Asim Al Balushi

By Asim Al Balushi, Maria A. Lopez Laporte and Pia Wintermark

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

By Asim Al Balushi, Samara Zavalkoff and Pia Wintermark

Asphyxiated newborns may be hemodynamically unstable during their first days of life. They often present with severe persistent pulmonary hypertension and/or cardiac dysfunction, which may require aggressive supportive management to maintain homeostasis and prevent further brain injury. In the most severe cases, extracorporeal membrane oxygenation (ECMO) may be required to ensure adequate oxygenation, ventilation and cardiac output. However, due to the risk of irreversible brain injury, clinicians often are concerned about offering ECMO to these newborns. Therapeutic hypothermia during the first days of life has become the standard of care for these newborns to improve their prognosis; however, this treatment in itself has been associated with increased hemodynamic instability and coagulopathy. An additional concern with using ECMO in these newborns is the potential increased bleeding risk when continuing the hypothermia treatment during the ECMO course. This chapter reviews the reported feasibility of performing hypothermia during ECMO. We also review the reported outcomes of asphyxiated newborns treated with hypothermia and ECMO and highlight their potential survival without neurodevelopmental impairments. Thus, ECMO should be considered as a therapeutic option for asphyxiated newborns treated with hypothermia.

Part of the book: Advances in Extra-corporeal Perfusion Therapies