Neonatal brain injury presents in a variety of ways depending on the timing and location of the injury, and the availability and application of timely interventions. Regardless of the etiology, these injuries have the potential to impact a infant’s life-long potential and quality of life.
It is for this reason, that year after year, NICU teams around the globe, invest countless hours implementing quality improvement projects, randomized controlled clinical trials, care bundles and other evidence based practices in an effort to decrease the incidence of common NICU complications. Although these massive efforts have achieved gains in neonatal survival, unfortunately, we have not reduced the rate of neonatal brain injury (and other morbidities) for term or preterm infants in decades. It is this sad reality that has spurred the trend of NeuroNICU’s world-wide.
Over the last few weeks, we have been focusing on the four pillars of a NeuroNICU Practice Model. And this week we will be focusing on the third pillar and extremely popular topic of Neuro-Protection.
Pillar #3: Neuro-Protection
It is often said that prevention is better than a cure. And, in the case of the developing neonatal brain this statement could not be more true.
In its most simple definition, Neuro-protection, simply means to prevent brain injury and neuronal cell death. However, over the last decade the concept of neuro-protection has expanded to encompass novel therapies or interventions seeking not only to prevent primary injuries from occurring in the first place but also to support the brain after an injury has occurred.
Emerging Neuro-Protective therapies are mostly investigational and fall in to a few primary categories that aim to:
- decrease the extension or exacerbation of an existing brain injury – such as the use of therapeutic hypothermia (1-2) and treatment of seizures (3) for infants with HIE;
- increase neuronal resiliency – e.g. investigational and neuro-protective agents like Magnesium Sulfate, Epogen, Indomethacin, Xenon, and practice changes like delayed cord-clamping (4-5); and/or
- enhance and accelerate recovery and/or salvage injured neurons – e.g. investigational use of melatonin in premature infants or those with HIE (6)
If you would like to know more about how to integrate the 4 Pillars of NeuroNICU Care in to your NICU today, download our free Quickstart Guide + video series. You can get this awesome resource by clicking on the image below!
Next up in this series, will be the fourth pillar of a NeuroNICU Practice, supporting optimal Neuro-Development in the NICU and beyond.
Also, in future blog posts we will be looking deeper in to those neuro-protective practices that should be considered standard of care in your practice.
1. Whole-Body Hypothermia for Neonates with Hypoxic–Ischemic Encephalopathy – http://www.nejm.org/doi/full/10.1056/NEJMcps050929
2. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005 Feb 19-25;365(9460):663-70.
3. Neonatal seizures and therapeutic hypothermia for hypoxic-ischemic encephalopathy 2015 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456026/
4. Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled Trial – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564438/
5. Delayed Umbilical Cord Clamping After Birth – ACOG Committee Opinion 2017 – https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth
6. Melatonin in the management of perinatal hypoxic-ischemic encephalopathy: light at the end of the tunnel? — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045913/