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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 |