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  1. Article: Editorial: Advances in the use of neuromonitoring in newborns.

    Chock, Valerie Y / Van Meurs, Krisa P

    Frontiers in pediatrics

    2023  Volume 11, Page(s) 1215991

    Language English
    Publishing date 2023-05-22
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1215991
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  2. Article: Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy.

    Chock, Valerie Y / Rao, Anoop / Van Meurs, Krisa P

    Frontiers in pediatrics

    2023  Volume 11, Page(s) 1138062

    Abstract: Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities ... ...

    Abstract Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
    Language English
    Publishing date 2023-03-08
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1138062
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  3. Article ; Online: Introduction.

    Van Meurs, Krisa P / Wilson Archer, Stephanie

    Seminars in perinatology

    2022  Volume 46, Issue 7, Page(s) 151633

    Language English
    Publishing date 2022-06-17
    Publishing country United States
    Document type Editorial
    ZDB-ID 752403-1
    ISSN 1558-075X ; 0146-0005
    ISSN (online) 1558-075X
    ISSN 0146-0005
    DOI 10.1016/j.semperi.2022.151633
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  4. Article ; Online: Prenatal management of congenital diaphragmatic hernia.

    Danzer, Enrico / Rintoul, Natalie E / van Meurs, Krisa P / Deprest, Jan

    Seminars in fetal & neonatal medicine

    2022  Volume 27, Issue 6, Page(s) 101406

    Abstract: Recently, two randomized controlled, prospective trials, the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, reported the outcomes on fetal endoluminal tracheal occlusion (FETO) for isolated left congenital diaphragmatic hernia (CDH). FETO ... ...

    Abstract Recently, two randomized controlled, prospective trials, the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, reported the outcomes on fetal endoluminal tracheal occlusion (FETO) for isolated left congenital diaphragmatic hernia (CDH). FETO significantly improved outcomes for severe hypoplasia. The effect in moderate cases, where the balloon was inserted later in pregnancy, did not reach significance. In a pooled analysis investigating the effect of the heterogeneity of the treatment effect by the time point of occlusion and severity, the difference may be explained by a difference in the duration of occlusion. Nevertheless, FETO carries a significant risk of preterm birth. The primary objective of this review is to provide an overview of the rationale for fetal intervention in CDH and the results of the randomized trials. The secondary objective is to discuss the technical aspects of FETO. Finally, recent developments of potential alternative fetal approaches will be highlighted.
    MeSH term(s) Female ; Humans ; Infant, Newborn ; Pregnancy ; Fetoscopy ; Hernias, Diaphragmatic, Congenital/surgery ; Premature Birth ; Prospective Studies ; Trachea/surgery ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2022-11-17
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2174416-6
    ISSN 1878-0946 ; 1744-165X
    ISSN (online) 1878-0946
    ISSN 1744-165X
    DOI 10.1016/j.siny.2022.101406
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  5. Article ; Online: Ductus arteriosus and the preterm brain.

    Chock, Valerie Y / Bhombal, Shazia / Variane, Gabriel F T / Van Meurs, Krisa P / Benitz, William E

    Archives of disease in childhood. Fetal and neonatal edition

    2022  Volume 108, Issue 2, Page(s) 96–101

    Abstract: As the approach to the patent ductus arteriosus (PDA) in the preterm infant remains controversial, the potential consequences of a significant ductal shunt on the brain should be evaluated. In this population at high risk of adverse outcomes, including ... ...

    Abstract As the approach to the patent ductus arteriosus (PDA) in the preterm infant remains controversial, the potential consequences of a significant ductal shunt on the brain should be evaluated. In this population at high risk of adverse outcomes, including intraventricular haemorrhage and white matter injury, as well as longer-term neurodevelopmental impairment, it is challenging to attribute sequelae to the PDA. Moreover, individual patient characteristics including gestational age and timing of PDA intervention factor into risks of brain injury. Haemodynamic assessment of the ductus combined with bedside neuromonitoring techniques improve our understanding of the role of the PDA in neurological injury. Effects of various PDA management strategies on the brain can similarly be investigated. This review incorporates current understanding of how the PDA impacts the developing brain of preterm infants and examines modalities to measure these effects.
    MeSH term(s) Infant ; Infant, Newborn ; Humans ; Infant, Premature ; Ductus Arteriosus, Patent/complications ; Ductus Arteriosus, Patent/diagnostic imaging ; Ductus Arteriosus ; Gestational Age ; Brain Injuries ; Brain/diagnostic imaging
    Language English
    Publishing date 2022-06-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/archdischild-2022-324111
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  6. Article ; Online: Neuroprotection for hypoxic-ischemic encephalopathy: Contributions from the neonatal research network.

    Bonifacio, Sonia Lomeli / Chalak, Lina F / Van Meurs, Krisa P / Laptook, Abbot R / Shankaran, Seetha

    Seminars in perinatology

    2022  Volume 46, Issue 7, Page(s) 151639

    Abstract: Therapeutic hypothermia (TH) is now well established as the standard of care treatment for moderate to severe neonatal encephalopathy secondary to perinatal hypoxic ischemic encephalopathy (HIE) in infants ≥36 weeks gestation in high income countries. ... ...

    Abstract Therapeutic hypothermia (TH) is now well established as the standard of care treatment for moderate to severe neonatal encephalopathy secondary to perinatal hypoxic ischemic encephalopathy (HIE) in infants ≥36 weeks gestation in high income countries. The Neonatal Research Network (NRN) contributed greatly to the study of TH as a neuroprotectant with three trials now completed in infants ≥36 weeks gestation and the only large randomized-controlled trial of TH in preterm infants now in the follow-up phase. Data from the first NRN TH trial combined with data from other large trials of TH affirm the safety and neuroprotective qualities of TH and highlight the importance of providing TH to all infants who qualify. In this review we will highlight the findings of the three NRN trials of TH in the term infant population and the secondary analyses that continue to inform the care of patients with HIE.
    MeSH term(s) Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain/therapy ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases/therapy ; Infant, Premature ; Neuroprotection ; Neuroprotective Agents/therapeutic use ; Randomized Controlled Trials as Topic
    Chemical Substances Neuroprotective Agents
    Language English
    Publishing date 2022-06-10
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 752403-1
    ISSN 1558-075X ; 0146-0005
    ISSN (online) 1558-075X
    ISSN 0146-0005
    DOI 10.1016/j.semperi.2022.151639
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  7. Article: Newer indications for neuromonitoring in critically ill neonates.

    Variane, Gabriel F T / Pietrobom, Rafaela F R / Noh, Caroline Y / Van Meurs, Krisa P / Chock, Valerie Y

    Frontiers in pediatrics

    2023  Volume 11, Page(s) 1111347

    Abstract: Continuous neuromonitoring in the neonatal intensive care unit allows for bedside assessment of brain oxygenation and perfusion as well as cerebral function and seizure identification. Near-infrared spectroscopy (NIRS) reflects the balance between oxygen ...

    Abstract Continuous neuromonitoring in the neonatal intensive care unit allows for bedside assessment of brain oxygenation and perfusion as well as cerebral function and seizure identification. Near-infrared spectroscopy (NIRS) reflects the balance between oxygen delivery and consumption, and use of multisite monitoring of regional oxygenation provides organ-specific assessment of perfusion. With understanding of the underlying principles of NIRS as well as the physiologic factors which impact oxygenation and perfusion of the brain, kidneys and bowel, changes in neonatal physiology can be more easily recognized by bedside providers, allowing for appropriate, targeted interventions. Amplitude-integrated electroencephalography (aEEG) allows continuous bedside evaluation of cerebral background activity patterns indicative of the level of cerebral function as well as identification of seizure activity. Normal background patterns are reassuring while abnormal background patterns indicate abnormal brain function. Combining brain monitoring information together with continuous vital sign monitoring (blood pressure, pulse oximetry, heart rate and temperature) at the bedside may be described as multi-modality monitoring and facilitates understanding of physiology. We describe 10 cases in critically ill neonates that demonstrate how comprehensive multimodal monitoring provided greater recognition of the hemodynamic status and its impact on cerebral oxygenation and cerebral function thereby informing treatment decisions. We anticipate that there are numerous other uses of NIRS as well as NIRS in conjunction with aEEG which are yet to be reported.
    Language English
    Publishing date 2023-04-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1111347
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  8. Article ; Online: Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative.

    Leandro, Danieli M K / Variane, Gabriel F T / Dahlen, Alex / Pietrobom, Rafaela F R / de Castro, Jessica A R R / Rodrigues, Daniela P / Magalhães, Mauricio / Mimica, Marcelo J / Van Meurs, Krisa P / Chock, Valerie Y

    American journal of perinatology

    2024  

    Abstract: Objective:  This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal ...

    Abstract Objective:  This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation.
    Study design:  Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring.
    Results:  Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%,
    Conclusion:  This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH.
    Key points: · Neurocritical care strategies vary widely in low- and middle-income countries.. · Heterogeneity of care may lead to suboptimal efficacy of neuroprotective strategies.. · Tele-education and international collaboration can decrease the variability of neurocritical care provided to infants with HIE..
    Language English
    Publishing date 2024-05-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/s-0044-1786720
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  9. Article ; Online: Neonatal Neurocritical Care: Providing Brain-Focused Care for All at Risk Neonates.

    Bonifacio, Sonia L / Van Meurs, Krisa

    Seminars in pediatric neurology

    2019  Volume 32, Page(s) 100774

    Abstract: Neonatal neurocritical care is an evolving subsubspecialty whose goal is to implement neuroprotective care strategies, continuous bedside monitoring of neurologic function, and therapies in order to reduce the risk of neurologic injury and improve long- ... ...

    Abstract Neonatal neurocritical care is an evolving subsubspecialty whose goal is to implement neuroprotective care strategies, continuous bedside monitoring of neurologic function, and therapies in order to reduce the risk of neurologic injury and improve long-term neurodevelopmental outcomes in neonates who require intensive care. The provision of neonatal neurocritical care requires a culture change across a Neonatal Intensive Care Unit (NICU) in which equal importance is placed on the neurologic care and the cardiorespiratory care of a given patient. It is a multidisciplinary framework of care in which neonatologist and pediatric neurologist come together to address the unique needs of NICU patients whose brains are still developing and are vulnerable to injury. Advances in bedside brain monitoring techniques and the use of therapeutic hypothermia for Hupoxic-Ischemic Encephalopathy have accelerated the development of NeuroNICUs across the United States and abroad. Neonatologists, neurologists, neurophysiologists, nurses, and other ancillary members of the team work together to develop guidelines for commonly encountered neurological conditions in the NICU. The use of these guidelines helps provide standardized care across a unit and can reduce morbidity and length of hospital stay.
    MeSH term(s) Brain/growth & development ; Brain/physiopathology ; Critical Care/methods ; Humans ; Hypothermia, Induced/methods ; Infant, Newborn ; Intensive Care Units, Neonatal ; Monitoring, Physiologic ; Neonatologists ; Neurologists ; Patient Care Team ; Practice Guidelines as Topic
    Language English
    Publishing date 2019-08-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1290000-x
    ISSN 1558-0776 ; 1071-9091
    ISSN (online) 1558-0776
    ISSN 1071-9091
    DOI 10.1016/j.spen.2019.08.010
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  10. Article ; Online: Better timing for cord clamping is after onset of lung aeration.

    Lakshminrusimha, Satyan / Van Meurs, Krisa

    Pediatric research

    2015  Volume 77, Issue 5, Page(s) 615–617

    MeSH term(s) Cardiovascular Physiological Phenomena ; Cardiovascular System ; Female ; Humans ; Parturition ; Pregnancy
    Language English
    Publishing date 2015-05
    Publishing country United States
    Document type Comment ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 4411-8
    ISSN 1530-0447 ; 0031-3998
    ISSN (online) 1530-0447
    ISSN 0031-3998
    DOI 10.1038/pr.2015.23
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