(精编)【体外膜肺ECMO精品课件】 Hypoxic Ischemic Encephalopathy教学课件.pptVIP

* * Selective Head Cooling for Acute Hypoxic Ischemic Encephalopathy Caroline O. Chua, MD Chief, Neonatal Fellow Regional NICU Maria Fareri Children’s Hospital at Westchester Medical Center Lance A. Parton, MD Associate Director Regional NICU Maria Fareri Children’s Hospital at Westchester Medical Center Hypoxic Ischemic Encephalopathy One of the leading causes of severe long-term neurologic deficits in infants and children (cerebral palsy) Incidence of 2-3 per 1,000 term live births Etiologies: abruptio (25%), uterine rupture, prepartum hemorrhage, dystocia, prolapsed cord, placental insufficiency, twins, extramural deliveries Mortality is 15-20% 25% of survivors have permanent disabilities HYPOXIA - ISCHEMIA Anaerobic Glycolysis ATP Glutamate NMDA Receptor Intracellular Ca+ Activates Lipases Free Fatty Acids Free Radicals O2 Adenosine Hypoxanthine Xanthine Free Radicals O2 Lactate Activates NOS NO Free Radicals NEURONAL CELL DEATH Superoxide radicals Xanthine oxidase inhibitors NMDA receptor blocker Ca+ channel blocker Hypothermia Free radical scavengers Cyclooxygenase inhibitors Activates proteases Activates nuclease Disruption of cytoskeleton Damage to DNA Foundation Fact The ability to identify infants at highest risk for progressing to HIE is critical Primary Energy Failure Injury Resolve Resolve Hypoxia Ischemia Secondary Energy Failure Injury No Injury Latent phase Potential Therapeutic Window Cool-Cap Trial Randomized, controlled, masked, multi-center (25), international trial (n=234) Protocol: Standard of care or rectal temp of 34 to 35?C for 72 hours using cool cap Passively rewarmed for 4 h (at ~0.5?C/h) Primary end point: death or severe neurodevelopmental disability at 18 months Confirmed Cool-Cap System is Effective Safe Gluckman et al. Lancet. 2005; 365:663-670 Cool-Cap Trial Findings – Efficacy Statistically significant treatment effect for moderately abnormal aEEG (p = 0.04) Moderate encephalopathy: 1 o