El recién nacido con encefalopatía hipóxico-isquémica perinatal en la era de la hipotermia terapéutica
The research work carried out is aimed at knowing relevant and novel aspects of the newborn (RN) with moderate-severe hypoxic-ischemic encephalopathy (HIE) who receives treatment with hypothermia (HT). The thesis has been structured in three main objectives whose justification and main results are:1...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/59939 |
| Acceso en línea: | https://doi.org/10.35376/10324/59939 https://uvadoc.uva.es/handle/10324/59939 |
| Access Level: | acceso abierto |
| Palabra clave: | Medicine Pediatrics Encephalopathy Encefalopatía Hypothermia Hipotermia Perinatal asphyxia Asfixia perinatal Hypoxic ischemic Hipoxico isquémico 3201.10 Pediatría |
| Sumario: | The research work carried out is aimed at knowing relevant and novel aspects of the newborn (RN) with moderate-severe hypoxic-ischemic encephalopathy (HIE) who receives treatment with hypothermia (HT). The thesis has been structured in three main objectives whose justification and main results are:1. Evolution of the incidence of HIE, severity and mortality in the era of HT. Multicenter cross-sectional study of RNs ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE in the first 6 h of life in a large region of Spain between 2011 and 2019 to detect trend changes over time in annual incidence, degree of neurological and multisystem involvement and neonatal death caused by HIE.The annual incidence rate of moderate to severe HIE was 0.84 (95% confidence interval (CI) 0.7–0.97) per 1,000 births, with no trend changes over time (p = 0.8), although the proportion of severe cases showed an average annual decrease of 0.86 points (95% CI 0.75 to 0.98). There were 102 (70%) RN diagnosed with moderate HIE and 44 (30%) with severe HIE. HT was offered at 139/146 (95%) RN. Lower clinical and/or electrical seizures were observed with a trend ranging from 56 to 28% (p = 0.006). Mortality decreased but without statistical significance (p = 0.4) and the severity of systemic damage remained unchanged (p = 0.3). Obstetric characteristics remained similar, while over time higher perinatal pH (p = 0.03) and Apgar (p = 0.05) values were found with less need for resuscitation (p = 0.07). 2. Challenges in the implementation of HT. We lack population data in Spain on the application of HT. The objective was to examine adherence to management standards during HT of RNs with HIE. An observational cohort study was conducted, multicenter from the beginning of HT (2010) in a Spanish region, until 2019.We included 133 patients, 72% with moderate HIE and the rest with severe HIE. The accessibility to HT in this Spanish region is very satisfactory. The precocity in reaching the target temperature and the implementation of therapy agree with the established standards. There are aspects of improvement in the application of the treatment such as a) reducing the differences in the age at which the target temperature is reached; b) in those with severe HIE, implement the study of MRI and biomarkers of harm in the time interval of decision-making on care redirection; (c) reduce the use of aminoglycosides; and d) improve the integration of the family in the care of RN with EHI in HT.3. Use of functional echocardiography (EcoFn) in the care of RN with HIE during treatment with HT. To know the reality of the use of this tool in the integral management of the RN with EHI that receives HT, a national cross-sectional study was carried out in Spain in 2015 through a questionnaire sent to the 57 level III units that offered HT. Almost half of the hospitals report not having professionals with experience in echocardiography, with knowledge of EcoFn clearly insufficient in 50% of the centers. 77% of the centers do not perform EcoFn as part of the study of factors that may contribute to influencing the evolution of neurological injury, and none took into account the Information of the EcoFn in the prognosis of death or disability in the long term. |
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