Dr. Pia Wintermark is a pediatrician and neonatologist. Her research is devoted to the study of the unique profile of brain injury in newborns using advanced neuroimaging techniques, bedside monitoring and basic lab to measure brain perfusion, in order to understand mechanisms underlying these injuries, develop therapies for these injuries and improve the neurodevelopmental outcome of these newborns. www.neobrainlab.org www.neobrainparents.org
Birth asphyxia and the resulting neonatal encephalopathy are a significant cause of mortality and long-term morbidity in children. Hypothermia is currently the only neuroprotective treatment to have been clinically tested in large trials to prevent the development of brain injury in some term asphyxiated newborns. Most of the asphyxiated newborns treated with hypothermia are intubated at birth as per resuscitation measures and remain on mechanical ventilation during some part of the hypothermia treatment or during the whole length of the treatment. They also may present with oxygenation problems. Very often, they present with hypocapnia that can be worsened with the use of mechanical ventilation during the first days of life. When taking care of these newborns, a few important points should be remembered about the impact of asphyxia and therapeutic hypothermia on oxygenation and ventilation. In this article, we review some of the physiopathology behind neonatal encephalopathy and the implications of brain cooling from a respiratory point of view. Strategies to optimize oxygenation and ventilation for these newborns, as well as to prevent further brain injury, are also discussed based on a current literature review.
Part of the book: Respiratory Management of Newborns