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Neurodevelopmental Follow Up After Therapeutic Hypothermia for Perinatal Asphyxia

Introduction: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy (HIE) was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Material and methods: Newborns with gestational age > 36 weeks and < 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. Outcome measures assessed were death and neurodevelopmental characteristics, which were compared at the different age using ASQ-3. Twenty-five children were assessed at age 3-6, 12-18 and 24-36 months. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died. Results: At the first assessment developmental categories of communication were normal in 78.9%, problem solving in 63.2%, personal-social in 68.4%, gross motor in 68.4%, and fine motor in 42.1% with a high need of retesting in this area. Second assessment was done in 17 patients: developmental categories of communication normal in 58.8%, problem solving in 70.6%, personal-social in 64.7%, gross motor in 64.7%, and fine motor in 35.3%. Third evaluation was done in 14 patients: developmental categories of communication were normal in 64.3%, problem solving in 71.4%, personal-social in 57.1%, gross motor in 64.3%, and fine motor in 42.9%. Conclusion: There was no correlation between baseline parameters and outcome. Results of the study are showing that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in HIE patients.

Plasmapheresis in Pediatric Intensive Care Unit.

Introduction: Plasmapheresis also known as a therapeutic plasma exchange (TPE) is extracorporeal procedure by which individual components of plasma that are harmful or blood cells can be removed from organism by using a blood separation technology. Aim: To present the results of the implementation of plasmapheresis in children in the Department of Pediatric Intensive Care of Pediatric Clinic, Clinical center of Sarajevo University, Bosnia and Herzegovina. Patients and methods: Research (period from December 2011 to June 2016) analyzed 66 plasmapheresis (11 patients–6 plasmapheresis per patient). Results: Out of 11 patients, 7 (63.6%) were girls and 4 (36.4%) were boys. The average age of patients was 11.6 ± 3.9 years (the youngest patient had 4 years and 7 months, while the oldest had 16 years and 10 months). Plasmapheresis were significantly more often done in the winter and summer. Underlying disease was in 54.5% of cases of neurological origin. The treatment was in form of receiving IVIG in 7 patients, or the application of mechanical ventilation in 6 patients. The most common complication was hypotension, which occurred in 45.5% of patients, followed by bleeding in 36.3%, hypercoagulability in 27.2% of patients and hematoma in 27.2% of patients. Lethal outcome occurred in 3 (27.2%) patients. Conclusion: Plasmapheresis represents an invasive method due to need for placement of centralized venous catheter that provides adequate blood flow during the procedure. Although complications can be serious, they are rare and are mainly related to the presence of central venous catheter, hemostasis disorders due to use of anticoagulant therapy, and hypotension of the cardiovascular system. It should be noted that for success of plasmapheresis in children multidisciplinary approach is necessary (children’s nephrologist, neuropediatrician, intensive care doctor) as well as well-trained team of doctors and nurses with the acquired knowledge and skills.

Interictal Electroencephalography (EEG) Findings in Children with Epilepsy and Bilateral Brain Lesions on Magnetic Resonance Imaging (MRI).

Introduction: Neuroimaging procedures and electroencephalography (EEG) are basic parts of investigation of patients with epilepsies. Aim: The aim is to try to assess relationship between bilaterally localized brain lesions found in routine management of children with newly diagnosed epilepsy and their interictal EEG findings. Patients and methods: Total amount of 68 patients filled criteria for inclusion in the study that was performed at Neuropediatrics Department, Pediatric Hospital, University Clinical Center Sarajevo, or its outpatient clinic. There were 33 girls (48,5%) and 35 boys (51,5%). Average age at diagnosis of epilepsy was 3,5 years. Results: Both neurological and neuropsychological examination in the moment of making diagnosis of epilepsy was normal in 27 (39,7%) patients, and showed some kind of delay or other neurological finding in 41 (60,3%). Brain MRI showed lesions that can be related to antenatal or perinatal events in most of the patients (ventricular dilation in 30,9%, delayed myelination and post-hypoxic changes in 27,9%). More than half of patients (55,9%) showed bilateral interictal epileptiform discharges on their EEGs, and further 14,7% had other kinds of bilateral abnormalities. Frequency of bilateral epileptic discharges showed statistically significant predominance on level of p<0,05. Cross tabulation between specific types of bilateral brain MRI lesions and EEG finding did not reveal significant type of EEG for assessed brain lesions. Conclusion: We conclude that there exists relationship between bilaterally localized brain MRI lesions and interictal bilateral epileptiform or nonspecific EEG findings in children with newly diagnosed epilepsies. These data are suggesting that in cases when they do not correlate there is a need for further investigation of seizure etiology.

Analysis of Electroencephalogram on Children with Epilepsy Using Global Wavelet Spectrum

The electroencephalography (EEG) is an electrophysiological monitoring method to record electrical activity of the brain and is used as the method of choice for the diagnosis of epilepsy. Nowadays, we can find dozens of EEG signal analysis papers using mathematical approach and with a focus on identification of epilepsy. This paper presents some results relating to the analysis of EEG on children using the Global Wavelet Spectrum (GWS). The signals are analyzed and collected on the UKCS during 2015 and 2016 using GWS. To be able to make comparison, EEG signals are gathered from both patients with and without epilepsy. Using this approach it is possible to clearly differentiate patients with a diagnosis of epilepsy from healthy ones.

Effects of Carbamazepine and Valproate on Serum Aspartate Aminotransferase, Alanine Aminotransferase and Gamma - Glutamyltransferase in Children

Introduction: Epilepsy is one of the most common neurological diseases in childhood and adolescence. Carbamazepine (CBZ) and valproate (VPA) have been widely used as the first generation of antiepileptic drugs (AED). Aim: The aim of the study has been to evaluate and compare the effect of CBZ and VPA monotherapy on aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) serum levels in children. Material and methods: The study has included 100 patients (boys 57/girls 43, age range 1 to 18 years), who have been treated with CBZ or VPA, as initial monotherapy, for at least 12 months. Patients with liver lesions or patients who have been treated with other drugs have been excluded from the study. The initial serum enzyme levels (AST, ALT and GGT) and after 12 months of treatment have been compared. Results: 53/100 (53%) patients have been treated with CBZ and 47/100 (47%) patients have been treated with VPA.The initial level of enzymes were within the referece range. After one year-long treatment AST was elevated at 4/53 (7.5%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =3.965, p<0.05). ALT was elevated at 5/53 (9.4%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =6.953, p<0.05). GGT was elevated at 18/53 (34%) CBZ patients and 7/47 (14.9%) VPA patients (x2 test =4.831, p<0.05). Conclusion: The levels of enzymes AST and ALT have been elevated statistically significant in VPA group and GGT in CBZ group.

Predictors of Mortality in Neonates with Seizures; a Prospective Cohort Study.

Objective: The aim of this study was to analyze prognostic indicators for mortality in neonates with seizures in a level III Neonatal Intensive Care Unit (NICU). Patients and methods: A cohort of 100 neonates with clinically manifested seizures hospitalized in the NICU during 4 years period was prospectively monitored for the first year of life. The cohort consisted of 33 preterm and 67 full-term babies with 60 male and 40 female infants. Results: The mortality rate in the first year of life of infants with seizures in the neonatal period was 23%. The most common cause of seizures was birth asphyxia for full-term infants and intra-periventricular hemorrhage for preterm infants. Death was more common in pre-term than term infants (p <0,005). Simple regression demonstrated statistically significant associations between death in the first year of life and a cluster of highly associated variables: resuscitation (p<0, 01), mechanical ventilation (p<0,01) and asphyxia (p<0,05). This cluster of variables significantly correlates with: gestational age (p<0, 05), birth weight (p<0, 05) and intracranial hemorrhage (p<0, 05). Conclusion: In this cohort of neonates with seizures asphyxia requiring neonatal resuscitation was the primary risk factor for death.

P5 – 2504: The magnetic resonance imaging as a diagnostic tool in unilateral spastic cerebral palsy

Objective Unilateral spastic cerebral palsy (US CP) is the unilateral motor impairment, congenital or early acquired, isolated or associated with additional impairments. The brain MRI is very useful tool to identify lesions and to provide early prognosis of motor outcome, but also presence and severity of associated disabilities. The aim of the study was to investigate brain MRI findings in children with unilateral spastic cerebral palsy and compare MRI findings between term and preterm (gestation age Methods The study was hospital based, which has included 106 patients with US CP (82 term/24 preterm). MRI findings were classified into 5 groups: 1. Brain maldevelopments 2. Periventricular white matter lesions 3. Cortical or deep gray matter lesions. 4. Other finding 5. Normal MRI findings. Results Periventricular white matter lesions where the most frequent (50/106, term 37/preterm 13), without statistically significant difference between term and preterm born children (χ 2 =0.4357; p=0.490517). Grey matter lesions had 32/106 children (term 25/preterm 7), without statistically significant difference between term and preterm born children (χ 2 =0.902; p=0.9862). There was only one case with deep grey matter lesions, all other cases where cortical-subcortical lesions. Normal MRI finding had 14/106 children (term 10/pre term 4). Brain malformations had 8/106 children and all of them were term born. Other finding had 2/106 children, and both of them were term born. Conclusion Brain MRI may help to understand morphological background of motor impairment in children with US CP. Periventricular white matter lesions were the most frequent, then cortical-subcortical lesions. There were no statistically significant difference between term and preterm born children.

PP10.9 – 2483: Neurodevelopmental outcome of infants with neonatal seizures

Objective Prospective study was performed on a cohort of 100 patients: term and preterm newborns, who had clinically manifested seizures during the neonatal period. Methods Initial assessment was performed during their hospitalisation, while furder follow-up was done through regular visits to outpatient facilities of Deparment of Child Neurology. Patients were divided into two groups – preterm and term newborns (67/33). During early and late neonatal period, 23 children died (12 terms/11 preterms). Use of medications and drugs during pregnancy (38%), underlaying disease in mothers (22%), type of labour (vaginaly 61%), intrauterine growth restriction (28%), necessity for resustitation mesures (54%), perinatal aspyxia (52%) and mechanical ventilation (54%) were considered as risk factor. Neurodevelopmental assessment was performed at the age of one year with Alberta Infant Motor scale (AIMS) and Developmental scale. Results According to AIMS 68.83% patients had scores below 10 th percentile which corresponded to motoric developmental delay. According to Developmental scale, 62.33% of children showed developmental discordance with the results expected for chronological age. 28.57% of patients with diagnosis of epilepsy at the age of one year had also low scores at AIMS ( Conclusion Neonatal seizures have strong prediction for short and long term morbidity and mortality.

P123 – 2671: Follow up of neurodevelopmental outcome after therapeutic hypothermia for perinatal asphyxia

Objective Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Methods Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics, which we compared at the different age using ASQ-3, at least 3 times during follow-up. Results Twenty-five children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the first assessment developmental categories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fine motor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all five categories, while three (15.8%) had abnormal results for all categories. Second assesment was done in 17 patients with developmental categories of communication normal in 70.5%, problem solving in 76.5%, personal-social in 70.5%, gross motor in 58.8%, and fine motor in 41.1%. Third evaluation was done in 13 patients: developmental categories of communication were normal in 69.2%, problem solving in 76.9%, personal-social in 69.2%, gross motor in 61.5%, and fine motor in 46.2%. Conclusion Relatively small number of patients and limitations of this study design precluded any far-reaching conclusions, but we think that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.

Neurodevelopmental outcome following therapeutic hypothermia for perinatal asphyxia

Studies are supporting neuroprotective benefi t of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy. We assessed survival and neurodevelopmental outcome of neonates subjected to the procedure and factors that may have infl uenced it. Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxi al encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics. Twenty-fi ve children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the age of fi nal assessment, developmental cate gories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fimotor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all fi e categories, while three (15.8%) had abnormal results for all categories. None of the 18 parameters that were correlated with neurodevelopmental outcome showed statistical signifi cance. Amplitude integrated electroencephalography was done in ten patients and the most prominent fiwas discontinuous activity in eight patients. In conclusion, a relatively small number of patients and l imitations of this study design precluded any far-reaching conclusions, but we think that this method can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.