Mechanisms Of Cerebral Injury And Strategies For Neuroprotection Following Deep Hypothermic Circulatory Arrest In The Neonatal Piglet

It is with great pleasure that I present to you this book. At the present time, physicians and scientists are working feverishly to find novel strategies for neuroprotection in human preterm and term hypoxic newborns. Cerebral hypoxia-ischemia and asphyxia present a great challenge to all of us concerned with the deleterious consequences that manifest as cerebral dysfunction, mental retardation, and cerebral palsy. This book entitled Mechanisms of Hypoxic Brain Injury in the Newborn and Potential Strategies for Neuroprotection will be of great interest to physicians, clinician-scientists, and researchers in a number of disciplines including Pediatrics, Neonatal-Perinatal Medicine, Developmental Biology, Neurology, Pediatric Neurology, Obstetrics and Gynecology, Neuroscience, Developmental Neuroscience, Developmental Neurochemistry, and to everyone interested in the developing brain . The information presented in this book will be appropriate to residents, clinical fellows, pre- and post-doctoral fellows, faculty of basic science departments, faculty of clinical departments, and to the most advanced researchers in the field of hypoxic ischemic brain injury in the fetus and the newborn. I would like to thank sincerely my colleagues and contributors to this book for their excellent efforts and extremely valuable time. Each contributor to this book is a pioneer in his or her field: the contributions are superb. As a reader, you will find that the authors of this book are from different parts of the world and that this book presents the forefront of cutting-edge global research and developments in the field of hypoxic brain injury in newborns. Finally, I would like to thank my wife Ira Mishra, whose constant support and patience have been invaluable in helping to produce not just this book but thirty years of my research investigations on the mechanisms of hypoxic injury in the developing brain.

This thesis explores potential mechanisms of brain injury in preterm and term fetuses. I first demonstrated that prolonged umbilical cord occlusion (UCO) in un-anaesthetised near-term fetal sheep was associated with moderate to severe sub-cortical neuronal injury but with relative sparing of the cortex. Fetuses that had status epilepticus had significantly greater injury than fetuses with discrete seizures alone. There was high mortality due to post-asphyxial hypotension, and i.v. infusion of dopamine, a commonly used inotrope, was ineffective at preventing hypotension or improving survival. The ontogeny of the cerebral mitochondrial response to in-utero oxygen deprivation is unclear. Compared with preterm fetal sheep, I demonstrated that near-term fetal sheep initially showed a more rapid increase of oxidised cytochrome oxidase during UCO followed by delayed loss, suggesting loss of mitochondrial membrane integrity that may contribute to the maturational increase in neuronal vulnerability to hypoxia-ischaemia. Therapeutic hypothermia is incompletely neuroprotective in term neonates, and not available in preterm neonates. I showed that both low-dose melatonin and a novel inhibitor of nNOS were partially neuroprotective when administered prophylactically before UCO in preterm fetal sheep. Neuroprotection with melatonin was partly confounded by basal ganglia protection by the ethanol used as a diluent. Finally, I demonstrated the ability of near-infrared spectroscopy to identify a paradoxical increase in intracerebral oxygenation with reduced oxygen extraction following deep hypothermic circulatory arrest during cardiac surgery in term neonates with congenital heart disease, although this was not associated with new white matter injury.

Theses on any subject submitted by the academic libraries in the UK and Ireland.

Since the publication of the first edition of Core Topics in Cardiac Anaesthesia, the clinical landscape has undergone significant change. Recent developments include the increased use of electrophysiology, the resurgence of primary percutaneous intervention in acute coronary syndromes, the use of percutaneous devices in patients previously considered inoperable, and the withdrawal of aprotinin. Against this landscape, this invaluable resource has been fully updated. New chapters are dedicated to right heart valves, pulmonary vascular disease, cardiac tumours and cardiac trauma. All other chapters have been updated according to the latest international guidelines. Written and edited by an international author team with a wealth of expertise in all aspects of the perioperative care of cardiac patients, topics are presented in an easy to digest and a readily accessible manner. Core Topics in Cardiac Anaesthesia, Second Edition is essential reading for residents and fellows in anaesthesia and cardiac surgery and clinical perfusionists.

As a leading reference on pediatric cardiology and congenital heart disease, Anderson's Pediatric Cardiology provides exhaustive coverage of potential pediatric cardiovascular anomalies, potential sequelae related to these anomalies, comorbidities and neurodevelopmental problems, and current methods for management and treatment. The fully revised 4th Edition addresses significant and ongoing changes in practice, including recent developments in fetal, neonatal, and adult congenital heart conditions as well as expanded content on intensive care, nursing issues, and societal implications. The outstanding illustration program provides superb visual guidance, and is now supplemented with a remarkable collection of more than 200 professionally curated, author-narrated videos. Offers authoritative, long-term coverage of a broad spectrum of cardiology conditions ranging from fetal development to age 21, including congenital heart disease, adult congenital heart disease (ACHD), acquired heart disease, cardiomyopathies, and rhythm disturbances. Features exceptionally detailed and original drawings by Dr. Robert Anderson and Diane Spicer, including over 850 anatomic, photographic, imaging, and algorithmic figures, and incorporating new images using virtual dissections of 3D datasets obtained in living patients. Contains new chapters on quality improvement in congenital heart disease, models of care delivery, neurocognitive assessment and outcomes, psychosocial issues for patients and families, ethics, nursing implications, acute and chronic renal complications, and telemedicine. Offers a completely new section on fetal imaging and management. Provides a new focus on patient and family-centered care with expert advice on how to communicate difficult diagnoses to patients and families. Features new integration of nursing content into all disease-specific chapters, as well as updated content on genetics, congenital heart disease and follow-up, and new imaging modalities. Contains chapters on new and emerging topics such as MRI and Quantifying the Fetal Circulation in Congenital Cardiac Disease; Congenital Anomalies of the Coronary Arteries; and The Global Burden of Pediatric Heart Disease and Pediatric Cardiac Care in Low- and Middle-Income Countries. Shares the experience and knowledge of an international team of multidisciplinary experts in medicine and advanced practice nursing.

Part of the Monographs in Cardiac Surgery Series – Introducing ‘basic science into the cardiac operating room’. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery ‘tomes’. This entry into the series will provide readers with a complete review of the current understanding in brain injury and the methods used to avoid or limit its effects on patient morbidity and mortality.

Worldwide more than one million babies die annually from perinatal asphyxia and its associated complications such as neonatal encephalopathy - one of the major causes of cerebral palsy and cognitive deficiencies in children aside from prematurity. Cooling the head - or the entire body - minimizes neuronal death, enabling the neonatal brain to be 'rescued' thus greatly improving developmental outcomes. Hypothermic neural rescue therapy has revolutionized the treatment of this condition and is a major recent achievement in neonatal medicine. This landmark book provides a brief scientific underpinning of hypothermic neural rescue therapy and lays out the evidence base for good practice. Internationally recognized authorities give practical advice, drawn from personal experience, on how to deliver hypothermia in the neonatal intensive care unit. A valuable addition to any neonatal unit, this is essential reading for neonatologists, neonatal nurses and paediatric neurologists.