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Kelly edwards calibre systems10/20/2023 ![]() During the initial insult a proportion of cells undergo primary cell death and the neuronal supply of high energy metabolites such as adenosine triphosphate (ATP) is exhausted, also termed “primary energy failure.” Following successful resuscitation the brain enters a latent phase lasting for ~6–24 h which is characterized by the partial recovery of cerebral oxidative metabolism and cerebral blood flow, although a degree of hypoperfusion continues. Early pre-clinical and clinical studies using phosphorous ( 31P) nuclear magnetic resonance spectroscopy (MRS) described the evolution of secondary energy failure with a reduction in high energy phosphates and a rise in cerebral lactate over hours and days following birth ( 5, 6). In high income settings NE affects between 1 and 3/1,000 live births whereas the incidence is up to 10 times higher in mid and low income settings ( 1– 3).įollowing an intrapartum hypoxic-ischaemic event, the brain suffers significant hemodynamic and metabolic derangements which are dynamic, evolving over a period of hours, days and weeks due to the neurotoxic and neurochemical cascade that ensues ( 4). It is the second most common cause of preventable childhood disability and this has not improved significantly over the past two decades despite hypothermia treatment ( 2, 3). Neonatal encephalopathy (NE) resulting from intrapartum related events is a global health problem accounting for a quarter of neonatal deaths world-wide ( 1). This review discusses the role of optical neuromonitoring in NE and why this modality may provide the next significant piece of the puzzle toward understanding the real time state of the injured newborn brain. Increasing use of commercially available cerebral oximeters in the NICU, and the introduction of advanced optical measurements using broadband NIRS (BNIRS), frequency domain NIRS (FDNIRS), and diffuse correlation spectroscopy (DCS) have widened the scope by allowing the direct monitoring of oxygen metabolism and cerebral blood flow, both key to understanding pathophysiological changes and predicting outcome in NE. ![]() Research studies within this population have also increased, alongside the development of both instrumentation and signal processing techniques. The clinical use of near-infrared spectroscopy (NIRS) technology has increased in recent years. There is therefore a real need for a neuromonitoring tool that provides cot side, early and continuous monitoring of brain health which can reliably stratify injury severity, monitor response to current and emerging treatments, and prognosticate outcome. The neuromonitoring technologies currently used in NE however, have limitations in either their availability during the active treatment window or their reliability to prognosticate and stratify injury confidently in the early period following insult. ![]() Current neuromonitoring tools provide information utilized for seizure management, injury stratification, and prognostication, whilst systemic monitoring ensures multi-organ dysfunction is recognized early and supported wherever needed. Assessment of injury severity and effective management in the neonatal intensive care unit (NICU) relies on multiple monitoring modalities from systemic to brain-specific. Neonatal encephalopathy (NE) in term and near-term infants is a significant global health problem the worldwide burden of disease remains high despite the introduction of therapeutic hypothermia.
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