Ebook Pediatric neurology: Part 2
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Ebook Pediatric neurology: Part 2
,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2 of Acute Severe Hypoxia AND Chronic Sublethal Hypoxia onTHE Neonatal BrainstemZe Dong Jiang' and Andren' R. WilkinsonDepartment of Paediatrics. University of Oxford. John Radcliffe Hospital. Oxford.United KingdomAbstractPerinatal asphyxia and neonatal chronic lung disease (CT.D) are two major probl Ebook Pediatric neurology: Part 2ems U1 newborn infants, often leading to ncurodcvclopmenlal deficits or disabilities later in life. Both problems are associated with hypoxia, but theEbook Pediatric neurology: Part 2
nature of the hypoxia in the two problems is different. Hie hypoxia after perinatal asphyxia IS often acute, severe or IcthaL and associated with isc,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2on the functional integrity and development of the neonatal brain, leading to different neuropalhological changes and neurodcvclopmcntal outcomes.Tn recent years, some investigators have studied the functional integrity of the neonatal auditory brainstem in infants after perinatal asphyxia and neona Ebook Pediatric neurology: Part 2tal CLD and have found differences in the effects of acute severe hypoxia and chronic sublethal hypoxia on rhe neonatal brainstem. Tn infants after peEbook Pediatric neurology: Part 2
rinatal asphyxia, neural conduction and synaptic function are unpaired in both peripheral and central regions of the brainstem, although rhe impairmen,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2function are impaired predominantly in the more central regions of the brainstem, whereas the more peripheral regions arc relatively intact. These findings indicate that perinatal asphyxia affects both the central and peripheral regions of the brainstem, while neonatal CLD affects predominantly the Ebook Pediatric neurology: Part 2central regions, without appreciable effect on the peripheral regions, fins difference may be. at least partly, related to rhe different nature of hypEbook Pediatric neurology: Part 2
oxia in the two clinical problems. These findings shed light on the pathophysiology underlying neurological impairment andCorrespondence address: Depa,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2 „ 92Ze Dong Jiang and Andrew R. \\ ilkinsondevelopmental deficits ill neonatal CLD. related to cluonic sublethal hypoxia, and after perinatal asphyxia, related to acute lethal hypoxia and the associated ischemia. The knowledge obtained from these studies also provides valuable information for study Ebook Pediatric neurology: Part 2ing and implementing neuroprotective interventions or therapies for the two neonatal problems. The interventions should target more central regions ofEbook Pediatric neurology: Part 2
the brain for infants with CLD. but target both peripheral and central regions of the brain for infants after perinatal asphyxia.Recent studies have ,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2 major neuronal injury and or neuronal death after severe hypoxia-ischemia. For these infants there is a need to intervene with radical neuroprotective measures (e.g. brain cooling) as early as possible to reduce further neuronal injury and death and rescue severely injured neurons. In infants with Ebook Pediatric neurology: Part 2CT.D, however, there was no noticeable depression of electrophy siological activity in the neonatal brainstem, suggesting no severe neuronal injruy anEbook Pediatric neurology: Part 2
d or neuronal death. It appears that for infants with CI.D there is no need to implement radical treatments, and well regulated supplemental oxygen ma,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2 major perinatal problems, often leading to ncurodevclopmcnlal deficits or disabilities later in life. Asphyxia occurring during the perinatal period is the most unportant cause of acquired brain damage in infants with subsequent life-long sequelae (Levene and Evans, 2005: Volpe, 2001). Many of the Ebook Pediatric neurology: Part 2survivors have various degrees of learning difficulties, language deficits, attention deficit, hyperactivity disorders and cerebral palsy. Neonatal ('Ebook Pediatric neurology: Part 2
I.I) is one of the most common longterm complications in very low birthweight or very preterm infants (Cĩrcenough and Milner, 2005; J eng el al., 2008,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2a major concern of CLD survivors (Bohm and Katz-Salamon. 2003: Jeng et al.. 2008: Karemaker et al.. 2006; Katz-Salamon et al.. 2000). Therefore, neonatal CLD and perinatal asphyxia arc two major problems that have attracted considerable clinical attention.rhe neonatal brain, particularly the cortex, Ebook Pediatric neurology: Part 2 is well known to be sensitive to arterial blood oxygen tension and hypoxia. Neonatal ('Ll) and perinatal asphyxia arc both associated with hypoxia (BEbook Pediatric neurology: Part 2
ohm and Katz-Salamon, 2003; Grccnough and Milner. 2005; Jeng et al.. 2008; Karemaker et al., 2006; Levene and Evans. 2005: Volpe, 2001). However, the ,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2rinatal asphyxia is often acute, severe or lethal, and associated with ischaemia of the brain (Johnston et al., 2001; I.evenc and Evans, 2005; Volpe, 2001). Therefore, perinatal asphyxia and neonatal (’Ll) may exert some different effects on the neonatal brain, resulting in differential ncuropatholo Ebook Pediatric neurology: Part 2gical changes and neurodevelopmental outcome. Understanding the mechanisms is important for studying and implementing neuroprotective interventions orEbook Pediatric neurology: Part 2
therapies for infants with the two different clinical problems (Barks. 2008: Glass and Ferriero. 2007; Tin and Wiswell. 2008).The brainstem auditory ,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2n As a non-mvasive objective test, the BAER has been an important tool to study the functional......................... ~~. Differential Effects of Acute Severe Hypoxia .integrity and maturation of the neonatal, specifically auditory, brainstem and detect neural abnormalities in infants with various Ebook Pediatric neurology: Part 2 perinatal problems (Chiappa, 1991; Jiang, 2008.2010: Mustek et al., 2007: Wilkinson and Jiang. 2006). The BAER is sensitive to arterial blood oxygenEbook Pediatric neurology: Part 2
tension and hypoxia (Inagaki et al.. 1997: Jiang et al., 2005b.2006C; Sohmer et al.. 1986) It has been used to assess the functional integrity of the ,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2.20041 Karmel et al., 1988; Kileney et al.. 1980). Nevertheless, there arc some limitations in conventional BAER (i.e. the B.AER recorded using conventional average technique) to delect neuropathology that affects the auditory brainstem. False-negative results arc not uncommon.Increase in the repeti Ebook Pediatric neurology: Part 2tion rate of stimuli that elicit the BAER could enhance the detection of some neuropathology that affects the brainstem auditory pathway (Wilkinson anEbook Pediatric neurology: Part 2
d Jiang. 2006). However, in conventional evoked potential instruments (or averagers) the increase is limited by the need lo prevent responses from ove,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2auditory response (Bell cl al., 2001.2002.2006; Eysholdl and Schreiner. 1982: Jirsa. 2001; Jiang. 2008: Jiang cl al., 2000: l.asky. 1997; l.asky cl al., 1998: Lina-Granada et al.. 1994; Mustek and Lee, 1997; Mustek et al., 2007; Picton et al., 1992). Unlike the uniformly spaced stimuli used m conven Ebook Pediatric neurology: Part 2tional BAER testing, the MLS uses patterned stimulus presentation to elicit evoked potentials. Tins relatively new technique permits lhe overlapping oEbook Pediatric neurology: Part 2
f responses to successive stimuli, and allows presentation of stimuli at much higher rales than is possible with conventional methods, rhe stimuli con,... TcnxT In: Pediatric NeurologyISBNEditors: P.N. Lawson. E.A. McCarthy, pp. 91-114©2012 Nova Science Publishers. Inc.Chapter 4Differential Effects Ebook Pediatric neurology: Part 2. The nature of the stimuli and the newly developed processing technique make it unnecessary to wait for the response of each pulse to be completed before application of a new pulse. Thus, pulses can be delivered at maximal rales of up lo 1000 sec or even higher, rhe higher rales provide a much stro Ebook Pediatric neurology: Part 2nger physiological temporal challenge lo auditory neurons, and permit a more-exhaustive sampling of physiological recovery or "fatigue” than is possibEbook Pediatric neurology: Part 2
le with conventional stimulation. Such a stimulus ’stress’ provides a potential to improve the detection of some neuropathology that may not be detectGọi ngay
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