[PS11] Parallel Session 11: Neonatal Neurology

[PS11-2C-3] Critical Issues on the Diagnosis and Treatment of Newborn with Hypoxic-ischemic Brain Injury

^○Chao-Ching Huang^{1, 2} (1.Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan, 2.Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan)

Evidence-based medicine has shown the long-term efficacy of hypothermia that initiated within 6 hours after birth for neonates with hypoxic-ischemic encephalopathy. However, there are still important issues that need to be addressed in this post-hypothermia era. First important issue is early identification of the mimics of hypoxic-ischemic encephalopathy, such as intracranial hemorrhage, metabolic encephalopathies, in newborns who shows low Apgar scores in first days of life. Second important issue is to look for the antecedents and/or sentinel events in the antenatal and intrapartum periods that are related to the onset of hypoxia. Third important issue is to have detailed placental pathology for every newborn admitted with birth asphyxia. Analyses that do not evaluate placenta evidence of infection/inflammation, severity of inflammation and vasculopathy may lead to an exaggeration of the role of intrapartum asphyxia as a singular cause for neonatal encephalopathy. Fourth important issue is to avoid high FiO2 hyperoxemia, over-ventilation hypocarbia, hyperglycemia and hyperthermia after neonatal resuscitation. Fifth important issue is the expanded use of Cooling, such as the depth of cooling, prolonged duration of cooling, and early and late cooling. Sixth important issue is to search for effective additional therapy that can enhance the neuroprotective effects of hypothermia. Combined therapy using hypothermia and stem cell therapeutics may appear as an emerging paradigm for neonatal encephalopathy.
In conclusion, the post-hypothermia era raises the possibility to characterize the causal pathway-oriented pathogenesis and the treatment strategy for each individual newborn who suffers from hypoxic-ischemic brain injury.