Full Program »

Neonatal Neurology: What We Have and What We Want

Administrator: Steven Miller

Neonatal Neurocritical Care: from brain injury to repair
Hannah Glass
There are many neuroprotective and neurorestorative therapies for neonatal brain injury currently under investigation. In the first talk of this session, there will be a particular focus on adjunctive therapies currently under investigation for use in combination with therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy (HIE). Given the findings of the recent HELIX trial showing that therapeutic hypothermia was not beneficial for term infants with moderate-severe neonatal encephalopathy in low and middle-income countries, identifying effective adjunctive and/or alternative therapies to therapeutic hypothermia is critical to promoting more equitable care at a global scale for infants with HIE. This talk will also review recent advances in therapies for preterm brain injury including the findings of a recent randomized controlled trial investigating the use of erythropoietin in preterm brain injury.

1. HELIX Trial: Thayyil S et al. Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh. Lancet Glob Health. 2021 Sep;9(9):e1273-e1285. 
   2. PENUT Trial: Juul SE et al. A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants. N Engl J Med. 2020 Jan 16;382(3):233-243.

 

Talk title- Neuromonitoring in Neonatal Neurocritical Care: neonatal seizures and neurodevelopmental outcomes 
Geraldine Boylan

 Neuromonitoring is an important component of neonatal neurocritical care for promoting optimal neurodevelopmental outcomes in infants at high risk for developmental impairments. The second talk of this symposium by Dr. Geraldine Boylan will review recent advances in neonatal neuromonitoring while highlighting priority areas for improving clinical care and in need of further research in this field. Specifically, there will be a focus on the importance of EEG monitoring in the Neonatal Intensive Care Unit (NICU) for the prompt recognition and treatment of neonatal seizures. Recently developed seizure recognition algorithms to reliably detect neonatal seizures will also be reviewed; these may be particularly helpful with expanding neuromonitoring in the NICU in centres with less experience with neonatal EEG, or where resources for neonatal EEG may be limited. Recent advances in the use of EEG monitoring for neuroprognostication after neonatal brain injury will also be discussed in this session.

 

Promoting brain health in preterm infants: looking beyond the NICU
Steven Miller

Preterm infants, including those without brain injury, are at risk for neurodevelopmental impairments that persist through to adolescence and adulthood. Much of our focus has been on understanding how clinical care in the NICU can reduce rates of brain injury and promote optimal brain development and neurodevelopmental outcomes in children born preterm. However, environmental factors that extend beyond the NICU period such as socioeconomic status (SES) and parental mental health and wellbeing are important predictors of neurodevelopmental outcomes in children born preterm. Further, advanced neuroimaging methods having shown that SES is associated with changes in brain structure and function in children. This talk will review recent literature in this field and highlight priority areas for research. Specifically, we hope to convince attendees of the importance to look at factors beyond NICU care in modifying neurodevelopmental outcomes and the need to further understand the specific pathways through which SES modifies outcomes.

 

Promoting brain health in infants with congenital heart disease: back to the fetus
Thiviya Selvanathan

Abnormalities in brain maturation and growth, which begin in utero, are associated with an increased risk for brain injury and with adverse neurodevelopmental outcomes in children with congenital heart disease. This talk will review key factors contributing to brain dysmaturation in fetuses with congenital heart disease and how these may be modified to promote brain health in this population. Specifically, advanced cardiac imaging studies point to alterations in fetal hemodynamics as a key contributor to fetal brain dysmaturation in congenital heart disease. Maternal hyperoxygenation is currently under investigation as a potential treatment to promote optimal brain health, reduce brain injury and improve neurodevelopmental outcomes in infants with congenital heart disease. There will also be a focus on the importance of environmental and maternal psychosocial factors in influencing fetal brain development with a discussion of further priorities for research and clinical care in this area.