | ||
| Gaps in Knowledge | 39 | ||
| Conclusions | 40 | ||
| References | 40 | ||
| 4 Posthemorrhagic Hydrocephalus Management Strategies | 47 | ||
| Question 1: What Measurements of Ventricular Size Are Used in Diagnosis of PHVD? | 49 | ||
| Question 2: How Can Ventricular Dilation Driven by Cerebrospinal Fluid Under Pressure Be Distinguished from Ventricular Dilation Due to Loss of Periventricular White Matter? | 50 | ||
| Question 3: How Is Excessive Head Enlargement Defined? | 50 | ||
| Question 4: How Is Raised Intracranial Pressure Recognized? | 50 | ||
| Question 5: What Is Infant A’s Prognosis? | 52 | ||
| Question 6: What Is the Mechanism of PHVD? | 53 | ||
| Question 7: How Can PHVD Injure White Matter? | 53 | ||
| Raised Intracranial Pressure, Parenchymal Compression, and Ischemia | 54 | ||
| Free Radical–Mediated Injury | 55 | ||
| Proinflammatory Cytokines | 55 | ||
| Loss of White Matter and Gray Matter | 55 | ||
| Question 8: What Interventions Have Been Used in PHVD, and Is There Any Evidence That They Improve Outcome? | 55 | ||
| Ventriculoperitoneal Shunt Surgery | 55 | ||
| Objectives in Treating PHVD | 56 | ||
| Repeated Lumbar Punctures or Ventricular Taps | 56 | ||
| Drug Treatment to Reduce CSF Production | 56 | ||
| Intraventricular Fibrinolytic Therapy | 56 | ||
| External Ventricular Drain | 57 | ||
| Tapping via an Ommaya Reservoir | 57 | ||
| Third Ventriculostomy | 58 | ||
| Choroid Plexus Coagulation | 58 | ||
| Drainage, Irrigation and Fibrinolytic Therapy | 58 | ||
| Conclusions | 59 | ||
| Gaps in Knowledge | 60 | ||
| References | 60 | ||
| 5 The Use of Hypothermia to Provide Neuroprotection for Neonatal Hypoxic-Ischemic Brain Injury | 63 | ||
| Experimental Evidence for the Use of Therapeutic Hypothermia | 65 | ||
| Animal Work | 65 | ||
| Clinical Trials | 65 | ||
| Implementation of a New Therapy | 67 | ||
| Temperature Control Before and After Therapeutic Hypothermia | 68 | ||
| Assessment of Encephalopathy | 69 | ||
| Is an Amplitude-Integrated Electroencephalography Necessary? | 69 | ||
| Cooling on Transport | 71 | ||
| Selective Use of Therapeutic Hypothermia | 72 | ||
| Future of Therapeutic Hypothermia | 73 | ||
| References | 73 | ||
| 6 General Supportive Management of the Term Infant with Neonatal Encephalopathy Following Intrapartum Hypoxia-Ischemia | 77 | ||
| Delivery Room Management | 79 | ||
| Early Identification of Infants at Highest Risk for Development of Hypoxic-Ischemic Brain Injury | 80 | ||
| Supportive Care | 80 | ||
| Ventilation | 81 | ||
| Maintenance of Adequate Perfusion | 81 | ||
| Fluid Status | 82 | ||
| Control of Blood Glucose Concentration | 82 | ||
| Temperature | 82 | ||
| Seizures | 83 | ||
| Prophylactic Phenobarbital | 83 | ||
| Potential Neuroprotective Strategies Aimed at Ameliorating Secondary Brain Injury | 84 | ||
| Oxygen Free Radical Inhibitors and Scavengers | 84 | ||
| Excitatory Amino Acid Antagonists | 85 | ||
| Potential Role of Magnesium | 85 | ||
| Xenon | 85 | ||
| Erythropoietin | 86 | ||
| Other Therapies | 87 | ||
| Gaps in Knowledge | 87 | ||
| References | 87 | ||
| 7 Perinatal Stroke | 91 | ||
| Case Histories | 92 | ||
| Definitions | 94 | ||
| Etiology | 96 | ||
| Etiology and Risk Factors for Fetal Stroke | 96 | ||
| Etiology and Risk Factors for Neonatal Stroke | 97 | ||
| Pathology | 99 | ||
| Fetal Stroke | 99 | ||
| Neonatal Stroke | 99 | ||
| Incidence | 99 | ||
| Gender Effect in the Incidence of Stroke | 100 | ||
| Clinical Manifestations | 100 | ||
| Seizures | 100 | ||
| Neonatal Encephalopathy | 101 | ||
| Spastic Hemiplegic Cerebral Palsy | 101 | ||
| Diagnosis | 101 | ||
| Role of Ultrasound | 101 | ||
| Role of Magnetic Resonance Imaging | 102 | ||
| Role of Placental Pathology | 102 | ||
| Treatment | 102 | ||
| Prognosis | 102 | ||
| Fetal Stroke | 102 | ||
| Mortality and Long-Term Outcome | 102 | ||
| Indicators of Long-Term Prognosis | 103 | ||
| Neonatal Stroke | 103 | ||
| Mortality | 103 | ||
| Recurrence | 103 | ||
| Long-Term Prognosis | 103 | ||
| Indicators of Long-Term Prognosis | 104 | ||
| Conclusions | 104 | ||
| Acknowledgment | 105 | ||
| References | 105 | ||
| 8 Diagnosis and Treatment of Neonatal Seizures | 109 | ||
| Recognition of Neonatal Seizures | 110 | ||
| Clinical Seizure Criteria | 111 | ||
| Subtle Seizure Activity | 111 | ||
| Clonic Seizures | 113 | ||
| Multifocal (Fragmentary) Clonic Seizures | 116 | ||
| Tonic Seizures | 116 | ||
| Myoclonic Seizures | 118 | ||
| Nonepileptic Behaviors of Neonates | 118 | ||
| Tremulousness or Jitteriness with EEG Correlates | 120 | ||
| Neonatal Myoclonus without EEG Seizures | 120 | ||
| Neonatal Dystonia without EEG Seizures | 120 | ||
| Electrographic Seizure Criteria | 122 | ||
| Ictal EEG Patterns: A More Reliable Marker for Surface-Recorded Seizure Onset, Duration, and Severity | 124 | ||
| Seizure Duration and Topography | 124 | ||
| Subcortical Seizures versus Nonictal Functional Decortication | 124 | ||
| Brainstem Release Phenomena | 125 | ||
| Electroclinical Dissociation Suggesting Subcortical Seizures | 125 | ||
| Variation in the Incidence of Neonatal Seizures Based on Clinical versus EEG Criteria | 127 | ||
| Seizures in the Clinical Context of Maternal-Fetal-Placental-Neonatal Disease: Developing a Diagnostic Algorithm | 128 | ||
| Clinical Findings | 129 | ||
| Etiology | 129 | ||
| Diagnostic Considerations | 130 | ||
| Principles of Therapy | 130 | ||
| Emergency Anticonvulsant Drug Treatment | 131 | ||
| Efficacy of Treatment | 133 | ||
| Discontinuation of Drug Use | 134 | ||
| Novel Drug Approaches | 134 | ||
| Single or Synergistic Treatments for General Neonatal Disease States | 134 | ||
| Treatments That Alter Neurotransmission | 135 | ||
| Selective Alteration of a Specific Receptor | 136 | ||
| Summary | 136 | ||
| Gaps in Knowledge | 137 | ||
| References | 137 | ||
| 9 Glucose and Perinatal Brain Injury: | 143 | ||
| Glucose Metabolism in the Fetus and Newborn | 144 | ||
| Preterm Infants | 144 | ||
| Intrauterine Growth Restriction | 145 | ||
| Cerebral Metabolism of Glucose | 145 | ||
| Alternative Substrates to Glucose | 146 | ||
| Glucose Transporters | 146 | ||
| Definitions | 147 | ||
| Controversy and Question | 148 | ||
| Symptomatic Versus Asymptomatic Hypoglycemia | 148 | ||
| Duration of Hypoglycemia | 149 | ||
| Causes of Hypoglycemia | 150 | ||
| Incidence | 150 | ||
| Pathophysiology of Hypoglycemia | 151 | ||
| Cerebral Blood Flow, Glucose Utilization, and Cerebral Energy Metabolism | 151 | ||
| Cerebral Biochemical Alterations During Hypoglycemia | 151 | ||
| Hypoglycemia and Brain Damage | 152 | ||
| Neuroimaging Abnormalities | 153 | ||
| Controversy and Question | 155 | ||
| Hypoglycemia and Hypoxia-Ischemia, Seizures | 155 | ||
| Outcome | 157 | ||
| Treatment | 157 | ||
| Conclusions | 158 | ||
| References | 159 | ||
| 10 Hyperbilirubinemia and the Risk for Brain Injury | 163 | ||
| Case History | 163 | ||
| Pathogenesis | 165 | ||
| Approaches: Strategies for Diagnosis and Treatment | 167 | ||
| Acute Bilirubin Encephalopathy (Acute Kernicterus) | 168 | ||
| Diagnosis of Chronic Bilirubin Encephalopathy (Chronic Kernicterus) | 170 | ||
| Recommendations for Treatment | 172 | ||
| Gaps in Knowledge | 174 | ||
| The New Frontier—Bilirubin-Induced Neurologic Disorders in Preterm Infants: Part of a Kernicterus Spectrum Disorder | 176 | ||
| Acknowledgments | 177 | ||
| References | 178 | ||
| 11 Neonatal Meningitis: | 181 | ||
| Question 1: What Risk Factors Predispose this Infant to Early-Onset Bacterial Meningitis? | 182 | ||
| Question 2: Do Infants with Meningitis Have Positive Blood Culture Results? | 183 | ||
| Question 3: What is the Optimal Evaluation for Possible Late-Onset Sepsis in Preterm Infants in the NICU? | 185 | ||
| Question 4: What is the Empiric Antimicrobial Choice for Possible Late-Onset Sepsis in the NICU? | 186 | ||
| Question 5: What is the Treatment of Meningitis in Neonates, and in Particular that due to Gram-Negative Bacilli? | 187 | ||
| Question 6: Should Other Therapies Be Considered? | 191 | ||
| Question 7: What is the Duration of Treatment for Meningitis in Neonates? | 193 | ||
| Question 8: When Should Neuroimaging Be Considered, and What Type of Examination is Recommended? | 193 | ||
| Question 9: Should Other Adjunctive Therapies Be Provided to an Infant with Meningitis? | 194 | ||
| Question 10: What If the Infant’s CSF Is Abnormal but Routine Bacterial Cultures of CSF and Blood Are Sterile? | 196 | ||
| Question 11: What is the Outcome of Meningitis in Neonates? | 196 | ||
| Conclusions | 197 | ||
| References | 197 | ||
| 12 Neonatal Herpes Simplex Virus and Congenital Cytomegalovirus Infections | 203 | ||
| Question 1: When Does Infection Occur? | 204 | ||
| Neonatal HSV Disease | 204 | ||
| Congenital CMV Infection | 204 | ||
| Question 2: What Are the Risk Factors for Neonatal Infection? | 204 | ||
| Neonatal HSV Infection | 204 | ||
| Congenital CMV Infection | 205 | ||
| Question 3: What Are the Clinical Manifestations of Neonatal Infection and Disease? | 206 | ||
| Neonatal HSV Disease | 206 | ||
| Congenital CMV Infection | 206 | ||
| Question 4: What Are the Treatments and Outcomes for HSV and CMV Brain Infections in Neonates? | 208 | ||
| Neonatal HSV Disease | 208 | ||
| Congenital CMV Infection | 211 | ||
| Question 5: Do All Babies with HSV and CMV Infections Have to Be Treated? | 212 | ||
| 13 Pain and Stress | 219 | ||
| Pain Circuits | 220 | ||
| Development of Pain Circuits | 221 | ||
| Developmental Fine-Tuning of Pain Circuits | 221 | ||
| Influence of Neurotrophins | 221 | ||
| Influence of Excitatory and Inhibitory Synaptic Connections | 223 | ||
| Influence of Descending Pathways | 224 | ||
| Neonatal Pain Reflex Versus Pain Experience | 224 | ||
| Long-Term Consequences of Early Pain Exposure | 225 | ||
| Evidence from Rodent Models | 226 | ||
| Evidence in Humans | 226 | ||
| Stress | 227 | ||
| The Stress Axis | 227 | ||
| The Stress Response | 227 | ||
| Development of the Stress Axis | 227 | ||
| Corticotropin-Releasing Hormone | 228 | ||
| Arginine Vasopressin | 228 | ||
| Adrenocorticotropic Hormone | 229 | ||
| Cortisol | 229 | ||
| Allostasis | 230 | ||
| Long-Term Consequences of Early Stress Exposure | 230 | ||
| Effect of Early Stress on Stress Reactivity | 230 | ||
| Experimental Observations | 230 | ||
| Human Observations | 230 | ||
| Effect of Early Stress on Cognition | 231 | ||
| Effect of Early Stress on Affect and Behavior | 231 | ||
| Conclusions | 232 | ||
| References | 232 | ||
| Sources for Table 13-3 | 236 | ||
| 14 Neonatal Hypotonia and Neuromuscular Disorders | 237 | ||
| Definition of Hypotonia | 237 | ||
| Physical Examination and Assessment of a Hypotonic Child | 237 | ||
| Traction Response | 238 | ||
| Vertical Suspension | 238 | ||
| Horizontal Suspension | 239 | ||
| Differential Anatomic Diagnosis of Hypotonia | 239 | ||
| Common Neuromuscular Disorders Manifesting Principally with Hypotonia | 241 | ||
| Anterior Horn Cell and Peripheral Nerve Disorders | 241 | ||
| Spinal Muscular Atrophies | 241 | ||
| SMA Type I, or Werdnig-Hoffmann Disease | 242 | ||
| SMA Types II and III | 242 | ||
| Congenital Neuropathies | 243 | ||
| Congenital Hypomyelinating and Axonal Neuropathies | 243 | ||
| Disturbances of Neuromuscular Transmission | 243 | ||
| Transient Neonatal Myasthenia Gravis | 243 | ||
| Acquired Autoimmune Myasthenia Gravis | 244 | ||
| Congenital Myasthenic Syndromes | 244 | ||
| Infantile Botulism | 245 | ||
| Magnesium Intoxication | 245 | ||
| Muscle Disorders | 245 | ||
| Congenital Muscular Dystrophies | 245 | ||
| Congenital Muscular Dystrophies Without Structural CNS Anomalies | 246 | ||
| Merosin-Deficient Classic Congenital Muscular Dystrophy (MDC1A). | 246 | ||
| Merosin-Positive Classic Congenital Muscular Dystrophy. | 248 | ||
| Congenital Muscular Dystrophies with Structural CNS Anomalies and/or Mental Retardation | 248 | ||
| Fukuyama Muscular Dystrophy. | 248 | ||
| Walker-Warburg Syndrome. | 249 | ||
| Muscle-Eye-Brain Disease (Santavuori Congenital Muscular Dystrophy). | 249 | ||
| Congenital Myotonic Dystrophy | 249 | ||
| Infantile Facioscapulohumeral Muscular Dystrophy | 250 | ||
| Congenital Myopathies | 251 | ||
| Nemaline Myopathy | 251 | ||
| Central Core Disease | 254 | ||
| Centronuclear/Myotubular Myopathy | 254 | ||
| Congenital Fiber Type Disproportion | 254 | ||
| Minicore Myopathy | 255 | ||
| Other Congenital Myopathies | 255 | ||
| Metabolic Myopathies | 255 | ||
| Acid Maltase Deficiency (Glycogen Storage Disease II) | 255 | ||
| Infantile Acid Maltase Deficiency (Pompe’s Disease). | 255 | ||
| Mitochondrial Myopathies | 256 | ||
| Cytochrome c Oxidase Deficiency | 256 | ||
| Fatal Infantile Myopathy. | 256 | ||
| Benign Infantile Myopathy. | 256 | ||
| Fatty Acid Oxidation Defects | 256 | ||
| Nonlysosomal Glycogenoses | 257 | ||
| Phosphorylase Deficiency | 257 | ||
| Phosphofructokinase Deficiency | 257 | ||
| Approach to Hypotonia | 257 | ||
| References | 258 | ||
| 15 Amplitude-Integrated EEG and Its Potential Role in Augmenting Management Within the NICU | 263 | ||
| Amplitude-Integrated EEG | 263 | ||
| Assessment of aEEG Background Pattern | 264 | ||
| Comparison with Standard EEG | 266 | ||
| Background Pattern | 266 | ||
| Prognostic Value of aEEG in HIE: Noncooled Situation | 266 | ||
| Prognostic Value of aEEG in HIE: Cooled Situation | 267 | ||
| aEEG and Seizures | 268 | ||
| Seizure Detection | 268 | ||
| Should Subclinical Seizures Be Treated? | 271 | ||
| aEEG in Preterm Infants | 272 | ||
| Pitfalls and Artifacts | 274 | ||
| Seizure-Like Artifacts | 275 | ||
| aEEG in Other Clinical Conditions | 276 | ||
| Gaps in Knowledge | 281 | ||
| Conclusion | 281 | ||
| References | 281 | ||
| 16 Magnetic Resonance Imaging’s Role in the Care of the Infant at Risk for Brain Injury | 285 | ||
| The Term Newborn | 285 | ||
| Cranial Ultrasonography for the Evaluation of HIE | 294 | ||
| MR Techniques in the Evaluation of Perinatal Asphyxia or HIE | 295 | ||
| Conventional MRI Sequences and Features in HIE | 295 | ||
| Selective Neuronal Necrosis after Perinatal Asphyxia | 295 | ||
| Parasagittal Cerebral Injury | 296 | ||
| Multicystic Encephalomalacia | 296 | ||
| Diffusion-Weighted Imaging Sequences and Features in HIE | 296 | ||
| Magnetic Resonance Spectroscopy in HIE | 297 | ||
| MRI in the Settings of Therapeutic Neonatal Hypothermia | 300 | ||
| MRI During Hypothermia | 301 | ||
| MRI Performed after Hypothermia | 301 | ||
| Focal and Multifocal Ischemic Brain Necrosis without Asphyxia | 302 | ||
| MR Techniques in the Evaluation of Focal Ischemic Infarction in the Term Newborn | 305 | ||
| Traumatic Brain Lesions of the Posterior Fossa | 305 | ||
| MR Techniques in the Evaluation of Traumatic Brain Injury in the Term Newborn | 307 | ||
| The Preterm Infant | 307 | ||
| MR Techniques in the Evaluation of the Preterm Infant | 307 | ||
| Cranial Ultrasonography in the Preterm Infant | 313 | ||
| Conventional MRI in the Preterm Infant | 316 | ||
| DWI in the Preterm Infant | 316 | ||
| MRS in the Preterm Infant | 319 | ||
| Advanced Quantitative MRI with Image Analysis Tools | 319 | ||
| Conclusions | 320 | ||
| Acknowledgement | 320 | ||
| References | 320 | ||
| 17 Long-Term Follow-Up of Very Low-Birth-Weight Infants | 325 | ||
| Outcome: Cerebral Palsy and Other Neurologic or Sensory Sequelae | 325 | ||
| The 18- to 24-Month-Old Child | 326 | ||
| Cerebral Palsy | 326 | ||
| Visual Assessment | 327 | ||
| Hearing Assessment | 328 | ||
| Early Developmental Assessments | 328 | ||
| Bayley Scales of Infant Development II | 328 | ||
| Important Lessons for Diagnosis and Intervention | 331 | ||
| The 3- to 6-Year-Old Child | 331 | ||
| Important Lessons for Diagnosis and Intervention | 333 | ||
| The School Age Child | 334 | ||
| Index | 341 | ||
| A | 341 | ||
| B | 341 | ||
| C | 342 | ||
| D | 343 | ||
| E | 343 | ||
| F | 343 | ||
| G | 344 | ||
| H | 344 | ||
| I | 345 | ||
| J | 346 | ||
| K | 346 | ||
| L | 346 | ||
| M | 346 | ||
| N | 347 | ||
| O | 347 | ||
| P | 347 | ||
| R | 348 | ||
| S | 348 | ||
| T | 349 | ||
| U | 350 | ||
| V | 350 | ||
| W | 350 | ||
| X | 350 | ||
| Y | 350 | ||
| Z | 350 |